European Working Group On Sarcopenia In Older People Research Articles

Association between oral intake magnesium and sarcopenia: a cross-sectional study

BackgroundSarcopenia is a common skeletal muscle disorder in the elderly population. The patients with sarcopenia increased the cost of care and the risk for hospitalization. Magnesium deficiency might increase reactive oxygen species and protein damage. The purpose of our study was to demonstrate the relation between oral intake magnesium and sarcopenia by European Working Group on Sarcopenia in Older People (EWGSOP) 2 definition.MethodsOur study included 2532 participants with 1310 males and 1222 females. The multiple logistic regression model was designed to test the cross-sectional protective outcome of oral intake magnesium for sarcopenia.ResultsOral intake magnesium had a protective outcome with sarcopenia (odd ratio (OR) = 0.997, 95% CI = 0.996, 0.998, P < 0.001). After fully adjusted, the significance persisted with OR = 0.998 (95% CI = 0.996, 0.999, P < 0.001).ConclusionResults of the present study showed the dose dependent relationship between oral intake magnesium and sarcopenia. Sufficient oral intake magnesium might prevent patient from sarcopenia.

CT-Diagnosed Sarcopenia and Cardiovascular Biomarkers in Patients Undergoing Transcatheter Aortic Valve Replacement: Is It Possible to Predict Muscle Loss Based on Laboratory Tests?-A Multicentric Retrospective Analysis.

Background: Patients with severe aortic valve stenosis (AS) often present with heart failure and sarcopenia. Sarcopenia, described as progressive degradation of skeletal muscle mass, has frequently been implicated as a cause of increased mortality, prolonged hospitalization and generalized poor outcome after transcatheter aortic valve replacement (TAVR). At present, sarcopenia is defined by the European Working Group on Sarcopenia in Older People (EWGSOP) based on clinical examination criteria and radiological imaging. The aim of the present study was to compare patients with Computed Tomography (CT)-diagnosed sarcopenia with regard to the expression of cardiovascular biomarkers in order to obtain additional, laboratory-chemical information. Methods: A total of 179 patients with severe AS were included in this retrospective study. Sarcopenia was determined via CT by measurement of the psoas muscle area (PMA), which was indexed to body surface area (PMAi). According to previous studies, the lowest tertile was defined as sarcopenic. Patients with (59/179) and without sarcopenia (120/179) in the overall cohort were compared by gender-specific cut-offs with regard to the expression of cardiovascular biomarkers such as brain natriuretic peptide (BNP), soluble suppression of tumorigenicity-2 (sST2), growth/differentiation of factor-15 (GDF-15), heart-type fatty-acid binding protein (H-FABP), insulin like growth factor binding protein 2 (IGF-BP2) and soluble urokinase-type plasminogen activator receptor (suPAR). Additionally, binary logistic regression analyses were calculated to detect possible predictors of the presence of sarcopenia. Results: No statistical differences regarding one-year survival could be detected between sarcopenic and non-sarcopenic patients in survival curves (log rank test p = 0.179). In the entire cohort, only BNP and hemoglobin (HB) showed a statistically significant difference, with only HB emerging as a relevant predictor for the presence of sarcopenia after binary logistic regression analysis (p = 0.015). No relevant difference in biomarker expression could be found in the male cohort. Regarding the female cohort, statistically significant differences were found in BNP, HB and hematocrit (HK). In binary logistic regression, however, none of the investigated criteria could be related to sarcopenia. Conclusion: Regardless of gender, patients with imaging-based muscle degradation did not demonstrate significantly different cardiovascular biomarker expression compared to those without it.

Sarcopenia

Sarcopenia is defined as a progressive, generalized muscular-skeletal abnormality with accelerated loss of muscle mass and function. It is related to negative health outcomes such as functional impairment, falls, frailty, an increase in healthcare costs, and mortality. The most used definition and diagnostic criteria are those of the European Working Group on Sarcopenia in Older People (EWGSOP). They propose a probable diagnosis of sarcopenia when diminished muscle strength is detected. Said diagnosis would be confirmed when the presence of low muscle quantity or quality is measured. They define severe sarcopenia as the detection of low muscle strength, low muscle quantity/quality, and low physical performance. The measurement of low muscle mass by means of DXA confirms the diagnosis of sarcopenia (with updated cut-off points of less than 7kg/m2 for men and less than 5.5kg/m2 for women). At present, no specific drug for treating sarcopenia has been approved. As non-pharmacological therapies, strength or resistance exercise has shown moderate quality of evidence and a strong level of recommendation.

1613P Prevalence and predictive value for 6-month mortality of four criteria for assessment of sarcopenia in older patients with cancer: NutriAgeCancer national prospective cohort study

Older patients with cancer are at increased risk of sarcopenia. The European Working Group on Sarcopenia in Older People (EWGSOP)2 proposed criteria for case-finding, diagnosis and severity assessment of sarcopenia. The aim was to estimate the prevalence of each criteria: an abnormal SARC-F [Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls] questionnaire, low handgrip strength (HGS), low arm circumference (AC, substitute for muscle mass), low physical performance (PP; abnormal timed up-and-go test [TUG] or incapable), and their predictive value for 6-month mortality in older cancer patients, overall and by metastatic status.

Sarcopenia, obesity and sarcopenic obesity among community-dwelling and institutionalized female older woman in Caxias do Sul, Brazil

Introduction: Sarcopenia, obesity, and sarcopenic obesity are considered risk factors for the health of the elderly, which may cause or worsen the reduction in functional capacity. Objective: To determine the prevalence of sarcopenia, obesity, and sarcopenic obesity among community-dwelling and institutionalized female elderly in Caxias do Sul, Brazil. Methods: Observational epidemiological study, with cross-sectional design. 423 elderly women (≥60 years old) institutionalized and community-dwellers, participated in the study. Sarcopenia was identified according to the criteria established by the European Working Group on Sarcopenia in Older People (EWGSOP). The gait speed test estimated low skeletal muscle mass (SMM) by bioimpedance, low handgrip strength using a hand dynamometer, and low physical performance. Obesity was defined as Body Mass Index ≥27.0kg/m² and sarcopenic obesity by the simultaneous occurrence of obesity and sarcopenia. The Chi-Square test was performed, with a 5% significance level. Results: The overall prevalence of obesity was 53.9%. Sarcopenia was observed in 16.3% of the total sample, affecting 7.5% of the elderly in the community and 25.1% in institutions (p≤0.0001). Regarding sarcopenic obesity, 0.9% of the community and 3.8% of institutionalized elderly presented the dysfunction. Non-sarcopenic elderly women had a high prevalence of obesity. In the elderly of both groups, sarcopenia was more frequent in those with advanced age. Conclusion: Institutionalized elderly women had a higher prevalence of sarcopenia, emphasizing the importance of paying attention to the health of this population and highlighting the need for preventive measures.

Relation of Malnutrition and Nosocomical Infections in Cancer Patients in Hospital: An Observational Study.

Aim To investigate the relation between malnutrition and nosocomial infections (NI) in hospitalized cancer patients. Methods This observational, cross-sectional, noninterventional, descriptive study was conducted in a 500-bed university hospital in Valencia (Spain). Adult cancer patients admitted to the oncology ward were consecutively enrolled regardless of their nutritional status between November 2019 and March 2020. Patients were nutritionally assessed 24 to 48 hours after admission. Body weight, height and BMI, body composition through measurement of bioelectrical impedance analysis (BIA), and muscle strength and functionality using hand grip strength (HGS) were prospectively collected. The diagnosis of malnutrition and sarcopenia was assessed using the Global Leadership Initiative on Malnutrition (GLIM) criteria and the European Working Group on Sarcopenia in Older People (EWGSOP) criteria, respectively. Patients were followed up during their hospital stay or outpatient oncology visits to identify possible NI. Results A total of 107 patients were included in this study (mean age 66 years; 66.4% were men). The most frequent reason for admission was cancer treatment (19.6%), followed by infections (18.7%) and digestive tract symptoms (18.7%). Overall, 77.5% (83/107) of the patients were malnourished at admission according to the GLIM criteria, while 52.3% (56/107) were sarcopenic. Nosocomial infections (NI) were significantly more frequent in malnourished (52.1%; 25/48) and severely malnourished (42.1%; 8/19) patients, compared with well-nourished patients without malnutrition (25%; 10/40; p=0.035). The mean length of hospital stay was 13.9 days, significantly longer in patients with an NI compared to those without infections (18.6 vs. 10.8 days, p < 0.024). Conclusion This study evidenced the need to implement a routine protocol for the nutritional assessment and support of cancer patients at risk of malnutrition and sarcopenia to reduce the risk of NI during their hospital stay.

Sarcopenia, Obesity, Sarcopenic Obesity and Risk of Poor Nutritional Status in Polish Community-Dwelling Older People Aged 60 Years and Over.

Poor nutritional status (PNS) is a modifiable factor determining abnormalities in body composition-sarcopenia, obesity, and sarcopenic obesity (SO). We aimed to assess the prevalence of these conditions and their association with PNS in 211 community-dwelling older adults. Sarcopenia was diagnosed based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) recommendations. Obesity was diagnosed with the Percent Body Fat (>42% in women and >30% in men). Subjects fulfilling the criteria for obesity and concomitantly with reduced lower and/or upper limbs muscle strength and muscle mass (ALM/BMI < 0.512 in women and <0.789 in men) were classified as SO phenotype. Participants without obesity and sarcopenia were categorized as ‘normal’ phenotype. Nutritional status was estimated with the Mini Nutritional Assessment, and a score of <24 indicated PNS. In total, 49.8% participants had abnormal body composition (60.7% men and 42.5% women; p = 0.001). Sarcopenia, obesity, and SO were diagnosed in 10%, 32.7%, and 7.1% of subjects. PNS was found in 31.3% of the study sample. Its prevalence differed between phenotypes: 81% in sarcopenia, 60% in SO, 14.5% in obesity, and 28.3% in the ‘normal’ phenotype group (p = 0.000). Based on the results, abnormal body composition is prevalent in elderly subjects. Sarcopenia and SO are often associated with PNS.

Impact of sarcopenia on daily functioning: a cross-sectional study among older inpatients

Background and aimGeriatric patients with sarcopenia are at increased risk for functional decline with loss of independence in daily living. This cross-sectional study aims to investigate the impact of sarcopenia on different domains of functional status in hospitalized geriatric patients.MethodsSarcopenia was assessed at hospital admission using the recommendations of the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Body impedance analysis (BIA) was performed to determine muscle mass, and a pneumatic hand dynamometer was used to assess muscle strength. The functional independence measure (FIM) score, an 18-item tool exploring an individual's physical, cognitive and social functions, was used to measure functional status.ResultsIn 305 included inpatients with a median age of 84.0 years (65.6% female), prevalence of sarcopenia was 22.6%. Overall, sarcopenic patients had significant lower FIM scores compared to non-sarcopenic patients (p = 0.006). An association with sarcopenia was found for the FIM items bed/chair/wheelchair transfer (p = 0.047), transfer to toilet (p = 0.048), locomotion (p = 0.001), climbing stairs (p = 0.012), comprehension (p = 0.029), and social interaction (p = 0.028).ConclusionIn hospitalized geriatric patients, sarcopenia was found to be associated with both cognitive and mobility domains, but not with self-care domains of the FIM score. Therefore, when addressing sarcopenia in inpatients, tailored and multi-dimensional training interventions mainly should focus on motor-cognitive abilities.

Prevalencia de sarcopenia en pacientes mayores de 75 años ingresados por fractura de cadera

IntroductionHip fracture in the population aged 75 years and older is one of the most disabling pathologies. Likewise, disease related malnutrition (DRM) and sarcopenia are two frequent diagnoses in this age group, whose prevalence may be increased in patients with hip fracture. AimTo determine the prevalence of malnutrition and/or sarcopenia in patients admitted for hip fracture and evaluate the existence of malnutrition related to disease and sarcopenia, and the differences between the sarcopenic and non-sarcopenic group. Methods186 patients aged 75 years or over, hospitalised for hip fracture from March 2018 to June 2019 were included. Demographic, nutritional and biochemical variables were collected. Nutritional screening was carried out with the Mini-Nutritional Assessment (MNA), the presence of DRM was established with The Global Leadership Initiative on Malnutrition (GLIM) criteria. For sarcopenia screening, the Strength, Assistance with walking, Rising from a chair, Climbing stairs and Falls (SARC-F) was used and the diagnosis of sarcopenia was made using the criteria from the European Working Group on Sarcopenia in Older People (EWGSOP) reviewed in 2019 (EWGSOP2). Muscle strength was determined by hand-grip strength, body composition by measurement of bioelectrical impedance. ResultsThe mean age was 86.2 years, most of the patients were women (81.7%). 37.1% of patients were at nutritional risk (MNA 17-23.5) and 16.7% were malnourished (MNA<17). 72.4% of women and 79,4% of men, were diagnosed with DRM. 77.6% of the women and 73.5% of the men had low muscle strength. The appendicular muscle mass index was below the cut-off points for sarcopenia in 72.4% of the women and 79.4% of the men. Patients with sarcopenia had a lower body mass index, older age, poorer previous functional status and higher disease burden. The relationship between weight loss and hand grip strength (HGS) was significant (p=0.007) Conclusions53.8% of patients admitted for hip fracture present malnutrition or are at risk after screening with MNA. Sarcopenia and DRM affects at least three out of four patients older than 75 years admitted for hip fracture. Older age, worse functional status, lower body mass index and high number of comorbidities, are associated with these two entities. There is a relationship between DRM and sarcopenia.

Causal Relationship of Genetically Predicted Serum Micronutrients Levels With Sarcopenia: A Mendelian Randomization Study.

ObjectivesPrevious observational studies have suggested associations between concentrations of several circulating micronutrients and sarcopenia. However, the causality inferred from those studies was subjected to residual confounding and reverse causation. Therefore, we aimed to examine the causal effects of the levels of genetically predicted serum micronutrients on sarcopenia.MethodsSingle nucleotide polymorphisms (SNPs) were chosen from large-scale genome-wide association studies of participants only with European descent and were used as genetic instruments for the levels of 10 serum micronutrients (calcium, magnesium, selenium, copper, iron, zinc, Vitamin A, Vitamin B12, Vitamin D, and Vitamin E). Sarcopenia was defined by referencing to the 2019 definition given by the European Working Group on Sarcopenia in Older People (EWGSOP). A two-sample Mendelian randomization (MR) analysis was carried out to examine the associations between the levels of genetically predicted serum micronutrients and the risk of sarcopenia. Then, sensitivity analyses (including weighted median, MR-Egger and leave-one-out sensitivity analyses) were performed to evaluate the robustness of study findings. The estimates were presented as odds ratio (OR) with their 95% confidence intervals (CIs) per one standard deviation (SD) increase in the exposures.ResultsA total of 378,635 UK Biobank participants, including 572 participants who were identified with sarcopenia, were included in this study. The iron status was shown to have a clear effect on the risk of sarcopenia based on MR analyses. The per one SD increment in the genetically-determined serum iron level corresponded to a 53% increase in the risk of sarcopenia (OR = 1.53, 95% CI: 1.31–1.78, P = 0.001). The exclusion of SNPs of the circulating iron level (i.e., rs1799945 SNP, rs1800562 SNP or rs855791 SNP) did not attenuate the magnitude of the signal in MR analysis. There was little evidence supporting the associations between other remaining micronutrients and sarcopenia.ConclusionsAn increased risk of sarcopenia was observed with a genetically higher concentration of iron, suggesting that iron may play a role in the occurrence or development of sarcopenia.

Impact of sarcopenia on effectiveness of lumbar decompression surgery in patients with lumbar spinal stenosis

To investigate the impact of sarcopenia on effectiveness of lumbar decompression surgery in patients with lumbar spinal stenosis. The clinical data of 50 patients with lumbar spinal stenosis who met the selection criteria between August 2017 and December 2020 were retrospectively analyzed. According to the diagnostic criteria of the European Working Group on Sarcopenia in Older People (EWGSOP), based on the calculation of the skeletal muscle index (SMI) at the L 3 level, SMI<45.4 cm 2/m 2 (men) and SMI<34.4 cm 2/m 2 (women) were used as the diagnostic threshold, the patients were divided into sarcopenia group (25 cases) and non-sarcopenia group (25 cases). There was no significant difference in gender, age, disease duration, level of lumbar spinal stenosis, surgical fusion level, and comorbidity between the two groups ( P>0.05); the body mass index in sarcopenia group was significantly lower than that in non-sarcopenia group ( t=-3.198, P=0.002). Clinical data of the two groups were recorded and compared, including operation time, intraoperative blood loss, postoperative drainage volume, hospitalization stay, and complications. The visual analogue scale (VAS) scores of low back pain and sciatica and Oswestry disability index (ODI) scores were recorded preoperatively and at last follow-up. The effectiveness was evaluated according to modified MacNab standard. There was no significant difference between the two groups in terms of operation time, intraoperative blood loss, and postoperative drainage volume ( P>0.05). However, the hospitalization stay in sarcopenia group was significantly longer than that in non-sarcopenia group ( t=2.105, P=0.044). The patients were followed up 7-36 months (mean, 29.7 months). In sarcopenia group, 1 case of dural tear and cerebrospinal fluid leakage occurred during operation, as well as 1 case of internal fixator loosening during follow-up; 1 case of incision exudation and poor healing occurred in each of the two groups, and no adjacent segment degeneration and deep vein thrombosis of lower extremity occurred in the two groups during follow-up. There was no significant difference in the incidence of complications (12% vs. 4%) between the two groups ( χ 2=1.333, P=0.513). VAS scores in low back pain and sciatica as well as ODI scores in two groups significantly improved when compared with preoperative results at last follow-up ( P<0.05). The differences of VAS scores in low back pain and ODI scores before and after operation in sarcopenia group were significantly lower than that in non-sarcopenia group ( P<0.05). However, there was no significant difference of that in VAS scores of sciatica between the two groups ( t=-1.494, P=0.144). According to the modified MacNab standard, the excellent and good rate of the sarcopenia group was 92%, and that of the non-sarcopenia group was 96%, showing no significant difference between the two groups ( χ 2 =1.201, P=0.753). Patients with sarcopenia and lumbar spinal stenosis may have longer postoperative recovery time, and the effectiveness is worse than that of non-sarcopenic patients. Therefore, for elderly patients with lumbar spine disease, it is suggested to improve preoperative assessment of sarcopenia, which can help to identify patients with sarcopenia at risk of poor surgical prognosis in advance, so as to provide rehabilitation guidance and nutritional intervention in the perioperative period.

Circulating Levels of Apelin, GDF-15 and Sarcopenia: Lack of Association in the MAPT Study.

Apelin and GDF-15 have been proposed as biomarkers of age-related sarcopenia but evidence in human models is scarce. This study aimed to explore the associations between blood apelin and GDF-15 with sarcopenia incidence and the evolution of sarcopenia components over two years in older adults >70 years. Secondary longitudinal analysis of the Multidomain Alzheimer Preventive Trial. Older adults (>70 years) attending primary care centers in France and Monaco. Community. Serum Apelin (pg/mL) and plasma GDF-15 (pg/mL) were measured. Outcomes included sarcopenia defined by the European Working Group on Sarcopenia in Older People (EWGSOP) and its determinants (appendicular lean mass [ALM] evaluated through a Dual-energy X-ray Absorptiometry (DXA) scan, handgrip strength (HGS) and the 4-meter gait speed) measured over 2 years. Linear mixed models and logistic regression were used to explore the longitudinal associations. We included 168 subjects from MAPT (median age=76y, IQR=73-79; 78% women). Serum apelin was not significantly associated with sarcopenia incidence (OR=1.001;95%CI=1.000,1.001;p-value>0.05 in full-adjusted models) nor with ALM (β=-5.8E-05;95%CI=-1.0E-04,2.12E-04;p>0.05), HGS (β=-1.1E-04;95%CI=-5.0E-04,2.8E-04;p>0.05), and GS (β=-5.1E-06;95%CI=-1.0E-05,2.0E-05;p>0.05) in fully adjusted models. Similarly, plasma GDF-15 was not associated with both the incidence of sarcopenia (OR=1.001,95%CI=1.000,1.002,p>0.05) and the evolution of its determinants ([ALM, β=2.1E-05;95%CI=-2.6E-04,3.03E-04;p>0.05], HGS [β=-5.9E-04;95%CI=-1.26E-03,8.1E-05; p>0.05] nor GS [β=-2.6E-06;95%CI=-3.0E-05, 2.3E-05;p>0.05]) in fully adjusted models. Blood apelin and GDF-15 were not associated with sarcopenia incidence or with the evolution of sarcopenia components over a 2-year follow-up in community-dwelling older adults. Well-powered longitudinal studies are needed to confirm or refute our findings.

Prediction of Probable Sarcopenia with an Alternative Method: Plantar Flexion Strength

Objective : Sarcopenia is a geriatric syndrome characterized by age-related reduction in muscle mass and strength. Assessment of handgrip strength (HGS) is an essential measurement for the diagnosis of sarcopenia; however, disorders affecting upper limb muscles and joints may pose challenges in assessing handgrip strength. Therefore, the present study aimed to show the validity of plantar flexion strength (PFS) in diagnosing probable sarcopenia and investigating the relations between comprehensive geriatric assessment (CGA) and PFS while determining appropriate cutoff values for PFS. Methods : A total of 304 older participants who underwent CGA were included. The revised criteria of the European Working Group on Sarcopenia in Older People (EWGSOP) were used to determine PFS cutoff values for gender groups. Associations between probable sarcopenia and CGA parameters were investigated using PFS cutoffs. Results : The mean age was 74.50±7.10, and 170 of the participants (55.9%) were women. The mean HGS was 14.40±5.63 kg in women and 25.08±8.07 kg in men. The mean PFS were 13.17±3.62 and 14.92±3.86 kg respectively. In females, PFS cutoff with sensitivity/specificity; 0.81/0.60 was set at 14.95 kg (AUC 0.69, 95%CI: 0.611-0.772, p<0.001). In males, PFS cutoff with sensitivity/specificity; 0.80/0.55 was set at 16.80 kg (AUC 0.68, 95%CI: 0.593-0.772, p<0.001). Probable sarcopenia identified by GMS was associated with basic living activities, mobility, and frailty after adjusting for age and sex (p<0.001, p=0.021, and p=0.011 respectively). Conclusions : Probable sarcopenia identified by PFS could be associated with CGA. PFS may be useful for evaluating probable sarcopenia in older whose HGS cannot be estimated accurately.

MO960: Sarcopenia: An Overlooked Diagnosis in Kidney Transplant Recipients

Abstract BACKGROUND AND AIMS Sarcopenia is characterized by an involuntary loss of skeletal muscle mass, strength, and function and is usually associated with older age. However, sarcopenia may also be seen at younger ages in patients with chronic kidney disease. The European Working Group on Sarcopenia in Older People (EWGSOP) recently proposed a standardized definition of sarcopenia. We aimed to investigate the incidence of sarcopenia and associated factors in renal transplant recipients. METHOD We examined consecutive adult (age &amp;gt;18 years) renal transplant recipients under regular follow-up in our outpatient clinic during December 2021. We assessed the muscle strength with a handgrip test using a dynamometer and with a chair stand test. Using the Sergi formula, we used bioimpedance analysis to estimate the appendicular skeletal mass. Finally, we measured the gait speed to assess physical performance. Probable sarcopenia was defined as the presence of low muscle strength. Following that, sarcopenia was diagnosed with low muscle quantity in patients with probable sarcopenia according to the revised criteria by the EWGSOP. We retrieved the clinical and laboratory data from the patients’ medical records. RESULTS We recruited a total of 93 kidney transplant recipients (mean age: 59 ± 1.4, male gender 58.1%). About 15.0% of the patients were cadaveric transplants. Probable sarcopenia was found in 31 patients (33.3%), of which 14 (15.0%) were diagnosed with sarcopenia. Diabetes mellitus and lower albumin levels were the significant factors associated with the presence of probable sarcopenia (P = 0.01, P = 0.015, respectively; Table 1). On the other hand, sarcopenia was significantly associated with cadaveric transplantation (P = 0.02; Table 2). CONCLUSION We found that probable sarcopenia and sarcopenia were highly prevalent in our relatively young renal transplant recipients. We recommend active screening for the presence of sarcopenia in renal transplant recipients, especially in the cadaveric ones.

Screening, diagnosis and monitoring of sarcopenia: When to use which tool?

Sarcopenia is a muscle disorder associated with loss of muscle mass, strength and function. Early screening, diagnosis and treatment may improve outcome in different disease conditions. A wide variety of tools for estimation of muscle mass is available and each tool has specific technical requirements. However, different investigational settings and lack of homogeneity of populations influence the definition of gold standards, proving it difficult to systematically adopt these tools. Recently, the European Working Group on Sarcopenia in Older People (EWGSOP) published a revised recommendation (EWGSOP-2) and algorithm for using tools for screening and diagnosing sarcopenia. However, agreement of the EWGSOP2 criteria with other classifications is poor and although an overview of available tools is valuable, for the purpose of clinical decision-making the reverse is useful; a given scenario asks for the most suitable tools. Tools were identified for screening, diagnostics and longitudinal monitoring of muscle mass. For each of these clinical scenarios the most appropriate tools were listed and for each technique their usability is specified based on sensitivity and specificity. Based on this information a specific recommendation is made for each clinical scenario. This narrative review provides an overview of currently available tools and future developments for different clinical scenarios such as screening, diagnosis and longitudinal monitoring of alterations in muscle status. It supports clinical decision-making in choosing the right tools for muscle mass quantification depending on the need within a given clinical scenario as well as the local availability and expertise.

Assessment of sarcopenia and malnutrition using estimated GFR ratio (eGFRcys/eGFR) in hospitalised adult patients.

The aim of our study was to clarify whether the eGFR ratio (eGFRcys/eGFR) is appropriate for evaluating muscle mass as an alternative method to bioelectrical impedance analysis (BIA). We also investigated the accuracy and usefulness of the eGFR ratio in the diagnosis of sarcopenia and malnutrition. Serum creatinine (Cre) and cystatin C (Cys) were measured, and the eGFR ratio was calculated among 151 hospitalised patients (65 men and 86 women). The correlation between the eGFR ratio and skeletal muscle mass index (SMI) measured using BIA was analysed. Sarcopenia was diagnosed using the European Working Group on Sarcopenia in Older People (EWGSOP) 2 and Asian Working Group for Sarcopenia (AWGS) 2019 algorithms, while malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria. The diagnostic accuracy of the calculated SMI (Cal-SMI) based on the eGFR ratio was analysed. A moderate correlation between the eGFR ratio and muscle mass was observed. For the diagnosis of sarcopenia using the EWGSOP2 and Cal-SMI using the eGFR ratio, the sensitivity was 0.952 (95% confidence interval [CI] 0.892-0.984); specificity, 0.848 (95% CI, 0.711-0.937); and diagnostic accuracy, 0.921 (95% CI, 0.865-0.958). For the diagnosis of malnutrition using GLIM, the sensitivity was 0.980 (95% CI 0.929-0.998); specificity, 0.788 (95% CI 0.653-0.889); and diagnostic accuracy, 0.914 (95% CI 0.857-0.953). An accurate diagnosis of sarcopenia using the EWGSOP2 and AWGS2019, and an accurate diagnosis of malnutrition using GLIM, was made using the eGFR ratio. The eGFR ratio may be a suitable alternative when BIA cannot be used.

Influence of sarcopenia as defined by EWGSOP2 on complications after pancreaticoduodenectomy and on the prognosis of pancreatic head cancer: A prospective cohort study

ObjectivesIt has been reported that sarcopenia is associated with higher postoperative complication rates in various surgeries and with a poorer prognosis in various carcinomas. However, many of these reports did not strictly follow the definition of sarcopenia. Therefore, we prospectively evaluated the influence of sarcopenia, as defined by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), on complications after pancreaticoduodenectomy (PD) and on the prognosis of pancreatic head carcinoma. MethodsWe prospectively investigated 180 patients who underwent PD at Chiba University Hospital from January 2016 to March 2020. The skeletal muscle mass, grip strength, and gait speed of the patients were measured preoperatively. Sarcopenia was defined in accordance with the EWGSOP2 definition. We evaluated the frequency and severity of postoperative complications in infectious, non-infectious, and overall complications. We analyzed the prognosis of 83 patients with pancreatic head carcinoma who underwent PD. ResultsThere were no differences in the severity and frequency of infectious, non-infectious, and overall complications between patients with and without sarcopenia. In patients with pancreatic head carcinoma, the recurrence-free and overall survival rates were significantly lower in patients with sarcopenia than in those without sarcopenia (P = 0.017 and P = 0.011, respectively). In multivariate analysis, sarcopenia was an independent risk factor for poor recurrence-free survival and overall survival (HR, 4.48; 95% CI, 1.68–11.98; P = 0.003 and HR, 3.25; 95% CI, 1.19–8.86; P = 0.021, respectively). ConclusionsSarcopenia, as defined by EWGSOP2, did not affect complications after PD. Sarcopenia is an important prognostic factor for surgically resected pancreatic head carcinoma.

Assessment of Sarcopenia Related Quality of Life Using SarQoL® Questionnaire in Patients With Liver Cirrhosis.

IntroductionSarcopenia, malnutrition, physical deconditioning, and frailty contribute to a significantly altered quality of life (QoL) in patients with cirrhosis and sarcopenia.AimTo investigate the sarcopenia-linked alterations of QoL by SarQoL® questionnaire in patients with end-stage liver disease.MethodsConsecutive patients with liver cirrhosis, admitted to our department between May and August 2021, completed the SarQoL® questionnaire by themselves. They were evaluated for sarcopenia according to the 2019 European Working Group on Sarcopenia in Older People (EWGSOP) definition [hand grip cut-offs and skeletal muscle index (SMI) calculation at CT scan].ResultsA total of 71 patients with liver cirrhosis were included in the study, with a median age of 54 years. Sarcopenia was present in 31.2% of patients with Child-Pugh class A, in 58.3% with class B, and in 93.5% with class C. The SarQoL® score was statistically significant and lower in Child-Pugh class C vs. class B and class A (70.2 vs. 66.5 vs. 52.5 points, p = 0.0002). The SarQoL® score was evaluated according to different complications of cirrhosis, with statistically significant lower scores in patients with sarcopenia (p < 0.0001), in patients with ascites requiring paracentesis (p = 0.0006), and in patients with hepatic encephalopathy (p < 0.0001). A cut-off level of 75.9 points for SarQoL® score can accurately detect sarcopenia in patients with end-stage liver disease [area under the receiver operating characteristic (AUROC) curve of.823, SE of 92.1%, SP of 45.5%, positive predictive value (PPV) and negative predictive value (NPV) of 66 and 83.3%, respectively, correctly classified 73.2% of cirrhotic patients with sarcopenia].ConclusionsThe use of SarQoL® questionnaire in cirrhotic patients can, at the same time, evaluate the quality of life and identify subjects with sarcopenia and altered QoL.

Adverse childhood experiences and handgrip strength among middle-aged and older adults: a cross-sectional study in China

BackgroundEvidence on the association between adverse childhood experiences (ACEs) and handgrip strength (HGS) in later life was limited and inconclusive. We aimed to explore the impact of ACEs on HGS among middle-aged and older Chinese adults.MethodsWe conducted a cross-sectional study with data extracted from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey with respondents recruited from 450 villages/urban communities of 28 provinces. Participants aged 45 years or older were drawn from the CHARLS 2014 life history survey and the 2015 health survey. Twelve ACE indicators before the age of 17 years were collected. HGS was measured with a dynamometer and the maximum value of HGS obtained from both hands was used in the analyses. Low muscle strength (LMS) was defined according to the recommendation of European Working Group on Sarcopenia in Older People (EWGSOP). Multivariate linear and logistic regression models were constructed to evaluate the association of ACEs with continuous HGS and LMS, with adjustment for age, sex, marital status, ethnicity, area of residence, smoking and drinking status, body mass index, hypertension, dyslipidaemia, diabetes mellitus, cardiovascular disease, arthritis, hip fracture, and memory-related disease.ResultsOf the 7209 eligible participants, 2258 (31.3%) had experienced three or more ACEs. Compared to individuals without ACEs, exposure to ≥ 3 ACEs was negatively associated with continuous HGS in kilogram (β = -0.93, 95% CI: -1.37, -0.49) and positively associated with the risk of LMS (OR = 1.34, 95% CI: 1.12, 1.61). Such associations were consistently found both in men and women who had experienced three or more ACEs. Significant dose–response relationship between the number of ACEs and outcomes was also observed in the overall population and different sex groups.ConclusionExposure to ACEs was associated with lower HGS and increased risk of LMS among middle-aged and older Chinese adults, indicating the importance of intervention in individuals with experience of ACEs in order to mitigate its detrimental impact on HGS and promote healthy ageing.

Acute Sarcopenia after Elective and Emergency Surgery.

Sarcopenia is an increasingly recognised condition of loss of muscle mass and function. The European Working Group on Sarcopenia in Older People 2 (EWSOP2) updated their definition in 2018, emphasising the importance of low muscle strength in diagnosis. Acute sarcopenia has been arbitrarily defined as sarcopenia lasting less than 6 months. This review highlights the pathophysiology involved in muscle wasting following surgery, focussing on hormonal factors, inflammation, microRNAs, and oxidative stress. Biomarkers such as GDF-15, IGF-1 and various microRNAs may predict post-surgical muscle loss. The impact of existing sarcopenia on various types of surgery and incident muscle wasting following surgery is also described. The gaps in research found include the need for longitudinal studies looking in changes in muscle strength and quantity following surgery. Further work is needed to examine if biomarkers are replicated in other surgery to consolidate existing theories on the pathophysiology of muscle wasting.