Lower Muscle Function Research Articles

Identification of sarcopenic obesity in adults undergoing orthopaedic surgery: Relationship between "a body shape index" (ABSI) and fat-free mass. A cross -sectional study.

BackgroundSarcopenic obesity is a condition characterised by the coexistence of low muscle mass and function (sarcopenia) and excessive fat mass (obesity). The aim of this study was to determine the prevalence of this condition in patients undergoing orthopaedic surgery by gender and type of orthopaedic surgery. In addition, this study investigated the suitability of a waist circumference-based anthropometric measure, body shape index (ABSI), for predicting sarcopenic obesity and the predictive power of ABSI for fat-free mass index (FFMI), a surrogate marker of lean body mass.Methods and findingsA cross-sectional study of overweight and obese orthopaedic patients undergoing knee or hip and spine surgery was conducted between October 2019 and March 2020 in Orthopaedic Hospital Valdoltra, Slovenia. General anthropometric parameters body mass index (BMI) and ABSI = (WC/(BMI2/3x height½) as well as body composition data (fat mass FM, fat-free mass FFM, FFMI, and the ratio FM/FFM as an index of sarcopenic obesity) were determined in 120 women (aged 66.5 ± 9.6 years) and 89 men (aged 65.5 ± 7.8 years) with overweight (25 kg/m2 ≤ BMI < 30 kg/m2) and obesity (BMI ≥ 30 kg/m2) by bioelectrical impedance analysis (BIA). Sarcopenic obesity phenotypes based on FM/FFM ratio > 0.80 was present in 15.3% of patients, mainly in female patients undergoing knee surgery. ABSI was significantly associated with age in all women and obese men and with waist circumference (WC) in all patients. ABSI did not correlate with BMI in women and men; however, multiple linear regression analysis showed that BMI independently predicted FFMI (R = 0.83 and 0.70, respectively, p < 0.001) in women and men (β-coefficients: 0.801 and 0.686, respectively) and ABSI in women only (β-coefficient: -0.104). Women with a lower ABSI had a significantly higher FFMI than the group with a higher ABSI.ConclusionsSarcopenic obesity was most prevalent in obese women scheduled for knee surgery. In addition, ABSI, independently predicted FFMI in women and represents a significant predictor of sarcopenic obesity.

Comparative analysis of fat composition in marrow, serum, and muscle from aging C57BL6 mice

Osteosarcopenia is an age-related condition characterized by fragile bone and low muscle mass and function. Fat infiltration concomitantly contributes to age-related bone and muscle decline. Fat-secreted factors could be locally secreted in the muscle and bone marrow milieu affecting cell function and survival. However, the specific fat-related secretory factors that may simultaneously affect those tissues remain unknown. Using targeted-lipidomics approach, we comprehensively quantified fat composition (lipid mediators [LMs]) in bone marrow flush, gastrocnemius and serum obtained from 6-, 24- and 42-week-old C57BL6 mice. Compared to young mice (6wks), all tissues in older mice showed significantly higher levels of arachidonic acid (AA) and AA-derived eicosanoids, PGA 2, TXB 2, and 11,12-EET, which are known to affect muscle and bone function. Moreover, Lipoxin B4, another AA product and an enhancer of bone turnover and negative regulator for muscle, showed significantly lower values in older mice compared to young mice in both genders. Furthermore, eicosapentaenoic acid and docosahexaenoic acid autoxidation products (20-HDoHE, 11-HDoHE, 7-HDoHE and 4-HDoHE), and omega-3 fatty acids that negatively regulate bone and muscle health, were significantly higher in older mice. In conclusion, these results suggest that LMs could play a role in modulating musculoskeletal function during aging.

Olfaction, ability to identify particular olfactory clusters and odors, and physical performance in community-dwelling older adults: The Yanai Study.

Olfactory dysfunction is associated with poor physical performance in older adults. However, it remains unknown whether the ability to identify particular olfactory clusters and/or odors is associated with physical performance in physically independent community-dwelling older adults. This cross-sectional study included 130 community-dwelling older adults (70.1±5.5years). The Odor Stick Identification Test for Japanese people, consisting of 12 odors in four clusters (wood, grass, herb; sweet; spices; foul-smelling), was used to examine olfaction. Participants also completed physical performance tests (one leg standing with open eyes; aerobic capacity; lower muscle function: five-times chair stand [CS] and vertical jump; mobility: star walking and timed up and go [TUG]) and cognitive function tests. Worse overall olfaction was not significantly associated with any physical performance measure. Worse performance for identifying sweet odors and an inability to identify some specific odors (menthol and rose) were associated with worse mobility and/or lower muscle function-adjusted covariates. Moreover, an inability to identify menthol and rose was associated with worse TUG (odds ratio [OR]: 0.424; 95% confidence interval [CI]: 0.215-0.836), star walking (OR: 0.714; 95% CI: 0.506-0.976), CS (OR: 0.638; 95% CI: 0.470-0.864), and vertical jump (OR: 1.12; 95% CI: 1.001-1.24) performance, even when the analysis was adjusted to exclude menthol and rose score from the overall olfaction score (p<.05 for all). The current study may help to increase awareness of olfactory and physical dysfunction at an earlier stage among physically independent community-dwelling older adults.

1200-P: The Prevalence of Obesity-Associated Loss of Lean Muscle Mass

Sarcopenia, originally defined as age-related low muscle mass and function, has also been used to describe the loss of muscle mass and quality among certain populations, such as sarcopenic obesity (SO) . SO refers to loss of muscle and function in obese subjects; however, given age is not a factor in SO, we classified SO as obesity with low lean muscle mass (OLLMM) . Given the paucity of data in OLLMM, the purpose was to describe the prevalence of OLLMM in the US. Data from NHANES 2017-2018 were used to estimate the prevalence of OLLMM in adults ≥20 yrs of age. OLLMM was defined as DEXA-assessed low appendicular lean mass, adjusted for BMI (men &amp;lt;0.789, women &amp;lt;0.512) and obesity (body fat%: men &amp;gt;25%, women &amp;gt;35%) . Since DEXA was only measured in those aged 20-59 in NHANES 2017-2018, we utilized logistic regression models to predict OLLMM from NHANES 1999-20for those ≥60 yrs. The prevalence of OLLMM was estimated overall, by sex, age group, and diabetes status (prediabetes and T2DM) . We extrapolated results to the US using NHANES sampling weights. Of the 4174 adults (representing 181M US adults) , we identified 827 (28.8M, 15.9% of the US pop.) with OLLMM. Older adults had higher prevalence of OLLMM as did those with prediabetes and T2DM (Figure 1) . The prevalence of OLLMM in the US is high. While the prevalence of OLLMM was higher with age, its prevalence was also high in diabetics, regardless of age. Clinicians should monitor for OLLMM among obese T2DM patients. Disclosure D.J. Murdock: Employee; Regeneron Pharmaceuticals Inc. Stock/Shareholder; Regeneron Pharmaceuticals Inc. N. Wu: Employee; Regeneron Pharmaceuticals Inc. Stock/Shareholder; Regeneron Pharmaceuticals Inc. D.J. Glass: Employee; Regeneron Pharmaceuticals Inc. Stock/Shareholder; Regeneron Pharmaceuticals Inc. J.S. Grimsby: Employee; Regeneron Pharmaceuticals Inc. Stock/Shareholder; Regeneron Pharmaceuticals Inc. R.A. Calle: Employee; Regeneron Pharmaceuticals Inc. Stock/Shareholder; Regeneron Pharmaceuticals Inc. S. Donahue: Employee; Regeneron Pharmaceuticals Inc. Stock/Shareholder; Regeneron Pharmaceuticals Inc. M. Sleeman: Employee; Regeneron Pharmaceuticals Inc. Stock/Shareholder; Regeneron Pharmaceuticals Inc. R.J. Sanchez: Employee; Regeneron Pharmaceuticals Inc. Stock/Shareholder; Regeneron Pharmaceuticals Inc. Funding Supported by Regeneron Pharmaceuticals, Inc.

Homing in on cognition with cross-sectional analysis of sarcopenia-related measurements: the SARCOG study.

Cognitive impairment may cause significant decline in muscle function and physical performance via affecting the neuromotor control. To investigate the relationship between cognition and sarcopenia-related parameters in middle-aged and older adults. Demographic data and comorbidities of adults ≥ 45-year-old were noted. The Mini-Mental State Examination (MMSE) was used to evaluate global cognitive function. Sonographic anterior midthigh muscle thickness, handgrip strength, chair stand test (CST) and gait speed were measured. The diagnosis of sarcopenia was established if low muscle mass was combined with low muscle function. Dynapenia was defined as low grip strength or increased CST duration. Among 1542 subjects (477M, 1065 F), sarcopenia and dynapenia were detected in 22.6 and 17.2% of males, and 17.2 and 25.3% of females, respectively. Sarcopenic patients were older and had higher body mass index, higher frequencies of hypertension, diabetes mellitus and obesity. They had lower muscle thickness, grip strength in males only, CST performance in females only and gait speed than the other groups (all p < 0.05). Sarcopenic and dynapenic patients had similar MMSE scores which were lower than those of normal subjects (both p < 0.001). After adjusting for confounding factors, MMSE values were positively related with grip strength in females only, CST performance and gait speed (all p < 0.001); but not with muscle thickness in either gender. Cognitive impairment may unfavorably affect muscle function and physical performance, but not muscle mass. Accordingly, its prompt management can help to decrease patient morbidity and mortality.

Exploring Muscle Health Deterioration and Its Determinants Among Community-Dwelling Older Adults.

BackgroundAge-related muscle mass and function decline are critical issues that have gained attention in clinical practice and research. Nevertheless, little is known regarding the time course of muscle health progression, and its determinants during this transition should be estimated.MethodsWe enrolled community-dwelling adults aged ≥65 years during their regular health checkup. The participants’ body composition and muscle function were measured annually from 2015 to 2021. Presarcopenia was characterized by the loss of muscle mass only; dynapenia was defined as low muscle function without changes in muscle mass; and sarcopenia was indicated as a decline in both muscle mass and muscle function. We observed the natural course of muscle health progression during aging. The relationship between muscle health decline and different determinants among old adults was examined.ResultsAmong 568 participants, there was 18.49%, 3.52%, and 1.06% of healthy individuals transited to dynapenia, presarcopenia, and sarcopenia, respectively. Significant positive correlations between age, fat-to-muscle ratio (FMR) and the dynapenia transition were existed [hazard ratio (HR) = 1.08 and HR = 1.73, all p < 0.05]. Serum albumin level had negative correlation with the dynapenia transition risk (HR = 0.30, p = 0.004). Participants with these three risk factors had the highest HR of dynapenia transition compared to those without (HR = 8.67, p = 0.001). A dose-response effect existed between risk factors numbers and the risk of dynapenia transition (p for trend < 0.001). This positive association and dose-response relationship remains after multiple covariates adjustment (HR = 7.74, p = 0.002, p for trend < 0.001). Participants with two or more than two risk factors had a higher risk of dynapenia transition than those with low risk factors (p = 0.0027), and the HR was 1.96 after multiple covariate adjustment (p = 0.029).ConclusionHealthy community-dwelling old adults tended to transit to dynapenia during muscle health deterioration. Individuals with older age, higher FMR, lower albumin level had a higher risk of dynapenia transition; and a positive dose-response effect existed among this population as well.

Body Composition Characteristics of Community-Dwelling Older Adults With Dynapenia or Sarcopenia.

This study aimed to determine the differences in muscle and fat masses of the arm and leg between older adults with dynapenia, sarcopenia, or presarcopenia and normal individuals. The percent body fat, lean body mass, and skeletal mass index were measured with bioelectrical impedance analysis. Muscle function was evaluated using grip strength and walking speed. Participants were classified into four categories. Dynapenia was defined as low muscle function with normal muscle mass. Sarcopenia was defined as the presence of both low muscle mass and low muscle function. Presarcopenia was defined as low muscle mass with normal muscle function. Control was defined as normal muscle mass and function. Multivariate analyses of variance were performed separately for women and men to test the main effect of sarcopenia category on body composition. Among the 356 enrolled participants, 270 were women, and 86 were men. In older women, the dynapenia and sarcopenia groups had significantly less muscle mass in the leg than the control group. In older men, the dynapenia group demonstrated a higher body fat mass in the leg than the control group. These results suggest that different strategies are necessary to prevent dynapenia in women and men.

Objective Physical Activity Levels, Sedentary Time, and Muscle Mass, Strength, and Function: Impact on Physical and Mental Health-Related Quality of Life in Older Adults.

Limited physical activity, sedentary behavior, and reduction in muscle mass, strength, and function are accompanied by negative outcomes. The relationship between these factors and physical and mental health-related quality of life (HRQoL) has yet to be elucidated in continuing care retirement community (CCRC) residents. The current study investigated the relationships among physical activity, sedentary behavior, and muscle mass, strength, and function to physical and mental HRQoL. A sample of 105 CCRC residents participated in this cross-sectional correlational study. Findings demonstrated that low physical activity and muscle function were significantly associated with low physical HRQoL and explained 38% of the variance in physical HRQoL. Handgrip strength was significantly associated with low mental HRQoL and explained 8% of the variance in mental HRQoL. Older adults living in CCRCs may benefit from interventions targeting physical activity and the distinct muscle components of sarcopenia that have the potential to improve physical and mental HRQoL. [Research in Gerontological Nursing, 15(3), 131-139.].

Mapping ongoing nutrition intervention trials in muscle, sarcopenia, and cachexia: a scoping review of future research.

Muscle loss alone, or in the context of sarcopenia or cachexia, is a prevalent condition and a predictor of negative outcomes in aging and disease. As adequate nutrition is essential for muscle maintenance, a growing number of studies has been conducted to explore the role of specific nutrients on muscle mass or function. Nonetheless, more research is needed to guide evidence‐based recommendations. This scoping review aimed to compile and document ongoing clinical trials investigating nutrition interventions as a strategy to prevent or treat low muscle mass or function (strength and physical performance), sarcopenia, or cachexia. ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched up to 21 April 2021 for planned and ongoing trials. Randomized controlled trials with ≥20 participants per arm were included based on intent to explore the effects of nutrition interventions on muscle‐related outcomes (i.e. muscle mass or strength, physical performance, or muscle synthesis rate) in both clinical and non‐clinical conditions (i.e. aging). Two reviewers independently screened records for eligibility, and a descriptive synthesis of trials characteristics was conducted. A total of 113 trials were included in the review. Most trials (69.0%) enroll adults with clinical conditions, such as cancer (19.5%), obesity and metabolic diseases (16.8%), and musculoskeletal diseases (10.7%). The effects of nutrition interventions on age‐related muscle loss are explored in 31% of trials. Although nutrition interventions of varied types were identified, food supplements alone (48.7%) or combined with dietary advice (11.5%) are most frequently reported. Protein (17.7%), amino acids (10.6%), and β‐hydroxy‐β‐methylbutyrate (HMB, 6.2%) are the top three food supplements' nutrients under investigation. Primary outcome of most trials (54.9%) consists of measures of muscle mass alone or in combination with muscle strength and/or performance (as either primary or secondary outcomes). Muscle strength and physical performance are primary outcomes of 38% and 31.9% of the trials, respectively. These measurements were obtained using a variety of techniques. Only a few trials evaluate muscle synthesis rate either as a primary or secondary outcome (5.3%). Several nutrition studies focusing on muscle, sarcopenia, and cachexia are underway and can inform future research in this area. Although many trials have similar type of interventions, methodological heterogeneity may challenge study comparisons, and future meta‐analyses aiming to provide evidence‐based recommendations. Upcoming research in this area may benefit from guidelines for the assessment of therapeutic effects of nutrition interventions.

Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement

Loss of skeletal muscle mass and function (sarcopenia) is common in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases), and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of an universally established SO Definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes. The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a Definition and diagnostic criteria for SO. The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into Stage I in the absence of clinical complications, or Stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction. ESPEN and EASO, as well as the expert international panel, advocate that the proposed SO Definition and diagnostic criteria be implemented into routine clinical practice. The panel also encourages prospective studies in addition to secondary analysis of existing datasets, to study the predictive value, treatment efficacy, and clinical impact of this SO definition.

Normative values of skeletal muscle indices for nutritional assessment and implications on definition of sarcopenia in Indian adult population.

Sarcopenia is defined as both low muscle function (performance or strength) and low muscle mass. Although aging is the main cause of sarcopenia, it can also occur due to poor nutrition and chronic diseases like liver cirrhosis, chronic kidney disease, and diabetes. To do the quantitative analysis of various normative skeletal muscle indices (to define sarcopenia) in the Indian population. Sex-specific means, standard deviations (SD), and sarcopenia cutoffs (mean-2SD) of psoas muscle thickness (PMTH), psoas muscle area (PMA), psoas muscle index (PMI), erector spinae muscle area (ESMA), skeletal muscle radiation attenuation (SMRA), total skeletal muscle area (SMA), and total skeletal muscle index (SMI) were computed. A total of 2002 individuals (1308 males and 694 females) underwent CT evaluation. PMTH (mm/m) was observed to be 15.87±2.67 in males vs. 12.61±2.46 in females (p=0.0001); PMA (cm2) was 18.55±3.45 in males vs.13.52±2.80 in females (p=0.0001); PMI (cm2/m2) was 6.69±1.40 in males vs. 5.57±1.18 in females (p=0.0001); ESMA (cm2) was 45.74±6.01 in males vs. 35.37±5.63 in females (p=0.0001); ESMI (cm2/m2) was 16.5±2.55 in males vs. 14.62±2.6 in females (p=0.0001); SMRA was 55.80±3.91 Hounsfield unit (HU) in males vs. 52.36±3.67 HU in females (p=0.0001); SMA (cm2) was 147.73±11.77 in males vs. 106.33±12.00 in females (p=0.0001); and SMI (cm2/m2) was estimated to be 51.00±5.70 in males vs. 43.93±6.05 in females (p=0.0001). PMTH, PMI, ESMI, SMI, and SMRA cutoffs for sarcopenia at L3 were observed to be 10.53 mm/m, 3.89 cm2/m2, 11.40 cm2/m2, 39.59 cm2/m2, and 47.98 HU among males and 7.69, 3.20, 9.42, 31.83, and 45.01 among females, respectively; these values wereconsistent with previously reported cutoffs in Indian studies but not consistent with the cutoffs reported in other countries. Normative values of skeletal muscle indices for either sex among the Indian adult population would enable future studies on sarcopenia in various medical conditions.

25OH Vitamin D Is No Associated with Muscle Function Loss in Adults and Elderly Patients Undergoing Hemodialysis.

In patients with chronic kidney disease, sarcopenia is associated with dialysis treatment, accelerated protein catabolism, and high energy demand. Thus, this study aimed to assess the association between 25-OH vitamin D concentrations and muscle function in patients undergoing hemodialysis. A cross-sectional study. Performed in a hemodialysis clinic. 79 adult and elderly patients undergoing hemodialysis. The sample was divided according to the SARC-F definition, being 55 patients allocated in the SARC-F <4 group and 24 in the SARC-F ≥4 group. Normal 25-OH vitamin D concentrations was considered when ≥30 ng/dL. Vitamin D concentrations and number of patients with low or normal muscle function did not differ between the groups. There was no correlation between SARC-F and 25-OH vitamin D levels (r: -0.09, p=0.42). 25-OH vitamin D has no association with muscle function loss in adults and elderly patients undergoing hemodialysis.

Individual and Synergistic Relationships of Low Muscle Mass and Low Muscle Function with Depressive Symptoms in Korean Older Adults.

This study examined the relationship of low appendicular skeletal muscle mass and low muscle function with depressive symptoms in Korean older adults. Community-dwelling Korean older adults aged 65 years and older (n = 521) participated in this study. Appendicular muscle mass (ASM) and muscle function (MF) scores were assessed using dual-energy X-ray absorptiometry (DXA) scanning and sit-to-stand mean power based on a 30 s chair stand test, respectively. Depressive symptoms were evaluated using the Korean form of the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of depressive symptoms according to ASM- and MF-based subgroups; normal ASM/normal MF, low ASM/normal MF, normal ASM/low MF, and low ASM/low MF. The prevalence of depressive symptoms was 21.3% in all patients: 20.7% in women and 21.5% in men. Compared to the normal ASM/normal MF participants (OR = 1), the risk of depressive symptoms rose incrementally in subjects with low ASM/normal MF (OR = 2.963, p = 0.019), normal AMS/low MF (OR = 3.843, p = 0.002), and low ASM/low MF (OR = 7.907, p < 0.001), respectively. The current findings suggest that the coexistence of low ASM and low MF is significantly and independently associated with an increased risk for depressive symptoms, with dynapenia having a stronger relationship.

Assessment of Sarcopenia in the Intensive Care Unit and 1-Year Mortality in Survivors of Critical Illness.

Skeletal muscle wasting in the intensive care unit (ICU) has been associated with mortality, but it is unclear whether sarcopenia, defined by skeletal muscle mass and function, is useful for detailed risk stratification after ICU discharge. In this cohort study, 72 critically ill patients with an ICU stay of ≥48 h were identified. Skeletal muscle mass was assessed from the muscle thickness (MT) of the patients’ quadriceps using ultrasound images before ICU discharge. Skeletal muscle function was assessed from the patients’ muscle strength (MS) before ICU discharge according to the Medical Research Council sum score. A diagnosis of sarcopenia in the ICU was made in patients with low MT and low MS. The study endpoint was 1-year mortality. Sarcopenia in the ICU was diagnosed in 26/72 patients (36%). After adjusting for covariates in the Cox regression, sarcopenia in the ICU was significantly associated with 1-year mortality (hazard ratio 3.82; 95% confidence interval, 1.40–10.42). Sarcopenia in the ICU, defined by low skeletal muscle mass and function, was associated with 1-year mortality in survivors of critical illness. Skeletal muscle mass and function assessed at the bedside could be used to identify higher-risk patients in the ICU.

Muscle Quantity at C3 and/or L3 on Routine Trauma Series Computed Tomography Correlate With Brain Frailty and Clinical Frailty Scale: A Cross-Sectional Study.

BackgroundSarcopenia (low muscle mass and function) is increasingly recognised to impact the quality of life and patient outcomes. The relationship with brain frailty is unknown.ObjectivesAssess if muscle mass at C3 correlates with muscle mass at L3 on routine trauma imaging. Assess for associations between muscle mass, brain frailty, and Clinical Frailty Scale (CFS) on routine trauma imaging.MethodsRoutine trauma-series computed tomography (CT) scans were retrospectively analysed for patients aged ≥16-years-old admitted to Queen Elizabeth Hospital in January 2020. Paravertebral, sternocleidomastoid, and total muscle cross-sectional area (CSA) at C3 (C3-SMM), and total psoas muscle CSA (TPA), total muscle CSA (L3-SMM), and total adipose CSA at L3 were calculated. Brain frailty scores were calculated assessing for leukoaraiosis, cerebral atrophy, and old vascular lesions/infarcts. CFS was calculated retrospectively from clinical notes. We assessed for correlation against age, CFS, muscle mass, and brain frailty using Pearson’s correlations.ResultsWe included 111 patients in this study (mean age 49, SD 25.6; 65.8% female). C3-SMM strongly correlated with L3-SMM (r=0.746, p<0.001). Paravertebral and sternocleidomastoid CSA correlated with C3-SMM (paravertebral: r=0.814, p<0.001; sternocleidomastoid: r=0.814, p<0.001). TPA strongly correlated with L3-SMM (r=0.800, p<0.001). Sternocleidomastoid CSA and TPA both negatively correlated moderately with age (sternocleidomastoid: r=−0.460, p<0.001; TPA: r=−0.468, p<0.001), CFS (sternocleidomastoid: r=−0.414, p<0.001; TPA: r=−0.431, p<0.001), and brain frailty (sternocleidomastoid: r=−0.395, p<0.001; TPA: r=−0.436, p<0.001). Adipose CSA at L3 did not correlate with age, CFS, brain frailty, or muscle mass.ConclusionMuscle mass at C3 relates to muscle mass at L3. Muscle mass on routine trauma imaging is negatively associated with age, CFS, and brain frailty.

The Relevance of Diet, Physical Activity, Exercise, and Persuasive Technology in the Prevention and Treatment of Sarcopenic Obesity in Older Adults

The aging population faces two conditions that threaten healthy aging: high fat mass (obesity) and low muscle mass and function (sarcopenia). The combination of both—referred to as sarcopenic obesity—synergistically increases the risk of adverse health outcomes. The two conditions often co-occur because they reinforce each other and share common etiologies, including poor nutrition and inactivity. All aging people are at risk of gaining weight and losing muscle mass and could benefit from improvements in physical activity, exercise and dietary intake. one specific window of opportunity is during the transient time of retirement, as older adults already need to restructure their daily activities. It is key to change lifestyle behavior in a sustainable manner, providing scientifically proven, personalized, and acceptable principles that can be integrated in daily life. Health technologies (e.g., applications) can provide promising tools to deliver personalized and appealing lifestyle interventions to a large group of people while keeping health care costs low. Several studies show that health technologies have a strong positive effect on physical activity, exercise and dietary intake. Specifically, health technology is increasingly applied to older people, although strong evidence for long term effects in changing lifestyle behavior is generally lacking. Concluding, technology could play an important role in the highly warranted prevention of sarcopenic obesity in older adults. Although health technology seems to be a promising tool to stimulate changes in physical activity, exercise and dietary intake, studies on long lasting effects and specifically targeted on older people around the time of retirement are warranted.

Nutrient Intake and Muscle Measures in Geriatric Outpatients

Objective Low muscle mass and muscle function are associated with adverse health outcomes in older adults. This study examined nutrient intake as a potential contributing factor for low muscle mass, muscle strength, and muscle power in geriatric outpatients. Method This cross-sectional study included geriatric outpatients (n = 58, 38 female) with a mean age of 77.2 ± 9.0 years referred to the Falls and Balance outpatient clinic between December 2017 and January 2019. Nutrient intake (macro- and micronutrients) was examined using a 3-day food diary. Energy-adjusted nutrient intake was calculated using the residual method. Sex-standardized muscle measures included muscle mass assessed using bioelectrical impedance analysis (skeletal muscle mass [SMM in kilograms], SMM index [SMM/height2 in kg/m2], and SMM/body mass index), handgrip strength (muscle strength) assessed using a dynamometer, and chair-stand test (muscle power). Univariate linear regression analyses were used to examine the associations of nutrient intake with muscle measures adjusted for age and body weight. A Bonferroni correction was applied to account for multiple testing (p < 0.001). Results Higher energy, iodine, and folate intake were associated with higher muscle mass, and higher folate intake was associated with higher muscle strength (p < 0.05). After Bonferroni correction, none of the nutrient intakes remained statistically significant. None of the other nutrients was associated with muscle measures. Conclusions Only a few nutrients were associated with muscle measures. Nutrient intake appears to be more related to muscle mass than muscle strength and muscle power in geriatric outpatients.

Relationship Between Sarcopenia and Electrocardiographic Abnormalities in Older People: The Bushehr Elderly Health Program.

Background: Sarcopenia is characterized by low skeletal muscle mass and function, which is associated with cardiovascular risk factors and may even be related to adverse cardiovascular events and mortality. This study aimed to evaluate whether sarcopenia is related to electrocardiographic (ECG) abnormalities in a large sample of older adults.Methods: We performed a cross-sectional study based on the data collected during the Bushehr Elderly Health (BEH) cohort study. Body composition was measured by dual X-ray absorptiometry (DXA) and muscle strength was measured using a digital dynamometer for each hand of every participant. A person who had low muscle strength, as well as low muscle mass was identified as having sarcopenia. The subjects were classified into three groups according to the Minnesota Code (MC) as major, minor ECG abnormalities and participants with no abnormalities ECG.Results: Of the 2,426 participants, 354 (14.6%) had major ECG abnormalities and 193 (8%) had minor ECG abnormalities. Sarcopenia was associated with an increased risk of major ECG abnormality in all models. After adjustment for confounders of CHD in full model, the OR for major ECG abnormality was 1.47 (95% CI 1.11–1.95) in those with sarcopenia. Low muscle strength and low muscle performance were both with an increased risk of major ECG abnormality in all models. Sarcopenia and low muscle strength increased 28% and 62% risk of any ECG abnormality in the full models [sarcopenia: 1.28(1.01–1.63), low muscle strength: 1.62(1.30–2.03)], respectively.Conclusions: This study showed that sarcopenia and its components are associated with ECG abnormalities in Iranian older people. Although some older adults have higher cardiovascular risk factors, these data showed that further factors such as sarcopenia may be identified as a particular risk factor for future cardiovascular events. Therefore, sarcopenia could be added to the screening of the older population to reduce the risk of cardiovascular events.

Sarcopenic Obesity in Africa: A Call for Diagnostic Methods and Appropriate Interventions.

This perspective aims to highlight the lack of current knowledge on sarcopenic obesity in Africa and to call for diagnostic methods and appropriate interventions. Sarcopenic obesity has been defined as obesity that occurs in combination with low muscle mass and function, which is typically evident in older adults. However, there has been no clear consensus on population-specific diagnostic criterion, which includes both gold-standard measures that can be used in a more advanced health care system, and surrogate measures that can be used in low-income settings with limited resources and funding. Importantly, low and middle-income countries (LMICs) across Africa are in an ongoing state of economic and social transition, which has contributed to an increase in the aging population, alongside the added burden of poverty, obesity, and associated co-morbidities. It is anticipated that alongside the increased prevalence of obesity, these countries will further experience an increase in age-related musculoskeletal diseases such as sarcopenia. The developmental origins of health and disease (DOHaD) approach will allow clinicians and researchers to consider developmental trajectories, and the influence of the environment, for targeting high-risk individuals and communities for treatment and/or prevention-based interventions that are implemented throughout all stages of the life course. Once a valid and reliable diagnostic criterion is developed, we can firstly assess the prevalence and burden of sarcopenic obesity in LMICs in Africa, and secondly, develop appropriate and sustainable interventions that target improved dietary and physical activity behaviors throughout the life course.

Uncovering the Bone-Muscle Interaction and Its Implications for the Health and Function of Older Adults (the Wellderly Project): Protocol for a Randomized Controlled Crossover Trial.

BackgroundBone and muscle are closely linked anatomically, biochemically, and metabolically. Acute exercise affects both bone and muscle, implying a crosstalk between the two systems. However, how these two systems communicate is still largely unknown. We will explore the role of undercarboxylated osteocalcin (ucOC) in this crosstalk. ucOC is involved in glucose metabolism and has a potential role in muscle maintenance and metabolism.ObjectiveThe proposed trial will determine if circulating ucOC levels in older adults at baseline and following acute exercise are associated with parameters of muscle function and if the ucOC response to exercise varies between older adults with low muscle quality and those with normal or high muscle quality.MethodsA total of 54 men and women aged 60 years or older with no history of diabetes and warfarin and vitamin K use will be recruited. Screening tests will be performed, including those for functional, anthropometric, and clinical presentation. On the basis of muscle quality, a combined equation of lean mass (leg appendicular skeletal muscle mass in kg) and strength (leg press; one-repetition maximum), participants will be stratified into a high or low muscle function group and randomized into the controlled crossover acute intervention. Three visits will be performed approximately 7 days apart, and acute aerobic exercise, acute resistance exercise, and a control session (rest) will be completed in any order. Our primary outcome for this study is the effect of acute exercise on ucOC in older adults with low muscle function and those with high muscle function.ResultsThe trial is active and ongoing. Recruitment began in February 2018, and 38 participants have completed the study as of May 26, 2019.ConclusionsThis study will provide novel insights into bone and muscle crosstalk in older adults, potentially identifying new clinical biomarkers and mechanistic targets for drug treatments for sarcopenia and other related musculoskeletal conditions.Trial RegistrationAustralia New Zealand Clinical Trials Registry ACTRN12618001756213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375925.International Registered Report Identifier (IRRID)DERR1-10.2196/18777