Low Grip Strength Research Articles

514 FRAILTY IN OSTEOARTHRITIS AND THE INFLUENCE OF CO-MORBIDITY

Abstract Introduction Risk factors for frailty, including low physical activity and chronic pain, are common among people with osteoarthritis. The aim of this analysis was to determine the association between osteoarthritis and frailty and to determine whether comorbidities interact additively with OA to increase the likelihood of frailty. Methods Men and women aged 40-69 years who contributed to the UK Biobank were analysed. Data about self-reported physician-diagnosed diseases was collected, as well physical measurements, including hand-grip strength. Frailty (robust, pre-frail, frail) was assessed using a modified frailty phenotype, comprising five components: low grip strength, slow walking speed, weight loss, low physical activity, and exhaustion. The association between osteoarthritis and the frailty phenotype was determined using negative binomial regression, adjusting for age, sex, body mass index, smoking status, and Townsend deprivation score. We calculated the attributable proportion of risk of frailty due to additive interaction between osteoarthritis and common co-morbidities (cardiovascular disease, diabetes, COPD, and depression). Results 457,561 people were included, 35,884 (7.8%) had osteoarthritis. The adjusted relative risk ratio (95% CI) for pre-frailty and frailty (versus robust), respectively was higher among people with (versus without) osteoarthritis: 1.58 (1.54, 1.62) and 3.41 (3.26, 3.56). There was significant additive interaction between the presence of osteoarthritis and each of the co-morbidities considered in increasing risk of frailty, particularly diabetes (attributable proportion of risk due to additive interaction with osteoarthritis (95% CI)), 0.49 (0.42, 0.55), coronary heart disease 0.48 (0.41, 0.55), and depression 0.47 (0.41, 0.53). Conclusions Our results suggest that people with OA are at increased risk of pre-frailty and frailty. The mechanisms are not fully understood, though co-morbidity appears to contribute to the risk of frailty beyond the expected additivity of risk due to OA and co-morbidity. Early diagnosis and optimal management of co-morbidities in people with OA may be beneficial.

Grip strength as a predictor of disease severity in hospitalized COVID-19 patients

BackgroundGrip strength is one of the main components for the physical functioning in sarcopenia and physical frailty. ObjectivesTo explore the role of grip strength measurement at admission for predicting disease severity in COVID-19. MethodsDemographic data, smoking status, comorbidities, COVID-19 related symptoms, grip strength, laboratory and computed tomography (CT) findings at admission were all noted. Using a Smedley hand dynamometer, the maximum grip strength value (kg) after three measurements on the dominant side was recorded. Low grip strength was defined as two standard deviations below the gender-specific peak mean value of the healthy young adults (<32 kg for males, <19 kg for females). Patients were categorized into three groups according to clinical and CT findings. Severe illness group had pneumonia with a respiratory rate >30/min, oxygen saturation ≤90%, or extensive lung involvement in CT. Moderate illness group had pneumonia with CT score ≤11. Mild illness group had normal CT findings. ResultsThe study population included 312 patients (140 F, 172 M). The distribution of mild, moderate and severe disease groups were 36.9%, 51.0% and 12.2%, respectively. Cough, fever, dyspnea, hypertension, obesity, cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) were most frequent, and C-reactive protein (CRP), ferritin, D-dimer, and neutrophil levels were highest in the severe group (all p<.05). Absolute grip strength values were lowest and the frequency of having low grip strength were highest in the severe group (both p<.01). Since we found that the significant differences were stemming from the severe group, we combined the mild and moderate group as non-severe, and compared severe vs. non-severe groups with binary logistic regression analyses. When age, gender, body mass index, smoking status, presence of comorbidities and low grip strength, and abnormal laboratory findings were taken into analyses; age (odds ratio [OR]: 1.054 [95% confidence interval (CI): 1.020-1.089]), obesity (OR: 2.822 [95% CI: 1.143-6.966]), COPD (OR: 5.699 [95 %CI: 1.231-26.383]), CRP level (OR: 1.023 [95% CI: 1.010-1.036]) and low grip strength (OR: 3.047 [95% CI: 1.146-8.103]) were observed to be independent predictors for severe COVID-19 disease (all p<.05). ConclusionsIn addition to the well-known independent risk factors (i.e. age, obesity, COPD, and CRP level), low grip strength independently increased (about three times) the severity of COVID-19.

Get a Grip on Factors Related to Grip Strength in Persons With Hand Osteoarthritis: Results From an Observational Cohort Study.

To compare levels of grip strength in individuals with hand osteoarthritis (OA) with normative values, and to examine how hand OA severity and other biopsychosocial factors are associated with grip strength. Levels of grip strength across age groups were compared with normative values from the general population in sex-stratified analyses using 2-sample t-tests. Associations between radiographic hand OA severity (Kellgren/Lawrence sum score) in different joint groups and grip strength of the same hand were examined in 300 individuals from the Nor-Hand study using linear regression. Analyses were repeated using markers of pain, demographic factors, comorbidities, and psychological and social factors as independent variables. We adjusted for age, sex, and body mass index. Individuals with hand OA had lower grip strength than the general population, especially in individuals age <60 years. In thumb base joints, increasing radiographic severity (range 0-8) and the presence of pain were associated with lower grip strength (β = -0.83 [95% confidence interval (95% CI) -1.12, -0.53] and β = -2.15 [95% CI -3.15, -1.16], respectively). Negative associations with grip strength were also found for women, low education, higher comorbidity index, and higher resting heart rate. Individuals with hand OA have lower grip strength than the general population. Our results support the idea that studies on thumb base OA should include grip strength as an outcome measure. However, other biopsychosocial factors should also be considered when the grip strength is being interpreted, because other factors such as sex, socioeconomic factors, physical fitness, and comorbidities are negatively associated with grip strength.

Implementing grip strength assessment in hip fracture patients: a feasibility project.

Objectives:Risk stratification scores are used in hip fracture surgery, but none incorporate objective tests for low muscle strength. Grip strength testing is simple and cheap but not routinely assessed for patients with hip fracture. This project aimed to assess the feasibility of implementing grip strength testing into admission assessment of patients with hip fracture.Methods:A scalable protocol and a corresponding training programme of instructional presentations and practical assessments were designed and delivered by and for physiotherapy staff. Grip strength values were collected pre-surgery on patients with hip fracture at a single centre whilst supine in bed. Implementation of the process was evaluated using narrative, quantitative and cost measures.Results:53 hip fracture patients with a mean age 80.6 (SD 10.4), of which 36 (67.9%) were female, were included. Testing was offered to 42/52 (81%) patients. Cognitive impairment prevented 14/42 (33%) of patients from completing testing; one patient declined testing. Of the 27 patients who completed testing, 14/27 (52%) had low grip strength as defined by EWGSOP2 criteria. The projected cost of testing for one year was £2.68-£2.82 per patient. Fidelity to the protocol was high using multiple criteria.Conclusions:Grip strength assessment is acceptable to physiotherapy staff and can be rapidly and cost-effectively implemented into hip fracture admission assessment.

Adults With Clinically Meaningful Depressive Symptoms Are More Vulnerable to the Effects of a Pro-inflammatory Diet on Frailty Onset

Abstract Objectives The dietary inflammatory index (DII®) reflects the inflammatory potential from dietary intakes. A pro-inflammatory diet (higher DII score) has been linked with frailty and increased risk of depression. It is unclear if depressive symptoms exacerbate the association between a pro-inflammatory diet and frailty. We determined if the association between DII score and frailty differed by depressive symptoms in adults from the Framingham Heart Study (FHS). Methods This prospective study included non-frail individuals (n = 1712) with baseline (1998–2001) diet assessment from food frequency questionnaire (FFQ), depressive symptoms from Center for Epidemiologic Studies Depression (CES-D) scale and follow-up frailty measurement (2011–2014). Energy-adjusted DII (E-DIITM) scores were calculated from foods and nutrients reported on the FFQ. Frailty was defined as fulfilling ≥3 Fried frailty criteria: unintentional weight loss, exhaustion, low physical activity, slow gait speed, and low grip strength. We stratified by baseline CES-D scores &amp;lt;16 or ≥ 16, which denotes the absence or presence of clinically meaningful depressive symptoms, respectively. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (95%CI) for frailty development, adjusting for baseline age, sex, energy intake, current smoking, treatment for diabetes and/or cardiovascular disease, and non-skin cancers. Results Of the 1712 non-frail individuals at baseline (mean age: 58 ± 8 years, range: 33–81; 45% male), 227 individuals became frail over 16 years. Mean E-DII for all participants was −1.95 ± 2.20 (range: −6.71–5.44). Mean E-DII in frail individuals was −1.73 ± 2.13, while in non-frail individuals it was −1.98 ± 2.21. In those with CES-D &amp;lt; 16, one-unit increase in E-DII (more pro-inflammatory diet) was associated with 16% higher odds (95%CI:1.08–1.26) of frailty. In the cohort who had CES-D ≥16(∼6%), one-unit increase in E-DII was associated with 51% higher odds of frailty (95%CI:1.12–2.03). Conclusions In this cohort of older adults, those with depressive symptoms had higher odds of frailty with a more inflammatory diet compared to those without. Thus, especially among those with depressive symptoms, addressing the pro-inflammatory diet components may be a useful strategy for reducing or preventing frailty in older adults. Funding Sources NIA(T32-AG023480)

Dairy Food Intake Is Not Associated With Frailty or Frailty Progression Over Time in Adults: Framingham Offspring Study

Abstract Objectives High-fat dairy foods are calorically dense, which may prevent anorexia and malnutrition that are often seen in frail persons. We determined the association of dairy food intake [milk, yogurt, cheese, total dairy (milk + yogurt + cheese), low-fat, and high-fat dairy, serv/wk] with frailty and frailty progression in older adults from the Framingham Offspring study. Methods This prospective cohort study included non-frail participants at index exam (1998–01) with food frequency questionnaires (FFQ) and ≤2 follow-up frailty assessments (2005–08, 2011–14). Average dairy food intakes were calculated from index and prior FFQs (1998–01 and 1995–98). Fried's frailty phenotype was used: presence of ≥3 criteria of unintentional weight loss, exhaustion, slow gait speed, low physical activity, and low grip strength. Frailty progression was defined as an increased number of frailty criteria over follow-up. Repeated measures logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for frailty and frailty progression (separate models) adjusting for age, sex, energy intake (residual analysis), current smoking, multivitamin use, and self-reported health status. Results Mean baseline age was 60y ± 9 (range 33–86 y) and 45% were female. Mean dairy food intakes [serv/wk] were: 5.7 ± 5 (milk), 1.1 ± 1.9 (yogurt), 2.8 ± 3.0 (cheese), 9.6 ± 6.9 (total dairy), 6.2 ± 6.0 (low-fat dairy), and 4.5 ± 4.3 (high-fat dairy). Of the 2550 non-frail individuals at baseline, 8.8% (2005–08) and 13.5% (2011–14) became frail over time. Frailty progression was seen in 34% (2005–08) and 40% (2011–14) of the participants. In age and sex adjusted models, high-fat dairy foods were associated with 2% increased odds of frailty (95%CI: 1.00–1.04, P = 0.01). This association did not change after further adjustment (OR: 1.02, 95%CI: 0.99–1.05, P = 0.07). Other dairy foods were not associated with frailty (P range: 0.23–0.78) or with frailty progression (P range: 0.32–0.86). Conclusions In this study of healthy older adults, most dairy food intake was not associated with frailty or frailty progression after considering important covariables. The observed trend for slightly increased odds of frailty with high-fat dairy intake should be re-examined in other studies with frailty assessed over time. Funding Sources Boston Pepper Center OAIC, NHLBI &amp; Dairy Management Inc.

Three definitions of probable sarcopenia and associations with falls and functional disability among community-dwelling older adults

ObjectivesTo assess the prevalence of probable sarcopenia according to 3 different definitions (“strength, assistance with walking, rise from a chair, climb stairs, falls”- SARC-F score, low grip strength, and the guidelines indicated by the European Working Group on Sarcopenia in Older People 2 - EWGSOP2) and assess the association of probable sarcopenia with functional disability and falls among community-dwelling older adults. MethodsCross-sectional study with 419 older adults. Probable sarcopenia was assessed by 3 definitions: a SARC-F ≥ 4, low grip strength (< 27 kg for men and < 16 kg for women), and the EWGSOP2 criteria. Associations were investigated using Pearson's chi-square test and prevalence ratios were estimated by Poisson regression (P < 0.05). ResultsOf the total, probable sarcopenia was identified in 23.0% of participants (SARC-F ≥ 4 score), 33.7% (low grip strength), and 10.4% (EWGSOP2) according to each different definition. In adjusted regression models, having at least 1 instrumental activities of daily living (IADL) disability and having fallen in the last 12 months were significantly associated with a SARC-F ≥ 4 (prevalence ratio, PR = 1.60; and PR = 2.50, respectively) and EWGSOP2 (PR = 1.78; and PR = 2.19, respectively). ConclusionsIADL disability and falls were associated with a SARC-F ≥ 4 and the EWGSOP2 criteria (SARC-F ≥ 4 and low grip strength). Probable sarcopenia may be used in clinical practice in order to facilitate the diagnosis of definite sarcopenia and to implement early interventions that could prevent functional decline and falls in older people.

Low Grip Strength Associated with Clinical Outcomes after Total Hip Arthroplasty - A Prospective Case-Control Study.

ObjectiveTo assess whether low grip strength (GS) is associated with clinical outcomes after total hip arthroplasty (THA).MethodsA prospective case–control study was designed to assess 231 cases of primary THA between January 1, 2015 to May 1, 2018, at an urban tertiary care hospital. Patients were placed into two cohorts based on preoperative GS levels. Low GS in the present study was defined as GS lower than 26 kg for men and 16 kg for women in the dominant hand. Baseline data were prospectively collected and included patient demographics (age, sex, body mass index [BMI]), the surgeon's diagnoses, medical history, length of stay, and American Society of Anaesthesiologists' (ASA) score. Clinical outcomes included surgery‐ and prosthesis‐related variables. The Harris hip score (HHS) and the Short Form Health Survey (SF‐12) were completed at the baseline visit and at 1 and 2 years postoperatively in the outpatient department to assess the hip's function and quality of life. Differences in baseline data, length of study (LOS), 90‐day postoperative complications, and hospital readmissions were compared. Besides, the correlations between GS and Harris hip score (HHS) and Short Form score (SF‐12) were tested.ResultsA total of 202 participants have completed records for analysis finally. The patients were followed up for an average of 24.8 months postoperatively (24–26 months). Eighty‐two patients (40.6%) had low GS before THA. Patients with low GS were more likely to be female, older, fracture of femoral head or neck as the primary cause, albumin <3.5 g/dL, and have a lower BMI, higher ASA score, increased rates of the pressure sore, blood transfusion, and LOS compared to normal GS (all P < 0.05). Also, patients in the low GS cohort showed a statistically significant increased unplanned hospital readmissions and decreased discharge home compared to normal GS (both P < 0.05). There was an increasing rate of complications between the two cohorts, for cardiac complications, pressure sore after THA, respiratory complications, urinary tract infection, stroke, and DVT (all P < 0.05). A partial correlation test by controlling medical comorbidities and demographic factors was used to determine the correlation between GS and HHS. There was a significant correlation between them (r = −0.673; P = 0.002). A similar condition was detected in the correlation between GS and SF‐12 (r = 0.645; P = 0.001).ConclusionsClinicians should be encouraged to include GS assessment in their evaluation of patients who planned to undergo THA in order to optimize the treatment of high‐risk individuals.

Cancer Survivors with Low Hand Grip Strength Have Decreased Quality of Life Compared with Healthy Controls: The Korea National Health and Nutrition Examination Survey 2014-2017.

BackgroundCancer survivors experience decreased physical function and reduced muscle strength, which leads to lower quality of life (QOL). The hand grip strength (HGS) can be a predictor of poor health-related QOL as a parameter of sarcopenia. The purpose of this study was to investigate the relationship between low HGS and QOL in cancer survivors and healthy controls.MethodsWe analyzed 392 cancer survivors and 1,176 healthy controls from the Korea National Health and Nutrition Examination Survey, 2014–2017. We defined low HGS as 2 standard deviation values for healthy young Korean adults from a previous study. QOL was evaluated using the European Quality of Life Scale-Five Dimensions. A complex sample logistic regression model was used to assess the relationship between each dimension of low HGS and QOL.ResultsThe odds ratios (ORs) for decreased QOL were significantly higher in male cancer survivors with low HGS on self-care (OR, 8.51; 95% confidence interval [CI], 1.69–42.83) and usual activities (OR, 6.63; 95% CI, 1.22–36.03). The ORs for problems in mobility (OR, 5.87; 95% CI, 2.04–16.91), usual activities (OR, 14.46; 95% CI, 3.84–54.44), pain/discomfort (OR, 4.90; 95% CI, 2.00–12.01), and anxiety/depression (OR, 6.43; 95% CI, 2.16–19.12) were significantly high in female cancer survivors with low HGS. However, healthy controls showed no significant relationship between low HGS and QOL.ConclusionFor cancer survivors, low HGS was associated with poor QOL in some domains. Strategies to increase muscle strength must be considered to improve the QOL of cancer survivors.

Comparison of hip structure analysis and grip strength between femoral neck and basicervical fractures

BackgroundThe purpose of this study was to analyze differences in geometrical properties of the proximal femur and predict the occurrence of basicervical fractures through a comparative study of femoral neck and basicervical fractures in patients undergoing hip structural analysis (HSA).MethodsAll patients with hip fractures who were at least 65 years old and admitted to our hospital between March 2017 and December 2019 were eligible for this study. During the study period, 149 femur neck fractures (FNF) and basicervical fractures (intertrochanteric fractures of A31.2) were included in this study. Fifty-nine patients were included in the final analysis. Factors considered to be important confounders affecting the occurrence of basicervical hip fractures were chosen for propensity-score analysis. A logistic model with basicervical hip fracture as the outcome and age, sex, weight, spinal T-score, hip T-score, and vitamin D levels as confounders was used to estimate the propensity score.ResultsThe cross-sectional moment of inertia (CSMI) of the intertrochanter was significantly lower in patients with basicervical hip fracture (HF) than in patients with FNF (p = 0.045). However, there was no significant differences in any other HSA variable between the two groups. Receiver operating characteristic (ROC) analysis showed that cutoff point for HSA was 100 for hip axis length (HAL) (AUC = 0.659, p < 0.001) and 5.712 for CSMI of the intertrochanter (AUC = 0.676, p < 0.001). ROC analysis showed that cutoff points of HAL, CSMI of intertrochanter, and handgrip strength were 104.8, 8.75, and 16.9, respectively (AUC = 0.726, p < 0.001).ConclusionsProximal femoral geometric analysis using HSA is a useful method for predicting the type of hip fracture. Additionally, a lower CSMI, a shorter HAL, and a lower grip strength are major predictors of basicervical fractures.

Risk Factors for Incident Fracture in Older Adults With Type 2 Diabetes: The Framingham Heart Study.

OBJECTIVETo identify risk factors for fracture in type 2 diabetes.RESEARCH DESIGN AND METHODSThis prospective study included members of the Framingham Original and Offspring Cohorts. Type 2 diabetes was defined as fasting plasma glucose >125 mg/dL or use of type 2 diabetes therapy. We used repeated-measures Cox proportional hazards regression to calculate hazard ratios (HRs) and 95% CIs for associations between potential predictors and incidence of fragility fracture.RESULTSParticipants included 793 individuals with type 2 diabetes. Mean ± SD age was 70 ± 10 years; 45% were women. A total of 106 incident fractures occurred over 1,437 observation follow-up intervals. Fracture incidence increased with age (adjusted HRs 1.00, 1.44 [95% CI 0.65, 3.16], and 2.40 [1.14, 5.04] for <60, 60–70, and >70 years, respectively; Ptrend = 0.02), female sex (2.23 [1.26, 3.95]), HbA1c (1.00, 2.10 [1.17, 3.75], and 1.29 [0.69, 2.41] for 4.45–6.46% [25–47 mmol/mol], 6.50–7.49% [48–58 mmol/mol], and 7.50–13.86% [58–128 mmol/mol]; Ptrend =0.03), falls in past year (1.00, 1.87 [0.82, 4.28], and 3.29 [1.34, 8.09] for no falls, one fall, and two or more falls; Ptrend =0.03), fracture history (2.05 [1.34, 3.12]), and lower grip strength (0.82 [0.69, 0.99] per 5-kg increase). Femoral neck bone mineral density, BMI, smoking, physical function, chronic diseases, medications, and physical function were not associated with fracture incidence.CONCLUSIONSPrior falls, fractures, low grip strength, and elevated HbA1c are risk factors for fractures in older adults with type 2 diabetes. Evaluation of these factors may improve opportunities for early intervention and reduce fractures in this high-risk group.

Plasma C-Terminal Agrin Fragment as an Early Biomarker for Sarcopenia: Results From the GenoFit Study.

Barriers associated with direct muscle quantification have prevented a consistent implementation of therapeutic measures for sarcopenia. Recently, the relevance of circulating C-terminal agrin fragment (CAF) as an accessible screening method alternative for sarcopenia has gained credence. Accordingly, this study aimed to verify the pertinence of plasma CAF as a biomarker for sarcopenia. Three hundred healthy adults aged between 50 and 83 years took part in this study. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People criteria. Body composition was assessed using dual-energy x-ray absorptiometry, while muscle strength was examined using hand dynamometry. Plasma CAF concentrations were determined using a commercially available ELISA kit. CAF concentrations were significantly associated with appendicular lean mass (ALM), but not grip strength (p = .028, p = .575, respectively). Plasma CAF concentrations were significantly elevated in sarcopenic individuals compared to nonsarcopenic (p < .001). Overall, individuals with low grip strength or low ALM displayed significantly higher CAF levels compared to healthy controls, after adjusting for age and body mass index (p = .027, p = .003, respectively). In males, those with low grip strength or low ALM had significantly elevated CAF levels (p = .039, p = .027, respectively), while in females, only those with low ALM had significantly raised CAF concentrations, compared to healthy controls (p = .035). Our findings illuminate the potential relevance of CAF as an accessible biomarker for skeletal muscle health. CAF determination may enhance clinical practice by facilitating more widespread treatment strategies for sarcopenia. Nevertheless, future research is needed to confirm the diagnostic pertinence of CAF concentrations in screening for sarcopenia.

Volar locking plate versus external fixation for unstable distal radius fractures: a systematic review and meta-analysis based on randomized controlled trials

BackgroundThe outcomes for volar locking plate (VLP) and external fixation (EF) in distal radius fracture cases remain controversial. The current study of randomized controlled trials (RCTs) aimed to assess VLP and EF, which might benefit distal radius fracture cases.MethodsRCTs comparing VLP and EF in distal radius fracture cases, until 18 March 2020, were systematically reviewed and summarized. The functional and radiographic outcomes, together with complications, for distal radius fracture cases, were evaluated.ResultsIn total, 12 studies comprising 1205 distal radius fracture cases were included. The VLP group had observed lower disability in the arm shoulder and hand score (DASH) at 3rd, 6th, and 12th -month post-operation, with the mean differences (MDs) of − 10.43 (95 % CI = − 15.77 to − 5.08, P < 0.01), − 3.48 (95 % CI = − 6.37 to − 0.59, P = 0.02), and − 4.13 (95 % CI = − 6.94 to − 1.33, P < 0.01), respectively. The VLP group also had lower visual analog scale scores (VAS) compared to the EF group, with MDs of − 0.10 (95 % CI = − 0.18 to − 0.03, P < 0.01) for the former at 6th -month post-operation. Also, the EF group exhibited better grip strength than that in the VLP group, with MD of 12.48 (95 % CI = 7.00–17.95, P < 0.01) at the 3rd month and 4.54 (95 % CI = 0.31–8.76, P = 0.04) at 6th month. No significant differences in radiographic outcomes were observed between the VLP and EF groups (P > 0.05). The VLP group had a lower complication rate than that in the EF group.ConclusionsVLP had a lower DASH score and VAS score but with lower grip strength. No significant differences in radiographic outcomes were observed. VLP had a lower complication rate than that of EF.

Low skeletal muscle density combined with muscle dysfunction predicts adverse events after adult cardiovascular surgery

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This study was supported by the Grant for Japan Society for the Promotion of Science (JSPS) KAKENHI. Introduction Although muscle dysfunction is widely known as a poor prognostic factor in patients with cardiovascular disease, no study has examined whether the addition of low skeletal muscle density (SMD) assessed by computed tomography (CT) to muscle dysfunction is useful. Purpose The present study aimed to examine whether SMDs can strengthen the predictive ability of muscle dysfunction for adverse events in patients who underwent cardiovascular surgery. Methods We retrospectively reviewed 853 patients (median age: 69 years, 65.1% male) aged ≥40 years who had preoperative CT for risk management purposes and muscle dysfunctions measured during postoperative cardiac rehabilitation. Muscle dysfunctions were determined from weakness (low grip strength) and slowness (slow gait speed) based on the Asia Working Group for Sarcopenia. Low SMD based on transverse abdominal CT images was defined as a mean Hounsfield unit of the psoas muscle &amp;lt;45. To examine the complementary prognostic value for all-cause deaths, all-cause events, and cardiovascular-related events when low SMDs were added to four patterns of muscle dysfunction (weakness only, slowness only, weakness or slowness, and weakness and slowness), the continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI) index were calculated. Results For all definitions of muscle dysfunction, the addition of SMDs was shown to significantly improve the cNRI (estimates: 0.377 to 0.468 for all-cause death, 0.220 to 0.248 for all-cause events, 0.308 to 0.322 for cardiovascular-related events) and IDI (estimates: 0.005 to 0.011 for all-cause death, 0.005 to 0.010 for all-cause events, 0.009 to 0.012 for cardiovascular-related events) in all analyses. Low SMDs combined with muscle dysfunctions were associated with the highest risk of all-cause death (Figure 1: A-D). Patients with neither low SMDs nor muscle dysfunction had the lowest risk of all-cause events and cardiovascular-related events (Figure1: E-L). Conclusion The predictive ability of muscle dysfunction for adverse events was consistently increased by addition of SMDs in patients who underwent cardiovascular surgery. Our results suggest that when CT is performed for any clinical investigation, the addition of the organic assessment of skeletal muscle can strengthen the diagnostic accuracy of muscle wasting. Abstract Figure 1

Associations of severity of liver damages with physical function and prognosis in patients with heart failure

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Heart failure (HF) and liver dysfunction often coexist because of complex cardiohepatic interactions, which adversely affects prognosis. However, the association between liver dysfunction and physical dysfunction, and between coexistence of both and prognosis in HF patients remains unclear. Purpose We evaluated the associations of severity of liver damage and physical function and prognosis in patients with HF. Methods The study population consisted of 895 patients with HF (mean age, 69.4 ± 14.2 years) who underwent liver function test using model for end-stage liver disease excluding international normalized ratio (MELD-XI) score and physical function test (grip strength, leg strength, gait speed, and 6-minute walking distance [6MWD]). The associations between MELD-XI score and physical function were assessed by multivariate linear regression model analysis. Moreover, we investigated the prognostic value of coexistence of liver dysfunction and physical dysfunction. The endpoint was all-cause mortality. Results After adjusting for covariates, MELD-XI score was independently associated with lower grip strength, leg strength, gait speed, and 6MWD (P &amp;lt; 0.001). In addition, hierarchical multivariate linear regression analysis revealed that adding MELD-XI scores or BNP explained additional variance in the physical function measures. The MELD-XI score added to the clinical model was significantly more predictive of physical function (grip strength, change in F: 27.105, P &amp;lt; 0.001; leg strength, change in F: 33.980, P &amp;lt; 0.001; gait speed, change in F: 22.826, P &amp;lt; 0.001; 6MWD, change in F: 59.193, P &amp;lt; 0.001) than BNP added to the clinical model. Eighty-six deaths occurred over a median follow-up period of 1.67 years (interquartile range: 0.62 – 3.04). Patients with high MELD-XI score and reduced physical function were found to have significantly higher mortality risk even after adjusting for several covariates (grip strength, hazard ratio [HR] = 3.80 [95% confidence interval (CI) = 2.04 – 7.08], P &amp;lt; 0.001; leg strength, HR = 4.65 [95% CI = 2.47 - 8.75], P &amp;lt; 0.001 and gait speed, HR = 2.49 [95% CI = 1.43 - 4.33], P = 0.001; 6MWD, HR = 5.48 [95% CI = 2.88 - 10.41], P &amp;lt; 0.001). Conclusions Liver dysfunction was correlated with reduced physical function. Moreover, the coexistence of lower physical function and liver dysfunction considerably affected prognosis in patients with HF. Abstract Figure. Kaplan–Meier survival curves

Low Serum Vitamin E Level Associated with Low Hand Grip Strength in Community-Dwelling Adults: Korean National Health and Nutrition Examination Survey (KNHANES VII) 2016-2018.

This study assessed the association between serum vitamin E levels and hand grip strength (HGS) in community-dwelling adults data of 1011 men aged 50 years and older and 1144 postmenopausal women were analyzed. Low HGS was defined as HGS below the sex-stratified median value. Proportion of low HGS was the greatest in the lowest quintile of serum vitamin E level (<10.51 mg/L, 57.1%), with a decreasing trend toward the highest vitamin E quintile (>17.81 mg/L, 43.6%; p < 0.001). A one-unit (mg/L) decrease in vitamin E levels was associated with lower HGS in men (adjusted beta coefficient −0.10, 95% confidence interval [CI] −0.18 to −0.02, p = 0.019), but not in women (−0.01, 95% CI −0.06 to 0.03, p = 0.550). Compared with the middle quintile (Q3; 12.59–14.69 mg/L), the lowest vitamin E quintile (Q1) was associated with elevated odds of low HGS (adjusted odds ratio [aOR]: 1.38, p = 0.045), independent of sociodemographic factors, health-related lifestyles, comorbidities, dietary intake, and cholesterol level. However, the odds of low HGS did not differ significantly in other vitamin E quintiles (Q2, aOR 1.12; Q4, aOR 1.38; Q5, aOR 1.12; p > 0.05). Individuals with the lowest quintile vitamin E level had elevated odds of low HGS independent of covariates, findings which merit further validation.

Probable sarcopenia is associated with cognitive impairment among community-dwelling older adults: results from the FIBRA study.

The link between sarcopenia and cognitive impairment has not yet been thoroughly evaluated, especially among older adults. To evaluate the relationship between probable sarcopenia and cognitive impairment among community-dwelling older adults in two Brazilian cities. Probable sarcopenia was assessed using the EWGSOP2 (2018) criteria. Thus, participants were classified as probably having sarcopenia if they had SARC-F (Strength, Assistance in walking, Rise from a chair, Climb stairs and Falls) ≥4 points and low grip strength. Cognitive function was evaluated through the Mini-Mental State Examination (MMSE), verbal fluency (VF) and clock drawing test (CDT). In a sample of 529 older adults (mean age 80.8±4.9 years; mean education 4.2±3.67 years; 70.1% women), 27.3% of the participants had SARC-F≥4, 38.3% had low grip strength and 13.6% were classified as probable sarcopenia cases. After adjusting for possible confounders (age, sex, education, depression, diabetes, hypertension, leisure-time physical activity and obesity), probable sarcopenia was found to be associated with impairment in the MMSE (OR 2.52; 95%CI 1.42‒4.47; p=0.002) and in VF (OR 2.17; 95%CI 1.17‒4.01; p=0.014). Low grip strength was found to be associated with impairment in the MMSE (OR 1.83; 95%CI 1.18‒2.82; p=0.006) and in the CDT (OR 1.79; 95%CI 1.18‒2.73; p=0.006). SARC-F scores were found to be associated with impairment in the MMSE (OR 1.90; 95%CI 1.18‒3.06; p=0.008). The results suggested that probable sarcopenia and its components present a significant association with cognitive deficits among community-dwelling older adults. Future longitudinal studies will further explore the causal relationship.

Exercise Preconditioning Preserves Skeletal Muscle Function and Stunts Tumor Growth in Male Mice

BACKGROUND Cancer cachexia is a complex muscle and fat wasting disorder that results in death in up to one-third of cancer patients. Currently, there are no clear diagnostic criteria, its effects are irreversible, and it cannot be treated. Therefore, a great need exists to better understand this disease. Research has shown that exercise has a positive impact on preserving muscle mass and inhibiting tumor growth, but questions remain regarding the timing, safety, and underlying mechanisms of benefits of exercise in cancer survivors. Therefore, the purpose of this study was to examine the effects of preconditioning exercise as a protective measure for cancer cachexia. METHODS To examine the effects of preconditioning exercise on skeletal muscle wasting and tumor growth, male LC3 Tg+ and sibling matched wildtype mice were randomly separated into four groups: sedentary non-tumor bearing (SED+NT), sedentary tumor bearing (SED+T), exercise non-tumor bearing (TM+NT), and exercise tumor bearing (TM+T). Mice underwent either 8 weeks of progressive treadmill trained exercise (TM) or remained sedentary. This was followed by 4-week sedentary period of tumor bearing (1x105 LLC cells in flank) or non-tumor bearing (NT). Grip strength, muscle mass, and tumor growth characteristics were measured to examine the protective effects of exercise in cancer cachexia skeletal muscle wasting. RESULTS Tumor bearing led to significant declines in muscle strength. Both SED+T and TM+T showed a significantly lower grip strength compared to non-tumor bearing groups (P <0.05). More importantly, the TM+T group showed a significant improvement (preservation) in grip strength versus the SED+T group (p<0.05), which were the weakest of all groups. In step with this finding, SED+T exhibited significantly smaller gastrocnemius muscle mass compared to TM+T (P<0.05). When comparing tumor characteristics, TM+T exhibited 2-fold smaller tumor mass (P<0.05) and 16-fold smaller tumor volume (P<0.001) compared to SED+T tumors. CONCLUSION These data indicate that preconditioning exercise is capable of eliciting a protective effect against cancer cachexia-mediated declines in muscle function and mass. This may be related to the massive stunt in tumor growth that was associated with exercise preconditioning, indicating that the protective effects of exercise may last for a period even when exercise is ceased. Such data are critical in understanding the importance of exercise in cancer cachexia and how the timing of exercise (preconditioning) can play a major role in protecting survivors against the effects of cachexia.

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

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

Associations between diabetes-related foot disease, diabetes, and age-related complications in older patients.

To examine the relationship of diabetes-related foot disease (DFD) with diabetes and age-related complications in older patients with diabetes mellitus (DM). We examined 562 outpatients with diabetes, aged ≥ 65years, for DFD. The variables collected in this study were demographics, DM-related complications, treatment method, and age-related complications. Differences in the complications were compared between patients with and without DFD. Logistic regression analysis was used to determine the associations of DFD with DM and age-related complications. A total of 246 patients (43.8%) had DFD. Logistic regression analysis identified low grip strength [Odds ratio (OR): 1.83, 95% confidence interval (CI) 1.21-2.76), hypertension (OR: 1.81, 95% CI 1.09-3.00), and diabetes-related peripheral neuropathy (DPN) (OR: 1.92, 95% CI 1.24-2.98) to be significantly associated with DFD. Patients with DPN and hypertension had a higher risk of DFD than patients with DPN or hypertension alone. Individuals with DPN and low grip strength (OR: 1.74, 95% CI 1.09-2.81) were at a lower risk than those with low grip strength alone. Hypertension, DPN, and low grip strength were significantly associated with DFD in older patients with DM, with the risk of DFD being higher in patients with both DPN and hypertension. When considering DFD in older patients with DM, low grip strength should be considered equally important as a DM-related complication.