Mid-upper Arm Muscle Circumference Research Articles

A close look at the nutritional status and mediterranean diet adherence in patients with behcet’s syndrome

OBJECTIVE: This study aimed to investigate Behçet’s syndrome (BS) patients’ regarding anthropometric measurements, daily energy and nutrient intake, and the MD adherence of patients. METHODS: 100 consecutive patients with BS were prospectively enrolled in two rheumatology outpatient clinics. Mid Upper Arm circumference (MUAC), Triceps skinfold thickness (TST), Mid Upper Arm Muscle Circumference (MUAMC), and Mid Upper Arm Muscle Area (MUAMA) measurements of patients were compared with Turkish reference values. Participants’ daily energy and nutrient intake were categorized by the ‘MD Adherence Score.’ RESULTS: Thirty patients (30%) had only mucocutaneous involvement. According to reference values, 47%, 36%, 14%, and 27% of the participants had low percentile values (<50. percentile) for MUAC, TST, MUAMC, and MUAMA, respectively. Walnuts (35%), eggplant (35%), and tomatoes (13%) were reported as the most prominent foods for symptom exacerbations. The mean MD adherence score was 23.5±6.5 (male: 23.2±6.9; female: 24.2±5.9) points and the adherence status was average (60%) and poor (35%) in the majority of the patients. CONCLUSIONS: Food consumption is important regarding symptom occurrence and multidisciplinary management of BS. Some participants had poor adherence to the MD. Increased waist/hip ratio, BMI, and decreased TST and MUAMA may indicate body muscle mass and unhealthy eating patterns. Patients with BS need encouragement for healthy eating habits.

Older adults, appendicular anthropometric measurements, and poor functional performance are predictors of sarcopenia in individuals with head and neck squamous cell carcinoma.

To identify predictors of sarcopenia (demographical, anthropometric measurements, tumor-related clinical characteristics, performance status, and serum C-reactive protein (CRP) and albumin levels in individuals with head and neck squamous cell carcinoma (HNSCC). This cross-sectional study selected diagnosed with HNSCC (n = 125). Sarcopenia was defined as low muscle strength and low physical performance. Association between sarcopenia and anthropometric assessments (weight, height, body mass index, triceps skinfold, mid-upper arm circumference [MUAC], mid-upper arm muscle circumference, mid-upper arm fat area [UFA], mid-upper arm bone free muscle area, calf circumference, and appendicular skeletal muscle mass and index), tumor clinical characteristics (anatomical site, tumor size, and cervical metastasis), performance status scale (Eastern Cooperative Oncology Group Performance Status [ECOG-PS]), and CRP and albumin levels was analyzed using binary logistic regression models. The diagnosis of sarcopenia was identified in 28 (22.4%) individuals with HNSCC. Being an older adult increases the odds of association with sarcopenia in individuals with HNSCC (odds ratio [OR] = 1.05). Increments in MUAC measurement reduce the odds of association with sarcopenia (OR = 0.69), while the increase in the UFA measurement increases the odds of association with sarcopenia (OR = 1.33). Poor ECOG-PS scores increase the odds of association with sarcopenia in individuals with HNSCC (OR = 5.54). Early identification of easy-to-perform, cost-effective predictors of sarcopenia tends to favor the implementation of personalized therapeutic and supportive interventions in individuals with HNSCC.

Association of sarcopenia defined by different skeletal muscle mass measurements with prognosis and quality of life in older patients with heart failure

BackgroundDiagnosing sarcopenia in heart failure (HF) patients is important, but how to assess skeletal muscle mass in HF patients with fluid retention is controversial. We aimed to examine the association between sarcopenia, defined by different skeletal muscle mass measurements, and clinical outcomes in older HF patients. MethodsWe included 546 older HF patients (≥ 65 years) who were assessed for sarcopenia at discharge (median age 77 years, 309 males). Sarcopenia was diagnosed using grip strength, usual gait speed, and skeletal muscle mass according to international criteria. We used mid-upper arm circumference (MUAC), mid-upper arm muscle circumference (MAMC), calf circumference (CC), and skeletal muscle mass index (SMI) assessed by bioelectrical impedance analysis to assess skeletal muscle mass and defined sarcopenia in each of these measurements. Prognostic outcomes were composite events (all-cause death and HF rehospitalization) and cardiovascular disease (CVD) events (CVD death and CVD rehospitalization). Quality of life (QOL) was assessed using the 36-item Short-Form Health Survey physical functioning (SF-36PF) score. ResultsThe sarcopenia defined by MUAC [hazard ratio (HR): 2.50; 95 % confidence interval (95 % CI): 1.64–3.81; p < 0.001] or MAMC (HR: 1.98; 95 % CI: 1.35–2.92; p = 0.001) were associated with higher composite event rates than the non-sarcopenia. The sarcopenia defined by MUAC (HR: 1.88; 95 % CI: 1.25–2.83; p = 0.002) or MAMC (HR: 1.70; 95 % CI: 1.16–2.49; p = 0.007) were associated with higher CVD event rates than the non-sarcopenia. The sarcopenia defined by CC or SMI were not associated with prognoses. The sarcopenia defined by MUAC, MAMC, or CC were associated with low SF-36PF scores (all p < 0.05). ConclusionsThese results suggest that a diagnosis of sarcopenia based on MUAC or MAMC rather than CC or SMI reflects prognosis and QOL in older HF patients.

Assessing the risk factors associated with sarcopenia in patients with liver cirrhosis: a case–control study

Sarcopenia is a disease characterized by decreased muscle mass and strength, affecting 20–70% of patients with cirrhosis, and is associated with poor prognosis, complications, and high mortality. At present, the epidemiological investigation of sarcopenia in patients with liver cirrhosis is relatively limited, and because of the differences in population characteristics, regions, diagnostic criteria and diagnostic tools, the prevalence of sarcopenia in various studies varies greatly. The definition of sarcopenia in this study adopted the criteria of the Asian Working Group on Sarcopenia (AWGS 2019), including muscle mass and muscle strength / physical performance. A total of 271 patients with liver cirrhosis were included in this cross-sectional study to explore the influencing factors of sarcopenia in patients with liver cirrhosis. The prevalence of sarcopenia was 27.7%, 27.3% in male and 28.4% in female. The results of binary logistic regression analysis showed that age, physical activity, BMI, mid-upper arm muscle circumference, hepatic encephalopathy, nutritional status, alkaline phosphatase, albumin and total cholesterol were significantly correlated with the occurrence of sarcopenia in patients with liver cirrhosis. After adjusting for the potential influencing factors, it was found that the correlation between age and sarcopenia was weakened (OR = 0.870, 95% CI 0.338–2.239). The current findings show that sarcopenia is common in patients with cirrhosis and is independently associated with age, physical activity, BMI, nutritional status, and albumin, and serum alkaline phosphatase and total cholesterol are associated with the development of sarcopenia. Regular exercise may help maintain the grip strength of patients with cirrhosis and delay the deterioration of liver function.

Nutritional status of pediatric patients with inflammatory bowel diseases is related to disease duration and clinical picture at diagnosis

This cross-sectional study presents the nutritional status of newly diagnosed pediatric patients with Crohn’s disease (CD) and ulcerative colitis (UC) and its association with the duration of the disease and selected clinical features. We analyzed the data of 41 pediatric patients with CD and 29 with UC (mean age: 13.1 y, range: 5.2–18.0 y) up to 3 mo. from diagnosis. Anthropometry included body weight, body height, body mass index (BMI), three skinfold thicknesses, mid-upper arm circumference and mid-upper arm muscle circumference adjusted for age and sex using national standards. Anthropometry was linked to the disease duration, location of the disease, symptoms, and blood test results. Both studied groups presented significantly lower BMI compared to the reference population, but only children with CD characterized with significantly worse nutritional status according to arm anthropometry. In CD, better nutritional status was associated mainly with longer disease duration and, to a lesser extent, with extraintestinal manifestations, perianal disease, and small intestinal lesions. In UC, anemia at diagnosis was associated with poor nutritional status. Our finding emphasizes the need for more attentive diagnostic care for pediatric patients who exhibit extraintestinal symptoms or perianal disease with no obvious signs of malnutrition, to avoid diagnostic delays.

Prevalence of Malnutrition in Hospitalized Patients in Lebanon Using Nutrition Risk Screening (NRS-2002) and Global Leadership Initiative on Malnutrition (GLIM) Criteria and Its Association with Length of Stay.

(1) Background: Prevalence studies on hospital malnutrition are still scarce in the Middle East region despite recent global recognition of clinical malnutrition as a healthcare priority. The aim of this study is to measure the prevalence of malnutrition in adult hospitalized patients in Lebanon using the newly developed Global Leadership Initiative on Malnutrition tool (GLIM), and explore the association between malnutrition and the length of hospital stay (LOS) as a clinical outcome. (2) Methods: A representative cross-sectional sample of hospitalized patients was selected from a random sample of hospitals in the five districts in Lebanon. Malnutrition was screened and assessed using the Nutrition Risk Screening tool (NRS-2002) and GLIM criteria. Mid-upper arm muscle circumference (MUAC) and handgrip strength were used to measure and assess muscle mass. Length of stay was recorded upon discharge. (3) Results: A total of 343 adult patients were enrolled in this study. The prevalence of malnutrition risk according to NRS-2002 was 31.2%, and the prevalence of malnutrition according to the GLIM criteria was 35.6%. The most frequent malnutrition-associated criteria were weight loss and low food intake. Malnourished patients had a significantly longer LOS compared to patients with adequate nutritional status (11 days versus 4 days). Handgrip strength and MUAC measurements were negatively correlated with the length of hospital stay. (4) Conclusion and recommendations: the study documented the valid and practical use of GLIM for assessing the prevalence and magnitude of malnutrition in hospitalized patients in Lebanon, and highlighted the need for evidence-based interventions to address the underlying causes of malnutrition in Lebanese hospitals.

Frailty phenotype in heart failure: A condition that transcends age

Introduction and objectivesStudies on younger frail and pre-frail subjects suffering from heart failure (HF) are scarce, except for those focusing on the critically ill. This work aims to describe differences between younger (<65 years) and older (≥65 years) pre-frail and frail HF outpatients regarding their nutritional, functional and clinical statuses. MethodsIn this cross-sectional study, a sample of 99 HF frail and pre-frail patients (aged 24–81 years, 38.4% women, 21.2% frail, 59.6% <65 years) was recruited from an HF outpatients’ clinic in northern Portugal. Muscle mass was estimated from mid-upper arm muscle circumference. Weight status was assessed using body mass index. Hand grip strength and gait speed were measured. Medical records were reviewed. Associations between participants’ characteristics and age were calculated using binary logistic regression. ResultsAge was associated with hand grip strength (OR=0.90), gait speed (OR=0.01) and diabetes (OR=4.95). Obesity, muscle mass or heart failure functional classes were not associated with age categories. ConclusionThere is an overall lack of differentiation between younger and older HF patients with the frailty phenotype. Therefore, frailty phenotype should be assessed in all patients, regardless of age. Hand grip strength seems to be a good predictor for older age and more studies are needed to define age-specific hand grip strength cut-offs for HF populations.

Nutritional Assessment of Adult Patients Undergoing Maintenance Hemodialysis in the Gaza Strip

Malnutrition is a common condition in patients undergoing hemodialysis (HD), and it is associated with increased morbidity and mortality. The main objective of the study was to evaluate the nutritional status of patients on maintenance HD. After applying eligibility criteria, 141 HD patients attending major governmental dialysis centers were randomly recruited in this cross-sectional study and assessed for nutritional status using the Patient-Generated Subjective Global Assessment (PG-SGA) tool. The PG-SGA categorizes patients as well-nourished, moderately malnourished, and severely malnourished. Different anthropometric measurements, laboratory investigations, blood pressure measurements, and 24-h dietary recall were collected from each patient. According to PG- SGA results, 78% of patients were moderately malnourished and 22% of patients were severely malnourished. The mean body mass index was 27.8 kg/m2, and 5.7% of patients were underweight. There were significant differences in the mid-upper arm muscle circumference (P = 0.020) between the PG-SGA groups. The total energy and protein intake were significantly (P &lt;0.001) less than the recommended dietary intake by 1268.9 kcal and 41.4 g, respectively. The albumin level in 37.6% of patients was less than the normal level, and the results indicated that there were significant differences in serum iron (P = 0.022) between the moderately and severely malnourished patients. The results of this study indicated that all HD patients were suffering from different degrees of malnutrition and, unfortunately, most of their energy and nutrient intake was far less than the requirements, which might be the reason why they face nutritional and health risks.

The Association of Sarcopenia and Central Obesity with Mortality Risk in Patients with Chronic Kidney Disease – a 2-Year Observational Study

BackgroundPatients with chronic kidney disease (CKD) face numerous challenges regarding their nutritional status, including undernutrition, wasting, overweight, and obesity. However, there is a gap in the knowledge on the importance of nutritional status on the survival of CKD in patients along the spectrum of progression of CKD. ObjectivesThis study aimed to investigate the association of several nutritional measures with all-cause mortality. The hypothesis was that indicators of nutritional status exceeding BMI are associated with increased mortality risk. MethodsOne-hundred seventy adult patients with predialysis CKD (n = 82), receiving hemodialysis (n = 42) or kidney transplantation (n = 46) were recruited from 2014 to 2019. At baseline, nutritional status was assessed by anthropometry, body composition, and muscle function by handgrip strength. Patient survival was assessed after a 2-y follow-up by Cox regression models adjusted for age, sex, and renal function and generalized additive models. ResultsThirty-one patients (18%) died during the 2-y follow-up. Sarcopenia (n = 30) was associated with an increased risk of death (HR: 2.92; 95% CI: 1.24, 6.89), whereas central obesity (n = 82) was not associated with mortality (1.05; 0.51, 2.15) in the Cox regression analyses. An association between BMI and mortality risk per unit increase (0.97; 0.90, 1.05) was not observed. Other markers of nutritional status were inversely associated with mortality risk, including handgrip strength (0.89; 0.83, 0.95), mid-upper arm circumference (0.86; 0.78, 0.95), and phase angle (per 0.1 degree increase 0.86; 0.81, 0.92). In the generalized additive models, U-shaped relationships were observed between mortality risk and waist circumference and mid-upper arm muscle circumference, while BMI < 22 kg/m2 was associated with increased mortality risk. ConclusionsSarcopenia, but not central obesity was associated with total mortality in patients with CKD. The inclusion of muscle strength and mass measures in clinical practice should be considered.

ASSOCIATION OF MID UPPER ARM CIRCUMFERENCE AND COGNITION: A POPULATION-BASED COHORT STUDY

Abstract Introduction Evidence suggests a positive association between muscle mass and cognitive impairment exists. Mid-upper arm muscle circumference (MUMC) is a simple measure that may provide prognostic information on cognitive status. Methods We included adults aged ≥55 years from the China Health and Nutrition Survey 1997-2018 with MUAC and triceps skinfold (TSF) measurements at each visit. Cognition was estimated based on a subset of the modified Telephone Interview for Cognitive Status (TICS, 0─27). Sex-stratified linear mixed-effects models accounting for within-individual and within-community correlation assessed the association between MUAC and the ratio of MUAC:TSF with TICS across age. We tested whether the rate of cognitive decline by age differed by quartiles of MUAC and MUAC:TSF in separate models. In cases of no statistical differences in cognitive declines by age, we tested whether overall cognitive function was associated with quartiles of MUAC and MUAC:TSF across all ages. Results Of 5,964 adults (53% female, age 62.4±6.4), mean MUAC was 26.6±3.74 and 26.2±3.9 cm, mean MUAC:TSF ratio was 2.9±1.6 and 1.94±1.1, and baseline TICS was 15.4±6.1 and 13.2±6.4 for men and women, respectively. MUAC was not associated with the rate of cognitive decline. Lower MUAC was associated with higher overall cognitive function scores for men (p=0.01) and women (p=0.05). For men and women there was no association between MUAC:TSF ratio and either cognitive decline or overall function. Conclusion MUMC can be a marker to predict overall cognitive function across this period in the lifecycle, suggesting that declining MUAC may help predict lower overall cognitive function

Endothelial Damage and Muscle Wasting in Cardiac Surgery Patients.

This is a post-hoc analysis to assess the effect of anesthesia, surgical trauma, and extracorporeal circuit on endothelial integrity, microvascular permeability, and extracellular fluid balance, as well as on skeletal muscle catabolism, in patients undergoing elective cardiac surgery. We included 127 well-nourished patients undergoing "on-pump" elective cardiac surgery. One day prior to surgery (D0) and again on postoperative day 7 (POD7), body mass index, body composition assessment, hand-grip strength (HGS), and mid-upper arm muscle circumference (MAMC) were measured. Patients were assigned to early recovery (ER) and late recovery (LR) groups, depending on the duration of ICU stay (cut-off 48 hours). The magnitude of change (Δ) in all parameters studied was assessed in ER versus LR groups, regarding(i) epithelial tissue dysfunction (Δ-Extra-Cellular Water percentage (Δ-ECW%), Δ-Phase Angle (Δ-PhA)), (ii) skeletal muscle mass catabolism (Δ-Skeletal muscle mass reduction%, Δ-Hand Grip Strength (Δ-HGS) and Δ-Mid Upper-Arm Muscle Circumference (Δ-MAMC)). Baseline measurements were similar in both groups. A significant difference was observed in all Δ-parameters studied (Δ-ECW%, Δ-PhA and muscle catabolism, Δ-HGS, Δ-MAMC), the worse results being correlated to the LR group. The results raise the issue that patients with early recovery may silently have pathological conditions, continuing even on the day of discharge- further research should be planned.

Development of a risk prediction nomogram for sarcopenia in hemodialysis patients

BackgroundSarcopenia is associated with various adverse outcomes in hemodialysis patients. However, current tools for assessing and diagnosing sarcopenia have limited applicability. In this study, we aimed to develop a simple and reliable nomogram to predict the risk of sarcopenia in hemodialysis patients that could assist physicians identify high-risk patients early.MethodsA total of 615 patients undergoing hemodialysis at the First Affiliated Hospital College of Medicine Zhejiang University between March to June 2021 were included. They were randomly divided into either the development cohort (n = 369) or the validation cohort (n = 246). Multivariable logistic regression analysis was used to screen statistically significant variables for constructing the risk prediction nomogram for Sarcopenia. The line plots were drawn to evaluate the effectiveness of the nomogram in three aspects, namely differentiation, calibration, and clinical net benefit, and were further validated by the Bootstrap method.ResultsThe study finally included five clinical factors to construct the nomogram, including age, C-reactive protein, serum phosphorus, body mass index, and mid-upper arm muscle circumference, and constructed a nomogram. The area under the ROC curve of the line chart model was 0.869, with a sensitivity and specificity of 77% sensitivity and 83%, the Youden index was 0.60, and the internal verification C-statistic was 0.783.ConclusionsThis study developed and validated a nomogram model to predict the risk of sarcopenia in hemodialysis patients, which can be used for early identification and timely intervention in high-risk groups.

Correlation between intestinal flora disruption and protein\u2013energy wasting in patients with end-stage renal disease

BackgroundDifferent dialysis treatments may affect the composition and structure of the intestinal flora of dialysis-treated chronic kidney disease (CKD) patients. This study aimed to analyze the correlations between the different flora and the nutritional indexes and further explore the potential metabolic pathways in patients with CKD in end-stage renal disease (ESRD).MethodsAltogether, 102 patients with ESRD were recruited and categorized into the hemodialysis (HD) group (N = 49) and the peritoneal dialysis (PD) group (N = 53). Their biochemical indexes, anthropometric indicators, and inflammatory markers were determined. The total genomic DNA was extracted for 16S ribosomal DNA sequencing. Furthermore, bioinformatics analysis was employed for functional analysis.ResultsAnthropometric indicators, including handgrip strength, mid-upper arm circumference, mid-upper arm muscle circumference, and body mass index, in the HD and PD groups showed a positive correlation with butyric acid-producing bacteria (Rosella and Phascolarctobacterium) and a negative correlation with conditional pathogens (Escherichia spp.). Meanwhile, the inflammatory markers, including high-sensitivity C-reactive protein and interleukin-6, were significantly higher in the PD-protein–energy wasting (PEW) group than in the PD-non-protein–energy wasting (NPEW) group; although they showed an increasing trend in the HD-PEW group, no significant difference was noted. Rosella was considerably scarce in the HD-PEW group than in the HD-NPEW group, whereas Escherichia was substantially more abundant in the PD-PEW group than in the PD-NPEW group. Compared with the HD group, the essential amino acid synthesis pathway, amino acid metabolism-related enzyme pathways, and aminoacyl-transfer RNA biosynthesis pathways were weakened in the PD group. Most carbohydrate metabolic pathways were weakened, although the tricarboxylic acid cycle was slightly enhanced. Concurrently, the fatty acid metabolism was enhanced, whereas fatty acid synthesis was weakened; the metabolic pathways of B vitamins were also weakened. These potential metabolic pathways of the various compounds released by intestinal flora showed a significant correlation with blood biochemical indexes, anthropometric indicators, and inflammatory markers.ConclusionIn patients with ESRD, different dialysis treatments affected the abundance of butyric acid-producing bacteria (Rosella and Phascolarctobacterium) and conditional pathogens (Escherichia spp.). Butyric acid-producing bacteria showed a positive correlation with PEW and showed a negative correlation with Escherichia. Improving the intestinal diversity and increasing the amount of butyric acid-producing bacteria, such as Blautella, Faecococcus, and Phascolarctobacterium, are potential therapeutic approaches to enhance protein–energy consumption in patients with ESRD.

Comparison of Different Nutritional Assessment Tools in Detecting Malnutrition and Sarcopenia among Cirrhotic Patients.

Malnutrition and sarcopenia are common complications of liver cirrhosis. This study compares the performance of different nutritional assessment techniques in detecting malnourished patients. Data from 156 patients with liver cirrhosis were collected. We assessed the nutritional status of these patients according to: Subjective Global Assessment (SGA); Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), skinfold thickness (TSF), mid-upper arm circumference (MUAC), mid-upper arm muscle circumference (MUMC), handgrip strength (HGS), body mass index (BMI), and skeletal muscle index (SMI) evaluated by Contrast-Enhanced Computed Tomography (CT). According to EWGSOP2 criteria, combining low HGS with low SMI, the prevalence of malnutrition/sarcopenia was 60.2%. RFH-NPT, MUAC, MAMC, and HGS were excellent tests for detecting malnourished patients. Combining RFH-NPT with MUAC or MUMC increased diagnosis accuracy, AUC = 0.89, p < 0.0001. Age, Child-Pugh class C, albumin level, vitamin D deficiency, male gender, and alcoholic etiology were significantly associated with malnutrition. In conclusion, the prevalence of malnutrition among patients with cirrhosis was relatively high. Our study highlights the potential use of a simpler and inexpensive alternative that can be used as a valuable tool in daily practice, the combination between RFH-NPT and MUAC.

A prospective cohort study on the association of lean body mass estimated by mid-upper arm muscle circumference with hypertension risk in Chinese residents.

The associations of lean body mass (LBM) with elevated blood pressure (BP) and hypertension were controversial, and the causalities have never been shown. Mid‐upper arm muscle circumference (MAMC), an easily obtained anthropometric measurement, could provide an accurate estimate for LBM. Therefore, a prospective cohort study in general Chinese residents aiming to find out the relationship between LBM estimated using MAMC and hypertension risk was performed. Eight thousand one hundred eighty‐five eligible participants were included in the baseline analysis, among whom 3442 were subsequently selected into cohort analysis. MAMC was calculated using mid‐upper arm circumference (MUAC) and triceps skinfold thickness (TST). Associations of MAMC with BP values and hypertension prevalence were estimated by linear and logistic regression models. Associations with hypertension incidence were estimated by COX regression models, hazard ratio (HR) and 95% confidence interval (CI) were given. Nonlinear relationship between MAMC and hypertension risk was estimated using restricted cubic spline method. Standardized coefficients of MUAC and TST were compared to estimate their strengths of associations with hypertension. Baseline analysis showed that after adjusted for confounders, the increase of systolic BP per standard deviation (SD) of MAMC were 1.97 mmHg (95%CI: 1.46, 2.48) and 1.63 mmHg (95%CI: 1.10, 2.16) respectively in men and women, and the increases of diastolic BP per SD were 1.58 mmHg (95%CI: 1.23, 1.92) and 1.08 mmHg (95%CI: 0.74, 1.42). Additionally, the association of MAMC with the prevalence of hypertension were also found in both men and women (OR = 1.36, 95%CI: 1.26, 1.47 in men; OR = 1.33, 95%CI: 1.22, 1.44 in women). Cohort analysis showed that MAMC increased the risk of hypertension (HR = 1.10, 95%CI: 1.01, 1.19 for men; HR = 1.15, 95%CI: 1.06, 1.26 for women), and a trend of J‐shaped relationship was found. Additionally, the stronger associations of MUAC with both BP values and hypertension than that of TST were found in both baseline and cohort analyses. Findings in our study implied that we cannot neglect the capacity of LBM in predicting hypertension risk, and LBM estimates should be recommended in general health surveys or examinations.

Association of Subjective Global Assessment and Adductor pollicis muscle thickness with the Sarcopenia in older patients with type 2 diabetes

Background and AimSarcopenia is prevalent in older patients and increases the risk for negative outcomes during hospitalization and after hospital discharge. In patients with type 2 diabetes (T2D) this association may be even worse. Upon hospital admission, it is often difficult to identify sarcopenia, so the objective of this study was to assess whether the subjective global assessment (SGA), the European Society for Clinical Nutrition and Metabolism (ESPEN) and Global Leadership Initiative on Malnutrition (GLIM) criteria and/or usual anthropometric measures can predict sarcopenia. A secondary objective, to evaluate the accuracy of variables in the prediction of sarcopenia.MethodologyPatients ≥60 years old and with T2D were included. Malnutrition was evaluated in accordance with the guidelines of ESPEN and GLIM, and SGA. Anthropometric measurements were performed by Mid-arm circumference (MAC), mid-upper arm muscle circumference (MUAMC), and adductor pollicis muscle thickness (APMT) was performed. The sarcopenia was evaluated by handgrip strength, timed Up and Go (TUG) test and muscle mass by measuring the calf circumference (CC). Logistic regression was performed to assess the association of variables with Sarcopenia.ResultsA total of 311 patients were included. The prevalence of malnutrition in accordance to ESPEN, GLIM and SGA was 18 (5.8%), 65 (21%) and 15 (4%), respectively. The MAC and MUAMC showed a negative relationship with sarcopenia (HR: 0.92 CI95% 0.85–0.99). However, patients with overweight had a 66% reduction in the risk of sarcopenia (HR: 0.34 CI95% 0.19–0.59). After adjustments, malnourished patients according to the SGA had a risk of HR: 5.65 (CI95% 1.64–19.38) of sarcopenia, similarly to patients with APMT <5 th HR: 2.81 (CI95% 1.53–5.13), ESPEN and GLIM criteria presented HR:3.10 (CI95%1.12–8.22) and HR:2.94 (CI95%1.64–5.27), respectively. The interaction between SGA and APMT after adjusting the model has been significant (HR: 7.23 CI95% 2.98–17.67). In the area under the curve (ROC), only SGA + APMT showed greater accuracy in the prediction of sarcopenia (AUC: 0.713 CI95% 0.650–0.803).ConclusionIn our sample, it was possible to predict sarcopenia through the malnutrition criteria of ESPEN and GLIM, SGA, MAC and APMT. Measures such as APMT associated with the SGA tool seem to better predict sarcopenia in older patients with T2D. Sarcopenia is prevalent in older patients and increases the risk for negative outcomes during hospitalization and after hospital discharge. In patients with type 2 diabetes (T2D) this association may be even worse. Upon hospital admission, it is often difficult to identify sarcopenia, so the objective of this study was to assess whether the subjective global assessment (SGA), the European Society for Clinical Nutrition and Metabolism (ESPEN) and Global Leadership Initiative on Malnutrition (GLIM) criteria and/or usual anthropometric measures can predict sarcopenia. A secondary objective, to evaluate the accuracy of variables in the prediction of sarcopenia. Patients ≥60 years old and with T2D were included. Malnutrition was evaluated in accordance with the guidelines of ESPEN and GLIM, and SGA. Anthropometric measurements were performed by Mid-arm circumference (MAC), mid-upper arm muscle circumference (MUAMC), and adductor pollicis muscle thickness (APMT) was performed. The sarcopenia was evaluated by handgrip strength, timed Up and Go (TUG) test and muscle mass by measuring the calf circumference (CC). Logistic regression was performed to assess the association of variables with Sarcopenia. A total of 311 patients were included. The prevalence of malnutrition in accordance to ESPEN, GLIM and SGA was 18 (5.8%), 65 (21%) and 15 (4%), respectively. The MAC and MUAMC showed a negative relationship with sarcopenia (HR: 0.92 CI95% 0.85–0.99). However, patients with overweight had a 66% reduction in the risk of sarcopenia (HR: 0.34 CI95% 0.19–0.59). After adjustments, malnourished patients according to the SGA had a risk of HR: 5.65 (CI95% 1.64–19.38) of sarcopenia, similarly to patients with APMT <5 th HR: 2.81 (CI95% 1.53–5.13), ESPEN and GLIM criteria presented HR:3.10 (CI95%1.12–8.22) and HR:2.94 (CI95%1.64–5.27), respectively. The interaction between SGA and APMT after adjusting the model has been significant (HR: 7.23 CI95% 2.98–17.67). In the area under the curve (ROC), only SGA + APMT showed greater accuracy in the prediction of sarcopenia (AUC: 0.713 CI95% 0.650–0.803). In our sample, it was possible to predict sarcopenia through the malnutrition criteria of ESPEN and GLIM, SGA, MAC and APMT. Measures such as APMT associated with the SGA tool seem to better predict sarcopenia in older patients with T2D.

Evaluation of techniques used to assess skeletal muscle quantity in patients with cirrhosis.

Loss of skeletal muscle mass is a well-recognised complication of cirrhosis. Bedside methods to assess skeletal muscle mass including anthropometrics and bioelectrical impedance analysis (BIA) are negatively impacted by fluid overload in advanced cirrhosis and thus there is a need to identify alternatives. There is a paucity of data on the accuracy of commonly used radiological methods such as dual X-ray absorptiometry (DXA) to assess appendicular lean mass (ALM), and computed tomography (CT) skeletal muscle area in patients with cirrhosis. The aim of this study was to evaluate the relationships and agreement of several skeletal muscle mass estimation methods compared to a reference model in patients with cirrhosis. A cross-sectional, single centre study was performed by prospectively recruiting patients with cirrhosis referred to the Queensland Liver Transplant Service. Patients underwent assessment of skeletal muscle mass using bedside techniques (mid-upper arm muscle circumference (MUAMC), bioelectrical impedance spectroscopy (BIS), ultrasound muscle thickness (USMT)) and radiological methods (DXA ALM, CT skeletal muscle area). These were compared to a reference measurement of body cell mass derived from a multi-compartment model using isotope dilution tests and DXA. Forty-two patients (age 56 years, interquartile range 48-60, 86% male) were recruited. Bedside skeletal muscle mass estimation techniques were strongly correlated to the body cell mass reference, with BIS estimation having the strongest correlation coefficients (r=0.78-0.79; P<0.01). A novel technique measuring USMT offered no advantage over traditional bedside techniques. Of the radiological methods, DXA ALM had the strongest correlation coefficient (r=0.781; P<0.01). Weaker correlation coefficients were observed in patients with ascites, except when using the MUAMC. Bland-Altman analysis of BIS body composition estimates demonstrated significant systematic biases and large limits of agreement compared to reference values. These results confirm the difficulties in assessing skeletal muscle mass in patients with cirrhosis, particularly in those with ascites. DXA ALM and BIS measurements provided the best correlation to body cell mass. We suggest DXA ALM for estimation of skeletal muscle mass in patients with cirrhosis as there are established thresholds for skeletal muscle mass depletion, and an accurate assessment of bone mass and density can also be provided. The use of USMT over other bedside skeletal muscle mass estimates was not supported by our results. Further studies evaluating novel bedside skeletal muscle mass estimation techniques in cirrhosis patients are required.

Bioelectrical Impedance Analysis and Mid-Upper Arm Muscle Circumference Can Be Used to Detect Low Muscle Mass in Clinical Practice.

Identification of low muscle mass becomes increasingly relevant due to its prognostic value in cancer patients. In clinical practice, mid-upper arm muscle circumference (MAMC) and bioelectrical impedance analysis (BIA) are often used to assess muscle mass. For muscle-mass assessment, computed tomography (CT) is considered as reference standard. We investigated concordance between CT, BIA, and MAMC, diagnostic accuracy of MAMC, and BIA to detect low muscle mass and their relation with the clinical outcome malnutrition provided with the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF). This cross-sectional study included adult patients with advanced esophageal and gastrointestinal cancer. BIA, MAMC, and PG-SGA-SF were performed. Routine CT-scans were used to quantify psoas muscle index (PMI) and skeletal muscle area. Good concordance was found between CTPMI and both BIAFFMI (fat free mass index) (ICC 0.73), and BIAASMI (appendicular skeletal muscle index) (ICC 0.69) but not with MAMC (ICC 0.37). BIAFFMI (94%), BIAASMI (86%), and MAMC (86%) showed high specificity but low sensitivity. PG-SGA-SF modestly correlated with all muscle-mass measures (ranging from −0.17 to −0.43). Of all patients with low muscle mass, 62% were also classified with a PG-SGA-SF score of ≥4 points. Although CT remains the first choice, since both BIA and MAMC are easy to perform by dieticians, they have the potential to be used to detect low muscle mass in clinical practice.

Frailty phenotype and associated nutritional factors in a sample of Portuguese outpatients with heart failure

Background and aimFrailty phenotype (FP) is very common in heart failure (HF) and both syndromes worsen one another. The aim of this study is to first describe FP in a sample of Portuguese patients with HF, and to analyse its association with nutritional and clinical statuses, namely, muscle mass, obesity and functional class. Methods and resultsIn this cross-sectional study, a sample of 136 outpatients with HF (24–81 years, 33.8% women) were randomly selected from the appointments' listings of a HF and Transplant clinic in a Portuguese University Hospital. FP was assessed according to Fried et al. muscle mass was estimated from the mid-upper arm muscle circumference; weight status was assessed using the body mass index; HF functional classes were registered. The association between participants' characteristics and FP categories was analysed using logistic ordinal regression. The frequency of pre-frailty and frailty is 57.4% and 15.4%, respectively. Within frail individuals, 52.4% were under the age of 65. In multivariable analysis, frailty was positively associated with age 70 or older (OR = 3.44) and obesity (OR = 2.66), and negatively associated with muscle mass (OR = 0.77) and HF functional classes I (OR = 0.14) or II (OR = 0.29). ConclusionMuscle mass seems to be an important predictor of frailty in patients with HF and should be taken into account when designing intervention plans that allow for reverting or modifying frailty and pre-frailty. Younger patients should be monitored for the presence and evolution of FP.

Effect of Dialysis Time on Dietary Intake, Body Composition, Muscle Strength, and Nutritional Status of Hemodialysis Patients.

The aim of this study is to evaluate the long-term changes that occur in the nutrition status, dietary intake, biochemical values, anthropometric measurements, body composition, and muscle strengths of hemodialysis patients. A total of 60 patients aged between 18 and 64 who were on dialysis for six months were included in the study. During the four-year follow-up; 17 patients died, four were transferred, and 6 moved to other provinces. The patient's food intake, biochemical values, anthropometric measurements, body compositions, handgrip strengths (HGS), and physical activity status were reviewed and subjective global assessment (SGA) was assessed at the beginning and the end of the four-year follow-up period. A statistically significant difference was found between the baseline and end-of-period SGA classifications of the patients (P <0.05). While there were no statistically significant differences at the end of the follow-up period in terms of the body weight, body mass index, mid-upper arm circumference, mid-upper arm muscle circumference, body water, lean body mass, creatinine, energy intake, protein intake values of the patients; there were significant differences in terms of their triceps skin-fold thicknesses, percentage of body mass, HGS, blood urea nitrogen levels, total protein, and albumin values (P <0.05). Extended time on dialysis leads to decrease values of albumin and HGS, increased rates of malnutrition.