Relative Skeletal Muscle Index Research Articles

Serum iron level is independently associated with sarcopenia: a retrospective study

Sarcopenia greatly reduces the quality of life of the elderly, and iron metabolism plays an important role in muscle loss. This study aimed to investigate the association between iron status and sarcopenia. A total of 286 adult patients hospitalized between 2019 and 2021 were included in this study, of which 117 were diagnosed with sarcopenia. Serum iron, total iron binding capacity (TIBC), transferrin, and transferrin saturation levels were compared between groups with and without sarcopenia and were included in the logistic analyses, with significant variables further included in the logistic regression model for the prediction of sarcopenia. Serum iron, TIBC, and transferrin levels decreased significantly in the sarcopenia group (p < 0.05), and were negatively associated with handgrip strength, relative skeletal muscle index, and multiple test performances (p < 0.05). Multivariate logistic analysis showed that sex, age, body mass index (BMI), and serum iron level were independent risk factors for sarcopenia. In the final logistic regression model, male sex (odds ratio [OR] 3.65, 95% confidence interval [CI] 1.67–7.98), age > 65 years (OR 5.40, 95% CI 2.25–12.95), BMI < 24 kg/m2 (OR 0.17, 95% CI 0.08–0.36), and serum iron < 10.95 μmol/L (OR 0.39, 95% CI 0.16–0.93) were included. Our study supported the impact of iron metabolism on muscle strength and performance.

THU065 Evaluation Of Sarcopenia And Bone Health In Patients With Acromegaly

Abstract Disclosure: I. Eroglu: None. B. Gonul İremli: None. A. Erkoc: None. I. Idilman: None. D. Yuce: None. E. C. Kutukcu: None. D. Akata: None. T. Erbas: None. Background: Although many complications related to high GH exposure develop in patients with acromegaly, musculoskeletal complications are among the most important complications that reduce the quality of life of patients. However, the effects of acromegaly on muscle and bone have not been adequately researched and are still not entirely understood. We aimed to investigate muscle and bone quality in acromegalic patients in this cross-sectional, case-controlled study. Methods: The study consisted of thirty-two (15F/17M) acromegalic patients (n=15 active acromegaly - AA and n=17 controlled acromegaly - CA) and 19 healthy controls (C). Dual energy X-ray absorptiometry (DXA) was used to determine body composition, appendicular skeletal muscle mass (ASM), relative skeletal muscle index (RSMI), and bone mineral density (BMD). The handgrip strength (HGS) and quadriceps muscle strength were measured by hand dynamometer. Magnetic resonans imaging at the L3 level was used to measure total abdominal muscle area (TAMA, cm2) and vertebral fat ratio (VFR). HGS adjusted by ASM (HGS/ASM) was used to define skeletal muscle quality (SMQ). SMQ was regarded “normal” when the HGS/ASM ratio was &amp;gt;1.53, and “weak” when the ratio was ≤1.36 in males and ≤1.35 in women. The SMQ of those with HGS/ASM levels between these ranges was considered “low”. Results: Age, gender, and BMI were similar between groups. The GH and IGF-1 levels in AA was greater than in CA, and C (p&amp;lt;0.001 for all). While lean tissue was higher in AA than CA and C (p=0.038 and p=0.041, resp.), body fat ratio was lower in AA than CA and C (p=0.04 and p=0.042 resp.). ASM, RSMI, TAMA, HGS and quadriceps strength were similar between groups. Median (IQR) HGS/ASM were 1.67 (1.15-1.9) in AA, 1.57 (1.36-1.79) in CA and 1.77 (1.67-1.93) in C. This difference was found to be significant between CA and C (p=0.008). According to skelatal muscle quality, 94.7% of the individuals in the C group were of normal SMQ, while this rate was 60% in the AA and 52.9% in CA. The ratio of those with low/weak SMQ was higher in the AA and CA compared to C (p=0.012 and p=0.013, resp.). Total and vertebra BMD were similar across groups. Pelvic BMD in CA was lower than C (p=0.02). VFR was higher in CA (56.5%) than in AA (43.75%) and C (42.6%) (p=0.04 and p=0.001 resp.). Conclusion: We showed for the first time that patients with acromegaly had lower muscle quality and pelvic BMD, while patients with controlled acromegaly had higher vertebral fat ratio. Even though lean tissue increased in AA patients, regional muscle distributions (ASM and TAMA) were shown to be similar. The increased muscle mass in acromegaly patients is not expressed as muscular strength, and muscle quality is low in these patients. The high vertebral fat ratio seen in patients with CA may be a result of ectopic adiposity with disease control, as well as the reason for the increased frequency of vertebral fractures seen in patients with acromegaly. Presentation: Thursday, June 15, 2023

608-P: Association of Neck Circumference and Sarcopenic Obesity in a Cohort of Chinese Community-Based Individuals

Aims: Neck circumference (NC) is a simple and reliable anthropometric measurement for estimating obesity. Sarcopenic obesity is a distinct condition of sarcopenia in the context of obesity, with the cumulative health risks of both phenotypes. This study was aimed to explore the association between NC and sarcopenic obesity in a Shanghai community population. Methods: The study included 1542 participants (622 men and 920 women) with mean age of 58.1 ± 7.06 years who underwent complete examinations at baseline in 2013-2014 and received a re-examination in 2015-2016. An automatic bioelectric impedance analyser (BIA) was used to measure body compositions. Relative skeletal muscle index was calculated using the BIA equation from Janssen et al. The abdominal fat distribution, including visceral fat area (VFA), was assessed by magnetic resonance imaging. Elevated NC was defined as NC ≥ 38.5 cm in men and NC ≥ 34.5 cm in women. The definition of sarcopenic obesity combined low muscle mass (skeletal muscle mass index of 1 SD below the sex-specific mean value) with obesity which defined according to overall adiposity or fat distribution as body mass index (BMI) ≥ 25 kg/m2, fat% ≥ 25% in men and 30% in women, or VFA ≥ 80cm2, respectively. Results: Subjects with elevated NC had a higher incidence of sarcopenic obesity in both men and women regardless of adiposity status assessed by BMI, fat%, or VFA (all P &amp;lt; 0.001). During the follow up, higher cumulative incidence of sarcopenic obesity was found in those with elevated NC (all P &amp;lt; 0.001). For each 1 cm increase in NC, multivariable-adjusted hazard ratios of sarcopenic obesity in which adiposity status assessed by high BMI were 1.40 (1.11-1.76) in men and 1.32 (1.13-1.56) in women; besides, the association assessed by high fat% or high VFA remained in both men and women. Conclusion: NC was closely associated with the incidence of sarcopenic obesity, which suggested that it could be helpful to screening sarcopenic obesity in a community-based population. Disclosure Y.Xu: None. T.Hu: None. Y.Shen: None. Y.Wang: None. X.Ma: None. Y.Bao: None.

Plasma levels of myokines and inflammatory markers are related with functional and respiratory performance in older adults with COPD and sarcopenia

This study investigated whether blood-based biomarkers were related to functional test performance and respiratory muscle strength in older adults with COPD and sarcopenia. The participants included in this cross-sectional study were from both sexes and sixty years or older. Based on clinical assessment, participants were categorized in COPD (n=43) and non-COPD (NCOPD) (n=43) groups. They were also assessed for body composition and muscular mass by dual-energy X-ray absorptiometry, using the relative skeletal muscle index for the diagnosis of sarcopenia. A series of functional tests, including short physical performance battery (SPPB), 6-minute walking test (6MWT), maximal inspiratory and expiratory pressures (MIP and MEP), were carried out. Plasma levels of myokines (Irisin and BDNF), and soluble TNF receptors (sTNFR1 and sTNFR2) were determined by ELISA. In the multivariate analysis, 6MWD was associated with age, COPD-related sarcopenia and BDNF (R2=0.29; f2=0.41). SPPB score was associated with COPD-related sarcopenia and sTNFR1 (R2=0.25; f2=0.33). MIP value was associated with sex, COPD-related sarcopenia, sTNFR2 and Irisin (R2=0.24; f2=0.31). Finally, MEP value was associated with sex COPD-related sarcopenia (R2=0.18; f2=0.22). Plasma levels of myokines and inflammatory markers are related with functional and respiratory performance in older adults with COPD and sarcopenia.

Body composition in patients with hepatic glycogen storage diseases

ObjectivesThe present study aimed to evaluate the body composition of hepatic glycogen storage disorders (GSDs) through dual energy x-ray absorptiometry. MethodsThis was an exploratory, observational, cross-sectional study. Twenty-four patients with GSD (type Ia: n = 13, Ib: n = 5, III: n = 2, and IX-α/β/γ: n = 4; female sex: n = 13; age <8 y: n = 3, 8–19 y: n = 14, and >19 y: n = 7) were included. Three-day dietary records were collected in the week preceding dual energy x-ray absorptiometry. Body composition findings were correlated with clinical parameters, uncooked cornstarch (UCCS) regimen, dietary intake, and markers of treatment adherence. ResultsAn elevated fat mass (FM) index was found in 16 of 21 patients (age 8–19 y: n = 10 and >19 y: n = 6; GSD type Ia: n = 12, Ib: n = 2, III: n = 1, and IX-γ: n = 1). A lean mass (LM) index evaluation showed no LM deficits in relation to corresponding reference populations. Relative skeletal muscle index values were decreased in 2 of 7 adult patients (type Ib: n = 1 and IX-α: n = 1). UCCS (g/d) correlated positively with the FM index (rs = 0.7; P ≤ 0.01). In contrast, relative UCCS intake (g/kg body weight) was negatively associated with LM/kg (rs = –0.8; P ≤ 0.01). ConclusionsThese findings suggest a high frequency of elevated FM in patients with hepatic GSDs. We also suggest that treatment with UCCS is associated with excess weight in these patients. Additionally, the treatment strategy can impair protein intake, and lead to a decrease in LM.

555-P: Premenopausal vs. Postmenopausal Women: Effect of Time-Restricted Eating on Body Weight and Metabolic Health Markers

Background: Time restricted eating (TRE) involves restricting the ad libitum eating window to a specific number of hours daily, while water fasting for the remaining hours. Objective: This study examined if changes in body weight and metabolic risk factors during TRE, differ in women based on menopausal status. Methods: This is a secondary analysis of an 8-week TRE study (4-6 h eating window, 18-20 h fasting window daily) conducted in adults with obesity. Male participants were excluded, and female subjects were classified in two groups based on menstrual status: premenopausal (n = 13) , or postmenopausal (n = 19) . Perimenopausal women were excluded from the original study. Results: Body weight decreased in both premenopausal women (-3.3 ± 0.4%) and postmenopausal women (-3.3 ± 0.5%) (main effect of time, P &amp;lt; 0.001) , with no difference between groups (no group × time interaction) by week 8. Adherence in both groups was very high, with premenopausal women adhering to their prescribed eating window on 6.2 ± 0.1 d/week, and postmenopausal women adhering to their window on 6.2 ± 0.2 d/week. Fat mass, lean mass, fasting insulin, insulin resistance, and 8-isoprostane (marker of oxidative stress) were reduced similarly in both groups (main effect of time, P &amp;lt; 0.for all comparisons) . Visceral fat mass, relative skeletal muscle index (RSMI) , blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, fasting glucose, HbA1c, TNF-alpha and IL-6 remained unchanged by 8 weeks in both groups. Conclusion: These findings suggest that the weight loss and metabolic benefits of TRE do not differ between premenopausal and postmenopausal women with obesity. Disclosure K.Gabel: None. K.Varady: None. S.Cienfuegos: None. M.Ezpeleta: None. Funding R01DK119783

The validity of ASMI, RASM, and L3 SMI in assessing skeletal muscle mass in patients with lung cancer.

Both bioelectrical impedance analysis (BIA) and electron computed tomography (CT) can be used as tools for assessing skeletal muscle mass. In order to find a more suitable method for assessing skeletal muscle mass in lung cancer patients, this study conducted a comprehensive comparative analysis of the two methods. We collected baseline data from patients admitted to the oncology department of the First Hospital of Hebei Medical University from October 2017 to December 2021, and collected data through physical examination, body composition analysis measurements and CT examinations. Then we calculated skeletal muscle mass index (ASMI), relative skeletal muscle index (RASM), and third lumbar spine skeletal muscle index (L3 SMI), respectively. Finally we analyzed the correlation between the three methods and body composition and biochemical indicators and the validity of the three methods. A total of 63 patients, 41 males and 22 females, were screened and eligible for enrollment, and the validity of RASM and ASMI was analyzed using L3 SMI as the diagnostic criteria: the sensitivity of RASM and ASMI were 66.67% and 13.33%, respectively, and the specificity was 70.83% and 39.58%, respectively, and the AUC of ROC was 0.736 (p<0.05), 0.264 (p<0.05). In this study, L3 SMI was used as the diagnostic criterion and after calculating and comparing the valid parameters of RASM and ASMI, RASM was recommended as the assessment criterion for skeletal muscle mass in Chinese lung cancer patients.

The Optimal Strategy of Vitamin D for Sarcopenia: A Network Meta-Analysis of Randomized Controlled Trials.

Sarcopenia is a disease of gradual loss of muscle mass in elderly people, and the most common treatment options include nutritional supplementation and exercise. Vitamin D has potential beneficial effects for skeletal muscle tissue and has often been included in nutritional therapy formulations. However, the therapeutic effect of vitamin D for the treatment of sarcopenia has not yet been determine and there is a lack of high-quality supporting evidence. We searched three databases for randomized controlled trials (RCTs) on this topic. Changes in hand grip strength, gait speed, chair-stand test, fat mass, relative skeletal muscle index, and muscle mass were assessed for analysis. Network meta-analysis was further employed, based on the frequentist approach. Outcomes were reported as weighted mean differences (WMD) with 95% confidence intervals (CIs). A total of 9 RCTs (n = 1420) met our eligibility criteria, which treated patients with vitamin D (D), protein (P, n = 165), exercise (E, n = 124), iso-caloric product (I, n = 226), usual care without nutritional supplement (n = 65), P + D (n = 467), D + E (n = 72), P + E (n = 69), D + E + I (n = 73), and P + D + E (n = 159). The pooled estimate showed that the P + D + E intervention induced a greater improvement in hand grip strength than iso-caloric product intervention (WMD = 3.86; 95%CI, 0.52–7.21). Vitamin D intervention could lead to shorter chair-stand time (WMD = −1.32; 95%CI, −1.98 to −0.65), but no significant findings could be found for gait speed and muscle mass outcomes. Our synthesis found that combining vitamin D supplementation with protein supplementation and exercise can significantly increase grip strength and also showed a trend toward increasing muscle mass. This result implies that adding vitamin D to a standard treatment protocol for sarcopenia may be helpful for regaining function.

Changes in body weight and metabolic risk during time restricted feeding in premenopausal versus postmenopausal women.

Time restricted feeding (TRF) involves confining the eating window to a specific number of hours, and fasting for the remaining hours of the day. This study examined if changes in body weight and metabolic risk factors during TRF, differ between premenopausal and postmenopausal women. This is a secondary analysis of an 8-week TRF study (4-6h eating window, 18-20h fasting window daily) conducted in adults with obesity. Male participants were excluded, and female subjects were classified in two groups based on menstrual status: premenopausal (n=13), or postmenopausal (n=19). Perimenopausal women were excluded from the original study. Body weight decreased by week 8 in premenopausal women (-3.3±0.4%) and postmenopausal women (-3.3±0.5%) (main effect of time, P<0.001), with no difference between groups (no group×time interaction). Adherence was excellent in both groups, with premenopausal women adhering to their prescribed eating window on 6.2±0.1d/week, and postmenopausal women adhering to their window on 6.2±0.2d/week. Fat mass, lean mass, fasting insulin, insulin resistance, and 8-isoprostane (marker of oxidative stress) were reduced similarly in both groups (main effect of time, P<0.05 for all comparisons). Visceral fat mass, relative skeletal muscle index (RSMI), blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, fasting glucose, HbA1c, TNF-alpha and IL-6 remained unchanged in both groups by week 8. These findings suggest that the weight loss and metabolic benefits of TRF do not differ between premenopausal and postmenopausal women with obesity.

Normal bone health in young adults with 21-hydroxylase enzyme deficiency undergoing glucocorticoid replacement therapy.

To compare regional bone mineral densities (BMDs) and bone statuses of young adults with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase enzyme (21OHase) deficiency with a control group. The duration and dose of glucocorticoid therapy and relative skeletal muscle index (an indicator of sarcopenia) were also analyzed as parameters to predict bone health. This case-control study included 23 patients (7 male and 16 female) and 20 controls (8 male and 12 female) matched by age range (18 to 31years). Dual energy X-ray absorptiometry and phalangeal quantitative ultrasound (QUS) were used to estimate BMD and bone status, respectively. No difference was observed between patients and controls (of both sexes) in absolute values of BMD and Z-scores for the total body, lumbar spine, and femoral neck; or the bone status (estimated by phalangeal QUS). Multiple linear regression analysis demonstrated that relative skeletal muscle index independently correlated with BMD of the entire body (β: 0.67, P = 0.007), the lumbar spine (β: 0.73, P = 0.005), and the femoral neck (β: 0.67, P = 0.007). However, the dose of glucocorticoids (β: - 0.38, P = 0.028) independently correlated with BMD in the femoral neck region alone. No signs of change in bone health were observed in patients with CAH when compared to the reference group. Additionally, a marker of sarcopenia was demonstrated to have a role in mineral density mechanisms in all analyzed bone sites. Only the femoral neck BMD seemed to be significantly dependent on glucocorticoid dose.

Osteosarcopenia in Very Old Age Adults After Hip Fracture: A Real-World Therapeutic Standpoint.

Loss of bone and muscle mass and strength (i. e., osteosarcopenia) is a highly prevalent clinical condition in older adults, associated with an increased risk of fragility fractures and unfavorable clinical outcomes. Although sarcopenia is a potential risk factor for osteoporosis and subsequent fracture, and the management of this hazardous duet is the key to preventing osteoporotic fracture, evidence pertaining to the treatment of sarcopenia for the purpose of preventing fragile fractures remains insufficient. Given this scenario we aimed at prospectively compare the long-term effectiveness of bisphosphonates vs. denosumab, on bone and muscle, in a cohort of old age hip fractured patients by virtue of a timely osteo-metabolic and sarcopenic assessment. Ninety-eight patients consecutively enrolled at the IRCCS Hospital San martino, Genoa, Italy, received at baseline comprehensive geriatric assessment and Bone Densitometry (DXA) with the quantitative and quantitative bone analysis and evaluation of relative skeletal muscle index (RSMI) and longitudinally after 1 year form hip surgery. The results showed a slightly and non-significant osteo-metabolic improvement in the Alendronate group compared to the Denosumab group, and a positive trend of RSMI measurements in the Denosumab group. Although preliminary in nature, this is the first report to longitudinally analyze osteosarcopenia in a real-world cohort of very old age patients after hip fracture and moved a step forward in the understanding of the best osteo-metabolic therapy for long- term treatment, exploring as well the potential dual role of denousumab as antiresorptive and muscle strength specific drug for osteosarcopenia in this vulnerable population.

Interaction of recommended levels of physical activity and protein intake is associated with greater physical function and lower fat mass in older women: Kuopio Osteoporosis Risk Factor- (OSTPRE) and Fracture-Prevention Study.

The aim of the study was to investigate whether the interaction of physical activity (PA) and protein intake is associated with physical function (PF). The women from the Osteoporosis Risk Factor and Fracture Prevention Study (n 610) completed a questionnaire on lifestyle factors and PA and underwent PF and body composition measurements at baseline (BL) and over 3years of follow-up (3y-FU). PA was categorised according to WHO cut-off PA=0, 0<PA<2·5 and PA≥2·5h/week. Protein intake was calculated from the 3-d food record at baseline and categorised according to the Nordic Nutrition Recommendations <1·1 and ≥1·1g/kg body weight (BW). The results showed in univariate ANOVA at the baseline and at the 3-year follow-up, women with high PA≥2·5h/week and protein intake≥1·1g/kg BW had higher grip strength adjusted for BMI, higher mean number of chair rises, faster mean walking speed, higher modified mean short physical performance battery score and lower mean fat mass compared with other interaction groups. High PA and protein intake were associated with lower BMI despite significantly higher energy intake. In conclusion, higher PA and protein intake interaction was associated with greater PF and lower fat mass, but the association with relative skeletal muscle index and muscle mass was inconclusive. The present study gives noteworthy information for preventing sarcopenia.

1441-P: Correlation of Serum Osteocalcin Levels and Relative Skeletal Muscle Index and Hyperglycaemia in a Cohort of Middle-Aged and Elderly Individuals

Aims: Osteocalcin is involved in energy metabolism and is sufficient to prevent age-related muscle loss. The aim of the present study was to investigate the association of serum osteocalcin levels with muscle mass and the role of metabolic factors in this association. Methods: A total of 1742 middle-aged and elderly subjects (median age: 61.2 years; interquartile range: 56.9-65.3 years) were enrolled from Shanghai communities, including 775 men and 967 postmenopausal women. Serum osteocalcin levels were measured by an electrochemical immunoluminescence assay. An automatic bioelectric impedance analyser (BIA) was used to measure body compositions. Relative skeletal muscle index (SMI) was calculated using the BIA equation from Janssen et al. Results: SMI was significantly higher in men than in postmenopausal women (37.30% [35.14%-39.63%] versus 27.72% [25.99%-29.66%], P &amp;lt; 0.001). Increasing SMI was associated with decreases in the frequency of overweight/obesity, central obesity, dyslipidaemia, elevated blood pressure, and hyperglycaemia (all P &amp;lt; 0.001). Serum osteocalcin levels were positively correlated with SMI in both men and women, regardless of treatment as a categorical or continuous variable (all P &amp;lt; 0.001). However, after accounting for confounding variables, the relationship remained only in men with hyperglycaemia (standardized β = 0.068, P = 0.024). Among men with isolated impaired glucose tolerance, the odds ratio of increased SMI was 2.861 in the fourth osteocalcin quartile compared with the lowest (P = 0.046). Multiple stepwise regression revealed that each standard deviation (SD) increase of serum osteocalcin levels resulted in an increase of 0.131 SD in SMI (P = 0.024). Conclusion: In men with hyperglycaemia, especially in those with isolated impaired glucose tolerance, serum osteocalcin levels were positively correlated to SMI. However, no association was detected in postmenopausal women. Disclosure Y. Xu: None. X. Ma: None. Y. Shen: None. C. Gu: None. J. Tang: None. Y. Bao: None.

Role of hyperglycaemia in the relationship between serum osteocalcin levels and relative skeletal muscle index

Studies have shown that osteocalcin is involved in energy metabolism and is sufficient to prevent age-related muscle loss. The present study investigated the association of serum osteocalcin levels with muscle mass and the influence of metabolic factors on this association in humans. A total of 1742 middle-aged and elderly subjects (median age: 61.2 years; interquartile range: 56.9-65.3 years) were enrolled from Shanghai communities, including 775 men and 967 postmenopausal women. Serum osteocalcin levels were measured by an electrochemical immunoluminescence assay. An automatic bioelectric impedance analyser (BIA) was used to measure body compositions. Relative skeletal muscle index (SMI) was calculated using the BIA equation from Janssen etal. SMI was significantly higher in men than in postmenopausal women (37.30% [35.14%-39.63%] versus 27.72% [25.99%-29.66%], p<0.001). Increasing SMI was associated with decreases in the frequency of overweight/obesity, central obesity, dyslipidaemia, elevated blood pressure, and hyperglycaemia (all p<0.001). Serum osteocalcin levels were positively correlated with SMI in both men and women, regardless of treatment as a categorical or continuous variable (all p<0.001). However, after accounting for confounding variables, the relationship remained only in men with hyperglycaemia (standardized β=0.068, p=0.024). Among men with isolated impaired glucose tolerance, the odds ratio of increased SMI was 2.861 in the fourth osteocalcin quartile compared with the lowest (p=0.046). Multiple stepwise regression revealed that each standard deviation (SD) increase of serum osteocalcin levels resulted in an increase of 0.131 SD in SMI (p=0.024). Serum osteocalcin levels were positively related to SMI in men with hyperglycaemia, especially in those with isolated impaired glucose tolerance. No association was detected between serum osteocalcin levels and SMI in postmenopausal women.

Effects of ethinyl estradiol-containing oral contraception and other factors on body composition and muscle strength among young healthy females in Finland—A cross-sectional study

Objective: The aim of this cross-sectional study was to determine the association of hormonal contraception and other life-style factors and habits affecting body composition (BC) and muscle strength.Study design: We measured the body composition of 400 healthy Finnish women (aged 20–40 years) using total body dual energy x-ray absorptiometry (TB-DXA) as well as grip strength (GS [kPa]) with a hand-held dynamometer and knee extension strength (KES [kg]) between 2011 and 2014. Investigated body composition variables were appendicular skeletal mass (ASM [kg]), body mass index (BMI [kg/m2]), relative skeletal muscle index (RSMI [ASM/m2]), total lean mass (TLM [kg]), skeletal muscle index (SMI [TLM/weight × 100]) and fat-%. Participants filled out a questionnaire concerning life-style factors and habits: hormonal contraception, physical activity, alcohol consumption, age, pregnancies, smoking and self-assessed health that were also adjusting factors in the covariate model. We investigated the effects of hormonal contraception and other life-style factors and habits on body composition and muscle strength using AN(C)OVA in the analyses.Results: Women using hormonal contraception with the combination of ethinyl estradiol + progestogen had significantly lower mean ASM (18.0), RSMI (6.5), TLM (40.8) (p < 0.01) and GS (34.6) (p < 0.001) compared to the women not using hormonal contraception with mean values of ASM (18.8), RSMI (6.7), TLM (42.6) and GS (36.9). After adjustment ASM (18.3), SMI (64.3), GS (35.2) (p < 0.05), RSMI (6.6) and TLM (41.2) (p < 0.01) were significantly lower and fat-% (31.4) higher (p < 0.05) compared to women not using hormonal contraception with mean values of ASM (19.0), SMI (66.1), GS (36.7), RSMI (6.8), TLM (42.7) and fat-% (29.8).Conclusion: Use of ethinyl estradiol + progestogen-containing hormonal contraception may have negative association with muscle mass and strength.

Assessment of Skeletal Muscle Mass in Older People: Comparison Between 2 Anthropometry-Based Methods and Dual-Energy X-ray Absorptiometry

ObjectivesSarcopenia is a common geriatric syndrome, whose diagnosis implies the assessment of muscle mass. Dual-energy x-ray absorptiometry (DXA) is the reference method for clinical practice, but it is not universally available. We compared DXA with 2 anthropometry-based methods to assess muscle mass in older adults. DesignCross-sectional. SettingAmbulatory patients. Participants148 (87 female and 61 male) white older adults. MeasurementsMid-arm muscle circumference (MAMC), whole skeletal muscle mass estimated by the Lee's formula (eTSMM), and relative skeletal muscle index (RSMI). ResultsMen and women did not differ for MAMC and RSMI, whereas eTSMM was higher (P < .001) in men. MAMC and eTSMM correlated with RSMI, in the whole sample as in men and women separately (P < .001). According to the McNemar test, the frequencies of older men and women with low muscle mass identified by eTSMM did not differ from those detected by RSMI (P = .066) at variance with MAMC. Using EWGSOP (European Working Group on Sarcopenia in Older People) criteria for RSMI as standard reference, the receiver operating characteristic (ROC) curves provided redefined cut-offs of reduced muscle mass: 18.6 cm in women and 22.3 cm in men for MAMC, and 17.7 kg in women and 28.3 kg in men for eTSMM. The areas under the ROC curves (AUCs) for MAMC were 0.882 in women (sensitivity 89%, specificity 84%) and 0.826 in men (sensitivity 94%, specificity 67%). The AUCs for eTSMM were 0.8913 in women (sensitivity 95%, specificity 81%) and 0.878 in men (sensitivity 97%, specificity 67%). No significant difference was found between the ROC curves of MAMC and eTSMM in both sexes. ConclusionTwo simple anthropometric methods, possibly used in every clinical setting, could be valuable screening tools for low muscle mass in older subjects.

Racial Differences in Relative Skeletal Muscle Mass Loss During Diet-Induced Weight Loss in Women.

ObjectiveIt is unclear whether there are race-specific differences in the maintenance of skeletal muscle during energy restriction. We compared changes in relative skeletal muscle index [RSMI (limb lean tissue/height2)] following: 1) diet alone (DIET); 2) diet + aerobic training (DAT) or; 3) diet + resistance training (DRT).MethodsOverweight, sedentary African American (AA; n = 72) and European American (EA; n = 68) women were provided an 800 kcal/day diet to reduce BMI < 25 kg/m2. Regional fat-free mass was measured with DXA. Steady-state VO2 and heart rate responses during walking were measured.ResultsAA women had greater RSMI and preserved RSMI during DIET while RSMI was significantly reduced among EA (EA −3.6% vs. AA +1.1%; p < 0.05). DRT subjects retained RSMI (EA +0.2% vs. AA +1.4%; p=0.05), whereas DAE subjects decreased RSMI (EA −1.4% vs. AA −1.5%; p<0.05). Maintenance of RSMI was related to delta walking ease and economy.ConclusionsCompared to AA, EA women are less muscular and lose more muscle during weight loss without resistance training. During diet-induced weight loss, resistance training preserves skeletal muscle especially among premenopausal EA women. Maintenance of muscle during weight loss associates with better ease and economy of walking.

Alaska Mountain Wilderness Ski Classic: Alterations in Caloric Expenditure and Body Composition

The Alaska Mountain Wilderness Ski Classic is a self-supported ultramarathon cross-country skiing event that traverses one of the mountain ranges of Alaska each winter. Unique aspects of this event challenge athletes with a significant amount of physical and mental stress while in the chronically cold conditions of the Arctic. Assessment of energy requirements or body composition has never been performed during this event. The objective of the study was to evaluate the influence of the 2016 Alaska Mountain Wilderness Ski Classic on caloric expenditure and body composition. Caloric expenditure was estimated using GT3x+ Actigraph accelerometers and ActiLife software. Lean tissue mass, total fat mass, visceral fat mass, and bone mineral density were measured using a General Electric iDXA before and after the event. Data are presented as mean±SD. Differences were analyzed using paired t tests with significance at P<0.05. Fifteen participants (age=32.7±6.6 years, body mass index=23.7±2.3 kg·m2) completed the study, 8 males and 7 females. Caloric expenditure was 6238±1390 kcal·day-1, and 37,163±8425 kcal for the entire event. Fat mass was reduced from pre-event (∆1.3±0.7 kg, P=0.00003). There was an increase in lean tissue mass (∆1.7±1.3 kg, P=0.0003) and relative skeletal muscle index (∆0.2±0.2 kg·m², P=0.001). There was no change in bone mineral density (∆0±0 g·cm3, P=0.4). Despite the metabolic demands, fat mass was reduced and lean tissue mass was preserved. Future studies of this event should be directed toward assessment of the nutritional provisions utilized and the mechanisms responsible for the preservation of lean tissue mass.

The relation between sarcopenia, associated factors, and disease activity in patients with rheumatoid arthritis

Aim The aim of this study was to detect the incidence of sarcopenia in patients with rheumatoid arthritis (RA) and study associated factors. Patients and methods Dual-energy X-ray absorptiometry was used to assess the body composition of 80 patients with RA and 80 healthy controls. Sarcopenia was defined as a relative skeletal muscle index of less than 5.5 kg/m2 in male and less than 7.26 kg/m2 in female patients. BMI, waist circumference, and disease activity score 28 erythrocyte sedimentation rate were used to assess disease activity. Functional disability was measured using Health Assessment Questionnaire, and 4-m gait speed test was used to determine patient's physical performance. Results The relative skeletal muscle index was significantly lower in the RA group (6.1 ± 1.2 vs. 7.2 ± 0.9 kg/m2, P Conclusion Sarcopenia is a common finding in patients with RA but does not have an association with disease activity, functional disability, or physical performance. Future studies are required for better comprehension of sarcopenia to clear up its relationship with different comorbidities.

Association of the Baltic Sea and Mediterranean diets with indices of sarcopenia in elderly women, OSPTRE-FPS study

To examine whether higher adherence to Baltic Sea diet (BSD) and Mediterranean diet (MED) have beneficial association with sarcopenia indices in elderly women. In total 554 women, aged 65-72years belonging to OSTPRE-FPS study answered a questionnaire on lifestyle factors and 3-day food record at baseline in 2002. Food consumptions and nutrient intakes were calculated. Nine components were selected to calculate BSD score. MED score was calculated using eight components. Body composition was measured by dual-energy X-ray absorptiometry. Physical function measures included walking speed 10m, chair rises, one leg stance, knee extension, handgrip strength and squat at baseline and at year 3. Sarcopenia and short physical performance battery (SPPB) score were defined based on the European working group on sarcopenia criteria. Lower body muscle quality (LBMQ) was calculated as walking speed 10m/leg muscle mass. Women in the higher quartiles of BSD and MED scores lost less relative skeletal muscle index and total body lean mass (LM) over 3-year follow-up (P trend≤0.034). At the baseline, women in the higher BSD score quartiles had greater LM, faster walking speed 10m, greater LBMQ, higher SPPB score (P trend≤0.034), and higher proportion of squat test completion. Similarly, women in the higher quartiles of MED sore had significantly faster walking speed 10m, greater LBMQ (P trend≤0.041) and higher proportion of squat test completion. Better diet quality as measured by higher adherence to BSD and MED might reduce the risk of sarcopenia in elderly women.