Sarcopenia In Clinical Practice Research Articles

Sarcopenia evaluated by EASL/AASLD computed tomography-based criteria predicts mortality in patients with cirrhosis: A systematic review and meta-analysis

Background & aimsSarcopenia is associated with increased morbidity and mortality in patients with cirrhosis, but its definition in current literature is very heterogeneous. We performed a systematic review and meta-analysis to assess the association between mortality and sarcopenia evaluated by computed tomography (CT) in patients with cirrhosis, both overall and stratified for the criteria used to define sarcopenia. MethodsMedline, Embase, Scopus, and Cochrane Library were searched up to January 2023. We included studies assessing sarcopenia presence with CT scans and providing data on the risk of mortality. Adjusted hazard ratios (HRs) and 95%-Confidence Interval (CI) were pooled using a random-effect model. ResultsThirty-nine studies comprising 12827 patients were included in the meta-analysis. The summary prevalence of sarcopenia was 44% (95%-CI: 38-50%). The presence of sarcopenia (any definition) was an independent predictor of mortality with an adjusted HR of 2.07 (95%-CI: 1.81-2.36), and the result was consistent in all subgroup analyses. The prognostic role of the EASL/AASLD criteria was confirmed for the first time with an HR of 1.86 (95%-CI: 1.53-2.26) (n=14 studies). The cut-offs used to define sarcopenia based on psoas muscle parameters varied among studies, thus, a subgroup analysis was not feasible. There was no substantial heterogeneity for the main estimates and no significant risk for publication bias. ConclusionsSarcopenia at CT is associated with a 2-fold higher risk of mortality in patients with cirrhosis. The cut-offs proposed by EASL/AASLD are prognostically relevant and should be the recommended criteria used to define sarcopenia in clinical practice. Impact and implicationsSarcopenia assessed by the reference standard (CT scan) is an independent predictor of mortality in patients with cirrhosis, with a 2-fold increase in the risk of death in all sensitivity analyses. This finding is particularly valid in patients from Europe and North America, and in transplantation candidates. Stratifying for definitions and cut-offs used, we confirmed for the first time the prognostic impact of the definition proposed by EASL/AASLD, supporting their use in clinical practice. Psoas muscle assessment is promising, but data are still limited and too heterogeneous to recommend its routine use at the time.

Obstacles to the Early Diagnosis and Management of Sarcopenia: Current Perspectives.

Research in sarcopenia has grown exponentially over the last 15 years in geriatrics and gerontology, as well as other specialties, including oncology and hepatology. There is now strong evidence for the role of resistance exercise to prevent declines in muscle strength and function, especially when combined with nutritional optimization with protein supplementation. However, there remains a disparity between research evidence and clinical practice. There are multiple factors for this, which relate to the current diagnostic criteria for sarcopenia, practical and logistical aspects of diagnosis of sarcopenia, clinician knowledge of both diagnosis and management, and the availability of pathways for interventions. Sarcopenia is currently defined based on the identification of muscle strength, in combination with muscle size or quality, below cut-off thresholds at a single timepoint. This defines sarcopenia as a binary process of either present or not present, thus early diagnosis can be challenging. In this article, we summarize current obstacles to early diagnosis and management of sarcopenia in clinical practice, and make recommendations to how these might be overcome. This includes our recommendation of incorporation of handgrip strength measurement into standard care, to enable dynamic assessment and identification of early declines in handgrip strength, so that interventions can be implemented to prevent disability.

An experimental study for quantitative assessment of fatty infiltration and blood flow perfusion in quadriceps muscle of rats using IDEAL-IQ and BOLD-MRI for early diagnosis of sarcopenia

BackgroundSevere sarcopenia may result in severe disability. Early diagnosis is currently the key to enhancing the treatment of sarcopenia, and there is an urgent need for a highly sensitive and dependable tool to evaluate the course of early sarcopenia in clinical practice. This study aims to investigate longitudinally the early diagnosability of magnetic resonance imaging (MRI)-based fat infiltration and blood flow perfusion technology in sarcopenia progression. Methods48 Sprague-Dawley rats were randomly assigned into six groups that were based on different periods of dexamethasone (DEX) injection (0, 2, 4, 6, 8, 10 days). Multimodal MRI was scanned to assess muscle mass. Grip strength and swimming exhaustion time of rats were measured to assess muscle strength and function. Immunofluorescence staining for CD31 was employed to assess skeletal muscle capillary formation, and western blot was used to detect vascular endothelial growth factor-A (VEGF-A) and muscle ring finger-1 (MuRF-1) protein expression. Subsequently, we analyzed the correlation between imaging and histopathologic parameters. A receiver operating characteristic (ROC) analysis was conducted to assess the effectiveness of quantitative MRI parameters for discriminating diagnosis in both pre- and post-modeling of DEX-induced sarcopenic rats. ResultsSignificant differences were found in PDFF, R2* and T2 values on day 2 of DEX-induction compared to the control group, occurring prior to the MRI-CSA values and limb grip strength on day 6 of induction and swimming exhaustion time on day 8 of induction. There is a strong correlation between MRI-CSA with HE-CSA values (r = 0.67; p < 0.001), oil red O (ORO) area with PDFF (r = 0.67; p < 0.001), microvascular density (MVD) (r = −0.79; p < 0.001) and VEGF-A (r = −0.73; p < 0.001) with R2*, MuRF-1 with MRI-CSA (r = −0.82; p < 0.001). The AUC of PDFF, R2*, and T2 values used for modeling evaluation are 0.81, 0.93, and 0.98, respectively. ConclusionImaging parameters PDFF, R2*, and T2 can be used to sensitively evaluate early pathological changes in sarcopenia. The successful construction of a sarcopenia rat model can be assessed when PDFF exceeds 1.25, R2* exceeds 53.85, and T2 exceeds 33.88.

Role of computed tomography in sarcopenia detection

The study aimed to summarize the available data on the role of computed tomography in sarcopenia detection in cancer patients. Material and Methods. A literature search was conducted in the Medline, Scopus, Pubmed, and Elibrary systems. More than 100 articles published in 2008-2022 were analyzed. We included 45 articles in this review. Results. According to the European Consensus, sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength due to age-related, neurohumoral changes, malnutrition or muscle catabolism. It is difficult to overestimate the importance of sarcopenia, since this syndrome is one of the five main risk factors for morbidity and mortality in people over 65 years of age. Sarcopenia is mainly observed in inflammatory diseases, malignancy or organ failure. According to most researchers, CT is considered the gold standard method to assess muscle mass and quality. It is a reliable method for quantitative analysis, which was shown in a study based on the comparison of quantitative assessment of various muscle groups based on CT with muscle volume measured on cadaveric tissues. The purpose of this literature review was to highlight the importance of computed tomography for the detection of sarcopenia in clinical practice. Based on the results of the literature analysis, sarcopenia is still a challenge for modern oncology. Sarcopenia negatively affects the prognosis of the disease and quality of life of cancer patients. Sarcopenia may develop due to metabolic changes caused by cancer treatment, as a result of which the degradation of muscle protein begins to prevail over its synthesis. Conclusion. Given the high prevalence and prognostic significance of sarcopenia in oncology, the need for its early diagnosis and active treatment becomes obvious. The use of routine CT examinations for the diagnosis of sarcopenia will allow us to search for possible causes and optimize treatment, determine the likelihood of risks and determine the treatment strategy at an early stage, when therapy can be most effective.

Soluble interleukin 2 receptor is risk for sarcopenia in Men with high fracture risk.

Sarcopenia is an age-related disease that increases the risk of falls and fractures in older adults. However, there is no blood biochemical marker to help to predict or diagnose sarcopenia in clinical practice. Soluble interleukin 2 receptor (sIL-2R) was reported to be associated with muscle satellite cell dysfunction which played an important role in the pathogenesis of sarcopenia. Thereby, we aimed to explore the association between serum sIL-2R and sarcopenia in older adults at high risk of fractures. A total of 429 hospitalized older adults (age ≥55 years) were enrolled in this cross-sectional study (mean age​=​66.62​±​6.59 years; 62.7% female). Logistic regression analysis was performed to assess the association of sIL-2R with sarcopenia, muscle mass, muscle strength, and physical performance, respectively. The optimal models for the diagnosis of sarcopenia and low hand grip strength (HGS) were established by multivariable binary logistic regression analysis with backward selection, and further were evaluated for the diagnostic values by receiver operating characteristic (ROC) curve. Higher sIL-2R levels were found in sarcopenia than no-sarcopenia group in male (median 421 U/mL (interquartile range [IQR] 217 U/mL) vs median 362 U/mL (IQR 157 U/mL); n​=​77 vs 83; p​<​0.01). Compared to the lowest sIL-2R tertile, the highest tertile of sIL-2R was independently associated with the risk of low HGS (odds ratio [OR] 4.608, 95% confidence interval [CI] 1.673-12.695) and the risk of sarcopenia (OR 3.306, 95% CI 1.496-7.302) in men. ROC curves revealed that the Area Under the Curve (AUC) of the optimal models for diagnosing sarcopenia and low HGS was 0.752 and 0.846. Our results suggest that serum sIL-2R is the independent risk factor for sarcopenia and low muscle strength only in men. sIL-2R may be developed to be a biochemical marker for sarcopenia and low muscle strength diagnoses in older men at high risk of fractures, but more prospective studies are needed to prove it. Our results showed that the highest tertile of sIL-2R was independent of low risk of HGS and sarcopenia in men, compared to the lowest tertile. As the population ages, sIL-2R may become a potential diagnostic tool for predicting low HGS and sarcopenia among men at high risk of fractures.

Translation and validation of the Taiwanese SarQoL, a quality of life questionnaire specific to sarcopenia

The Sarcopenia Quality of Life (SarQoL) questionnaire has been translated into various languages. This study validated the Taiwanese version of the SarQoL (SarQoL-TW) questionnaire. Forward-backward translation was conducted, along with a test of the prefinal version of the translated questionnaire. To validate the psychometric properties of the questionnaire, 50 older adults with sarcopenia and 50 older adults without sarcopenia completed the SarQoL-TW, the Short Form12 Health Survey (SF-12), and the EQ-5D-3L questionnaire. Participants with sarcopenia were asked to complete the SarQoL-TW questionnaire once more after 2 weeks. Validating the psychometric properties of the SarQoL-TW questionnaire involved assessing its discriminative power, internal consistency, construct validity, test-retest reliability, and potential floor and ceiling effects. The SarQoL-TW questionnaire was translated without major difficulties. The psychometric analysis revealed that older adults with sarcopenia scored significantly lower on the SarQoL-TW, both overall and in some of the domains. The Cronbach's alpha of 0.846 indicated high internal consistency. The SarQoL-TW questionnaire correlated well with similar constructs on the SF-12 and EQ-5D-3L for convergent validity and correlated weakly with distinct domains for divergent validity, confirming its favorable construct validity. The test-retest reliability was excellent (intraclass correlation coefficient: 0.970). Neither floor nor ceiling effects were observed. The SarQoL-TW questionnaire is a reliable and valid questionnaire, useful for assessing quality of life in older adults with sarcopenia in clinical practice and research.

SarQoL Questionnaire in Community-Dwelling Older Adults under EWGSOP2 Sarcopenia Diagnosis Algorithm: A New Screening Method?

This article is an observational and cross-sectional study that related the result obtained in the questionnaire for the evaluation of quality of life related to muscle mass (SarQoL) and the prevalence of sarcopenic pathology measured under the EWGSOP2 algorithm. Participants were 202 community-dwelling older adults living in Valencia, Spain. The prevalence of sarcopenia in men was 28.9%, while in women it was 26.2%. In the case of the SarQoL questionnaire, the mean score obtained for men was 75.5 and 72.6 for women, showing significant differences in both sexes between the results obtained by the group with and without sarcopenia. After the exhaustive data analysis, a high discriminative capacity for sarcopenic disease was found in the SarQoL questionnaire total score and in domains 2 (locomotion), 4 (functionality) and 5 (activities of daily living). In accordance with the existing controversy regarding the use of SARC-F as a screening method for sarcopenia, the authors pointed out the capacity of domain 2 (locomotion) in isolation as a possible screening method for this disease, exposing a high risk of suffering sarcopenia when scores in this domain were below 60 points. Further research is needed to develop new lines of research as these showed in this work, as well as new and easily applicable screening methods for sarcopenia in clinical practice, that allow a rapid detection of this disease in the community.

The Value of Artificial Intelligence-Assisted Imaging in Identifying Diagnostic Markers of Sarcopenia in Patients with Cancer.

Sarcopenia is defined as the loss of skeletal muscle mass and muscle function. It is common in patients with malignancies and often associated with adverse clinical outcomes. The presence of sarcopenia in patients with cancer is determined by body composition, and recently, radiologic technology for the accurate estimation of body composition is under development. Artificial intelligence- (AI-) assisted image measurement facilitates the detection of sarcopenia in clinical practice. Sarcopenia is a prognostic factor for patients with cancer, and confirming its presence helps to recognize those patients at the greatest risk, which provides a guide for designing individualized cancer treatments. In this review, we examine the recent literature (2017-2021) on AI-assisted image assessment of body composition and sarcopenia, seeking to synthesize current information on the mechanism and the importance of sarcopenia, its diagnostic image markers, and the interventions for sarcopenia in the medical care of patients with cancer. We concluded that AI-assisted image analysis is a reliable automatic technique for segmentation of abdominal adipose tissue. It has the potential to improve diagnosis of sarcopenia and facilitates identification of oncology patients at the greatest risk, supporting individualized prevention planning and treatment evaluation. The capability of AI approaches in analyzing series of big data and extracting features beyond manual skills would no doubt progressively provide impactful information and greatly refine the standard for assessing sarcopenia risk in patients with cancer.

Effect of position and exercise on measurement of muscle quantity and quality: towards a standardised pragmatic protocol for clinical practice

BackgroundUltrasonography is an emerging non-invasive bedside tool for muscle quantity/quality assessment; Bioelectrical Impedance Analysis (BIA) is an alternative non-invasive bedside measure of body composition, recommended for evaluation of sarcopenia in clinical practice. We set out to assess impact of position and exercise upon measures towards protocol standardisation.MethodsHealthy volunteers aged 18–35 were recruited. Bilateral Anterior Thigh Thickness (BATT; rectus femoris and vastus intermedius), BATT: Subcutaneous Ratio (BATT:SCR), and rectus femoris echogenicity were measured using ultrasound and BIA was performed; 1) lying with upper body at 45° (Reclined), 2) lying fully supine at 180o (Supine), 3) sat in a chair with upper body at 90o (Sitting), and 4) after exercise Reclined. Variability of Skeletal Muscle Mass (SMM) by two different equations from BIA (SMM-Janssen, SMM-Sergi), phase angle, fat percentage, and total body (TBW), extracellular (ECW), and intracellular water (ICW) were assessed.ResultsForty-four participants (52% female; mean 25.7 years-old (SD 5.0)) were recruited. BATT increased from Reclined to Sitting (+ 1.45 cm, 1.27–1.63), and after exercise (+ 0.51, 0.29–0.73). Echogenicity reduced from Reclined to Sitting (− 2.1, − 3.9 – -0.26). SMM-Sergi declined from Reclined to Supine (− 0.65 kg, − 1.08 – − 0.23) and after exercise (− 0.70 kg, − 1.27 – -0.14). ECW increased from Reclined to Sitting (+ 1.19 L, 0.04–2.35). There were no other statistically significant changes.ConclusionStandardisation of protocols is especially important for assessment of muscle quantity by ultrasonography; BIA measurements may also vary dependent on the equations used. Where possible, participants should be rested prior to muscle ultrasonography and BIA, and flexion of the knees should be avoided.

Imaging of sarcopenia: old evidence and new insights.

To date, sarcopenia is considered a patient-specific imaging biomarker able to predict clinical outcomes. Several imaging modalities, including dual-energy X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance (MR), and ultrasound (US), can be used to assess muscle mass and quality and to achieve the diagnosis of sarcopenia. With different extent, all these modalities can provide quantitative data, being thus reproducible and comparable over time. DXA is the one most commonly used in clinical practice, with the advantages of being accurate and widely available, and also being the only radiological tool with accepted cutoff values to diagnose sarcopenia. CT and MR are considered the reference standards, allowing the evaluation of muscle quality and fatty infiltration, but their application is so far mostly limited to research. US has been always regarded as a minor tool in sarcopenia and has never gained enough space. To date, CT is probably the easiest and most promising modality, although limited by the long time needed for muscle segmentation. Also, the absence of validated thresholds for CT measurements of myosteatosis requires that future studies should focus on this point. Radiologists have the great potential of becoming pivotal in the context of sarcopenia. We highly master imaging modalities and know perfectly how to apply them to different organs and clinical scenarios. Similarly, radiologists should master the culture of sarcopenia, and its clinical aspects and relevant implications for patient care. The medical and scientific radiological community should promote specific educational course to spread awareness among professionals. KEY POINTS: • DXA is an accurate, reproducible, and widely available imaging modality to evaluate body composition, being the most commonly used radiological tool to diagnose sarcopenia in clinical practice • CT and MR are the gold standard imaging modalities to assess muscle mass and quality, but no clear cutoff values have been reported to identify sarcopenia, limiting the application of these modalities to research purposes • US has shown to be accurate in the evaluation of muscle trophism, especially in the thigh, but its current application in sarcopenia is limited.

172 Sarcopenia, Frailty and Malnutrition in the Older Adults in the Emergency Department Setting

Abstract Background The physical phenotype of frailty shows significant overlap with sarcopenia, and sarcopenia phenotype is associated with malnutrition. Integrating screening of these interrelated conditions, could help identify those most vulnerable in the Emergency Department (ED) setting. Methods Patients ≥75 were screened in the Emergency department (ED) by an interdisciplinary Gerontological ED team using a standardised assessment tool, incorporating the Clinical Frailty Scale (CFS) and the mini-nutritional assessment short form (MNA-SF). Patients at risk of malnutrition ( MNA-SF &lt;12) were referred for Dietetics assessment and screened for sarcopenia, using the European Working Group on Sarcopenia in Older People (EWGSOP2) algorithm for case finding, followed by grip strength and calf muscle measurement. Results In a convenience sample of patients referred to dietetics following initial screen in ED, 57% were female (25/44) and the mean age was 83 years (range 75-94). Eighty-eight percent (39/44) were at risk of malnutrition/malnourished and 25% (11/44) were diagnosed with malnutrition (MNA-SF score 0-7). Seventy-three percent (32/44) scored ≥4 on the CFS. Fifty-two percent of all patients (23/44) had a Sarc-F ≥ 4, suggestive of sarcopenia, while 45% (20/44) had a probable diagnosis of sarcopenia and 39% (17/44) met diagnostic criteria for sarcopenia. Risk of malnutrition was more commonly observed in those patients with a CFS score ≥4 (94% vs. 75%), as was risk of sarcopenia (81% vs. 17%). Fifty percent (22/44) of all patients screened positive for suspicion of both frailty and sarcopenia (frailty score≥4 and Sarc-F score≥4). Patients with a probable diagnosis of sarcopenia and concomitant frailty had more ED attendances, falls and longer lengths of stay. Conclusion Frailty, malnutrition and sarcopenia are frequently observed in older patients in the acute setting. The integration of screening measures for malnutrition, frailty and sarcopenia in clinical practice can facilitate the identification of patients for multi-component targeted interventions.

Sarcopenia: an overview and analysis of molecular mechanisms

Healthy aging is the individual’s possibility of maintaining the functional ability that enables well-being in older age, along with the maintenance of independence, a crucial factor for ensuring health and quality of life in older people. Loss of muscle mass, strength, and function are relevant threats to independent living and progressively occur with senescence and aging, worsening physical performance, and thus characterizing sarcopenia. Identifying sarcopenia in clinical practice is essential for the early onset of treatment minimizing its impacts and thus improving the patient’s quality of life. The purpose of this work was to conduct a literature review of the pathophysiological and molecular mechanisms underlying muscle changes during aging, highlighting the role of oxidative stress, cytokines, and inflammation, as well as strategies to prevent and treat age-related muscle alterations.

A 3-Item SARC-F

ObjectivesTo examine individual items of the SARC-F in predicting adverse outcomes. DesignProspective cohort study. SettingCommunity-dwelling older people in Hong Kong SAR China. ParticipantsA total of 4000 men and women aged 65 years and over, stratified in 3 age groups (65–69, 70–74, 75+ years of age). MeasurementsInformation was collected by questionnaire, on sociodemographic details, lifestyle habits, cognitive function using the Mini-Mental State Examination, depression using the Geriatric Depression Scale, SARC-F, and physical limitation in daily activities. Physical performance measures include chair stand and walking speed. Adverse outcomes included physical limitation, lower limb strength using repeated chair stands, slow walking speed, length of hospital stay, and mortality. Predictive ability of each item of the SARC-F was assessed using receiver operating characteristic curve. Stepwise model was used to assess incremental predictive ability. ResultsThe overall ranking of the questions in order of highest predictability in terms of area under the curve values were strength, climb stairs, assistance in walking, rise from a chair, and falls. The first 3 questions individually predicted all the adverse outcomes, and in stepwise models of the individual questions, a combination of these 3 questions gave the highest area under the curve values. ConclusionsThe 5-item SARC-F may be shortened to 3 items (strength, climb stairs, and assistance in walking) in rapid screening for sarcopenia in clinical practice.

Potential early biomarkers of sarcopenia among independent older adults

ObjectivesThere are no tools or biomarkers for a quantitative analysis of sarcopenia. Study designCross-sectional study of the diagnosis of sarcopenia in 200 independent adults aged 70 years or over. Main outcome measuresSarcopenia was defined as loss of muscle mass together with low strength and/or loss of physical performance. We considered different clinical parameters and assayed potential blood biomarkers (cell energetic metabolism, muscle performance, inflammation, infection and oxidative stress). ResultsThe prevalence of sarcopenia was 35.3% in women and 13.1% in men, and it was significantly associated with advanced age, a low functional performance in the lower extremities, deficient weekly consumption of kilocalories, risk of malnutrition, and drug use for the digestive system. A close relationship was found between sarcopenia, pre-frailty and depressed mood. With these confounding variables, we observed that products of lipid peroxidation were closely associated with sarcopenia in independent older adults (frail participants and those with severe dependence had been excluded from the sample). The best multivariate model proposed was able to predict 67.6% of the variance in sarcopenia, with a power of discrimination of 93.5%. Additional analyses considering lipid levels, fat mass, dyslipidemia, use of lipid-lowering drugs and hypertension confirmed this close association between lipid peroxidation and sarcopenia. ConclusionsGiven the difficulty in the diagnosis of sarcopenia in clinical practice, we suggest the use of blood circulating products of lipid peroxidation as potential biomarkers for an early diagnosis of sarcopenia in independent older adults.

Treating sarcopenia in clinical practice: where are we now?

Sarcopenia – or the loss of muscle mass, strength and function with ageing – represents an important health issue of the twenty-first century because of its devastating effects in addition to an increased prevalence of aged people. The devastating health effects of sarcopenia are multiple: an increased falls risk, a decreased physical ability and quality of life and an independent increase of all-cause mortality. Although the ultimate remedy for sarcopenia yet has to be found, some interventions have proven their merit and might be of practical use in clinical practice, especially for geriatricians, who deal most with sarcopenia. This review intends to summarize the current therapeutic interventions, their proposed mechanism of action as well as their clinical value. The results of our review highlight the importance of exercise (50% resistance training, 50% endurance training), nutrition (25–30 g proteins with essential amino acids every meal and long-chain ω-3 fatty acids) and limitation of alcohol and smoking. In addition, studies also suggest a place for vitamin D (aim serum levels >30 ng/L), testosterone (aim serum levels >300 ng/dL) and creatine (15–20 g/d for five days, thereafter 3–5 g/d). In conclusion, although more studies are needed to elucidate the exact effectiveness and safety of many sarcopenia interventions, the current evidence already provides clinically useful information, which might benefit the patient with (pre-)sarcopenia.