Low Physical Performance Research Articles

Sarcopenia as a potential cause of chronic hyponatremia in the elderly

Hyponatremia is the most frequent electrolyte disorder found in clinical practice, particularly in hospitalized elderly patients, where it is associated with fractures, falls, hospital readmission, prolonged hospital stay and increased mortality. Pathophysiologically, hyponatremia can be induced by the reduction in sodium or potassium body content, and/or the increase in water body content. Sarcopenia is an ageing-associated progressive and generalized loss of musculoskeletal mass and strength which leads to low physical performance, particularly in the frail elderly. Since muscle mass is the main potassium body store, this condition usually represents a reduced body potassium content.In the present article it is hypothesized that sarcopenia, as a cause of low potassium body content, could induce or co-induce hyponatremia, particularly in elderly individuals suffering from frailty phenotype.

Association between sarcopenia and depressive mood in urban-dwelling older adults: A cross-sectional study.

The aim of the present study was to examine the relationship between depressive mood and diagnostic components of sarcopenia. The study used baseline data of participants in the Toyota Prevention Intervention for Cognitive Decline and Sarcopenia study. Participants in this cross-sectional study were 432 older adults (46.5% women, mean age 72.5 ± 4.7 years). We defined sarcopenia using the diagnostic algorithm recommended by the Asian Working Group for Sarcopenia, and all participants were classified into a sarcopenia or healthy control group. The skeletal muscle mass was measured by bioelectrical impedance. Depressive mood was assessed using the Geriatric Depression Scale-15 (range 0-15). Among the 432 participants, 9.5% were classified as having sarcopenia. The mean ± SD Geriatric Depression Scale-15 scores in the control and sarcopenia groups were significantly different at 3.9 ± 2.8 and 5.3 ± 3.3, respectively (P = 0.003). Furthermore, depressive mood was significantly more prevalent in the sarcopenia group (P = 0.011). Multiple linear regression analysis showed that the Geriatric Depression Scale score was associated with grip strength (β = -0.23, P = 0.004) and walking speed (β = -0.15, P = 0.006), but not skeletal muscle mass index (β = -0.16, P = 0.142), after controlling for demographic factors, chronic diseases, inflammatory markers and physical activity. Sarcopenia was associated with depressive mood. In terms of the diagnostic components of sarcopenia, depressive mood was not associated with decreased muscle mass, but was associated with low muscle strength and low physical performance. Geriatr Gerontol Int 2019; 19: 508-512.

Elevated Plasma Growth and Differentiation Factor 15 Is Associated With Slower Gait Speed and Lower Physical Performance in Healthy Community-Dwelling Adults

Growth and differentiation factor 15 (GDF-15) has been associated with obesity, muscle wasting, and cachexia. The receptor for GDF-15 was recently identified in the brainstem and regulates food intake and metabolism. The relationship of plasma GDF-15 with the age-associated decline of muscle mass and strength, gait speed, and physical performance in adults has not been well characterized. Plasma GDF-15, grip strength, 6-m gait speed, 400-m walking test time, lower extremity physical performance score, appendicular lean mass, and fat mass were measured in 194 healthy adult participants, aged 22-93 years, of the Baltimore Longitudinal Study of Aging. Plasma GDF-15 concentrations increased with age (p < .001) and were higher in whites compared with blacks and Asians (p = .04). Adults with higher plasma GDF-15 had slower 6-m gait speed, longer 400-m walking time, and lower physical performance score in multivariable analyses adjusting for age and race. Plasma GDF-15 was not associated with grip strength, appendicular lean mass, or fat mass. Elevated plasma GDF-15 is associated with slower gait speed, higher 400-m walking time, and lower physical performance in very healthy community-dwelling adults. The relationship between plasma GDF-15 and sarcopenia-related outcomes may be stronger in the population not selected to be healthy, and this hypothesis should be tested in a representative population.

Genetic Associations with Longevity Are Stronger in Females than in Males - A Bio-Demographic Analysis Contributing to a Research Basis for Precision Healthcare

Background: The male-female health-survival paradox that women live significantly longer, but have lower physical performance and more adverse health outcomes at older ages than men, is a phenomenon observed everywhere in the world. This study aims to provide an understanding of the male-female health-survival paradox, through investigating whether genetic associations with longevity are stronger in males or females. Methods: We conducted logistic regression and bio-demographic analyses, using the genome-wide association study (GWAS) datasets including 2,178 centenarians and 2,299 middle-aged controls of Chinese Longitudinal Healthy Longevity Study. Findings: We found that averages of probabilities of longevity, associated with each of the six mutually exclusive groups of 11 male-specific and 11 female-specific top loci (P<10-5), 35 male-specific and 25 female-specific strong loci (10-5≤P<10-4), 191 male-specific and 311 female-specific moderate loci (10-4≤P<10-3), are all significantly higher in females than in males by margins of 13.8% to 25.8%. Our analyses demonstrate that the female vs. male ratios of relative benefit for longevity due to each of the six exclusive groups of sex-specific loci associated with longevity at tiered significance levels are all substantially in favor of females. These empirical findings and additional analyses of both sex-specific and not-sex-specific loci all indicate and reconfirm that genetic associations with longevity are substantially stronger in females than in males. Interpretation: The findings of this study may be interpreted in the context of human genetic evolution in which females may gain and accumulate advantages in genetic constitution to meet their reproductive and offspring-caring duties as mothers and grandmothers. Funding Statement: The funding agencies provided financial support to the data and DNA samples collections and analyses, but they did not play any role in writing, interpreting the results and submission for consideration of publication of this manuscript. The authors were not paid by anyone to write this article. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: The Research Ethics Committees of Peking University and Duke University granted approval for the Protection of Human Subjects for the Chinese Longitudinal Healthy Longevity Survey, including collection of the data and DNA samples used for present study. The survey respondents gave informed consent before participation.

Relationship between Homocysteine, Folate, Vitamin B12 and Physical Performance in the Institutionalized Elderly.

Hyperhomocysteinemia causes various diseases including cardiovascular disease, osteoporotic fracture and dementia. Although there have been reports that hyperhomocysteinemia decreases physical performance, findings are inconsistent on the association of homocysteine, folate, vitamin B12 and physical performance. Considering that lower physical performance increases the risk of fall and fracture in the elderly, the effect of nutritional status on physical function must be clarified. This is a cross-sectional study conducted from April 2015 to November 2016. Eighty-six residents and users in five care facilities were evaluated for their blood homocysteine, folate and vitamin B12 concentrations and indices for physical performance; lower limb muscle strength, handgrip strength and gait speed. Analyses of physical performance were done in women only, considering the high proportion of women in the study population and the muscular gender difference. In the third tertile of plasma homocysteine concentration, handgrip strength was significantly lower than in the first tertile (p=0.027). In the first tertile of serum folate concentration, handgrip strength was significantly lower than in the third tertile (p=0.002). Although not statistically significant, lower limb muscle strength in the third tertile of folate was higher than in the first (p=0.061) and second (p=0.057) tertile. In the multiple regression analysis, however, only serum folate concentration was a significant contributor except for age. In subjects with their serum folate and vitamin B12 concentrations both exceeding the median, lower limb muscle strength was higher. Low serum folate concentration is a risk factor for lower physical performance independent of homocysteine in elderly women.

Comment lutter contre le vieillissement musculaire ?

Aging is associated with low physical performance in relation to low muscle quantity or quality as well neuromuscular transmission defect. There are several mechanisms that may be involved, included low physical activity, inadequate intake of protein, anabolic resistance, insulin resistance, lipotoxicity, endocrine factors, mitochondrial dysfunction, muscular denervation, inflammation. Increasing comorbidities with ageing potentiate the progressive muscular functional decline that is accelerated during acute episodes. Sarcopenia defined as a progressive loss of strength and muscle mass is associated with an increased risk of fall and disability, alteration of quality of life and an excess of mortality. It is frequently accompanied by a concomitant increase in fat mass defining sarcopenic obesity, which potentiates morbidity and mortality. To improve screening and diagnosis, European criteria have recently been revised, including self-questionnaire for case-finding and strength measurement as primary indicator. Interventions should be preventive and multimodal based on optimal protein, vitamin D and omega-3 fatty acids intakes, as well as maintaining regular physical activity. New specific treatments could soon enrich the therapeutic strategies.

Body weight changes and incidence of cachexia after stroke.

BackgroundBody weight loss is a frequent complication after stroke, and its adverse effect on clinical outcome has been shown in several clinical trials. The purpose of this prospective longitudinal single‐centre observational study was to investigate dynamical changes of body composition and body weight after ischemic stroke and an association with functional outcome.MethodsSixty‐seven consecutive patients (age 69 ± 11 years, body mass index 27.0 ± 4.1 kg/m2, 42% female patient, mean ± SD) with acute ischemic stroke with mild to moderate neurological deficit (National Institute of Health Stroke Scale median 4, ranged 0–12) were analysed in the acute phase (4 ± 2 days) and at 12 months (389 ± 26 days) follow‐up. Body composition was examined by dual energy X‐ray absorptiometry. Cachexia was defined according to the consensus definition by body weight loss ≥5% within 1 year and additional clinical signs. Lean tissue wasting was considered if a ratio of upper and lower limbs lean mass sum to squared height (kg/m2) was ≤5.45 kg/m2 for female patient and ≤7.25 kg/m2 for male patient.ResultsAccording to the body weight changes after 12 months, 42 (63%) patients had weight gain or stable weight, 11 (16%) patients had moderate weight loss, and 14 (21%) patients became cachectic. A relative decline of 19% of fat tissue and 6.5% of lean tissue was observed in cachectic patients, while no changes of lean tissue were observed in non‐cachectic patients after 12 months. The modified Rankin Scale was 48% higher (2.1 ± 1.6, P < 0.05), Barthel Index was 22% lower (71 ± 39, P < 0.01), and handgrip strength was 34% lower (21.9 ± 13.0, P < 0.05) in cachectic compared to non‐cachectic patients after 12 months.The low physical performance if defined by Barthel Index <60 points was linked to the lean tissue wasting (OR 44.8, P < 0.01), presence of cachexia (OR 20.8, P < 0.01), and low body mass index <25 kg/m2 (OR 11.5, P < 0.05). After adjustment for cofounders, lean tissue wasting remained independently associated with the low physical performance at 12 months follow‐up (OR 137.9, P < 0.05).ConclusionsIn this cohort study, every fifth patient with ischemic stroke fulfilled the criteria of cachexia within 12 months after index event. The incidence of cachexia was 21%. Cachectic patients showed the lowest functional and physical capacity.

Prevalence of sarcopenia among hospitalized internal medicine patients: A cross-sectional single-center pilot study according to EWGSOP2 criteria.

Sarcopenia is associated with a higher risk of adverse outcomes among hospitalized patients with chronic diseases. Currently, an unmet need lies in its low diagnostic yield. We conducted a pilot study with the aim to screen hospitalized patients for sarcopenia using the EWGSOP2 criteria. Across-sectional study among hospitalized patients in internal medicine was carried out, inclusion criteria: age>55, ability to stand-up from achair. bed-bound, terminal stages of the disease, ICU stay. We measured hand-grip strength, fat-free mass by bioimpedance and short physical performance battery test (SPPB). Sarcopenia was diagnosed in low hand-grip strength and low muscle mass (EWGSOP2), severe sarcopenia in sarcopenic patients with low physical performance (SPPBT≤8). 40 patients were enrolled, sarcopenia was diagnosed in 8/20 (40%) men and 3/20 (15%) women (p=0.15), severe sarcopenia in 6/20 men (30%) and 2/20 (10%) women (p=0.24). 65% of men and 40% of women had SPPBT≤8, and 60% of men and 55% of women had gait speed≤0.8m/s. Among hospitalized internal medicine patients sarcopenia and severe sarcopenia are common, particularly in males. New diagnostic criteria provide a relatively simple and applicable tool for screening among internal medicine inpatients (Tab. 3, Ref. 25).

Physical Performance, Body Composition and Somatotype in Colombian Judo Athletes

Background: Judo is a grappling sport that requires a combination of powerful actions (e.g., throwing techniques) and aerobic capacity. Physical performance, body composition and somatotype influences athletes' performance. Problem and aim. Analyze the physical performance, body composition and somatotype of elite Colombian judokas and compare them with athletes from other countries. In addition, to investigate the correlation between body composition and physical performance. Methods: Fifteen judoists, eight women (21±4.7 years) and seven men (20.5±3.9 years), participated in the present study. The athletes were black belt and had international and national competition experience, winning medals in the Pan-American Games, Central and South American Championships. Squat jumps (SJ) and countermovement jumps (CMJ) on a contact platform were performed to evaluate lower limbs power. The maximum oxygen uptake (VO2max) was estimated using the multistage 20-m shuttle run test. The Anthropometric measurements were taken for body fat and skeletal muscle mass estimation. Pearson correlation was performed between body composition and physical performance variables. Results: In summary, lower physical performance, and higher body fat percentages were observed in Colombian judoists compared to elite judoists. In other countries Moderate negative correlation was observed between aerobic power and body fat percentage (r=-0.67), and the endomorph characteristic (r=-0.69). In addition, the skeletal muscle mass presented a very large correlation with power from both SJ (r=0.88) and CMJ (r=0.89) (p Conclusion: Elite Colombian judokas presented lower physical performance, and higher body fat percentage than other elite judokas. The somatotype was adequate and in accordance with that reported at the elite level.

Semi-Recumbent Vibration Exercise in Older Adults: A Pilot Study of Methodology, Feasibility, and Safety.

Objectives:Older adults with impaired physical function are at risk for further functional decline in part due to limited ability to engage in regular exercise. Effective approaches to exercise in this vulnerable population are needed to improve functional capacity and optimize independence.Methods:Thirty-two residential care apartment complex (RCAC) residents, age ≥70, with low short physical performance battery (SPPB) scores were recruited and randomly assigned to a crossover-design study exploring feasibility and safety of semi-recumbent vibration exercise in older adults living in one RCAC. The primary outcomes were retention and adherence rates and adverse events.Results:The retention rate was 78%. Adherence rate was 79.7% and 78.6% during the vibration and control training sessions, respectively. Thirty-eight adverse events (AEs) occurred. Mild muscle soreness and knee pain were the only AEs related to vibration exercise. No serious adverse events (SAEs) were study-related. Participants were able to increase training intensity and load and rated the training enjoyable.Conclusion:Semi-recumbent vibration exercise was feasible, well tolerated, and safe in RCAC residents with reduced physical function. Future studies need to examine the effect of this type of exercise on physical function, mobility, falls, and quality of life.

Energy Utilization and Fatigue in Frail Older Women in Relation to Walking

Background and Objectives: Fatigue is one of the characteristics defining frailty. However, the mechanisms leading to fatigue are still poorly understood. Our objectives were to assess the efficacy of energy utilization (EU) during walking in frail older persons and their level of fatigue. Research Design and Methods: Clinical study of a convenient sample of frail older women. 10 healthy (H; 77 ± 4 year, BMI: 25 ± 3 kg/m2, MMSE: 29 ± 1) and 10 frail elderly women (F; 83 ± 6 year, 26 ± 5 kg/m2, 27 ± 3) were compared for their usual level of fatigue and changes in perceived fatigue and EU before and after walking. A 10 cm Visual Analogue Scale (VAS) prior to and following a 6-Minute Walk Test (6MWT) served to measure fatigue. EU was based on VO2 consumption adjusted for walking distance and measured using a portable Cosmed K4b2 indirect calorimeter. Participants underwent body composition measurements by DXA and venous blood sampling. Results: Groups had similar body composition and blood parameters. At rest, there were no differences in VO2 or energy expenditure, but the frail group had a lower heart rate. During 6MWT, between group differences were found for distance VO2, HR and EU. There were VAS changes in fatigue and a moderate correlation between the VAS of general fatigue and hsCRP. Discussion and Implications: Compared with their healthy counterparts, frail older women exhibited lower physical performance, efficacy of EU, and perceived more fatigue with activity. Inflammation was significantly correlated with subjective fatigue but did not characterize frailty.

Prevalence and factors associated with sarcopenia and dynapenia in elderly people.

Objectives:There is little information about the risk factors for sarcopenia and dynapenia. This study aimed to assess the prevalence of sarcopenia and dynapenia and to verify which risk factors are associated with the elderly population.Methods:A total of 387 elderly people were evaluated. We used a questionnaire to identify socio-demographic and behavioral aspects. For physical performance, we used the Short Physical Performance Battery. Using the European Working Group of Sarcopenia in Older People consensus, we defined sarcopenia that includes the occurrence of low muscle mass, added to low muscle strength or low physical performance. Dynapenia was defined using handgrip strength.Results:Sarcopenia and dynapenia were identified in 15.3% and 38.2% of the elderly people, respectively; 15.8% of women and 14.2% of men had sarcopenia, and 52.4% of women and 13.5% of men had dynapenia. Sarcopenia was associated with the increase in aging, white race, smoking, and risk of malnutrition. Dynapenia is more likely to occur in women and hospitalized patients.Conclusion:Sarcopenia had a greater association with the risk factors evaluated here, mainly with smoking and nutritional status. On the other hand, dynapenia was different, having a greater association with hospital intervention.

Impact of adding a cognitive task while performing physical fitness tests in women with fibromyalgia: A cross-sectional descriptive study.

Fibromyalgia symptoms cause a significant reduction in the ability to perform daily life activities. These activities often require the ability to perform more than 1 task at the same time.The aim was to investigate how the addition of a cognitive task modifies the performance in physical fitness tests in fibromyalgia and healthy controls.A total of 61 women participated in this study, 31 of them diagnosed with fibromyalgia by a rheumatologist. They performed 3 physical fitness tests (arm curl, handgrip, and 10-steps stair tests) in 2 conditions:a) regular (single task [ST]) andb) while thinking in 3 words that were given before each test and had to be recalled and verbalized after the execution of each test (dual task).The dual task cost was calculated as the difference between the performances in the regular and dual-task (DT) conditions.Healthy controls obtained significantly better results than fibromyalgia in both, dual and single-task conditions. Women with fibromyalgia significantly decreased the performance in the 10-steps stair test when a cognitive task was added. Between-group differences in the dual-task costs (DTC) were not found.Women with fibromyalgia showed lower physical performance than healthy controls in both, single and dual task conditions. In addition, differences between single and dual task conditions were observed in the 10-steps stair test in women with fibromyalgia. This could be related with a reduction in the ability to perform daily life activities. However, results regarding DTC indicate that both groups may be similarly influenced by the addition of a secondary cognitive. Thus, further research with different difficulty levels of DT conditions is needed in fibromyalgia.

A Prospective Observational Study Evaluating Sarcopenia By Using the Bioelectrical Impedance Analysis in Elderly Patients with Hematologic Malignancies

[Introduction] Sarcopenia is characterized by age-related decline of skeletal muscle plus low muscle strength and/or physical performance. Previous studies have confirmed the association of sarcopenia and adverse health outcomes, such as falls, disability, hospital admission, long term care placement, poorer quality of life, and mortality, which denotes the importance of sarcopenia in the health care for older people. Population-based studies reported that the prevalence of sarcopenia in Japanese healthy adults aged≥60 years was 8.5% among men and 8.0% among women. Sarcopenia was recently identified as a poor prognostic factor in patients with solid tumors. In cancer patients, sarcopenia is associated with treatment failure, chemotherapy toxicity, and a shorter time to tumor progression related to survival. In contrast to solid tumors, the clinical relevance of sarcopenia in hematologic malignancies is still unknown. The present study investigated the prevalence of sarcopenia based on the criteria of the Asian Working Group for Sarcopenia (AWGS) in elderly patients with hematologic malignancies.[Patients and Methods] We prospectively analyzed 56 elderly patients aged≥60 years with hematologic malignancies diagnosed at our institution between 2015 and 2018. Appendicular skeletal muscle mass (ASM) was measured at diagnosis by using multifrequency bioelectrical impedance analysis (BIA) (InBody 720). BIA is suitable for body composition monitoring in elderly patients as a fast, noninvasive, and convenient method. Skeletal muscle index (SMI) was defined as the ratio of ASM divided by height in square centimeters. We also evaluated physical function by using short physical performance buttery (SPPB). Sarcopenia was defined according to the AWGS algorithm, in which the patient has low muscle mass, and low muscle strength or low physical performance. Low muscle mass was defined as a skeletal muscle index (SMI: ASM/height2) of <7.0kg/m2 in men and <5.7kg/m2 in women. Pre-sarcopenia was defined as having only low muscle mass. Low muscle strength was defined as a handgrip strength of <26kg in men and <18kg in women; and low physical performance, as a gait speed of <0.8m/sec. The study protocol was approved by the Institutional Review Board of Yokohama Municipal Citizen's Hospital, and it was carried out in accordance with the Declaration of Helsinki.[Results] Median age at diagnosis was 77 years (60-93 years), with 34 males and 22 females. The diagnosis included non-Hodgkin lymphoma (NHL, n=36), multiple myeloma (MM, n=9), myelodysplastic syndrome (MDS, n=10), and acute myeloid leukemia (AML, n=1). The prevalence of low muscle mass (pre-sarcopenia) was 41% (14/34) in men and 77% (17/22) in women. The prevalence of low muscle strength was 35% (12/34) in men and 41% (9/22) in women. The prevalence of low physical performance status (Gait speed:<0.8m/sec) was 6% (2/34) in men and 9% (2/22) in women. The prevalence of sarcopenia based on a diagnosis of low muscle mass, low muscle strength, and low physical performance was 24% (8/34) in men and (8/22) 36% in women. The prevalence of low SPPB score (<10) was 9% (3/34) in men and 18% (4/22) in women. Among 36 NHL patients, the diagnosis included DLBCL (n=15), FL (n=10), MALT (n=3), SMZBCL (n=3), MCL (n=2), and others. The prevalence of sarcopenia was 25% (5/20) in men and 50% (8/16) in women. The mean age was 83 years in the sarcopenic group (n=13, 36%) and 73 years in the non-sarcopenic group (n=23, 64%) (p=0.0001). Sarcopenic patients displayed a similar level of serum albumin, LDH, sIL2-R, and BMI when compared with patients who were not sarcopenic. However, sarcopenic patients displayed significantly lower levels of serum dehydroepiandrosterone-sulfate (DHEA-S) and a higher CCI score than patients who were not sarcopenic. Sarcopenic patients failed to complete the treatment planned as compared with non-sarcopenic patients (p=0.001).[Conclusion] These results demonstrated that the prevalence of sarcopenia in elderly patients with hematologic malignancies is higher than that in the Japanese general elderly population. In particular, the prevalence of sarcopenia in female NHL patients is higher than that in male NHL patients. Several factors such as age, serum DHEA-S or comorbidities may affect the incidence of sarcopenia. Since our results are based on a small-sized analysis, further large prospective studies are warranted to verify this conclusion. DisclosuresNo relevant conflicts of interest to declare.

Sarcopenia is poor prognostic factor in older patients with locally advanced rectal cancer who received preoperative or postoperative chemoradiotherapy.

Sarcopenia is associated with low muscle mass and low physical performance. Here, we performed to evaluate the sarcopenia as prognostic factor and treatment outcomes in older patients with locally advanced rectal cancer (LARC) who received preoperative or postoperative chemoradiotherapy (CRT).LARC patients aged ≥65 years who received either preoperative or postoperative CRT were analyzed retrospectively. Preoperative or postoperative CRT consisted of 50.4 Gy and fluoropyrimidine. Surgery was performed at 6 weeks after CRT completion. Postoperative CRT was performed at 4 weeks after surgery. One month after surgery or CRT, adjuvant chemotherapy was given. Overall survival (OS) and disease free survival (DFS), local recurrence (LR), and prognostic factor were evaluated.Thirty patients received preoperative CRT and 35 patients received postoperative CRT. Five-year OS rate, 5-year DFS rate, or 5-year LR rate was not significantly different between preoperative and postoperative CRT groups (69.0%, 58.5%, and 3.4% vs 73.6%, 67.9%, and 6.9%, P = .56, P = .37, and P = .77, respectively). Age, sex, stage, CEA level, or timing of CRT did not affect OS. However, 5-year OS rate of patients with sarcopenia was significantly lower than those without sarcopenia (38.0% vs 92.5%, P < .001). Multivariate analysis showed that sarcopenia was the only independent prognostic factor for overall survival (OS) (hazard ratio [HR]: 6.08, P = .001).There was no difference in survival between preoperative CRT and postoperative CRT in older patients with LARC. Sarcopenia is a poor prognostic factor in older patients with LARC who received preoperative or postoperative CRT.

The Association between Sarcopenia and Prealbumin Levels among Elderly Chinese Inpatients.

The goal of the present study was to assess the relationship between sarcopenia and prealbumin levels among hospitalized patients ages 60 and older. Cross-sectional study. The geriatric wards in Guizhou Provincial People's Hospital, Guiyang. Guizhou, China. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) criteria, which consist of three components: low muscle mass, assessed based on an index of appendicular skeletal mass/height2 <7.0kg/m2 for men and <5.4kg/m2 for women; low muscle strength, defined as handgrip strength <26kg for men and <18kg for women; and low physical performance, defined as gait speed <0.8m/s. Using these criteria, sarcopenia was defined as presence of low muscle mass in addition to low muscle strength and/or low physical performance. Prealbumin levels and other variables were considered as being independent variables in an effort to evaluate any potential associations between these factors and sarcopenia status using non-adjusted and multivariate-adjusted regression models. The overall prevalence of sarcopenia was 60.17%, affecting 65 (70.65%) men and 6 (23.08%) women in the present study. Age, body mass index (BMI), and prealbumin levels were each independently associated with sarcopenia (p<0.05). In a multivariate model, after adjusting for all potential covariates, prealbumin levels remained significantly associated with sarcopenia incidence, with an inflection point of 265.9mg/L. The effect sizes and the confidence intervals on the left and right sides of this inflection point were 0.94 (0.90 to 0.99) and 1.07 (0.93 to 1.23), respectively. Among older Chinese inpatients in the present study, prealbumin levels were negatively correlated with sarcopenia incidence, when prealbumin levels were below 265.9mg/L.

Ultrasound measurements of gastrocnemius muscle thickness in older people with sarcopenia.

BackgroundSarcopenia, defined as low muscle mass and low muscle strength and/or low physical performance, is affecting more and more people. The European Working Group on Sarcopenia in Older People has suggested the routine community screening. However, selecting the most suitable method to evaluate muscle mass to detect sarcopenia in community screening is a challenge. This study sought to analyze the correlation between ultrasound (US) measurements of the gastrocnemius muscle and low muscle mass, as defined by sarcopenia.MethodsOne hundred thirty-five elderly participants were enrolled. US measurements included muscle thickness (MT), fat thickness (FT), MT/body mass index (BMI), and MT/FT. The definition of low muscle mass was based on the proposal from the Asian Working Group for Sarcopenia, in which the cutoff values for low muscle mass were 7.0 kg/m2 for men and 5.4 kg/m2 for women using dual energy X-ray absorptiometry (DXA). The participants were divided into low and normal muscle mass groups. Participants with low muscle mass were divided into presarcopenia, sarcopenia, and severe sarcopenia groups.ResultsThose in the low muscle mass group were older and had lower weights and BMIs (P<0.05). In addition, MT and MT/BMI were lower in the low muscle mass group (P<0.05). Binary logistic regression analysis revealed that MT was the factor associated with low skeletal muscle mass (OR =0.001, P<0.001). ANOVA revealed that MT was not significantly different between subjects with presarcopenia, sarcopenia, and severe sarcopenia (F=1.69, P=0.192). Receiver operating characteristic curve analyses indicated that the cutoff value of the gastrocnemius MT for low muscle mass was 1.50 cm.ConclusionMT measured by US was identified as the factor associated with low skeletal muscle mass. Those with gastrocnemius MT less than 1.5 cm can be considered as low muscle mass.

Sarcopenia is associated with the neutrophil/lymphocyte and platelet/lymphocyte ratios in operable gastric cancer patients: a prospective study.

PurposeSarcopenia is distinguished by decreased skeletal muscle plus low muscle strength and/or physical performance. This study was designed to demonstrate the relationship between sarcopenia and systemic inflammatory response (neutrophil/lymphocyte ratio [NLR], platelet/lymphocyte ratio [PLR], and large platelet/lymphocyte ratio [LPLR]) prior to radical gastrectomy for gastric cancer.Patients and methodsWe conducted a prospective study of gastric cancer patients who underwent radical gastrectomy. The clinical utility of the NLR, PLR, and LPLR was evaluated by receiver operating characteristic curves. Sarcopenia components including skeletal muscle index, handgrip strength, and 6 m usual gait speed were measured. Logistic analysis was used to identify the independent indices associated with sarcopenia.ResultsA total of 670 patients were included, representing 504 men and 166 women. Of these, 104 patients (15.5%) were diagnosed with sarcopenia and 567 (84.5%) were non-sarcopenia. PLR has a diagnostic sensitivity of 91.3% for sarcopenia. In addition to the indicators of preoperative age, nutritional risk screening, body mass index, preoperative albumin, and diabetes, the NLR and PLR were independent predictors for sarcopenia (P<0.05).ConclusionThe present study showed that at-diagnosis sarcopenia was associated with inflammation in patients with operable gastric cancer. Due to the complex assessment of muscle condition, PLR may be used as a primary screening test for sarcopenia. How systemic inflammatory response influences changes in sarcopenia may provide new therapeutic perception toward improving outcomes.

Study of the Relation between Body Composition and Physical Performance among Elderly

AbstractAim: To study the relation between body composition and physical performance in elderly population..Methods: A cross sectional study conducted on 267 elderly participants 60 years old or more. All of them were subjected to assessment of body composition using anthropometric measures and Bioelectrical impedance analysis, as well as assessment of physical performance hand grip strength, 6 meters walking speed, Basic activity of daily living and Instrumental activity of daily living .Results: Study showed that elderly participants either with low skeletal muscle mass index or high fat mass percentage measured by Bioelectrical Impedance have the lowest physical performance measures. Also increased age, smoking, institutionalization and malnutrition were associated with low physical performance.Conclusions: low skeletal muscle mass index and high fat mass percentage were both risk factors of low physical performance measures. Combination of both showed the worst physical performance measures. Increasing age, institutionalization and low nutritional state were also independent risk factors of low physical performance in elderly

Association of obesity and sarcopenia among adult Filipinos

ObjectiveStudies on the association of obesity and sarcopenia are conflicting. Some studies showed that obesity is associated with muscle loss and frailty while others showed that lower body mass index (BMI) is associated with increased sarcopenia. To date, there is paucity of data on sarcopenia and obesity among Filipinos. This study aims to determine the association of obesity and sarcopenia among Filipinos. MethodsThis is a cross sectional analytic study comparing sarcopenic versus nonsarcopenic in terms of obesity as measured by BMI and waist circumference (WC). Filipinos older than 40 years were included. Obesity was defined using the World Health Organization (WHO) cutoff for BMI and WC. Sarcopenia was defined as low muscle mass and low muscle strength or physical performance. Population-specific cutoff points were used to define low muscle mass, strength, and performance. ResultsA total of 164 participants were included. The mean age is 60.33 years. Ten (6.1%) were sarcopenic and 4 (40%) of them were obese. Regression analysis showed that obesity is not significantly associated with increased sarcopenia (incidence risk ratio [IRR], 14.62; 95% confidence interval [CI], 0.96–221.92; P = 0.05). However, age (IRR, 1.15; 95% CI, 1.09–1.21; P ≤ 0.01), WC (IRR, 0.92; 95% CI, 0.85–0.99; P = 0.02), smoking (IRR, 3.17; 95% CI, 1.11–9.03; P = 0.03), and alcoholic beverage drinking (IRR, 3.71; 95% CI, 1.26–10.89; P = 0.02) were found to be significant predictors of sarcopenia. ConclusionsThere is no statistically significant association between obesity and increased risk of sarcopenia among participants, however, older age, smaller WC, smoking, and alcoholic beverage drinking were significant predictors of sarcopenia.