Diagnosis Of Sarcopenia Research Articles

The agreement of different techniques for muscle measurement in diagnosing sarcopenia: a systematic review and meta-analysis.

The measurement or estimation of muscle mass plays an important role in the diagnosis of sarcopenia. Beside dual-energy X-ray absorptiometry (DXA), several modalities, including bioelectrical impedance analysis (BIA), ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), have helped to provide imaging or electrical biomarkers for muscle mass. This study was aimed at summarizing the diagnostic performance of different techniques on muscle assessment for sarcopenia. Studies on the assessment of muscle mass by different techniques (compared with DXA), published from inception to 12 October, 2023 were retrieved from 4 electronic databases: the Cochrane Library, Embase, PubMed, and Web of Science. The quality assessment of included studies was conducted using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). The sensitivity, specificity, Cohen's kappa coefficient (κ), and Pearson correlation coefficient (r) with 95% confidence intervals (CIs) were pooled and presented via forest plots. The area under the curve (AUC) with 95% CI was pooled and presented via summary receiver operating characteristic (sROC) curve. A total of 28 studies involving 4,926 participants were included. Compared with DXA, the pooled sensitivity and specificity, AUC, and Cohen's κ were 0.79 (95% CI: 0.71-0.86, P<0.001), 0.95 (95% CI: 0.82-0.99, P<0.001), and 0.88 (95% CI: 0.85-0.90), and 0.61 (95% CI: 0.51-0.72) for BIA. The pooled r value between DXA and BIA or US or MRI was 0.94 (95% CI: 0.92-0.96, P<0.001), 0.69 (95% CI: 0.54-0.80, P<0.001), and 0.96 (95% CI: 0.95-0.97, P=0.21), respectively. No qualified original study in relation to CT was included. BIA, US, and MRI would provide acceptable diagnostic accuracy for sarcopenia by evaluating muscle mass in terms of sensitivity, specificity, accuracy, and their higher correlations with DXA. Further investigation is required to elucidate the value of CT in diagnosing sarcopenia.

Relation Between Ultrasonographic Measurements of the Biceps Brachii and Total Muscle Mass in Older Hospitalized Persons: A Pilot Study.

To assess the link between ultrasonographic measurements of the biceps brachii and total muscle mass measured by bio-impedancemetry in hospitalized older patients. A prospective observational study was conducted. The study included patients older than 65 years admitted in internal medicine, acute geriatrics, orthogeriatrics and rehabilitation departments. All measurements, ultrasonographic measurements and muscle mass and function by bio-impedancemetry and dynamometry, were taken within the first 48 hours of admission. In total 19 patients were included, the mean age was 85.4 ± 3.9 years and 7 (36.8%) were females. Very strong direct correlations were obtained in the entire cohort in both biceps brachii cross-sectional area and muscle thickness with skeletal muscle mass displayed in kilograms. Biceps brachii looks like a very good muscle measuring tool: easy, comfortable, fast, good correlated with total body muscle mass. This muscle could effectively be used for the assessment of muscle mass in the diagnosis of sarcopenia since it reflects muscle mass precisely, however more studies are needed to provide reference values in all age cohorts.

Validity of the modified versions of SARC-F+EBM for sarcopenia screening and diagnosis in China: the PPLSS study.

It is recommended by Asian Working Group for Sarcopenia to early identify people at risk for sarcopenia using simple screening tools like SARC-F. The modified version SARC-F+EBM showed higher diagnostic performance. However, this cut-off value of body mass index (BMI) remained uncertain to be used in Chinese population. In this study, we used appropriate BMI recommended for Chinese older population and further modified SARC-F+EBM by combining calf circumference. Diagnostic tests were performed and the receiver operating characteristics analyses were conducted between the SARC-F, SARC-F+EBM (cut-off of BMI: ≤ 21 kg/m2), SARC-F+EBM (CN) (cut-off of BMI: ≤ 22 kg/m2), SARC-CalF and SARC-CalF+EBM (CN) (cut-off of BMI: ≤ 22 kg/m2) in 1660 community-dwelling participants aged ≥ 65 years from China. The participants had an average age of 71.7±5.1 years, of which 56.8% were women. All the modified models could enhance the areas under the receiver operating characteristic curve (AUC) of original SARC-F (all p<0.001). The SARC-F+EBM (CN) also showed a significantly higher sensitivity of 47.4% (p<0.001) and an AUC of 0.809 (p=0.005) than SARC-F+EBM. SARC-CalF+EBM (CN) was validated to be of great diagnostic value of the highest AUC of 0.88 among these sarcopenia screening tools, including SARC-F, SARC-CalF and SARC-F+EBM (CN) (all p<0.001). Using this study population as a reference, the optimal cut-off value of SARC-CalF+EBM (CN) is ≥12 points, with a sensitivity of 79.3% and a specificity of 80.7%. The SARC-F+EBM (CN) and SARC-CalF+EBM (CN) could enhance the diagnostic performance of SARC-F and SARC-F+EBM and are suitable sarcopenia screening tools for Chinese population.

Sarcopenia in children: Lecture

Primary sarcopenia characterizes frailty of old age. Secondary sarcopenia can occur in both adults and children with severe somatic or surgical pathology. A model for studying sarcopenia in children can be patients with cerebral palsy, whose muscle development differs from typically developing children. The lecture presents the mechanism of the development of sarcopenia, diagnostic criteria for adult patients presented in consent documents, as well as analogues of diagnostic scales used in pediatric practice. The diagnosis of sarcopenia in children has something in common with the diagnosis of the patient’s nutritional status. Diagnosis of sarcopenia in children using bioimpedansometry method was proposed by the authors, and a Eurasian patent was received. Based on the volumes of adipose and active cellular tissue in the component composition of the body: with a combination of a percentage of fat mass of 40.5% and above and a percentage of active cell mass of 37% and below, sarcopenia is diagnosed, and with a combination of a percentage of fat mass of 30.5% and above and percentage of active cell mass from 37% to 43.5% is diagnosed as presarcopenia. Options for preventing sarcopenia are presented, including patented ones. A multidisciplinary approach to working with a patient with sarcopenia includes, while treating the underlying disease, nutritious nutrition, restoration of the intestinal microflora and motor activity of the patient.

The diagnostic performance of Cr/CysC for sarcopenia and its predictive value on clinical outcomes in hospitalized older patients: a prospective cohort study.

The utilization of the creatinine-to-cystatin C ratio (Cr/CysC) represents an innovative method for predicting sarcopenia. Our objectives encompassed the evaluation of sarcopenia diagnostic accuracy for Cr/CysC, SARC-F, SARC-CalF, the combination of Cr/CysC and SARC-CalF, and the Ishii score, as well as an exploration of the predictive value of Cr/CysC concerning clinical outcomes within hospitalized older individuals. We employed receiver operating characteristic (ROC) curves and calculated areas under the curves (AUCs) to assess the diagnostic accuracy. Furthermore, we applied univariate and multivariate Cox proportional-hazard models to calculate the hazard ratio (HR) and 95% confidence interval (CI) of risk factors affecting prognosis. Our study included 312 participants, comprising 167 men and 145 women, with an average age of 71years. Among males, the AUCs for Cr/CysC, SARC-F, SARC-CalF, the combination of Cr/CysC and SARC-CalF, and the Ishii score were 0.717 [95% CI 0.642-0.784], 0.669 (95% CI 0.592-0.739), 0.845 (95% CI 0.781-0.896), 0.882 (95% CI 0.823-0.926), and 0.938 (95% CI 0.890-0.969), respectively. In females, the AUCs for Cr/CysC, SARC-F, SARC-CalF, the combination of Cr/CysC and SARC-CalF, and the Ishii score were 0.706 (95% CI 0.625-0.779), 0.631 (95% CI 0.547-0.710), 0.763 (95% CI 0.686-0.830), 0.789 (95% CI 0.714-0.853), and 0.898 (95% CI 0.837-0.942), respectively. After adjusting for age, sex, physical exercise, smoking, drinking, hypertension, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and cancer, sarcopenia identified by Cr/CysC (adjusted HR = 2.176, 95% CI 1.062-4.460, P = 0.034) was independently associated with poor overall survival in hospitalized older patients. Cr/CysC has satisfactory diagnostic accuracy for sarcopenia diagnosis and predictive value for poor outcomes in hospitalized older patients. The combination of Cr/CysC and SARC-CalF may provide a more accurate screening for sarcopenia and the Ishii score may be the most accurate clinical method for detecting sarcopenia.

The global leadership into malnutrition criteria reveals a high percentage of malnutrition which influences overall survival in patients with gastroenteropancreatic neuroendocrine tumours.

Patients with neuroendocrine tumours located in the gastroenteropancreatic tract (GEP-NETs) and treatment with somatostatin analogues (SSA's) are at risk of malnutrition which has been reported previously evaluating weight loss or body mass index (BMI) only. The global leadership into malnutrition (GLIM) criteria include weight loss, BMI, and sarcopenia, for diagnosing malnutrition. These GLIM criteria have not been assessed in patients with GEP-NETs on SSA. The effect of malnutrition on overall survival has not been explored before. The aim of this study is to describe the presence of malnutrition in patients with GEP-NET on SSA based on the GLIM criteria and associate this with overall survival. Cross-sectional study screening all patients with GEP-NETs on SSA's for malnutrition using the GLIM criteria. Body composition analysis for sarcopenia diagnosis were performed. Bloods including vitamins, minerals, and lipid profile were collected. Overall survival since the date of nutrition screening was calculated. Uni- and multivariate Cox regression analysis were performed to identify malnutrition as risk factor for overall survival. A total of 118 patients, 47% male, with median age 67 years (IQR 56.8-75.0) were included. Overall, malnutrition was present in 88 patients (75%); based on low BMI in 26 (22%) patients, based on weight loss in 35 (30%) patients, and based on sarcopenia in 83 (70%) patients. Vitamin deficiencies were present for vitamin D in 64 patients (54%), and vitamin A in 29 patients (25%). The presence of malnutrition demonstrated a significantly worse overall survival (p-value = .01). In multivariate analysis meeting 2 or 3 GLIM criteria was significantly associated with worse overall survival (HR 2.16 95% CI 1.34-3.48, p-value = .002). Weight loss was the most important risk factor out of the 3 GLIM criteria (HR 3.5 95% CI 1.14-10.85, p-value = .03) for worse overall survival. A high percentage (75%) of patients with GEP-NETs using a SSA meet the GLIM criteria for malnutrition. Meeting more than 1 GLIM criterium, especially if there is weight loss these are risk factors for worse overall survival.

Diabetes Mellitus Should Be Considered While Analysing Sarcopenia-Related Biomarkers.

Sarcopenia is a chronic, progressive skeletal muscle disease characterised by low muscle strength and quantity or quality, leading to low physical performance. Patients with type 2 diabetes mellitus (T2DM) are more at risk of sarcopenia than euglycemic individuals. Because of several shared pathways between the two diseases, sarcopenia is also a risk factor for developing T2DM in older patients. Various biomarkers are under investigation as potentially valuable for sarcopenia diagnosis and treatment monitoring. Biomarkers related to sarcopenia can be divided into markers evaluating musculoskeletal status (biomarkers specific to muscle mass, markers of the neuromuscular junction, or myokines) and markers assuming causal factors (adipokines, hormones, and inflammatory markers). This paper reviews the current knowledge about how diabetes and T2DM complications affect potential sarcopenia biomarker concentrations. This review includes markers recently proposed by the expert group of the European Society for the Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) as those that may currently be useful in phase II and III clinical trials of sarcopenia: myostatin (MSTN); follistatin (FST); irisin; brain-derived neurotrophic factor (BDNF); procollagen type III N-terminal peptide (PIIINP; P3NP); sarcopenia index (serum creatinine to serum cystatin C ratio); adiponectin; leptin; insulin-like growth factor-1 (IGF-1); dehydroepiandrosterone sulphate (DHEAS); C-reactive protein (CRP); interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α). A better understanding of factors influencing these biomarkers' levels, including diabetes and diabetic complications, may lead to designing future studies and implementing results in clinical practice.

The optimal cut-off value of five-time chair stand test for assessing sarcopenia among Chinese community-dwelling older adults.

The five-time chair stand test (5CST) as an indicator of muscle strength and physical function is the first step in assessing sarcopenia. We aimed to determine the optimal cut-off value of the 5CST for assessing older adults with sarcopenia in the Chinese community. We used a stratified cluster random sampling method to recruit older adults from Chinese communities. The handgrip strength was assessed using an electronic handgrip dynamometer. The 5CST and gait speed were assessed by the trained researchers. The bioimpedance analysis device was used to evaluate the skeletal muscle index. We used the Asian Working Group for Sarcopenia diagnosis criteria as the gold standard. According to the receiver operating characteristic curve, we determine the optimal cut-off value using the Youden index. A total of 1027 participants were included in this analysis, including 337 men and 690 women with an average age of 70.35±7.24years. The prevalence of sarcopenia in total participants was 24.9%. The optimal cut-off value of 5CST in the total population was 10.9s. Stratified by age and gender, for the older adults aged 60-69years, the optimal cut-off values were 9.2s in men and 10.8 s in women; for the older adults aged 70-79years, cut-off values were 10.2s in men and 10.9s in women; and for the older adults over 80years, cut-off values were 14.0s in men and 11.5s in women (all P<0.001). The areas under the curve of 5CST were 0.632 in men and 0.650 in women (both P<0.001). Using the newly defined cut-off values, the prevalence of sarcopenia increased significantly (P<0.001). We determined the optimal cut-off value of the 5CST for assessing older adults with sarcopenia in the Chinese community, and this cut-off can significantly improve the detection rate of sarcopenia. The cut-off determined in our study will help community workers detect more people with sarcopenia and benefit from early intervention and management of sarcopenia in practice.

Ultrasound Evaluation of Sarcopenia in Patients with Hepatocellular Carcinoma: A Faster and Easier Way to Detect Patients at Risk.

The condition of sarcopenia, defined as a progressive loss of musculoskeletal mass and muscular strength, is very common in patients with hepatocellular carcinoma (HCC) and presents a remarkable association with its prognosis. Thus, the early identification of sarcopenic patients represents one of the potential new approaches in the global assessment of HCC, and there is increasing interest regarding the potential therapeutic implications of this condition. The gold standard for the quantification of muscle mass is magnetic resonance imaging (MRI) or computed tomography (CT), but these techniques are not always feasible because of the high-cost equipment needed. A new possibility in sarcopenia identification could be muscle ultrasound examination. The measurement of specific parameters such as the muscle thickness, muscular fascicles length or pennation angle has shown a good correlation with CT or MRI values and a good diagnostic accuracy in the detection of sarcopenia. Recently, these results were also confirmed specifically in patients with chronic liver disease. This review summarizes the role of imaging for the diagnosis of sarcopenia in patients with HCC, focusing on the advantages and disadvantages of the diagnostic techniques currently validated for this aim and the future perspectives for the identification of this condition.

Sarcopenia, sarcopenic obesity, and arterial stiffness among older adults.

Aging is associated with a higher prevalence of sarcopenia, sarcopenic obesity (SO), and increased arterial stiffening, with possible detrimental effects on morbidity and mortality. The aim of this study was to assess the relationships between sarcopenia, SO, and different indexes of arterial stiffness in older adults. A total of 77 hospitalized patients (mean age 78.68 ± 9.65 years) were evaluated, obtaining anthropometric variables, biochemical samples, handgrip test, and body composition assessment. Arterial stiffness was evaluated by measuring both carotid-femoral pulse wave velocity (cfPWV), a proxy for central stiffness, and cardio-ankle vascular index (CAVI), as well as considering peripheral arteries. The population was sorted into four subgroups: obese, sarcopenic, SO, and controls. The highest CAVI (11.31 ± 2.58) was found in sarcopenic patients. SO had the highest value of cfPWV (15.18 ± 8.44 m/s), even after adjustment for significant covariates. In multiple regressions, SO diagnosis resulted as a significant predictor of cfPWV (p = 0.03, R2 = 0.20), and sarcopenia diagnosis resulted as a predictor of CAVI (p = 0.042, R2 = 0.12). In conclusion, a positive correlation is found between sarcopenia, SO, and arterial stiffness among older subjects. In particular, greater central arterial stiffness is associated with SO, outlining a remarkable effect on the cardiovascular risk profile.

Concordance between muscle mass assessed by bioelectrical impedance analysis and by muscle ultrasound: a cross-sectional study in a cohort of patients on chronic hemodialysis

BackgroundSarcopenia is a common problem in hemodialysis (HD) patients, and it is diagnosed by low muscle mass, strength and/or low physical performance. Muscle ultrasound (US) is a non-invasive portable tool that might be used for assessment of muscle mass. The aim of the current study was to investigate the concordance between muscle US and bioelectrical impedance analysis (BIA) in diagnosis of sarcopenia in HD patients.MethodsThis cross-sectional study included 41 HD patients. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People (EWGSOP). The skeletal mass index was measured by BIA and the muscle strength was measured by handgrip strength. Muscle US was used to measure cross-sectional area (CSA) and thickness of quadriceps and biceps muscles.ResultsThe current study included 41 patients on HD (25 males), with a mean (SD) age of 44.18 (13.11) years and a median HD duration of 48 months. Sarcopenia was diagnosed in 58.5% of the patients. Patients with sarcopenia had significantly lower quadriceps muscle CSA than those without sarcopenia. The optimal cut-offs of quadriceps muscle CSA for both males and females for the diagnosis of sarcopenia were 2.96 and 2.92 cm2, respectively.ConclusionSarcopenia is prevalent among Egyptian HD patients. US on quadriceps muscle CSA could be used for diagnosis of sarcopenia in these patients.

Obstacles to the Early Diagnosis and Management of Sarcopenia: Current Perspectives.

Research in sarcopenia has grown exponentially over the last 15 years in geriatrics and gerontology, as well as other specialties, including oncology and hepatology. There is now strong evidence for the role of resistance exercise to prevent declines in muscle strength and function, especially when combined with nutritional optimization with protein supplementation. However, there remains a disparity between research evidence and clinical practice. There are multiple factors for this, which relate to the current diagnostic criteria for sarcopenia, practical and logistical aspects of diagnosis of sarcopenia, clinician knowledge of both diagnosis and management, and the availability of pathways for interventions. Sarcopenia is currently defined based on the identification of muscle strength, in combination with muscle size or quality, below cut-off thresholds at a single timepoint. This defines sarcopenia as a binary process of either present or not present, thus early diagnosis can be challenging. In this article, we summarize current obstacles to early diagnosis and management of sarcopenia in clinical practice, and make recommendations to how these might be overcome. This includes our recommendation of incorporation of handgrip strength measurement into standard care, to enable dynamic assessment and identification of early declines in handgrip strength, so that interventions can be implemented to prevent disability.

A machine learning-based online web calculator to aid in the diagnosis of sarcopenia in the US community.

Sarcopenia places a heavy healthcare burden on individuals and society. Recognizing sarcopenia and intervening at an early stage is critical. However, there is no simple and easy-to-use prediction tool for diagnosing sarcopenia. The aim of this study was to construct a well-performing online web calculator based on a machine learning approach to predict the risk of low lean body mass (LBM) to assist in the diagnosis of sarcopenia. Data from the National Health and Nutritional Examination Surveys 1999-2004 were selected for model construction, and the included data were randomly divided into training and validation sets in the ratio of 75:25. Six machine learning methods- Classification and Regression Trees, Logistic Regression, Neural Network, Random Forest, Support Vector Machine, and Extreme Gradient Boosting (XGBoost)-were used to develop the model. They are screened for features and evaluated for performance. The best-performing models were further developed as an online web calculator for clinical applications. There were 3046 participants enrolled in the study and 815 (26.8%) participants with LBM. Through feature screening, height, waist circumference, race, and age were used as machine learning features to construct the model. After performance evaluation and sensitivity analysis, the XGBoost-based model was determined to be the best model with better discriminative performance, clinical utility, and robustness. The XGBoost-based model in this study has excellent performance, and the online web calculator based on it can easily and quickly predict the risk of LBM to aid in the diagnosis of sarcopenia in adults over the age of 60.

Estimation of the appendicular skeletal muscle mass and phase angle cut-off values from a young Turkish reference population using multifrequency bioelectrical impedance analysis.

Population-specific muscle mass cut-off values are recommended for the diagnosis of sarcopenia. In this study, we aimed to determine the appendicular muscle mass index (ASMI) and phase angle (PA) cut-off values for the Turkish population using multi-frequency bioelectrical impedance analysis (mBIA). A total of 250 healthy volunteers aged 18-40 years were included in the study between September 2020 and December 2021. PA was measured by mBIA, and appendicular skeletal muscle mass (ASM) was calculated by the Sergi formula using the resistance and reactance measurements from mBIA. ASMI was calculated as ASM (kg)/(height in meters)2. Two standard deviations (SD) below the mean values were accepted as cut-off points. 134 women and 116 men were included in the study (26.0±5.6 years). The ASMI cut-offs for men and women were 5.86 and 4.36 kg/m2, respectively. The PA cut-offs were 5.66° in men and 4.38° in women. The present study reported the ASMI and PA cut-off values specific to the Turkish population using the Sergi formula, which was suggested by the European Working Group on Sarcopenia in Older People (EWGSOP).

Sarcopenia in cirrhotic patients: Does frailty matter while waiting for a liver transplant?

Sarcopenia reflects patient frailty and should be routinely assessed due to its high prevalence in cirrhotic patients awaiting liver transplants. Pre-transplant nutritional optimization should be tailored for patients with a definitive diagnosis of sarcopenia, therefore improving functional status at transplant and reducing post-transplant mortality. Hepatologists and transplant surgeons should have raised awareness regarding sarcopenia and the reflected frailty that hinder posttransplant outcomes. The policymakers should also take into account when modifying the organ allocation model that sarcopenia or frailty might become a decisive factor in allocating organs for cirrhotic patients, in order to ensure post-transplant survival and quality of life.

Sarcopenia and Neuroendocrine Neoplasms.

To summarise the current literature regarding the presence of sarcopenia in patients with neuroendocrine neoplasms (NENs). These are uncommon cancers separated into well-differentiated neuroendocrine tumours (NETs) and poorly differentiated neuroendocrine carcinoma (NECs). For the diagnosis of sarcopenia, there needs to be low muscle strength and low muscle quantity/quality. Five studies exist describing either low muscle strength or low muscle quantity in patients with NETs. The studies used different techniques to analyse muscle strength and muscle quantity, included heterogeneous populations, and performed the analysis at different time points following the diagnosis of the NET. Only 2 studies regarding patients with NECs could be found, both included mainly patients with a mixed adenoneuroendocrine carcinoma (MiNEN) and are, therefore, difficult to interpret for patients with a NEC. The main findings of this review are to describe the presence of sarcopenia in patients with NENs. However, results should be interpreted with caution, and future research should focus on the correct technique, homogenous population and same time point.

P563 Nutritional screening in patients with inflammatory bowel disease: a challenge in the timely diagnosis of malnutrition and sarcopenia

Abstract Background Malnutrition is prevalent in inflammatory bowel disease (IBD) and has been reported in up to 70% in patients with active disease and 38% in patients in remission, being related to sarcopenia, so different tools have been proposed for the nutritional screening of these patients taking into account the importance of early intervention avoiding consequences related to altered body composition such as inadequate response to treatment and poor quality of life, but the evidence in IBD patients is still unclear and there are no studies in Colombian IBD patients. Therefore, the aim of this study is to describe the nutritional status of patients using multiple nutritional screening and assessment tools. Methods Descriptive observational cross-sectional study in patients diagnosed with IBD with clinical activity, by applying nutritional screening tools such as the Malnutrition Universal Screening Tool (MUST) and the Malnutrition Inflammation Risk Tool (MIRT) to determine their nutritional status and degree of sarcopenia. Results Nutritional screening was performed in 20 patients with Inflammatory Bowel Disease, with mild to moderate clinical activity of the disease; patients in clinical remission were excluded. Sixty percent were men and 40% women; with an average age of 44.5 years, 19 years as minimum age and 73 years as maximum age. Taking into account the Malnutrition Universal Screening Tool (MUST), 30% have a high risk of malnutrition, with a higher percentage in men. On the other hand, the MIRT (Malnutrition Inflammation Risk Tool), which evaluates BMI, showed that 25% have a score greater than or equal to 3, which indicates a risk. In addition, and 40% of the population underwent nutritional status assessment in order to rule out sarcopenia. Muscle strength, muscle mass and muscle function were assessed and 25% of this population were diagnosed with sarcopenia and another 25% with possible sarcopenia. Conclusion Patients with IBD are at increased risk of malnutrition, This is the first Colombian study to approach the nutritional assessment of IBD patients with mild to moderate disease activity using nutritional screening tools such as the Malnutrition Universal Screening Tool (MUST) and the Malnutrition Inflammation Risk Tool (MIRT), showing that up to one third of patients are at high risk of malnutrition and 50% have a diagnosis or possible diagnosis of sarcopenia, which is slightly lower than that described in the literature, However, it does raise awareness of the importance of nutritional screening in IBD patients as these alterations have been shown to be associated with increased hospitalisation requirements, number of disease flares and associated complications.

Sarcopenia diagnosed by ultrasound-assessed quadriceps muscle thickness and handgrip strength predicts mortality in patients on hemodialysis.

Estimation of muscle mass is a pivotal component in the diagnosis of protein-energy wasting and sarcopenia. While bioimpedance spectroscopy is a widely accepted technique for the assessment of lean tissue related to the diagnosis of sarcopenia, to date skeletal muscle ultrasound (US) has not gained full acceptance for this purpose. The aim of this study was to assess the predictive value for mortality of the indexed thickness of the quadriceps vastus intermedius, as measured by US, compared to lean tissue index as estimated by bioimpedance spectroscopy, both combined with handgrip strength in a group of patients with end-stage kidney disease (ESKD) on maintenance hemodialysis (HD). The cut-off values for low handgrip strength were < 27kg for males and < 16kg for females. The cut-off value for low lean tissue index was obtained from an age-matched healthy control group, with low lean tissue index being defined as values below the 10th percentile of the distribution of healthy subjects. The cut-off values for low quadriceps vastus intermedius thickness index were < 3.44mm/m2 for males and < 3.52mm/m2 for females. Ultrasound and bioimpedance spectroscopy were performed in 99 patients, and handgrip strength was assessed in 64 patients, all on maintenance HD. After a median follow-up of 28months (interquartile range 19-41months) 38 patients died. Lean tissue index was not associated with mortality, while low quadriceps vastus intermedius thickness index and low handgrip strength were associated with an increased hazard of death. In the fully adjusted model, only the combination of low handgrip strength and low quadriceps vastus intermedius thickness index was significantly associated with higher mortality. When combined with low handgrip strength, low quadriceps muscle US outperformed low lean tissue index as assessed by bioimpedance spectroscopy in predicting mortality in a cohort of patients on maintenance HD. Ultrasound may be a useful and convenient technique for the assessment of sarcopenia and protein-energy wasting in this patient population.

Evaluation of sarcopenia and phase angle in elderly patients with Parkinson’s Disease

Purpose To investigate sarcopenia and related factors and to determine the disease-specific phase angle (PhA) cut-off score in detecting sarcopenia in elderly patients with Parkinson’s Disease (PD). Methods This cross-sectional study was conducted with 89 participants. The Mini-Nutritional Assessment (MNA), the Eating Attitude Test-10 (EAT-10), the Physical Activity Scale for The Elderly (PASE) questionnaire and the Hoehn-Yahr scale have been used. Additionally, anthropometric measurements were performed. The diagnosis of sarcopenia was based on the new consensus published by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). PhA has been performed by Bioelectrical Impedance Analysis (BIA) with Tanita MC 780®. Results The mean age was of the participants 68.9 ± 6.4 years, and 57.3% were male. The prevalence of sarcopenia was 12.3%. PhA, malnutrition, age, disease severity, low calf circumference (CC), low body mass index (BMI), the difference between the pre-diagnosis and current weight loss, dopaminergic treatment, and low PASE score were associated with sarcopenia. The cut-off value of the PhA in terms of the ability to identify sarcopenia was <4.5o with a sensitivity of 53.3% and a specificity of 93.2% (p = 0.001). When we grouped the PhA of the patients according to this cut-off score, it was seen that 14.6% of them were sarcopenic. Age, disease severity, PASE score and hand grip strength were significantly related to both sarcopenia and PhA. Conclusion It is important to be aware of sarcopenia and related factors at an early stage in Parkinson’s patients. Because of disease-related symptoms, it may be more appropriate to use a disease-specific PhA cut-off score in the definition of sarcopenia.

Muscle weakness is more strongly associated with functional outcomes in patients with stroke than sarcopenia or muscle wasting: an observational study

BackgroundStroke-related sarcopenia is an important prognosis factor and an intervention target for improving outcomes in patients with stroke.AimThis study aimed to identify the association between sarcopenia, possible sarcopenia, muscle weakness, muscle mass and calf circumference, and the functional outcomes 3 months after stroke.MethodsIn this single-centre prospective observational study, muscle strength, muscle mass, and calf circumference were measured in patients with acute stroke at hospital discharge. Diagnosis of sarcopenia, possible sarcopenia, muscle weakness, low muscle mass, and low calf circumference were defined according to the 2019 Asian Working Group for Sarcopenia criteria. The primary outcome measure was the modified Rankin Scale (mRS) score at 3 months, with an mRS score of 3 or higher indicating a poor outcome. Logistic regression analysis was conducted to examine independent associations between each assessment and functional outcomes.ResultsA total of 247 patients (median age: 73 years) were included in this study. The prevalence of sarcopenia was 28% (n = 70), and in the adjusted model, sarcopenia (aOR = 2.60, 95% CI 1.07–6.31, p = 0.034), muscle weakness (aOR = 3.40, 95% CI 1.36–8.52, p = 0.009), and low muscle mass (aOR = 2.61, 95% CI 1.04–6.52) were significantly associated with poor functional outcome. Nevertheless, other evaluations did not demonstrate an independent association with the outcome.ConclusionSarcopenia, muscle weakness, and low muscle mass were found to be independently associated with functional outcomes 3 months after stroke, and muscle weakness exhibited the strongest association with outcomes among them.