Sarcopenia In Patients Research Articles

Sarcopenia and COVID-19: A Manifold Insight on Hypertension and the Renin Angiotensin System.

Sarcopenia and COVID-19: A Manifold Insight on Hypertension and the Renin Angiotensin System.

Comparative Analysis on the Effects of Sarcopenia following Primary Total Knee Arthroplasty: A Retrospective Matched-Control Analysis.

Despite the high incidence of sarcopenia in the orthopaedic community, studies evaluating the influence of sarcopenia following primary total knee arthroplasty (TKA) are limited. Therefore, the purpose of this study is to determine if sarcopenic patients undergoing primary TKA have higher rates of (1) in-hospital lengths of stay (LOS); (2) medical complications; (3) implant-related complications; (4) fall risk; (5) lower extremity fracture risk; and (6) costs of care. Sarcopenia patients were matched to controls in a 1:5 ratio according to age, sex, and medical comorbidities. The query yielded 90,438 patients with (n = 15,073) and without (n = 75,365) sarcopenia undergoing primary TKA. Primary outcomes analyzed included: in-hospital LOS, 90-day medical complications, 2-year implant-related complications, fall risk, lower extremity fracture risk, and costs of care. A p-value of less than 0.05 was considered statistically significant. Patients with sarcopenia undergoing primary TKA had greater in-hospital LOS (4 vs. 3 days, p < 0.0001). Sarcopenic patients were also found to have increased incidence and odds of 90-day medical complications (2.9 vs. 1.1%; odds ratio [OR] = 2.83, p < 0.0001), falls (0.9 vs. 0.3%; OR = 3.54, p < 0.0001), lower extremity fractures (1.0 vs. 0.2%; OR = 5.54, p < 0.0001), and reoperation (0.9 vs. 0.5%; OR = 1.87, p < 0.0001). Additionally, sarcopenic patients had greater 2-year implant-related complications (4.3 vs. 2.4%; OR = 1.80, p < 0.0001), as well as day of surgery ($52,900 vs. 48,248, p < 0.0001), and 90-day ($68,303 vs. $57,671, p < 0.0001) costs compared with controls. This analysis of over 90,000 patients demonstrates that patients with sarcopenia undergoing primary TKA have greater in-hospital LOS, increased odds of 90-day medical complications, falls, lower extremity fractures, and reoperations. Additionally, sarcopenia was associated with greater 2-year implant-related complications, day of surgery costs, and 90-day costs. The study is useful as it can allow orthopaedic surgeons to properly educate these patients of the potential complications which may occur following their surgery.

1530-P: Metabolic Characteristics in Chinese Sarcopenia Patients with Type 2 Diabetes

Objective: To evaluate glucose metabolism characteristics in middle-aged and elderly sarcopenia patients with type 2 diabetes. Methods: Data were collected from a multicenter, cross-sectional survey study. Eligible patients aged 50 years or older with a previous diagnosis of type 2 diabetes were recruited from the endocrinology department of nine different hospitals in Beijing, China. All participants were grouped into a probable sarcopenia group with low muscle strength and a nonsarcopenia group with normal muscle strength according to the recommendations from EWGSOP2 (2018). Body composition, glucose metabolism, laboratory and nutritional index were compared between two groups. Results: A total of 1125 diabetic participants were included, with 405 in probable sarcopenia group and 720 in nonsarcopenia control group. Compared to the controls, the probable sarcopenia participants were older and had lower waist-to-hip ratio and BMI, higher fasting plasma glucose level and glycosylated hemoglobin (HbA1c), decreased estimated glomerular filtration rate, and lower bone mineral content, basal metabolic rate, fatless upper arm circumference, appendicular skeletal muscle mass index (ASMI) and muscle quality in both men and women. The prevalence of low muscle mass was obviously elevated in probable sarcopenia group in both sexes (men: 11.0% vs. 25.4%, women: 6.8% vs. 19.1%). Multivariable logistic regression analysis showed that aged, male sex, low BMI, increased HbA1c, diabetic nephropathy and decreased serum albumin level were risk factors associated with low muscle strength in diabetes patients. Conclusions: Sarcopenic diabetic patients were older and had lower BMI, worse nutritional status and glucose metabolism, decreased renal function and reduced muscle quality and mass with a greater likelihood of osteoporosis. Clinically, diabetic aged patients should receive an assessment on muscle strength and muscle quality to optimize their treatment program. Disclosure Q. He: None. L. Guo: None.

Stroke Sarcopenia Patients Cause Weakness and Atrophy in the Knee and Ankle Joints

Abstract Objectives Chronic stroke survivors tend to be inactive, often with sarcopenia, and have decreased physical function and activities of daily living. Muscle atrophy and weakness differ between sarcopenia patients and stroke patients. Therefore, it is difficult to evaluate physiotherapy and intervention for sarcopenic patients with stroke. The purpose of this study was to identify muscles that cause muscle weakness and muscle atrophy in stroke sarcopenia patients. Methods The subjects were 117 chronic stroke survivors who were 65 years or older. Subjects were determined using the criteria of the Asian Working Group on Sarcopenia in 2019 to determine the presence of sarcopenia and were classified into sarcopenia group (SG, n = 60) and non sarcopenia group (nSG, n = 57). Atrophy assessments obtained unaffected lower limb muscle thickness (iliopsoas, gluteus maximus, gluteus medius, hamstrings, quadriceps femoris, tibialis anterior, triceps surae) using B-mode of transverse ultrasound imaging. Strength assessments obtained unaffected lower limb muscle strength (flexion, extension, abduction, adduction, external rotation and internal rotation of hip joint, flexion and extension of knee joint, planter flexion and dorsiflexion of ankle joint) using handheld dynamometer. We conducted a Student's t-test to compare the two groups. A P-value of &amp;lt;0.05 was considered to show statistical significance for all analyses. When the significance level is less than 0.05, the power is also calculated, and it is considered that the significant difference can be secured when P &amp;lt; 0.05 and power &amp;gt;0.8. We conducted with the approval of the ethics committee of Aichi Saiseikai Rehabilitation Hospital (201,908). Results SG had muscle atrophy in all muscles compared to nSG (P &amp;lt; 0.05, power &amp;gt;0.8). SG had muscle weakness in all joint direction compared to nSG (P &amp;lt; 0.05, power &amp;gt;0.8). In particular, extension of knee joint and planter flexion of ankle joint muscle weakness, quadriceps femoris and triceps surae muscle atrophy occurred (P &amp;lt; 0.01, power &amp;gt;0.8). Conclusions Assessment and intervention of skeletal muscle in stroke sarcopenia patients should focus on the knee joint and ankle joint. Funding Sources The authors declare no conflicts of interest associated with this manuscript.

Muscle strength and physical performance, rather than muscle mass, correlate with mortality in end-stage liver disease.

Sarcopenia is characterized by the loss of skeletal muscle mass, strength and performance. The study aimed to provide cut off values of various Sarcopenia parameters [computerized tomography skeletal muscle index (SMI), handgrip strength (HGS), gait velocity and chair stand] to predict mortality in end-stage liver disease (ESLD). The inclusion criteria were age 18-75 years, model for end-stage liver disease > 15. All patients with advanced heart, lung, kidney diseases, active malignancy were excluded from the study. Sarcopenia indices were compared between survivors and non-survivors to find cut off value for prediction of mortality in ESLD patients. One hundred sixty-one subjects suffering from ESLD were enrolled. The cutoff value of the SMI to identify high risk of mortality in sarcopenia patients is ≤21.2 cm2/m2, area under the curve (AUC) 0.537 [95% confidence interval (CI) 0.456-0.616]. The cutoff value of the hand grip strength to identify high-risk mortality is ≤25.3 kilogram-force, AUC 0.682 (95% CI 0.604-0.753). The cutoff value of the gait velocity for the same is as ≤0.84 m/s, AUC 0.551 (95% CI 0.459-0.641). The cutoff value of the chair stand is ≥20.9 seconds, AUC 0.956 (95% CI 0.910-0.983). In the multivariate analysis, HGS, gait velocity and chair stand correlated with mortality. The current study is a comprehensive Asian study that gives the cut off values of Sarcopenia: muscle mass, strength and performance which identify high risk of mortality in ESLD patients. Muscle strength and performance correlated with mortality.

Is postural dysfunction related to sarcopenia? A population-based study.

Postural dysfunction is one of the most common community health symptoms and frequent chief complaints in hospitals. Sarcopenia is a syndrome characterized by degenerative loss of skeletal muscle mass, muscle quality, and muscle strength, and is the main contributor to musculoskeletal impairment in the elderly. Previous studies reported that loss of muscle mass is associated with a loss of diverse functional abilities. Meanwhile, there have been limited studies concerning postural dysfunction among older adults with sarcopenia. Although sarcopenia is primarily a disease of the elderly, its development may be associated with conditions that are not exclusively seen in older persons. Also, recent studies recognize that sarcopenia may begin to develop earlier in life. The objective of this paper was to investigate the association between the prevalence of sarcopenia and postural dysfunction in a wide age range of adults using data from a nationally representative cohort study in Korea. Korean National Health & Nutrition Exhibition Survey V (KNHANES V, 2010–2012) data from the fifth cross-sectional survey of the South Korean population performed by the Korean Ministry of Health and Welfare were used. Appendicular skeletal muscle mass (ASM)/height (ht)2 was used to define sarcopenia, and the Modified Romberg test using a foam pad (“foam balance test”) was performed to evaluate postural dysfunction. ASM/ht2 was lower in women and significantly decreased with age in men. Subjects with sarcopenia were significantly more likely to fail the foam balance test, regardless of sex and age. Regression analysis showed a significant relationship between sarcopenia and postural dysfunction (OR: 2.544, 95% CI: 1.683–3.846, p<0.001). Multivariate regression analysis revealed that sarcopenia (OR: 1.747, 95% CI: 1.120–2.720, p = 0.014) and age (OR: 1.131, 95% CI: 1.105–1.158, p<0.001) are independent risk factors for postural instability. In middle age subjects, the adjusted OR for sarcopenia was 3.344 (95% CI: 1.350–8.285) (p = 0.009). The prevalence of postural dysfunction is higher in sarcopenia patients, independent of sex and age.

Prevalence and Risk Factors Governing the Loss of Muscle Function in Elderly Sarcopenia Patients: A longitudinal Study in China with 4 Years of Follow-Up.

Data regarding the occurrence of risk factors that promote the loss of muscle mass, strength and function in sarcopenia patients in elderly Chinese patients are sparse. Here, we investigated the alterations in muscle mass, function and strength in those with sarcopenia over a 4-year period. We further evaluated the risk factors leading to a loss of grip strength, gait speed and skeletal muscle mass index in sarcopenia patients. A face-to-face cross-sectional survey. The study population consisted of 560 Chinese aged over 59 years. Study recordings took places over a four-year period from 2014. Muscle mass was assessed through bioelectrical impedance analysis (BIA) performed on an Inbody720, Biospace. Hand-grip strength and 6 m walking speed were used as measurements of muscle strength and function. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria (AWGS). In total, 474 of the elderly residents completed the follow-up. The rates of decreased ASMI, grip strength, and gait speed in the sarcopenia patients increased over the 4-year period. Following multivariate analysis, age was identified as the main risk factor for all the observed decrease, gender was specifically related to the loss of ASMI, stroke was a risk factor for gait speed and sarcopenia. A high BMI was a risk factor for a low gait speed but was protective for a loss of skeletal muscle mass and sarcopenia. Age leads to a decline in muscle strength and function. In elderly Chinese patients with sarcopenia, the rates of reduced grip strength, gait-speed and sarcopenia increased. A high BMI was protective against the decline in muscle mass and sarcopenia, but represented a risk factor for low gait speed. Stoke was identified to cause a loss of gait speed in sarcopenia patients.

Sarcopenia and Short-Term Outcomes After Esophagectomy: A Meta-analysis.

This meta-analysis aimed to investigate the value of preoperative sarcopenia in predicting complications after esophagectomy. Clinicopathologic characteristics of sarcopenia patients, which may support sarcopenia management, also were studied. This study searched for articles describing an association between sarcopenia and short-term outcomes after esophagectomy using PubMed, EMBASE, and the Cochrane Library. Mantel-Haenszel and inverse variance models were used for the meta-analyses of end points. The meta-analysis included 14 studies comprising a total of 2387 patients. Sarcopenia was significantly associated with advanced age (weighted mean difference [WMD], 3.48; 95% confidence interval [CI], 2.22-4.74), lower body mass index (WMD - 2.22; 95% CI - 2.65 to - 1.79), squamous cell carcinoma (odds ratio [OR], 2.78; 95% CI 1.72-4.47), advanced clinical tumor stage (OR 1.65; 95% CI 1.28-2.15), and neoadjuvant therapy (OR 1.87; 95% CI 1.38-2.53). The sarcopenia patients showed lower preoperative albumin levels (WMD - 0.11; 95% CI - 0.19 to - 0.04) than the nonsarcopenia patients. Sarcopenia was significantly predictive of pneumonia (OR 2.58; 95% CI 1.75-3.81) and overall complications (OR 1.52; 95% CI 1.07-2.15) after esophagectomy. The sarcopenia patients also showed nonsignificant increases in the risks of anastomotic leakage (OR 1.29; 95% CI 0.99-1.67), vocal cord palsy (OR 2.03; 95% CI 0.89-4.64), and major complications (≥ Clavien-Dindo gradeIII; OR 1.30; 95% CI 0.95-1.79) but not increased operation time, blood loss, or mortality. Preoperative sarcopenia assessment showed considerable potential for predicting postoperative complications for esophageal cancer patients. To realize this potential, more effective diagnostic criteria and severity classifications for sarcopenia are warranted.

The effects of sarcopenic dysphagia on the dynamics of swallowing organs observed on videofluoroscopic swallowing studies

ObjectivesThe aim of the present study was (a) to determine the relationship of videofluoroscopic swallowing study (VFSS) findings of the swallowing musculature with the diagnostic criteria for sarcopenic dysphagia and (b) to examine the usefulness of VFSS for diagnosing sarcopenic dysphagia.MethodsThe participants were 132 patients (mean age, 80.4 ± 8.8 years). Their skeletal muscle mass, nutritional status and swallowing functions as assessed by VFSS findings were measured. Also, the relationship between the VFSS findings and sarcopenia was examined.ResultsOf all the participants, 20 men (mean age, 83.2 ± 6.9 years) and 27 women (mean age, 85.3 ± 6.9 years) were diagnosed with sarcopenia. In men, the amount of laryngeal upward movement (ALUM) was significantly lower and the pharyngeal area was significantly wider in the sarcopenia group than in the non‐sarcopenia group. In women, the pharyngeal area was significantly wider in the sarcopenia group than in the non‐sarcopenia group. In a logistic regression model, ALUM (odds ratio [OR] 1.135, 95% confidence interval [CI] 1.037‐1.241, P = .006) and pharyngeal area (OR 0.028, 95% CI 0.001‐0.670, P = .027) was a significant independent factor for the presence or absence of sarcopenia.ConclusionsThe decline in swallowing function of sarcopenia patients was characterised by lower laryngeal movement and enlargement of the pharyngeal cavity due to decreased skeletal muscle mass and decreased muscle strength. The present study suggested the usefulness of measuring ALUM during swallowing and measuring the pharyngeal area with VFSS as indicators of decreased swallowing muscle function in sarcopenia.

Association Between Sarcopenia and Clinical Outcomes in Patients With Esophageal Cancer Under Neoadjuvant Therapy.

This study aimed to evaluate the association of sarcopenia and Clinical Outcomes with esophageal cancer under neoadjuvant chemoradiotherapy (CRT). A retrospective study assessing patients with esophageal cancer who underwent CRT between 2001 and 2014 was conducted in the medical center. Hospital patients' records on sarcopenia and treatment outcomes were statistically analyzed. The sarcopenia group had significantly lower body mass index than the non-sarcopenia group. CRT-related severe adverse events with mucositis, fever, and neutropenic fever were greater in the sarcopenia group. Overall survival and disease-free survival were significantly better in the non-sarcopenia group. Sarcopenic patients who received nutritional support with enteral access had less severe mucositis. There was no difference in mortality of sarcopenia patients with nutritional support via enteral access or without. Moreover, sarcopenia and advanced tumor stage were independent factors for mortality outcome. Sarcopenia before CRT may be associated with increased toxicities and worse overall survival/ disease-free survival in esophageal cancer patients.

Sarcopenia is an actual problem in chronic kidney disease of the 5d stage

BACKGROUND. The lack of data on the epidemiology of presarcopenia/sarcopenia leads to an underestimation of the role of this condition in the structure of morbidity and mortality of haemodialysis patients in theRussian Federation. THE AIM: to study the epidemiological aspects of presarcopenia /sarcopenia in patients with chronic kidney disease stage 5d. PATIENTS AND METHODS. This study comprised 317 patients receiving programmed bicarbonate haemodialysis for 8.2 ± 5.1 years, among them 171 women and 146 men, the average age was 57.1 ± 11.3 years. The assessment of the presence of sarcopenia was performed using the method recommended by the European Working Group on Sarcopenia in Older People. RESULTS. The prevalence of presarcopenia was 0.7 % and sarcopenia 29.6 %. The incidence of skeletal muscle mass deficiency according to muscle mass index (IMM) was 30.3 %, 48.7 % showed a decrease in muscle strength according to dynamometry, and low performance of skeletal muscles according to 6 minute walk test was determined in 42.8 %. Sarcopenia patients were significantly characterized by lower body mass index, as well as higher body fat mass values. The duration of haemodialysis (χ2 = 22.376, p = 0.0001) and the patient's age (χ2 = 10.545 p = 0.014) were an independent risk factors for the development of sarcopenia. CONCLUSION. Sarcopenia is recorded more frequently in hemodialysis patients than presarcopenia. Its prevalence increases among patients of older age groups and with a hemodialysis duration of more than 5 years. The age and experience of dialysis make their independent contribution to the development of this syndrome.

Rodent Model of Muscular Atrophy for Sarcopenia Study.

The hallmark symptom of sarcopenia is the loss of muscle mass and strength without the loss of overall body weight. Sarcopenia patients are likely to have worse clinical outcomes and higher mortality than do healthy individuals. The sarcopenia population shows an annual increase of ~0.8% in the population after age 50, and the prevalence rate is rapidly increasing with the recent worldwide aging trend. Based on International Classification of Diseases, Tenth Revision, a global classification of disease published by the World Health Organization, issued the disease code (M62.84) given to sarcopenia in 2016. Therefore, it is expected that the study of sarcopenia will be further activated based on the classification of disease codes in the aging society. Several epidemiological studies and meta-analyses have looked at the correlation between the prevalence of sarcopenia and several environmental factors. In addition, studies using cell lines and rodents have been done to understand the biological mechanism of sarcopenia. Laboratory rodent models are widely applicable in sarcopenia studies because of the advantages of time savings, cost saving, and various analytical applications that could not be used for human subjects. The rodent models that can be applied to the sarcopenia research are diverse, but a simple and fast method that can cause atrophy or aging is preferred. Therefore, we will introduce various methods of inducing muscular atrophy in rodent models to be applied to the study of sarcopenia.

Inflammation-dependent downregulation of miR-532-3p mediates apoptotic signaling in human sarcopenia through targeting BAK1.

Inflammation and apoptosis are considered as two major pathological causes of human sarcopenia. The current understanding based on different models recognizes that apoptosis does not trigger inflammation, while emerging evidence indicates that inflammation can induce apoptosis. Here, we provide solid evidence to suggest that the inflammation-dependent downregulation of miR-532 causes apoptosis through targeting a proapoptotic gene BAK1 (BCL2 antagonist/killer 1). To identify miRNAs and genes that are aberrantly expressed in the muscle tissues of sarcopenia patients, we conducted two independent microarray analyses. In total, we identified 53 miRNAs and 69 genes with differential expression levels. Of these aberrantly expressed miRNAs, miR-532-3p showed the most obvious changes in sarcopenia tissues, and more importantly, it can be repressed by the well-known inflammatory inducer lipopolysaccharide (LPS) in vitro. According to gene-based microarray results and the predicted targets of miR-532-3p, we presumed that BAK1 was a putative target of miR-532-3p. Further in vitro and in vivo analyses verified that miR-532-3p could directly bind to the three prime untranslated region (3'-UTR) of BAK1 through the seed sequence CUCCCAC. In addition, we found that NFKB1 (also known as p50), a subunit of the transcription factor NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells), could specifically bind to the promoter region of miR-532-3p and repress its expression. Further analysis revealed that the activation of TLR4 (Toll-like receptor 4) signaling led to the translocation of p50 from the cytoplasm to the nucleus, where it repressed miR-532-3p expression and thus led to an increase of BAK1. The accumulated BAK1 activated its downstream apoptotic signaling pathways and resulted in apoptosis, eventually causing the pathogenesis underlying sarcopenia. Overall, our results uncovered a new mechanism by which the inflammation-dependent downregulation of miR-532-3p contributed to the pathogenesis of sarcopenia through mediating BAK1 expression.

Prognostic Value of Pre-Therapeutic Sarcopenia in Adult Cancer Patients and Its Impact on Postoperative Complications: A Systematic Analysis

Background & Aim: Sarcioenia is an important factor affecting the prognostic outcomes in adult cancer patients. The aim of this study was to quantify the prognostic value of pre-therapeutic sarcopenia and investigate its impact on postoperative complications. Methods: We searched PubMed and Web of Science for articles up to May 2019 that reported observational studied of the important impact of pretherapeutic sarcopenia on clinical outcomes in adult cancer patients over 18 years. The primary outcomes of the studies were the OS (overall survival) and the OR (odds ratio) for postoperative complications. And the secondary outcomes included CSS (cancer-specific survival), DFS (disease-free survival), which also called RFS, DSS (disease specific survival), PFS (progression-free survival). Results: A total of 20938 patients from 86 articles were included in this meta-analysis. We observed that sarcopenia was associated with worse OS in patients with tumor of digestive system (univariate: HR=1.578, 95%CI, 1.442 - 1.713; multivariate: HR=1.004, 95%CI, 0.916 - 1.091), respiratory system (univariate: HR=2.011, 95%CI, 1.519 - 2.502; multivariate: HR=2.019, 95%CI, 1.399 - 2.640 ), urinary system (univariate: HR=1.449, 95%CI, 1.141 - 1.757; multivariate: HR=1.611, 95%CI, 1.253 - 1.968) and lymphatic and hematologic system (univariate: HR=2.681, 95%CI, 1.371 - 3.991; multivariate: HR=2.152, 95%CI, 1.228 - 3.075). Sarcopenia patients with tumor of digestive system were more susceptible to postoperative complications and associated with poor DFS, And sarcopenia was also associated with inferior CSS. Results of subgroup analysis showed that sarcopenia was associated with in inferior OS for gastric cancer, pancreatic cancer, biliary tract cancer, lung cancer and bladder cancer relative to other cancer involved. Conclusion: Sarcopenia is an unfavorable factor for short- and long-term outcomes in cancer patients, especially those with tumor of digestive system. Funding Statement: This study is supported by grant no.2016YFC1302501 from Special Foundation for Establishment of new technologies and new models for monitoring and controlling malignant tumor risk factors. Declaration of Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Ethical Approval Statement: Not required.

Relationship between relative skeletal muscle mass and nonalcoholic fatty liver disease: a systematic review and meta-analysis

Background and AimNonalcoholic fatty liver disease (NAFLD) has gradually become one of the most common chronic liver diseases in the world. More and more evidence shows that low skeletal muscle mass index (SMI) may play a role in the development of NAFLD. Our aim was to quantify the association between SMI, sarcopenia and the presence and severity of NAFLD.MethodsWe systematically searched English relevant studies from PubMed, Embase, the Web of Science and the Cochrane Library updated to December 20th, 2018. Studies in which SMI was compared between NAFLD cases and controls were included. So were studies concerning the odds ratio (OR) of NAFLD, non-alcoholic steatohepatitis (NASH) and significant fibrosis in sarcopenia patients. Pooled weighted mean differences and ORs were calculated.ResultsOf the 1331 retrieved studies, 19 articles were included. SMI level in NAFLD patients was 1.77 (95% CI 1.15, 2.39) lower than that in normal controls. We also found a significantly higher occurrence risk of NAFLD (OR = 1.33, 95% CI 1.20 to 1.48), NASH (OR = 2.42, 95% CI 1.27 to 3.57) and NAFLD-related significant fibrosis (OR = 1.56, 95% CI 1.34, 1.78) in sarcopenia subjects.ConclusionsSMI level in patients with NAFLD was lower than healthy people, and patients with sarcopenia have higher occurrence risk of NAFLD, as well as its advanced stages including NASH or NAFLD-related significant fibrosis. Further well-designed prospective studies are required to strengthen the arguments.

The impact of computed tomography-assessed sarcopenia on outcomes for trauma patients – a systematic review and meta-analysis

IntroductionSarcopenia is the progressive loss of skeletal muscle mass, strength and general decline in function associated with age, and has previously been shown to be a predictor of poor outcomes following surgery. Computed tomography (CT)-assessed sarcopenia has been proposed to be an independent predictor of outcomes for trauma patients. This systematic review aims to determine the impact of CT-assessed sarcopenia on patient mortality following trauma. Materials and MethodsA systematic review and meta-analysis of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. EMBASE, MEDLINE and CENTRAL databases were searched from database inception to 26 November 2018. Bibliographies of included articles were hand searched for potential articles. All observational studies which included trauma patients who had skeletal muscle mass or density assessed by CT were included in the review. Two authors independently performed the search with decisions reached by consensus. Meta-analysis was performed using Review Manager v5.3 using a random effects model. The primary outcome was all cause mortality, as established a priori. ResultsFollowing an initial search of 1984 records, a total of 20 retrospective observational studies were included for qualitative analysis. Ten of these studies consisting of a pooled, partly-overlapping, 2867 patients were included in the meta-analysis. There was a wide variation in the reported prevalence of sarcopenia (25.0–71.1%). Sarcopenia patients were at a significantly increased risk of mortality during inpatient stay (RR 1.96 [95%CI 1.30–2.94], p = 0.001), at 30 days (RR 1.60 [95%CI 1.21–2.13], p = 0.001) and at 1-year (RR 3.11 [95%CI 1.94–4.96], p < 0.00001). There was no significant difference in total complications encountered, ICU duration or total inpatient stay. ConclusionSarcopenia identified by CT is associated with increased risk of inpatient, 30-day, and 1-year mortality in trauma patients.

Analysis of dietary and metabolic characteristics in elderly sarcopenia patients with diabetes mellitus

Objective To investigate the metabolic characteristics, body composition and dietary intake in elderly sarcopenia patients with type 2 diabetes(T2DM). Methods A total of 652 T2DM patients(327 males and 325 females)aged over 60 years were selected from endocrinology department of nine different hospitals in Beijing.Body composition was measured by bioimpedance analysis, and the appendicular skeletal mass index(ASMI)was calculated.Sarcopenia was defined as body height-adjusted skeletal muscle mass(ASMI)below the lower quintile of the young reference group.The diagnostic cutoff points for sarcopenia were 7.18 kg/m2 for men and 5.73 kg/m2 for women.All patients were divided into the sarcopenia group versus the control group(below vs.not below 7.18 kg/m2 for men and 5.73 kg/m2 for women). The anthropometric parameters, body composition, biochemical laboratory results and dietary intake were compared between the two groups.The blood glucose target levels were less than 7 mmol/L of fasting plasma glucose(FPG)or less than 7% of haemoglobin A1c(HbA1c). The obesity ratio was calculated according to body fat percentage more than 25% in men and more than 30% in women as obesity. Results There were 116(17.8%)patients in the sarcopenia group(men/women, 82/34), and 536(82.2%)patients in the control group(men/women, 245/291). Age was higher in the sarcopenia group than in the control group(t=4.385, P=0.000), and body mass index and waist hip ratio(WHR)were lower in the sarcopenia group than in the control group(t=11.724 and 4.173, P=0.000 and 0.000). FPG[(7.5±2.4)mmol/L vs.(8.5±2.5)mmol/L, t=-3.450, P=0.001]and HbA1c[(7.0±1.6)% vs.(8.2±1.7)%, t=-5.745, P=0.000]were higher in male sarcopenia group than in male control group.The control rate of FPG(127.0% or 51.8% vs.27.0% or 32.9%, χ2=8.817, P=0.003)and HbA1c(131.0% or 53.5% vs.23.0% or 28.0%, χ2=15.934, P=0.000)were lower in the sarcopenia group than in the control group.The red blood cell counts, hemoglobin and serum albumin levels, estimated glomerular filtration rate(eGFR)were lower in male sarcopenia group than in the male control group(P<0.05). eGFR was lower in female sarcopenia group than in female control group(t=4.090, P=0.000). Both in men and women, ASMI, grip power, fatless circumference on upper arm, bone mineral content and basal metabolic rate were lower in the sarcopenia group than in the control group(P<0.05). The total daily intake of energy, carbohydrate, protein and fat were lower in male sarcopenia group than in male control group(P<0.05). Conclusions Compared with the control group, sarcopenia patients are older with worse glycemic control and lower levels of BMI, WHR, renal function, muscle mass and muscle strength.Sarcopenia patients are more prone to osteoporosis.Furthermore, they have poorer nutritional status with an imbalance of dietary intake.Appropriate increase of protein especially high quality protein intake should be recommended to sarcopenia patients with T2DM. Key words: Diabetes mellitus; Sarcopenia; Nutrition assessment; Metabolism

Association of Sarcopenia with and Efficacy of Anti-PD-1/PD-L1 Therapy in Non-Small-Cell Lung Cancer.

Secondary sarcopenia is defined as a decrease in muscle mass due to disease or malnutrition. Several studies have reported that secondary sarcopenia is an indicator of postoperative recurrence. We hypothesized that there is a correlation between the effect of immune checkpoint inhibitors (ICIs) and sarcopenia. We retrospectively analyzed 38 patients with advanced non-small cell lung cancer (NSCLC) who were treated with ICIs between February 2016 and April 2018. Patients were divided into two groups according to the change rate of the psoas major muscle area (PMMA) at the L2–L3 position and investigated the correlation between the change rate of the PMMA and the efficacy of ICIs was investigated. The objective response and disease control rates were lower in patients with sarcopenia than in those without sarcopenia. Patients with sarcopenia exhibited a significantly shorter median progression-free survival (PFS) than non-sarcopenia patients. Moreover, focusing on good Eastern Cooperative Oncology Group performance status patients, sarcopenia patients showed a shorter PFS than non-sarcopenia patients. Patients with sarcopenia are associated with poor outcomes for immunotherapy among those with advanced NSCLC, based on retrospective analysis. Further research is needed to validate the clinical biomarkers involved in ICI responders.

884 - Sarcopenia patients are clinically dissatisfied with postoperative urinary function compared with non-sarcopenia patients in robot-assisted radical prostatectomy

884 - Sarcopenia patients are clinically dissatisfied with postoperative urinary function compared with non-sarcopenia patients in robot-assisted radical prostatectomy

Prevalence of Sarcopenia and Its Relationship with Nutritional State and Quality of Life in Patients with Digestive Diseases.

This study aimed to clarify the prevalence of sarcopenia, which is characterized by loss of skeletal muscle mass and strength, and its relationship with nutritional state and quality of life (QOL) in patients with digestive diseases. This study enrolled 303 patients (187 men and 116 women with a median age of 70 y) having digestive diseases. Diseases were gastrointestinal in 99 patients, biliary/pancreatic in 93, and hepatic in 111. Skeletal muscle cross-sectional area was measured by abdominal computed tomography at the 3rd vertebra (L3) level. Sarcopenia was defined using the L3 skeletal muscle index and hand grip strength. Nutritional state was assessed by Subjective Global Assessment (SGA), Mini nutritional Assessment®-Short Form (MNA®-SF), anthropometry, and blood biochemistry. QOL was evaluated by Short Form-8TM. Prevalence of sarcopenia was 32.0% in overall cases. The value was 22.2% in gastrointestinal disease, 36.6% in biliary/pancreatic disease, and 36.9% in hepatic disease. Advanced age, male sex, and advanced cancer state were associated with development of sarcopenia. Patients with sarcopenia had a significantly worse nutritional state according to SGA and MNA®-SF than those without sarcopenia. In anthropometry, % arm muscle area, % calf circumference, and body mass index were significantly lower in the sarcopenic group. Serum albumin and hemoglobin were also significantly lower in the sarcopenia patients. QOL was more impaired in physical component subscales in sarcopenia patients than non-sarcopenia ones. Patients with digestive diseases frequently suffer from sarcopenia and this is associated with worsening of nutritional state and QOL in these patients.