Diagnosis Of Sarcopenia Research Articles

Urinary titin as a biomarker of sarcopenia in diabetes: a propensity score matching analysis.

Measuring urinary titin levels is expected to be useful in screening for muscle damage or injury in various diseases. We evaluated whether urinary titin levels were elevated in individuals with type 2 diabetes mellitus (T2DM) and how urinary titin levels were associated with the diagnosis of sarcopenia in T2DM. We performed a cross-sectional analysis of 114 controls and 515 patients with T2DM. Multivariate-adjusted models were used to determine the odds ratios (OR) of urinary titin cutoff values for diagnosing sarcopenia. Urinary titin levels were higher in the T2DM group than in the non-diabetes group after propensity score matching (median [IQR] 3.2 [2.3, 4.6] vs. 4.4 [2.7, 6.9] pmol/mg·creatinine). T2DM was associated with high titin levels after correction for comorbidities (odds ratio 2.46, 95% confidence interval (CI) 1.29-4.70, P = 0.006) but not after correction for sarcopenia-associated factors. Urinary titin levels above the cutoff value showed an odd ratio of 6.61 (age- and body mass index-adjusted, 1.26-34.6, P = 0.021) for the diagnosis of sarcopenia in men with T2DM aged ≥ 75 years. Results indicated that T2DM was associated with a high-titin state and that the urinary titin cutoff value could be useful for identifying candidates at high risk for sarcopenia, such as elderly men.

Current approach to the diagnosis of sarcopenia in cardiovascular diseases

Muscle wasting syndrome, also known as sarcopenia, is an age-related geriatric condition characterized by a gradual loss of muscle mass, strength, and function. Sarcopenia can be classified into primary and secondary types. Primary sarcopenia is primarily associated with aging, while secondary sarcopenia is caused by systemic diseases such as cancer, diabetes, liver cirrhosis, musculoskeletal disorders, and disuse changes. In recent years, increasing evidence suggests that cardiovascular diseases can promote the occurrence of sarcopenia through various pathophysiological mechanisms. Additionally, sarcopenia increases the risk of adverse outcomes in patients with cardiovascular disease such as rehospitalization and mortality. Therefore, screening and diagnosing sarcopenia are particularly important for patients with cardiovascular diseases. This article provides a brief overview of the research progress on diagnostic methods for sarcopenia in patients with cardiovascular diseases.

Psoas muscle index in sarcopenia following transjugular intrahepatic portosystemic shunt: A multicenter, retrospective study

AbstractAimsAlthough the skeletal muscle index at the third lumbar vertebra (L3‐SMI) is commonly utilized for the diagnosis of sarcopenia, the psoas muscle index at L3 (L3‐PMI) may serve as a reliable alternative indicator. This study aims to investigate the application of the PMI in patients who have undergone transjugular intrahepatic portosystemic shunt (TIPS).MethodsThis study included a cohort of 406 patients with cirrhosis who underwent TIPS between February 2016 and July 2022 across three medical centers in China. Clinical and imaging data, specifically L3‐SMI and L3‐PMI, were collected for these patients. The prognosis of the patients was assessed through re‐examinations and telephone follow‐ups, which extended up to 5 years. The diagnostic thresholds for sarcopenia, as defined by L3‐PMI and L3‐SMI, were established at 6.36 or 42.00 cm²/m² for males and 3.92 or 38.00 cm²/m² for females, respectively. Cox proportional hazards and Kaplan–Meier (K‐M) analyses were employed to evaluate patient survival.ResultsThe findings indicated that both L3‐PMI and L3‐SMI before TIPS were independent risk factors for mortality. The results of the paired t‐test demonstrated a significant increase in L3‐PMI 1 month post‐TIPS (5.11 ± 1.81 vs. 5.71 ± 1.90 cm²/m², p < 0.001), whereas L3‐SMI did not exhibit a significant increase until 6 months post‐TIPS (45.45 ± 9.41 vs. 48.59 ± 10.38 cm²/m², p < 0.001). Among these patients, 191 (47.0%) and 159 (39.2%) were diagnosed with sarcopenia according to the L3‐PMI and L3‐SMI models, respectively. Patients identified as sarcopenic by both indicators demonstrated a significantly lower survival rate (L3‐SMI model: hazard ratio [HR], 1.913; 95% confidence interval [CI], 1.094–3.410; log‐rank p = 0.020; L3‐PMI model: HR, 1.867; 95% CI, 1.059–3.290; log‐rank p = 0.030). In sarcopenic patients, the reversal of sarcopenia associated with improved survival occurred 1 month after TIPS in the L3‐PMI model (HR, 2.675; 95% CI, 1.245–5.735; log‐rank p = 0.012), while a similar effect was not observed until 6 months post‐TIPS in the L3‐SMI model (HR, 3.342; 95% CI, 1.477–7.560; log‐rank p = 0.004).ConclusionsL3‐PMI and L3‐SMI demonstrate comparable efficacy in diagnosing cirrhosis‐related sarcopenia. Furthermore, L3‐PMI has the capacity to identify improvements in sarcopenia as early as 1 month following TIPS, thereby providing earlier insights into patient survival outcomes.

Abstract 4122780: Muscle Quality Defines Sarcopenic Obesity in Older Adults In Association with Cardiac Function

Background: Obesity phenotypes are increasingly used to define cardiovascular diseases (CVD) risks. Age-related deteriorations in skeletal muscle function have ignited interest in the co-occurrence of sarcopenia and obesity in older adults. However, the traditional definition of sarcopenia (low appendicular skeletal mass [ASM] and handgrip strength [HGS]) may lead to underdiagnosis of sarcopenic obesity (SO) in overweight individuals (due to higher muscle mass). To address this enigma, we evaluated the use of muscle quality (MQ), as an alternative metric for SO, in association with cardiac function. Methods: Community older adults without CVD were prospectively annotated for skeletal mass, HGS and cardiac function via bioimpedance analysis, dynamometer, and simultaneous acquisition of echocardiography respectively. Sarcopenia was defined by low ASM and low HGS. Low MQ (HGS divided by upper body ASM) was defined by males<5.76kg/kg and females<5.475kg/kg. Aerobic capacity (VO2 max,ml/kg/min) was computed by a physical activity prediction model. Mitral early diastolic inflow velocity to early diastolic annular tissue velocity (E/e’) and early to late diastolic inflow velocity (E/A) ratios were recorded. Results: Overall, low MQ was prevalent (34.3%) in n=574 participants (59% females), but only 17.4% fulfilled sarcopenia diagnosis. Higher BMI correlated with higher ASM but lower MQ (Fig 1). Low MQ prevalence was higher in the obese compared to the non-obese (64.7% vs 30.2%, p<0.0001). Low MQ group was significantly older (69.0±10.4 vs 64.8±14.0 years, p<0.0001), had higher prevalence of dyslipidemia (49.2% vs 40.9% p=0.002) and hypertension (45.2% vs 39.3% p<0.0001) than the normal MQ group. The low MQ group had greater left ventricular mass (129±45 vs 114±44, grams, p<0.0001), left atrial volumes (37±14 vs 33±13, ml, p=0.001), and demonstrated a greater degree of diastolic dysfunction (lower E/A (0.89±0.28 vs 1.1±0.49, p<0.0001 and higher E/e’(8.63±2.42 vs 8.00±2.58, p=0.005), compared to the high MQ. VO2 max was lower in low MQ group (33±5.7 vs 36±6.7, p<0.0001). By regression, low MQ was associated with E/A (β=-0.119, adjusted p<0.0001) and VO2 max (β=-0.137, p<0.0001) (Table 1). Conclusion: Muscle quality is a useful metric of muscle function for sarcopenia in obese older adults. The associations between low MQ with diastolic dysfunction and reduced aerobic capacity corroborate the clinical impact of MQ as a defining metric of sarcopenia in obesity.

Association Between Sarcopenia and Acupressure Testing in Older Adults Requiring Long-Term Care

Background and Objectives: This study analyzed the relationship between pressure pain test outcomes and sarcopenia in elderly patients and explored possible clinical applications. Materials and Methods: The participants included 143 older adults requiring long-term care who could be diagnosed with sarcopenia. Along with sarcopenia diagnosis, the participants underwent acupressure testing symmetrically at nine sites (occiput, lower cervical, trapezius, supraspinatus, second rib, lateral epicondyle, gluteus, greater trochanter, and knee), totaling 18 sites. The analyses included comparisons of sarcopenia status and total tender points between the groups and a multivariable analysis. The association between sarcopenia and the number of tender points were examined based on correlations between the number of tender points and grip strength, walking speed, and skeletal muscle mass index (SMI). Intergroup comparisons and multivariable analysis of tender points with and without sarcopenia were performed to investigate specific tender points associated with sarcopenia. Results: An independent association was observed between sarcopenia and the number of tender points (p = 0.001). Furthermore, the number of tender points was correlated with grip strength (ρ = −0.536, p < 0.001), walking speed (ρ = −0.200, p = 0.028), and SMI (ρ = −0.394, p < 0.001). The supraspinatus (p = 0.029, 95% confidence interval: 1.221–35.573) and lower cervical (p = 0.039, 95% confidence interval: 1.050–7.245) regions were identified as specific tender points. Conclusions: In older adult patients requiring long-term care, sarcopenia is associated with an increased number of tender points throughout the body, with the supraspinatus and lower cervical regions potentially being specific tender points. Acupressure testing for tenderness may be a useful assessment parameter in sarcopenia patients.

Modern views on the diagnosis of sarcopenia in patients with diffuse liver diseases

Currently, the term sarcopenia is primarily understood as a decrease in muscle strength as a key characteristic of sarcopenia, taking into account that the most unfavorable clinical outcomes occur in patients with a combination of impaired muscle strength and function. In particular, grip strength combined with evaluation of the end-stage liver disease (MELD) model is the best predictive model among widely used methods for diagnosing sarcopenia in patients with cirrhosis of the liver. Given that muscle mass does not always correlate well with muscle strength or function in the population of patients with cirrhosis of the liver, there is a need for a comprehensive diagnosis of sarcopenia based on a combination of functional research methods with modern instrumental methods. The presented review article highlights current information on the diagnosis of sarcopenia in patients with chronic diffuse liver diseases. Aspects of antrometric methods, functional tests, methods for evaluating muscle strength and mass, and physical performance are reflected. Special attention is paid to the advantages of modern methods of instrumental diagnosis of sarcopenia in patients with diffuse liver diseases. The advantages and disadvantages of each of the methods of instrumental diagnostics are noted.

An Artificial Intelligence Approach for Test-Free Identification of Sarcopenia.

The diagnosis of sarcopenia relies extensively on human and equipment resources and requires individuals to personally visit medical institutions. The objective of this study was to develop a test-free, self-assessable approach to identify sarcopenia by utilizing artificial intelligence techniques and representative real-world data. This multicentre study enrolled 11 661 middle-aged and older adults from a national survey initialized in 2011. Follow-up data from the baseline cohort collected in 2013 (n = 9403) and 2015 (n = 10 356) were used for validation. Sarcopenia was retrospectively diagnosed using the Asian Working Group for Sarcopenia 2019 framework. Baseline age, sex, height, weight and 20 functional capacity (FC)-related binary indices (activities of daily living = 6, instrumental activities of daily living = 5 and other FC indices = 9) were considered as predictors. Multiple machine learning (ML) models were trained and cross-validated using 70% of the baseline data to predict sarcopenia. The remaining 30% of the baseline data, along with two follow-up datasets (n = 9403 and n = 10 356, respectively), were used to assess model performance. The study included 5634 men and 6027 women (median age = 57.0 years). Sarcopenia was identified in 1288 (11.0%) individuals. Among the 20 FC indices, the running/jogging 1 km item showed the highest predictive value for sarcopenia (AUC [95%CI] = 0.633 [0.620-0.647]). From the various ML models assessed, a 24-variable gradient boosting classifier (GBC) model was selected. This GBC model demonstrated favourable performance in predicting sarcopenia in the holdout data (AUC [95%CI] = 0.831 [0.808-0.853], accuracy = 0.889, recall = 0.441, precision = 0.475, F1 score = 0.458, Kappa = 0.396 and Matthews correlation coefficient = 0.396). Further model validation on the temporal scale using two longitudinal datasets also demonstrated good performance (AUC [95%CI]: 0.833 [0.818-0.848] and 0.852 [0.840-0.865], respectively). The model's built-in feature importance ranking and the SHapley Additive exPlanations method revealed that lifting 5 kg and running/jogging 1 km were relatively important variables among the 20 FC items contributing to the model's predictive capacity, respectively. The calibration curve of the model indicated good agreement between predictions and actual observations (Hosmer and Lemeshow p = 0.501, 0.451 and 0.374 for the three test sets, respectively), and decision curve analysis supported its clinical usefulness. The model was implemented as an online web application and exported as a deployable binary file, allowing for flexible, individualized risk assessment. We developed an artificial intelligence model that can assist in the identification of sarcopenia, particularly in settings lacking the necessary resources for a comprehensive diagnosis. These findings offer potential for improving decision-making and facilitating the development of novel management strategies of sarcopenia.

Prognostic Value of Sarcopenia Definitions and Outcomes Consortium Criteria in Older Patients With Heart Failure

ObjectivesThe Asian Working Group for Sarcopenia in 2019 (AWGS 2019) emphasized muscle mass measurements. In contrast, the Sarcopenia Definitions and Outcomes Consortium (SDOC) prioritizes functional strength and mobility. Therefore, this study aimed to compare the prognostic utility of the SDOC and AWGS 2019 criteria for all-cause mortality in older patients with heart failure. DesignA post hoc analysis of the FRAGILE-HF study, a prospective, multicenter, observational study. Setting and ParticipantsPatients ≥65 years of age hospitalized for heart failure across 15 hospitals in Japan. MethodsSarcopenia was diagnosed according to the AWGS 2019 and SDOC definitions. According to the SDOC criteria and by integrating insights from previous research, patients were categorized into nonsarcopenia, possible sarcopenia, and sarcopenia groups. The primary outcome was 2-year mortality. ResultsOf the 1282 study patients, possible sarcopenia and sarcopenia were diagnosed in 357 and 786 individuals, respectively. Kaplan–Meier analysis revealed a significant difference between the groups. Adjusted Cox proportional hazards analysis indicated a significant stepwise association between sarcopenic status and mortality risk (possible sarcopenia: hazard ratio, 1.22; 95% CI, 0.66–2.28; P = .525; sarcopenia: hazard ratio, 1.89; 95% CI, 1.08–3.34; P = .027). When sarcopenia defined by the SDOC and AWGS 2019 criteria was added to the model incorporating conventional risk factors, no significant difference was observed in the prognostic capabilities between the 2 models (net reclassification improvement, −0.009; 95% CI, −0.193 to 0.174; P = .920, with areas under the receiver operating characteristic curve of 0.697 for SDOC and 0.703 for AWGS 2019; P = .675). Conclusions and ImplicationsAmong older patients with heart failure, the SDOC criteria for sarcopenia diagnosis are useful for risk stratification and provide prognostic capabilities equivalent to those of the AWGS 2019 criteria.

Diagnosis of Respiratory Sarcopenia for Stratifying Postoperative Risk in Non–Small Cell Lung Cancer

Physical biomarkers for stratifying patients with lung cancer into subtypes suggestive of outcomes are underexplored. To investigate the clinical utility of respiratory sarcopenia for optimizing postoperative risk stratification in patients with non-small cell lung cancer (NSCLC). This retrospective cohort study reviewed consecutive patients undergoing lobectomy and mediastinal lymph node dissection for NSCLC at 2 institutions in Tokyo, Japan, between 2009 and 2018. Eligible patients underwent electronic computed tomography image analysis. Follow-up began at the date of surgery and continued until death, the last contact, or March 2022. Data analysis was performed from April 2022 to March 2023. Respiratory sarcopenia was identified by poor respiratory strength (peak expiratory flow rate) and was confirmed by a low pectoralis muscle index (PMI; pectoralis muscle area/body mass index). Patients with poor peak expiratory flow rate but normal PMI received a diagnosis of pre-respiratory sarcopenia. Short-term and long-term postoperative outcomes were compared among patients with a normal status, pre-respiratory sarcopenia, and respiratory sarcopenia. Group differences were analyzed using the Kruskal-Wallis test and Pearson χ2 test for continuous and categorical data, respectively. Survival differences were compared using the log-rank test. Univariable and multivariable analyses were conducted using the Cox proportional hazards model. Of a total of 1016 patients, 806 (497 men [61.7%]; median [IQR] age, 69 [64-76] years) were eligible for electronic computed tomography image analysis. The median (IQR) duration of follow-up for survival was 5.2 (3.6-6.4) years. Respiratory strength was more closely correlated with PMI than pectoralis muscle radiodensity (Pearson r2, 0.58 vs 0.29). Respiratory strength and PMI declined with aging simultaneously (both P for trend < .001). Pre-respiratory sarcopenia was present in 177 patients (22.0%), and respiratory sarcopenia was present in 130 patients (16.1%). The risk of postoperative complications escalated from 82 patients (16.4%) with normal status to 39 patients (22.0%) with pre-respiratory sarcopenia to 39 patients (30.0%) with respiratory sarcopenia (P for trend < .001), as did the risk of delayed recovery after surgery (P for trend < .001). Compared with patients with normal status or pre-respiratory sarcopenia, patients with respiratory sarcopenia exhibited worse 5-year overall survival (438 patients [87.2%] vs 133 patients [72.9%] vs 85 patients [62.5%]; P for trend < .001). Multivariable analysis identified respiratory sarcopenia as a factor independently associated with increased risk of mortality (hazard ratio, 1.83; 95% CI, 1.15-2.89; P = .01) after adjustment for sex, age, smoking status, performance status, chronic heart disease, forced expiratory volume in 1 second, diffusing capacity for carbon monoxide, C-reactive protein, albumin, carcinoembryonic antigen, histology, and pathologic stage. This study identified individuals at higher risk of poor outcomes by screening and staging respiratory sarcopenia. The early diagnosis of respiratory sarcopenia could optimize management strategies and facilitate longitudinal care in patients with NSCLC.

Quality of muscle in the thigh predicts the prognosis in patients with non-ischemic cardiomyopathy

Abstract Background Skeletal muscle atrophy is an independent prognostic predictor for patients with chronic heart failure, and the concept of sarcopenia has garnered scientific attention. Furthermore, the importance of not only muscle mass but also quality of muscle has been pointed out. And a sarcopenia diagnosis is confirmed by the presence of low quality of muscle. However, there is a lack of consensus on the implications of ectopic fat as a quality of muscle for the prognosis in patients with non-ischemic cardiomyopathy. Purpose We investigated whether intramuscular fat (IMF) in the thigh affects the prognosis in patients with non-ischemic cardiomyopathy. Methods We recruited 250 patients who were diagnosed with non-ischemic cardiomyopathy by cardiac catheterization and echocardiographic date between September 2017 and November 2022. Finally, 223 patients enrolled in this prospective study conducted at a single center. Functional status was evaluated by using cardiopulmonary exercise test at baseline. All patients were measured quantity of the percentage of IMF (%IMF) in the thigh using computed tomography scan. Demographic, laboratory and echocardiographic date were collected from the patients’ medical records. Patients were followed up for up to 3 years. Clinical endpoints were cardiovascular death or unexpected rehospitalization because of cardiac events. Results During the follow-up 58 patients had cardiac events. The %IMF was significantly higher in the group with adverse events than without (4.49 ± 4.21 and 3.06 ± 2.39%, respectively; p = 0.001). Spearman correlation coefficient analysis showed a modest correlation between %IMF and exercise tolerance such as anaerobic threshold (Spearman r = -0.367; p &amp;lt; 0.001) and peak oxygen uptake (Spearman r = -0.382; p &amp;lt; 0.001). Patients were divided into 2 groups according to the median values of %IMF. Kaplan-Meier analysis demonstrated that events were significantly higher in the high %IMF group (log-rank p = 0.008). Furthermore, subgroup with left ventricular ejection fraction ≦ 40% or BMI ≧ 22 had a significantly greater frequency of adverse events in the high %IMF group. However, there was no significant difference in %IMF between the groups when divided into two groups at the mean age of this study. Multivariate Cox regression analysis adjusted for left ventricular ejection fraction, estimated glomerular filtration rate, hemoglobin and body mass index found %IMF as an independent factor of adverse events (hazard ratio 1.088; 95% confidential interval 1.024-1.156; p = 0.007). Conclusions In patients with non-ischemic cardiomyopathy, quality of muscle represented by %IMF in the thigh is an independent factor for predicting adverse cardiac events.

The application of Chinese version of SARC-F and SARC-CalF in sarcopenia screening against five definitions: a diagnostic test accuracy study

BackgroundSARC-F questionnaire is a simple and convenient tool for sarcopenia screening, and SARC-CalF is a modified version of it. The developments of their Chinese versions are warranted for the clinical use for Chinese population. This study aimed to culturally adapt the SARC-F questionnaire into Chinese using standardized methods, validate the reliability and diagnostic accuracy of the Chinese version SARC-F and SARC-CalF against five sarcopenia diagnosis criteria, and determine optimal cut-off values for clinical practice in Chinese population.MethodsThe translation and cross-cultural adaptation of SARC-F into Chinese were conducted following the methodological report from European Union Geriatric Medicine Society Sarcopenia Special Interest Group. The Chinese version of SARC-F was validated through a diagnostic test, using diagnostic criteria of sarcopenia recommended by the revised 2019 European Working Group on Sarcopenia in Older People (EWGSOP2) consensus, Asian Working Group for Sarcopenia (AWGS2019) consensus, the International Working Group on Sarcopenia (IWGS), the Foundation for the National Institutes of Health (FNIH) Biomarkers Consortium and the Sarcopenia Definition and Outcomes Consortium (SDOC). Additional analysis was done against the criteria of severe sarcopenia according to the revised EWGSOP2 and AWGS2019.ResultsThe Chinese version of SARC-F was well translated and demonstrated good reliability and acceptability. The diagnostic test included 1859 community-dwelling older individuals from two medical centers. Against five different definitions of sarcopenia, the Chinese version of SARC-F showed reasonable diagnostic accuracy for sarcopenia screening (AUC 0.614–0.821), and was demonstrated low sensitivity (13.7–37.9%) but high specificity (94.8–97.7%) with a cut-off value of ≥ 4. SARC-CalF significantly enhanced the diagnostic accuracy of SARC-F when using definitions of EWGSOP2, AWGS2019 and IWGS (all P ≤ 0.001). A score of ≥ 2 for SARC-F and ≥ 7 for SARC-CalF were established as optimal cut-off points for identifying older individuals as at risk of sarcopenia in Chinese population.ConclusionsThe Chinese version SARC-F is of reasonable reliability and validity for sarcopenia screening. Despite its low sensitivity, it proves to be a useful tool to identify severe cases in community taking advantage of its simplicity. SARC-CalF appears to be a more suitable screening tool for clinical use in detecting sarcopenia.

Anthropometric equation has sufficient diagnostic capacity to identify sarcopenia in women with breast cancer

BackgroundSarcopenia is a common condition in women with breast cancer, however still presents limitations for an effective diagnosis. This study aimed to evaluate the agreement and diagnostic accuracy of an anthropometric equation in diagnosing sarcopenia in women with breast cancer based on different constructs.MethodsCross-sectional study carried out with women with breast cancer aged ≥ 20 years. Sarcopenia was identified according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Muscle strength was obtained by the handgrip strength test (HGS) and muscle mass (MM) by dual-energy x-ray absorptiometry (DXA) and by the anthropometric predictive equation. For the diagnosis of sarcopenia, eight constructs were proposed based on the MM assessment method (equation or DXA) and different cutoff points. Agreement analyses using Cohen’s Kappa test and diagnostic performance measures were performed. The significance level for all tests was 5%.ResultsA total of 122 women, with a mean age of 55.3 ± 11.4 years, were evaluated. There was a predominance of brown participants (50.8%), insufficiently active (57.4%), with diagnosis time ≤ 3 months (54.1%), and with invasive breast carcinoma (69.7%). The prevalence of sarcopenia ranged from 3.3 to 8.2%, depending on the construct used. The constructs determined from the cutoff points < 16.0 kg/< 7.58 m² and < 23.0 kg/< 7.58 m² were the ones that showed the best ability to detect sarcopenia.ConclusionThe anthropometric equation showed sufficient diagnostic capacity to be used as an alternative in identifying sarcopenia in women with breast cancer.

Relationship between different muscle mass indices and physical performance measures in Turkish older adults

BackgroundSarcopenia, characterized by the loss of skeletal muscle, is assessed using appendicular skeletal muscle mass indices (ASMI). Various international groups propose different ASMI thresholds for assessing sarcopenia. However, the optimal ASMI that correlates best with physical performance measures in older Turkish adults remains unexplored. This study aims to determine which ASMI is most closely associated with physical performance measures, particularly low handgrip strength (dynapenia), in Turkish older adults.MethodsThe study included 326 individuals aged 60 and above. Comprehensive geriatric assessments were conducted on all participants, along with anthropometric evaluations and body composition analyses. ASMI was calculated by adjusting height squared, weight, and body mass index (BMI). Physical performance was assessed through handgrip strength, gait speed, and the chair stand test.ResultsThe mean age of the participants was 74 ± 5.77 years, with 59.8% being women and 37.5% having dynapenia. Height-squared adjusted ASMI was not significantly associated with gait speed or the chair stand test. Weight-adjusted ASMI correlated with handgrip strength and gait speed but not with the chair stand test. Both height and weight-adjusted ASMI did not differ significantly between participants with and without dynapenia (p > 0.05). BMI-adjusted ASMI significantly correlated with all physical performance parameters (p < 0.05). Furthermore, in multivariate regression analysis, BMI-adjusted ASMI (OR = 0.028, 95% CI = 0.01–0.31, p = 0.006) was independently associated with dynapenia.ConclusionThe study indicates that ASMI adjusted for BMI shows stronger correlations with all physical performance parameters and is independently associated with dynapenia. Utilizing ASMI adjusted for BMI may improve sarcopenia diagnosis in Turkish older adults.

Comparison of the utility of SARC-F, SARC-CalF, and calf circumference as screening tools for sarcopenia in patients with osteoporosis.

Patients with osteoporosis who also have sarcopenia are at a high risk for falls and fractures. Early detection of sarcopenia is crucial for these patients. This study aimed to compare the effectiveness of SARC-F, SARC-CalF, and calf circumference (CC) as screening tools for sarcopenia in patients with osteoporosis. This cross-sectional study was retrospectively conducted on patients who attended the outpatient clinic for Osteoporosis and Sarcopenia at Kyoto Medical Center. Sarcopenia was determined based on low skeletal muscle mass and weak handgrip strength. Sensitivity and specificity analyses were conducted on SARC-F, SARC-CalF, and CC. The diagnostic utility of these three tools was compared using the receiver-operating characteristic (ROC) curves and the area under the ROC curves (AUC). A total of 225 patients (men/women: 33/192) with a median age of 69.0 years (interquartile range: 61.0‒75.0) were enrolled. The prevalence of sarcopenia was found to be 11.6%. CC had the highest sensitivity (80.8%), while SARC-F had the highest specificity (93.0%) for detecting sarcopenia. ROC analysis revealed that all three tools had significant potential for sarcopenia diagnosis, with SARC-CalF having the highest AUC compared to SARC-F and CC (0.753 vs. 0.619 and 0.700). A multivariate logistic regression, incorporating other confounders as explanatory variables, revealed that SARC-CalF was independently related to sarcopenia (odds ratio: 14.80, 95% confidence interval: 3.83-57.30, p < 0.001). In patients with osteoporosis, SARC-CalF is more effective in the early detection of sarcopenia than SARC-F and CC.

The use of portable A-mode ultrasound in appendicular lean mass measurements among older adults: a comparison study with dual-energy X-ray absorptiometry and handgrip strength.

Strength and muscle mass are key factors for the diagnosis of sarcopenia. The EWGSOP2 recommended using ultrasound (US) as a reliable device to measure muscle mass (MM), but A-mode US still needs to be validated for older adults. This study aimed to evaluate the association between measurements of muscle thickness (MT) by portable A-mode US and, muscle quantity by Dual-Energy X-ray absorptiometry (DXA) in older adults. Cross-sectional study, with 115 participants included. Muscle mass was assessed by DXA and MT of the biceps, triceps, anterior thigh, and calf by A-mode US and handgrip strength by a dynamometer. The majority were women (n = 96; 83%), 69 ± 6 years. The MT sum (biceps, triceps, thigh, and calf) assessed by the US was not associated with the appendicular lean mass (ALM) assessed by DXA after controlling for sex and age (R2 = 0.524; p = 0.139; effect size = 0.53). The MT sum biceps and triceps was still significantly associated with MM arms/2 even when controlling for sex and age (which were also significant) (R2 = 0.551; p < 0.001; effect size = 0.56). The MT sum thigh and calf was not associated with MM legs/2 in adjusted models (R2 = 0.499; p = 0.688; effect size = 0.51). This finding shows that the portable A-mode US may not be an appropriate method for estimating MM in extremities (the sum of arms and legs), but can be appropriate for estimating only MM arms in healthy older adults.

Upper limb SMI for sarcopenia diagnosis in liver cirrhosis

Introduction. The muscle mass in sarcopenia is assessed in patients with liver cirrhosis (LC) using skeletal muscle indices (SMI) measured by dual-energy X-ray absorptiometry (DXA), the results of which are distorted due to lower limb edema. This requires the development of upper limb SMI (UL SMI) to ensure more accurate assessment of muscle mass in patients with LC and ascitice-dematous syndrome.Aim. To compare the diagnostic accuracy of standard MSI and UL SMI, and develop criteria for the reference range of UL SMI in patients with decompensated LC of various origin and sarcopenia, taking into account the lower limb edema in comparable age groups.Materials and methods. A prospective cohort study was conducted. The treatment group included patients with decompensated LC and lower limb edema of various origin; the control group included healthy volunteers matched to patients by gender and age to determine the diagnostic accuracy of the technique and calculate the criteria for the reference ranges in UP SMI. All patients underwent measurements of muscle mass by DXA.Results. A total of 59 patients were examined: 39 patients with LC and 20 healthy volunteers. Based on the results of the ROC analysis, it was determined that the cut-off values for UL SMI are 1.91 kg/m2 for men (sensitivity = 62.5%, specificity = 85.71%) and 1.47 kg/m2 for women (sensitivity = 86.96%, specificity = 69.23%) as compared to the cut-off values for the standard SMI of 7.78 kg/m2 for men (sensitivity = 75% and specificity = 57.14%), and SMI of 6.05 kg/m2 for women (sensitivity = 56.52% and specificity = 69.23%). UL SMI is a more accurate marker of sarcopenia in patients with LC and lower limb edema than the standard SMI.Conclusion. The advantages of UL SMI over classical SMI for sarcopenia diagnosis in patients with cirrhosis and lower extremity edema were demonstrated. The UL SMI criteria for the reference range in patients with decompensated LC and sarcopenia were developed.

Agreement between the EWGSOP2 and SDOC consensuses for sarcopenia in patients receiving hemodialysis: Findings of a cross sectional analysis from the SARC-HD study.

Differences in definitions and operational diagnoses for sarcopenia create difficulties in understanding the epidemiology of the disease. We examined the prevalences of sarcopenia using the revised European Working Group on Sarcopenia in Older People (EWGSOP2) and the Sarcopenia Definitions and Outcomes Consortium (SDOC) consensuses and analyzed their level of agreement in patients receiving hemodialysis. Data from the SARCopenia trajectories and associations with clinical outcomes in patients receiving hemodialysis (SARC-HD) multicenter study in Brazil were analyzed. Muscle strength was assessed using handgrip strength, muscle mass by calf circumference, and physical performance by the 4-m gait speed test. Sarcopenia was diagnosed according to both the EWGSOP2 (low muscle strength plus low muscle mass) and the SDOC (low muscle strength plus low physical performance). The Cohen kappa statistic was used to determine the level of agreement between the consensuses. 838 patients (57.8 ± 15.0 years; 61% men) from 19 dialysis units were included. We found similar prevalences of sarcopenia between the consensuses (EWGSOP2, n = 128, 15.3%; SDOC, n = 105, 12.5%) but with weak agreement (50 of 233 patients, 21.5%; κ = 0.34, 95% CI 0.25-0.43). Agreement was also weak within age categories (≥60 years, κ = 0.34; <60 years, κ = 0.15; both P < 0.001). Of the 51 patients diagnosed by the EWGSOP2 criterion as having severe sarcopenia, all but 1 (98.0%) met the SDOC criterion for sarcopenia (κ = 0.61, 95% CI 0.52-0.70). Low muscle strength was more frequently diagnosed using the SDOC than with the EWGSOP2 (52.3% vs 25.9%). We found a weak agreement between the EWGSOP2 and SDOC consensuses for the diagnosis of sarcopenia in patients receiving hemodialysis. Although still weak, agreement was marginally better for older patients. These findings highlight the importance of a global and standardized conceptual diagnosis of sarcopenia.

Advancements in sarcopenia diagnosis: from imaging techniques to non-radiation assessments.

Sarcopenia is a prevalent condition with significant clinical implications, and it is expected to escalate globally, demanding for effective diagnostic strategies, possibly at an early stage of the disease. Imaging techniques play a pivotal role in comprehensively evaluating sarcopenia, offering insights into both muscle quantity and quality. Among all the imaging techniques currently used for the diagnosis and follow up of sarcopenia, it is possible to distinguish two classes: Rx based techniques, using ionizing radiations, and non-invasive techniques, which are based on the use of safe and low risk diagnostic procedures. Dual-energy x-ray Absorptiometry and Computed Tomography, while widely utilized, entail radiation exposure concerns. Ultrasound imaging offers portability, real-time imaging, and absence of ionizing radiation, making it a promising tool Magnetic Resonance Imaging, particularly T1-weighted and Dixon sequences, provides cross- sectional and high-resolution images and fat-water separation capabilities, facilitating precise sarcopenia quantification. Bioelectrical Impedance Analysis (BIA), a non-invasive technique, estimates body composition, including muscle mass, albeit influenced by hydration status. Standardized protocols, such as those proposed by the Sarcopenia through Ultrasound (SARCUS) Working Group, are imperative for ensuring consistency across assessments. Future research should focus on refining these techniques and harnessing the potential of radiomics and artificial intelligence to enhance diagnostic accuracy and prognostic capabilities in sarcopenia.

Secondary Sarcopenia in Patients with Locomotor Disorders: Prevalence, Diagnosis and Medical Rehabilitation. A Review

INTRODUCTION. The development of rehabilitation methods for patients with sarcopenia, a generalized age-associated loss of skeletal muscle mass and strength, is important, since sarcopenia leads to pronounced weakness, functional and motor disorders and an increased risk of death in the elderly. AIM. To analyze the prevalence, features of pathogenesis, diagnosis of secondary sarcopenia, including against the background of motor disorders due to stroke, as well as methods of treatment and medical rehabilitation of such patients. MAIN CONTENT. Among the secondary forms, sarcopenia is of the greatest clinical importance against the background of the consequences of acute cerebrovascular accident (ACA), due to muscular atrophy associated with paralysis and immobility, spasticity, inflammation and denervation of muscles, malnutrition and intestinal absorption of protein and vitamin D. Recent studies show that the prevalence of sarcopenia in stroke patients in emergency hospitals is 8.5–33.8 %, according to other data — more than 42 %. Muscle weakness after a stroke contributes to a decrease in physical functions and the development of disability, and sarcopenia leads to adverse outcomes 90 days after a stroke. According to the meta-analysis, which included 7 cohort studies with a total sample of 1,774 patients who underwent ACA, 27.1 % of them had sarcopenia. Moreover, the presence of sarcopenia negatively affected the clinical and functional outcomes of ACA, as well as the results of medical rehabilitation (odds ratio: 2.42, 95 % confidence interval: 1.76–3.33, p 0.001). CONCLUSION. Despite the prevalence and relevance of this pathology, rehabilitation programs for patients with sarcopenia against the background of the consequences of ACA have not been developed. Isolated foreign publications demonstrate the effectiveness of certain methods of physical therapy and electrical stimulation, but the evidence base for their effectiveness is low.

Global Leadership Initiative in Sarcopenia (GLIS)–defined sarcopenia increases the mortality of esophageal cancer patients after esophagectomy: A Chinese real-world cohort study

ObjectivesTo assess the impact of the definition of the Global Leadership Initiative in Sarcopenia (GLIS) on mortality in esophageal cancer (EC) patients, postesophagectomy, within a Chinese cohort and to validate the effectiveness of a new GLIS framework in oncology. MethodsWe performed an observational real-world cohort study in a single center at Daping Hospital of the Army Medical University in China, spanning from December 2014 to July 2022. We used the combined definition of muscle mass and muscle strength in a new GLIS framework for the diagnosis of sarcopenia. Potential covariates were identified through univariate and multivariate analyses. The association between GLIS-defined sarcopenia and mortality was estimated using Kaplan–Meier curves and Cox models. We also conducted stratified analyses to assess the stability of multivariable Cox models. ResultsA total of 520 EC patients were included in the study, with a median follow-up of 48.7 months. A total of 229 EC patients (44.0%) were identified with GLIS-defined sarcopenia. Patients with GLIS-defined sarcopenia had significantly worse overall survival in Kaplan–Meier curves (log-rank P = 0.015). Age; sex; tumor, node, metastasis stage; blood glucose; bleeding volume in operation; and operating time were introduced as covariates in a fully adjusted Cox model. Multivariable-adjusted Cox models revealed that GLIS-defined sarcopenia was an independent prognostic factor for EC patients postesophagectomy (hazard ratio, 1.87, 95% confidence interval, 1.28–2.74, P = 0.001). Stratified analyses confirmed the stability of the relationship between GLIS-defined sarcopenia and mortality in EC patients. ConclusionsGLIS-defined sarcopenia is prevalent among Chinese EC patients and is linked to increased mortality risk postesophagectomy. This finding offers compelling evidence and serves as a valuable reference for the establishment of an operational definition of GLIS sarcopenia.