Measures Of Sarcopenia Research Articles

TRLR-01 THE PROGNOSTIC UTILITY OF TEMPORALIS MUSCLE THICKNESS MEASURED ON MAGNETIC RESONANCE SCANS IN PATIENTS WITH INTRA-AXIAL MALIGNANT BRAIN TUMOURS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract OBJECTIVE Sarcopenia is associated with worsened outcomes in solid cancers. Temporalis muscle thickness (TMT) has emerged as a measure of sarcopenia. Hence, this study aims to evaluate the relationship between TMT and outcome measures in patients with malignant intra-axial neoplasms. METHODS Following the PRISMA guidelines, we systematically searched PubMed, Embase, Scopus, and Cochrane databases for relevant studies from inception until June 17, 2022. Event ratios with 95% confidence intervals (CI) were analyzed using the RevMan 5.4 software. Where meta-analysis was impossible, vote counting was used to determine the effect of TMT on outcomes. The GRADE framework was used to determine the certainty of the evidence. RESULTS Four outcomes were reported for three conditions across 17 studies involving 4430 patients. Glioblastoma: thicker TMT was protective for overall survival (OS) (HR 0.59; 95% CI 0.46–0.76) (GRADE low), progression-free survival (PFS) (HR 0.40; 95% CI 0.26–0.62) (GRADE high), and early discontinuation of treatment (OR 0.408; 95% CI 0.168–0.989) (GRADE high); no association with complications (HR 0.82; 95% CI 0.60–1.10) (GRADE low). Brain Metastases: thicker TMT was protective for OS (HR 0.73; 95% CI 0.67–0.78) (GRADE moderate); no association with PFS (GRADE low). Primary CNS Lymphoma: TMT was protective for overall survival (HR 0.34; 95% CI 0.19–0.60) (GRADE moderate) and progression-free survival (HR 0.23; 95% CI 0.09–0.56) (GRADE high). CONCLUSION TMT has significant prognostic potential in intra-axial malignant neoplasms, showing a moderate to high certainty for its association with outcomes following GRADE evaluation. This will enable shared decision-making between patients and clinicians.

The POISE Study: POcus for Identification of Sarcopenia in Emergency departments

Abstract Background Sarcopenia is a progressive loss of muscle mass and strength, primarily affecting older adults, with a prevalence of up to 20% in >65-year-olds. It is associated with poor outcomes such as fractures, falls, loss of independence and mortality. Recent studies into the use of ultrasonography for sarcopenia diagnosis have yielded promising results, with good validity to estimate muscle mass when compared to DXA, CT or MRI. While point-of-care ultrasound (POCUS) is a commonly used technique in Emergency Medicine, its applicability to sarcopenia diagnosis in an ED setting has not been investigated. Methods This was a prospective, cross-sectional, observational pilot study. Patients >65 years were recruited sequentially from the ED triage list. Each subject had a POCUS scan of their thighs, to visualise and measure the thickness of the femoral quadriceps. Subjects’ handgrip was then measured using a digital grip strength dynamometer. Subjects’ gait speed was measured in metres per second using a standard 6 metre walk test. Data was then analysed to examine any correlation between muscle thickness on POCUS and functional measures of sarcopenia. Results 60 patients were recruited into this pilot study. Of these, 50% had evidence of sarcopenia on functional assessment. There was a statistically significant correlation between muscle thickness on POCUS and performance on functional assessment. Conclusion This pilot study demonstrates a possible new application for POCUS in the ED. This could guide therapy for falls prevention and may prevent further morbidity in this vulnerable population. Further research is needed to confirm the results of this pilot study within a wider population. Additional research examining the correlation between POCUS findings, Clinical Frailty Scale, and BMI would also be of benefit.

The relationship between imaging-based body composition parameters and disease prognosis in patients with endometrial cancer.

Obesity is known as a risk factor for endometrial cancer (EC). Only a few studies investigate the relationship between sarcopenia and sarcopenic obesity and EC. In this study, our aim was to investigate the relationship between the cross-sectional imaging-based body composition parameters and the disease prognosis in low-grade (LG) and high-grade (HG) EC. We conducted a retrospective study in women diagnosed with low and high-grade EC between January 2014 and May 2022 who had abdominal MRI and thorax CT as a part of routine staging workup. We used the skeletal muscle index (SMI) at the level of the third lumbar vertebra to assess sarcopenia on CT. The T2-weighted sequence at the level of the L2-L3 intervertebral disc is used for visceral fat area (VFA), subcutaneous fat area (SFA), and total fat area (TFA). Two radiologists in consensus, calculated the parameters. A total of 250 EC patients (144 low-grade EC, 106 high-grade EC).Sarcopenia was observed in 122 (48.8%) patients, and sarcopenic obesity was found in 82 (32.8%) patients. Although there was an increase in VFA in cases with high-grade EC, there was no significant difference in terms of SFA. Additionally, the frequency of sarcopenia and sarcopenic obesity was higher in cases with high-grade EC. There was no association between sarcopenia and age, histological type, FIGO staging, or comorbidity in the univariate analysis. However, BMI was found to be associated with sarcopenia. Quantitative radiological measurement of sarcopenia, sarcopenic obesity, and body fat composition can be used as novel parameters in the prediction of disease prognosis in endometrial cancer.

Causality between Sarcopenia and Depression: A Bidirectional Mendelian Randomization Study.

Numerous observational studies have suggested a correlation between sarcopenia and depression, but the nature of this relationship requires further investigation. This study employed bidirectional Mendelian randomization to explore this connection. Data from genome-wide association studies were used, encompassing measures of sarcopenia and mental factors, including depression and emotional states. The initial analysis concentrated on the impact of depression on sarcopenia, and then it examined the reverse relationship. The same methodology was applied to emotional data for validation. The results indicated a reciprocal causation between sarcopenia and depression, even when emotional state data were considered. Various emotions can impact sarcopenia, and in turn, sarcopenia can affect emotions, except subjective well-being. These findings highlight a cyclic deterioration between sarcopenia and depression, with a link to negative emotions and a partially ameliorative effect of subjective well-being on sarcopenia. In summary, this study sheds light on the interplay between psychiatric factors and sarcopenia, offering insights into intervention and prevention strategies.

A Digital Platform for Home-Based Exercise Prescription for Older People with Sarcopenia.

Digital therapeutics refers to smartphone applications, software, and wearable devices that provide digital solutions to improve healthcare delivery. We developed a digital platform to support the GYM (Grow Your Muscle) study, an ongoing 48-week randomized, controlled trial on reduction of sarcopenia through a home-based, app-monitored physical exercise intervention. The GYM platform consists of a smartphone application including the exercise program and video tutorials of body-weight exercises, a wearable device to monitor heart rate during training, and a website for downloading training data to remotely monitor the exercise. The aim of this paper is to describe the platform in detail and to discuss the technical issues emerging during the study and those related to usability of the smartphone application through a retrospective survey. The main technical issue concerned the API level 33 upgrade, which did not enable participants using the Android operating systems to use the wearable device. The survey revealed some problems with viewing the video tutorials and with internet or smartphone connection. On the other hand, the smartphone application was reported to be easy to use and helpful to guide home exercising. Despite the issues encountered during the study, this digital-supported physical exercise intervention could provide useful to improve muscle measures of sarcopenia.

The association of social isolation and loneliness with sarcopenia among the middle-aged and elderly in China

ObjectivesThis study examined the relationship of social isolation and loneliness on sarcopenia among Chinese middle-aged and elderly people.MethodsSocial isolation, loneliness, and sarcopenia were measured at baseline. Follow-up measures of new-onset sarcopenia were obtained 4 years later. Then used logistic regression to evaluate the association between social isolation, loneliness and sarcopenia.ResultsIn cross-sectional analysis, social isolation and loneliness are significantly associated with sarcopenia [OR = 1.88 (95% CI = 1.54–2.28)]. In longitudinal analysis, social isolation and loneliness are significantly associated with sarcopenia [OR = 1.09 (95% CI = 0.71–1.69)]. Social isolation and loneliness have a synergistic effect. Among them, individuals over 60 years old [OR = 2.01 (95% CI = 1.37–2.96)] and those without social support [OR = 2.64 (1.61–4.32), P-for interaction < 0.001] are at higher risk.ConclusionSocial isolation and loneliness were significantly associated with sarcopenia, and there was a synergistic effect between social isolation and loneliness.

Correlates and predictors of sarcopenia among men with metastatic castrate-resistant prostate cancer.

Sarcopenia is a predictor of clinical outcomes in men with metastatic castrate-resistant prostate cancer (mCRPC); however, correlates and predictors of sarcopenia are poorly understood in this population. The aim of this study was to examine correlates and predictors of sarcopenia in men with mCRPC prior to treatment. A secondary analysis of an observational study was performed. Participants were receiving care for mCRPC at the Princess Margaret Cancer Centre. Sarcopenia was assessed prior to treatment and was defined as the combination of low grip strength (<35.5 kg), low gait speed (<0.8 m/s), and computed tomography-derived low muscle mass or density. Participants' sociodemographic and clinical characteristics, comorbidity information, and clinically relevant blood markers were collected prior to treatment and were used to identify correlates and predictors of sarcopenia through Spearman correlations and multivariable logistic regression, respectively. In total, 110 men had complete data on sarcopenia measures and were included in the analysis. Sarcopenia was identified in 30 (27.3%) participants. Pre-treatment sarcopenia was moderately correlated with dependence in one or more instrumental activities of daily living (IADLs) (r=0.412), Vulnerable Elders Survey-13 (r=0.404), and a lower hemoglobin (r=0.407 per 10 g/L decrease). In adjusted logistic regression, dependence in one or more IADLs (odds ratio [OR] 4.37, 95% confidence interval [CI] 1.37-13.86, p=0.012), and a 10 g/L decrease in hemoglobin (OR 1.70, 95% CI 1.13-2.57, p=0.012) were significantly associated with sarcopenia. In settings where assessment of sarcopenia is not feasible, evaluation of IADLs and hemoglobin may be used to identify high-risk patients that can benefit from supportive care strategies aiming to improve muscle mass and function.

Serum Creatinine to Cystatin C as a Marker for Assessing Sarcopenia in Chronic Obstructive Pulmonary Disease – A Single-Center, Prospective, Observational Study

Abstract Background: Patients with chronic obstructive pulmonary disease (COPD) can develop systemic complications that include skeletal muscle dysfunction among others. Reduction in muscle mass and function is called as sarcopenia. Diagnosing sarcopenia requires the measurement of walking speed, handgrip strength (HGS), and muscular mass. This is cumbersome to both the patient and the examiner. It requires the use of instruments such as the bio-impedance assay (BIA) and hand dynamometer. Serum cystatin-C (Cys C) and creatinine (Cr) are employed as determinants for kidney function. Cr levels decrease in accordance with low muscle mass, while Cys C remains unchanged. It is due to this relationship among creatinine, cystatin C and muscle mass, serum Cr/Cys C is being tested as a determinant for sarcopenia. Objective: The objective of this study is to study the correlation between Cr-to-Cys C ratio and markers for sarcopenia – appendicular skeletal muscle index (ASMI), handgrip strength, gait speed (GS), and severity of COPD. Materials and Methods: This prospective, observational study was carried out at a tertiary care teaching hospital in Southern India and included patients admitted to the departments of medicine and pulmonology. Patients diagnosed to have COPD were classified according to the GOLD guidelines. Serum Cr and Cys C were measured. Sarcopenia was assessed using BIA for the calculation of ASMI, hand dynamometer for HGS, and 6-m walk test for GS. Results: The results from our study are as follows. The mean for Cr/Cys C was 0.71. Cr/Cys C correlated significantly to ASMI, HGS, GS, and severity of COPD. Conclusion: Serum Cr-to-Cys C ratio can be effectively used for the measurement of sarcopenia in individuals with COPD.

Clinical usefulness of psoas muscle thickness for the prognosis of acute type A aortic dissection patients undergoing total arch replacement.

Sarcopenia has emerged as a comprehensive predictor of mortality in diseased populations. The aim of this study was to evaluate the prognostic and predictive value of psoas muscle thickness/height (PMTH) measurement in patients with acute type A aortic dissection (AAAD). A retrospective analysis of patients (from January 2020 to December 2020) who underwent AAAD surgery at our institution was conducted. PMTH, as a measure of sarcopenia, was measured by preoperative computed tomography. Patients were classified into two groups according to the cut-off value of PMTH. To balance potential bias, a 1:1 propensity score matching (PSM) with a caliper 0.05 was conducted. PSM analysis created 68 pairs of patients. In short-term outcomes, a lower PMTH value was strongly correlated with higher in-hospital mortality and renal failure. Receiver operating characteristic (ROC) analysis suggested that sarcopenia had good predictive capabilities in in-hospital mortality, with the area under curve (AUC) of 0.81 [95% confidence interval (CI): 0.64-0.97]. During a median follow-up of 37 months, 24 (19.4%) patients died, including 16 in low PMTH group and 8 in high PMTH group. Kaplan-Meier analysis indicated the sarcopenia significantly affected long-term survival [log-rank P=0.02; hazard ratio (HR) 2.53 (95% CI: 1.13-5.66)]. Multivariable Cox regression analysis revealed that sarcopenia was an independent predictor for decreased survival [HR 2.73 (95% CI: 1.15-8.78)]. Sarcopenia defined from the PMTH may be a useful tool for predicting short- and long-term mortality in patients after AAAD surgery.

The 10-Item Physical Function Scale as a Sarcopenia Screening Tool for Patients on Hemodialysis

We investigated the accuracy of the 10-item Physical Function (PF-10) questions of the SF-36 quality of life questionnaire as a sarcopenia screening tool among patients on hemodialysis. A cross-sectional, multicenter study that included adult patients on hemodialysis. The revised European Working Group on Sarcopenia in Older People was used to diagnose sarcopenia. The 10 questions about daily activities from the SF-36 quality of life questionnaire were used to appoint the PF-10, where the final score could range from 10 to 30, and the lower the worse the physical function. The PF-10 accuracy to identify confirmed sarcopenia (low muscle strength+low muscle mass) was assessed through a receiver operating characteristic curve and the cutoff was calculated using the Youden index. One hundred eighty-five patients were included (median 59years; 45% female). Prevalence of confirmed sarcopenia was 31.4%. The median PF-10 score was 23 (interquartile range: 17-27) and a significant association with all sarcopenia measurements was found (all P<.05). The best cutoff calculated from the receiver operating characteristic curve was ≤26 points (area under the curve=0.69, 95% confidence interval 0.61-0.77) with sensitivity and specificity of 96.6% and 71.0%, respectively. Moreover, patients with ≤26 points (n=133, 72%) had a higher prevalence of low muscle strength by handgrip (53 vs. 19%; P<.001) and 5-time sit-to-stand (41 vs. 10%; P<.001), low gait speed (44 vs. 19%; P=.002), confirmed sarcopenia (39 vs. 11%; P<.001), and severe sarcopenia (26 vs. 4%; P=.001), but not low muscle mass (49 vs. 35%; P=.08), in comparison with those >26 points (n=52, 28%). The PF-10 may be a useful physical dysfunction and sarcopenia screening tool in patients on hemodialysis. A PF-10 threshold of around 26 points appeared to display the fairest accuracy for diagnosing sarcopenia.

P.151 A critical appraisal of the application of frailty and sarcopenia in the spinal oncology population

Background: Frailty and sarcopenia predict worse surgical outcomes among spinal degenerative and deformity-related populations; this association is less clear in the context of spinal oncology. Here, we identified frailty and sarcopenia tools applied in spinal oncology and appraised their clinimetric properties. Methods: A systematic review was conducted from January 1st, 2000, until June 2022. Study characteristics, frailty tools, measures of sarcopenia, component domains, individual items, cut-off values, and measurement techniques were collected. Clinimetric assessment was performed according to Consensus-based Standards for Health Measurement Instruments. Results: Twenty-two studies were included (42,514 patients). The three most employed frailty tools were the Metastatic Spine tumor Frailty Index (MSTFI), Modified Frailty Index-11 (mFI-11), and the mFI-5. The three most common sarcopenia measures were the L3-Total Psoas Area (TPA)/Vertebral Body Area (VBA), L3-TPA/Height2, and L3-Spinal Muscle Index (L3-Cross-Sectional Muscle Area/Height2). Frailty and sarcopenia measures lacked content and construct validity. Positive predictive validity was observed in select studies employing the HFRS, mFI-5, MSTFI, and L3-TPA/VBA. All frailty tools had floor or ceiling effects. Conclusions: Existing tools for evaluating frailty and sarcopenia in surgical spine oncology have poor clinimetric properties. Here, we provide a pragmatic approach to utilizing existing frailty and sarcopenia tools, until more clinimetrically robust instruments are developed.

The prognostic utility of temporalis thickness measured on MRI scans in patients with intra-axial malignant brain tumours: a systematic review and meta-analysis

Sarcopenia is associated with worsened outcomes in solid cancers [1].Temporalis muscle thickness (TMT) has emerged as a measure of sarcopenia[2]. Hence, this study aims to evaluate the relationship between TMTand outcome measures in patients with malignant intra-axial neoplasms.We searched Medline, Embase, Scopus, and Cochrane databases for relevantstudies. Event ratios with 95% confidence intervals (CI) were analysedusing the RevMan 5.4 software. Where meta-analysis was impossible, votecounting was used to determine the effect of TMT on outcomes. TheGRADE framework was used to determine the certainty of the evidence. Four outcomes were reported for three conditions across 17 studiesinvolving 4430 patients. Glioblastoma: thicker TMT was protective foroverall survival (OS) (HR 0.59; 95% CI 0.46–0.76) (GRADE low), progressionfree survival (PFS) (HR 0.40; 95% CI 0.26–0.62) (GRADE high),and early discontinuation of treatment (OR 0.408; 95% CI 0.168–0.989)(GRADE high); there was no association with complications (HR 0.82;95% CI 0.60–1.10) (GRADE low). Brain Metastases: thicker TMTwas protective for OS (HR 0.73; 95% CI 0.67–0.78) (GRADE moderate);there was no association with PFS (GRADE low). Primary CNSlymphoma: TMT was protective for overall survival (HR 0.34; 95%CI 0.19–0.60) (GRADE moderate) and progression free survival (HR0.23; 95% CI 0.09–0.56) (GRADE high).Across various intracranial intra-axial malignancies, patients withthicker TMT have better survival outcomes and are less prone to discontinuingtreatment secondary to drug toxicity. TMT has the potential tobe a valuable prognostic tool for risk-benefit considerations in the managementof these patients.

Utilizing a novel MRI technique to identify adverse muscle composition in end-stage liver disease: A pilot study

Introduction and ObjectivesSarcopenia is a common complication of end-stage liver disease (ESLD), but its exact relationship to myosteatosis and frailty remains unclear. In this pilot study, we tested the feasibility of a specialized MRI protocol and automated image analysis in patients with ESLD. Materials and MethodsIn a single-center prospective study, adult liver transplant candidates with ESLD underwent assessment of muscle composition between 3/2022 and 6/2022 using the AMRA® MAsS Scan. The primary outcome of interest was feasibility of the novel MRI technique in patients with ESLD. We also tested if thigh muscle composition correlated with validated measures of frailty and sarcopenia. ResultsEighteen subjects (71 % male, mean age 59 years) were enrolled. The most common etiologies of cirrhosis were alcohol-related liver disease (44 %) and non-alcohol-associated fatty liver disease (33 %), with a mean MELD-Na of 13 (± 4). The mean time needed to complete the MRI protocol was 14.9 min and only one patient could not complete it due to metal hardware in both knees. Forty-one percent of patients had adverse muscle composition (high thigh fat infiltration and low-fat free muscle volume) and these patients were more likely to have undergone a recent large volume paracentesis (43 % vs. 0 %, p < 0.02). The adverse muscle composition group performed significantly worse on the 6-minute walk test compared to the remainder of the cohort (379 vs 470 m, p < 0.01). ConclusionsThe AMRA® MAsS Scan is feasible to perform in patients with ESLD and can be used to quantify myosteatosis, a marker of muscle quality and potentially muscle functionality in ESLD.

AB164. SOH24AB_155. The relationship between radiological paraspinal lumbar measures and clinical measures of sarcopenia in older patients with chronic lower back pain

AB164. SOH24AB_155. The relationship between radiological paraspinal lumbar measures and clinical measures of sarcopenia in older patients with chronic lower back pain

Sarcopenia is associated with chemoradiotherapy discontinuation and reduced progression-free survival in glioblastoma patients

PurposeSarcopenia may complicate treatment in cancer patients. Herein, we assessed whether sarcopenia measurements derived from radiation planning computed tomography (CT) were associated with complications and tumor progression during radiochemotherapy for glioblastoma.MethodsConsecutive patients undergoing radiotherapy planning for glioblastoma between 2010 and 2021 were analyzed. Retrocervical muscle cross-sectional area (CSA) was measured via threshold-based semi-automated radiation planning CT analysis. Patients in the lowest sex-specific quartile of muscle measurements were defined as sarcopenic. We abstracted treatment characteristics and tumor progression from the medical records and performed uni- and multivariable time-to-event analyses.ResultsWe included 363 patients in our cohort (41.6% female, median age 63 years, median time to progression 7.7 months). Sarcopenic patients were less likely to receive chemotherapy (p < 0.001) and more likely to be treated with hypofractionated radiotherapy (p = 0.005). Despite abbreviated treatment, they more often discontinued radiotherapy (p = 0.023) and were more frequently prescribed corticosteroids (p = 0.014). After treatment, they were more often transferred to inpatient palliative care treatment (p = 0.035). Finally, progression-free survival was substantially shorter in sarcopenic patients in univariable (median 5.1 vs. 8.4 months, p < 0.001) and multivariable modeling (hazard ratio 0.61 [confidence interval 0.46–0.81], p = 0.001).ConclusionSarcopenia is a strong risk factor for treatment discontinuation and reduced progression-free survival in glioblastoma patients. We propose that sarcopenic patients should receive intensified supportive care during radiotherapy and during follow-up as well as expedited access to palliative care.

Abstract P272: Association of Depression and Handgrip Strength With Morbidity and Mortality in Patients With Heart Failure: A Secondary Analysis From a Randomized Controlled Trial

Introduction: Depression is associated with increased morbidity and mortality in patients with heart failure (HF). Handgrip strength (HGS) is a measure of sarcopenia and lower HGS has been associated with adverse HF outcomes. We hypothesized that relationships between HGS and morbidity and mortality would be moderated by depression in HF patients. Methods: We conducted a secondary analysis of patients hospitalized with HF categorized by depression status. We calculated HGS adjusted for body weight and categorized the values into tertiles, from lowest to highest. We fitted Cox proportional hazards models to estimate hazard ratios (HRs) comparing HGS tertiles in relation to 5-year mortality and 1-year readmissions among depressed and non-depressed and tested whether relationships differ by depression status. Models included HGS tertile, depression status, tertile-by-depression interaction, age, sex, race, medical comorbidities, educational attainment, employment, and HF severity. Results: A total of 494 patients were included in the analysis (mean age 63.4 ± 13.4 years, 44% female, 26% non-white race). A total of 83% of patients had depression and the mean LVEF (SD) was 27.8% (9.2). At 12-months following the index hospitalization the readmission rate was 56% (275 of 494), and the 5-year mortality rate was 41% (204 of 494). Individuals with higher HGS (tertile 2) were less likely to be readmitted compared to tertile 1 (46% vs. 63%; P=0.013). Depression status significantly moderated the relationship between HGS and readmission such that strong handgrip strength predicted readmission among depressed (adjusted HR of 0.35 (95% CI; 0.16, 0.81) comparing tertile 2 to tertile 1) but not among non-depressed patients (0.77 (0.55, 1.06)). However, the HGS-mortality relationship was not moderated by depression. Conclusion: HGS is a predictor of hospital readmission among HFrEF patients, and depression is a moderator of the HGS-readmission relationship. We recommend routinely assessing hospitalized HFrEF patients’ HGS and mood symptoms prior to discharge home, and further research is needed to assess the effects of depression on sarcopenia in its relation to clinical outcomes in HF patients.

Continuous home terlipressin infusion increases handgrip strength and reduces ascites-A prospective randomized crossover study.

Observational studies suggest a beneficial effect of continuous terlipressin infusion (CTI) on ascites and sarcopenia in decompensated cirrhosis with portal hypertension. This single-center, prospective, cross-over study randomized 30 patients with cirrhosis, ascites, and sarcopenia to commence on 12 weeks of home CTI or 12 weeks of observation prior to cross-over. The co-primary outcomes were change in handgrip strength and paracentesis volume. Secondary outcomes included quality of life, sarcopenia measures, renal function, safety, and hospitalization. The median age of participants was 62 years (IQR: 57-64), the median Model for End-Stage Liver Disease-Sodium was 16 (12.3-20.8), and 22 (73%) were male. Handgrip strength increased by a mean adjusted difference (MAD) of 3.09 kg (95% CI: 1.11-5.08 kg) between CTI and observation ( p =0.006); an 11.8% increase from baseline. The total volume of ascites drained decreased by a MAD of 11.39L (2.99-19.85, p =0.01), with 1.75 fewer episodes of paracentesis (0.925-2.59, p <0.001) on CTI. Serum creatinine decreased, urinary sodium excretion increased, and quality of life was significantly higher on CTI (all p <0.001), with an increase in Chronic Liver Disease Questionnaire score of 0.41 points (0.23-0.59). There were 7 minor line-related complications but no cardiac events or pulmonary edema. This novel study demonstrates a significant increase in handgrip strength, reduction in paracentesis volume, and improved quality of life in patients with decompensated cirrhosis treated with continuous terlipressin infusion. These findings provide a strong rationale for the use of ambulatory CTI in appropriately selected patients with cirrhosis.

Prevalence of Sarcopenia and its Risk Factors in Community-dwelling Older People during the COVID-19 Pandemic

Purpose: Sarcopenia is a state of reduced muscle function that can lead to increased falls, fractures, and mortality in the older population. This study aimed to identify the prevalence of sarcopenia and its related risk factors in older adults in the community during the coronavirus disease 2019 (COVID-19) pandemic.Methods: This cross-sectional study investigated sarcopenia, muscle strength, physical performance, fear of COVID-19, distress, and depression in 103 community-dwelling older individuals over 65 years of age.Results: The prevalence of sarcopenia among older people in the community was 4.8% and 29.1% in men and women, respectively. Age (odds ratio [OR]=14.48, 95% confidence interval [CI]=1.48~141.40), gender (OR=6.69, 95% CI=1.11~40.06), physical performance (OR=7.41, 95% CI=1.55~35.21) and depression (OR=5.29, 95% CI=1.16~24.06) were significant risk factors for sarcopenia, but COVID-19-related factors were not significant (&lt;i&gt;p&lt;/i&gt;&gt;.05).Conclusion: Preventive measures for sarcopenia in older people are urgently required. Since depression and physical performance are the main factors influencing sarcopenia, it is suggested to develop an intervention to prevent sarcopenia in older people.

Abdominal Body Composition Reference Ranges and Association With Chronic Conditions in an Age- and Sex-Stratified Representative Sample of a Geographically Defined American Population.

Body composition can be accurately quantified from abdominal computed tomography (CT) exams and is a predictor for the development of aging-related conditions and for mortality. However, reference ranges for CT-derived body composition measures of obesity, sarcopenia, and bone loss have yet to be defined in the general population. We identified a population-representative sample of 4900 persons aged 20 to 89 years who underwent an abdominal CT exam from 2010 to 2020. The sample was constructed using propensity score matching an age and sex stratified sample of persons residing in the 27-county region of Southern Minnesota and Western Wisconsin. The matching included race, ethnicity, education level, region of residence, and the presence of 20 chronic conditions. We used a validated deep learning based algorithm to calculate subcutaneous adipose tissue area, visceral adipose tissue area, skeletal muscle area, skeletal muscle density, vertebral bone area, and vertebral bone density from a CT abdominal section. We report CT-based body composition reference ranges on 4649 persons representative of our geographic region. Older age was associated with a decrease in skeletal muscle area and density, and an increase in visceral adiposity. All chronic conditions were associated with a statistically significant difference in at least one body composition biomarker. The presence of a chronic condition was generally associated with greater subcutaneous and visceral adiposity, and lower muscle density and vertebrae bone density. We report reference ranges for CT-based body composition biomarkers in a population-representative cohort of 4649 persons by age, sex, body mass index, and chronic conditions.

SARCOPENIA AT INITIAL DIAGNOSIS OF PEDIATRIC INFLAMMATORY BOWEL DISEASE

Abstract BACKGROUND Inflammatory bowel disease (IBD) can impact patients’ nutritional status. Poor oral intake, poor nutrient absorption, stool protein loss, and increased energy requirement all contribute. Poor nutritional status can manifest as inadequate growth, reduced weight gain, and sarcopenia, defined as decreased muscle mass and strength. Studies demonstrate decreased muscle mass in pediatric IBD patients leads to higher rates of therapy escalation, surgery, and post-operative complications. We sought to obtain the muscle mass at IBD diagnosis via cross-sectional imaging, compare to pediatric age- and sex-specific psoas muscle reference values for pediatric norms, and analyze muscle mass comparison between IBD subtypes and correlations with anthropometrics at diagnosis. METHODS Patients with new diagnosis of IBD [Crohn’s disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC)] aged 6-16 at diagnosis during 1/01/2016 through 12/31/2019 at our tertiary care facility were included in this retrospective study. Those with chronic medical conditions and lack of cross-sectional imaging within 3 months of diagnosis were excluded. Demographic and anthropometric data at diagnosis of IBD were obtained. The psoas muscle area in mm2 was measured on cross-sectional imaging at lumbar level 3-4 (L3-4) and 4-5 (L4-5) bilaterally to obtain total psoas muscle area (TPMA) at each level and compared to pediatric reference values. Statistical analysis included analysis of variance and Spearman correlations, performed using SAS v9.4. RESULTS Cross-sectional imaging from 162 patients with newly diagnosed IBD were reviewed. Average age was 12.1 years, with male predominance of 93 patients (57.4%). Most patients were diagnosed with CD (n=119, 73.5%), followed by UC (n=39, 24.1%), and IC (n=4, 2.5%) (Table 1). Measures of sarcopenia at both lumbar levels for TPMA and both lumbar levels z-score showed significant difference across IBD subtypes (Table 2). CONCLUSIONS Negative mean TPMA z-score &amp;lt; -1 was noted in all patients at both L3-4 and L4-5 levels, with a statistically significant difference between IBD types and mean TPMA at L3-4, TPMA at L4-5, mean z-score at L3-4, and mean z-score at L4-5. In a subgroup analysis, UC patients were significantly different from CD patients on all four measures, suggesting a higher rate of sarcopenia in CD patients at diagnosis. We plan to expand analysis to compare sarcopenia with disease location, medical therapy, hospitalization rate, need for surgical intervention, and anthropometrics over time. We hope to underscore importance of sarcopenia as measure of nutritional status at diagnosis, particularly when patients present with normal anthropometrics. Table 1 Table 2 SUBGROUP COMPARISONS Ulcerative Colitis patients were significantly different from Crohn’s Disease patients on all 4 measures. Indeterminate Colitis patients were significantly different from Ulcerative Colitis patient on the 2 Total Psoas Muscle Area Measures.