Skeletal Mass Index Research Articles

Differences in sarcopenia indices in elderly Japanese women and their relationships with obesity classified according to waist circumference, BMI, and body fat percentage

BackgroundSarcopenic obesity (SO) is defined as a decrease in lean body mass and an increase in body fat mass (BFM) due to aging. Detecting SO in elderly women is important from the perspective of extending healthy life expectancy. While various indices of SO are currently used, there is no global consensus regarding diagnostic criteria for SO. This study aimed to examine the relationship between obesity indices (waist circumference (WC), body mass index (BMI), and body fat percentage (BFP)) and sarcopenia indices (total body muscle mass (TBM), appendicular lean mass (ALM), skeletal mass index (SMI)), and physical function (gait speed (GS), handgrip strength (HGS)).MethodsSubjects were 170 community-dwelling healthy elderly women aged 65–79 years (mean: 72.7 ± 5.78 years) who underwent measurements for WC, BMI, and BFP. A WC of ≥ 90cm was defined as the obese group, BMI was determined as weight (kg) divided by height squared (m2) and a cutoff of ≥ 25 kg/m2 was used to define the obesity group. BFM was measured using the bioelectrical impedance analysis (BIA) method and BFP was calculated from body weight and a cutoff of ≥ 30% was used to define the obesity group. TBM and ALM (kg) were measured using the BIA method, ALM (kg) was corrected for height (m2) to obtain SMI (kg/m2). Physical function was assessed by GS and HGS, which were measured by the 5-m walk test and a digital grip strength meter, respectively.ResultsWhen obesity was assessed using BMI, WC and BFP, obese individuals had higher TBM, ALM and SMI, and lower GS among the sarcopenia indicators. HGS did not differ significantly between the non-obese and obese groups.ConclusionOur findings suggest HGS is thought to reflect muscle strength without being affected by obesity indices, suggesting that it may be useful in detecting possible sarcopenia in obese individuals.

Effect of low muscle mass on total mortality related to metabolic disease in chronic kidney disease patients

Low muscle mass is a risk factor for mortality in patients with chronic kidney disease (CKD). However, it is not clear to what extent low muscle mass contributes to this risk, either independently or in combination with metabolic abnormalities and frailty. This study used data from the National Health and Nutrition Examination Survey 1999–2006 and 2011–2018. Low muscle mass was defined as Appendicular Skeletal Mass Index < 7 kg/m2 in men or < 5.5 kg/m2 in women. The follow-up duration was from the first anthropometric and clinical measurements to death or the last follow-up. This study enrolled 2072 patients with CKD. Low muscle mass was associated with a lower risk of metabolic abnormalities, but was associated with an elevated mortality risk. Conversely, central obesity was associated with a higher likelihood of metabolic abnormalities and frailty, yet showed no significant association with mortality risk. Subsequently conducted mediation analysis indicated that the effect of low muscle mass on mortality was direct, not mediated by frailty and metabolic abnormalities. In spite of the inverse relationship between low muscle mass and metabolic abnormalities, low muscle mass are directly associated with an increased risk of all-cause mortality. Low muscle mass may directly contribute to mortality in patients with CKD, independent of metabolic abnormalities and frailty in these patients.

The Effects of Imeglimin on Muscle Strength in Patients with Type 2 Diabetes: A Prospective Cohort Study.

A bidirectional relationship has been observed between type 2 diabetes mellitus and sarcopenia, especially among older adults. While previous studies have reported that imeglimin improves mitochondrial function, they have not assessed its effects on muscle strength in patients with type 2 diabetes. Therefore, we aimed to investigate the effects of imeglimin on muscle strength in patients with type 2 diabetes. In this prospective cohort study, we recruited consenting patients with type 2 diabetes (20-75years). Changes in lean body mass (LBM), fat mass, quadriceps muscle strength, and grip strength from baseline (week 0) to week 24 were evaluated and compared between patients treated with imeglimin therapy (group I) and those who did not take imeglimin (controls, group C). We recruited 27 patients treated with imeglimin (group I) and 29 controls (group C), and 50 of them completed the study (group I: n = 23; group C: n = 27). The change in LBM, total body fat mass, or skeletal muscle index from baseline to week 24 did not differ significantly between the two groups. However, group I exhibited a significantly higher percent change in quadriceps knee extension strength from baseline to week 24 than group C (13 ± 19% and 2.1 ± 14%, p = 0.022). Conversely, the difference in percent change in grip strength was not significant. Multivariable analysis showed that imeglimin use was significantly associated with a percent change in quadriceps knee extension strength, independent of age, sex, body mass index, and skeletal mass index (β = 0.325, p = 0.0014). Imeglimin positively affected muscle strength in patients with type 2 diabetes without altering LBM. Therefore, imeglimin exerts a unique effect on skeletal muscles in humans. Further randomized controlled trials are needed to validate these findings. This research was registered in the University Hospital Medical Information Network (UMIN, UMIN000054715).

Cholinesterase as a predictor of skeletal muscle loss after gastrectomy for gastric cancer.

Cholinesterase is a classical nutritional and inflammatory marker. The aim of the present study was to evaluate the value of cholinesterase as a predictive marker for postoperative skeletal muscle loss after gastrectomy for gastric cancer. The study comprised 68 patients who had undergone gastrectomy for gastric cancer. Skeletal muscle mass was evaluated using skeletal mass index, and major skeletal muscle loss was defined as less than or equal to the median change rate (1-year postoperative/preoperative) of skeletal mass index in all patients. We explored the relationship between postoperative major skeletal muscle loss and disease-free survival and overall survival. Then we investigated the relationship between change rate of skeletal muscle index and serum cholinesterase levels after gastrectomy. The median value of change rate of skeletal mass index was 0.93. Postoperative major skeletal muscle loss was significantly associated with disease-free survival after gastrectomy (P=0.003). Although major skeletal muscle loss had worse overall survival, it was not significant (P=0.058). The change rate of skeletal mass index and cholinesterase had a stronger positive correlation compared with other nutritional indices according to Spearman's rank correlation coefficient (r=0.438, P≤0.001). Evaluation of serum cholinesterase levels may be valuable for predicting postoperative skeletal muscle loss after gastrectomy, suggesting the importance of cholinesterase in postoperative nutritional management of patients with gastric cancer.

Sarcopenia As a Determinant Prognostic Factor After Surgery Among Patients with Colorectal Cancer.

Surgery for colorectal cancer (CRC) is not risk-free; therefore, preoperative evaluation must be done to predict and prevent surgical complications. Sarcopenia, a loss of muscle mass and function, was shown to be associated with surgical complications. Our study evaluates the effects of sarcopenia on short-term patient outcomes after CRC resection. Our retrospective study included patients with histologically proven CRC between 2018 and 2020 who underwent surgical resection. Skeletal muscle mass (cm2) was evaluated on a preoperative CT scan at the level of L3 vertebrae then standardized using stature (m2) to obtain the skeletal mass index (SMI) (cm2/m2). Patients received proper adjuvant care if needed and were followed up 90 days post surgery. Descriptive statistics were presented in percentage for categorical variables and in mean for continuous variables. Multivariate was made by linear regression. 113 patients were included, and 15% were sarcopenic. A statistically non-significant association was found between sarcopenia and severe complications (grade III-IV) (23.53% in sarcopenic vs. 9.38% non-sarcopenic, p=0.02, multivariate p=0.675). Sarcopenia was not associated with anastomotic leakage, infectious complications, or ileus or intra-abdominal bleeding (p>0.05). In literature, some studies showed an association between sarcopenia and postoperative complications while others showed no relationship between the two. Most studies used SMI. A non-statistically significant association was found between sarcopenia and postoperative complications in CRC patients. Sarcopenia does not predict postoperative severe complications, anastomotic leakage, infectious complications, or ileus or intra-abdominal bleeding. Emergent surgeries and age >60 years were associated with more postoperative complications.

Sex differences in reduction of trunk muscle mass related to falls and cognitive function during the COVID-19 pandemic in older adults.

This study aimed to examine the influence of the COVID-19 pandemic on physical components and activity, and its relationship to physical performance in older adults. Sixty-seven participants aged 75 and older (81 ± 2 years, female: 66%), who underwent medical checkups continuously from 2018 to 2022 in one clinic, were enrolled. Muscle mass was assessed by the biometrical impedance analysis method, which was adjusted by height squared. Physical, oral, and cognitive performance data were obtained from Japanese standard questionnaires at medical checkups. Values obtained in 2018 and 2019 were defined as pre-pandemic, and those in 2021 and 2022 were defined as during the pandemic. Body weight, grip strength, and skeletal mass index did not change from 2018 to 2022, but trunk muscle mass index decreased significantly. A difference in the trunk muscle mass index (TMI) was observed between 2022 and 2018/2019 in men; however, a significant difference was found between 2021 and 2022 in women. Compared with the pre-pandemic period, TMI during the pandemic decreased only in men. The difference in TMI between the pre-pandemic period and during the pandemic (ΔTMI) was significantly decreased in participants with low physical activity and poor oral performance before the pandemic, and in those with falls and poor cognitive function during the pandemic only in men. Reduction of trunk muscle mass was related to falls and poor cognitive function during the COVID-19 pandemic in older male adults. These data suggest that the difference in response to the COVID-19 pandemic between men and women necessitates different types of support for older adults. Geriatr Gerontol Int 2024; 24: 1060-1066.

Impact of BMI and Body Composition on First-line Systemic Treatment for Unresectable Hepatocellular Carcinoma.

The effects of body mass index (BMI) and body composition on the outcomes of systemic treatment for unresectable hepatocellular carcinoma (uHCC) remain unclear. In this retrospective study, patients with uHCC treated with lenvatinib (LEN) or atezolizumab+bevacizumab, were classified into high- (≥25 kg/m2) and low- (<25 kg/m2) BMI groups and evaluated for prognosis. Prognostic impact of body composition was also evaluated. Patients with a high BMI had lower skeletal mass index (SMI), subcutaneous adipose tissue index (SATI), and visceral adipose tissue index (VATI) compared to those in the low-BMI cohort. The baseline Child-Pugh scores and Barcelona Clinic Liver Cancer stages were comparable between the two cohorts. The overall survival (OS) was better in the high BMI group compared to the low BMI group (median, 913 vs. 484 days; p=0.008). SMI had a strong influence on OS. Additionally, low BMI, VATI, SATI, and visceral-to-subcutaneous fat ratio (VSR) in the LEN treatment group were associated with shorter progression-free survival (PFS). Following systemic treatment for uHCC, patients with low BMI have a poor prognosis. Among anthropometric factors, low SMI is associated with poor OS. In the LEN treatment group, low VATI may impact PFS negatively.

The Association between Anthropometric Measurements and Body Composition with Hand Grip Strength among the Elderly Population in Indonesia.

Background/Objectives: Hand grip strength (HGS) is a crucial measure for evaluating muscle function and general physical ability, and it may be associated with several diseases. Previous studies have demonstrated inconsistent associations between anthropometric measurement and body composition with HGS. This study aims to investigate the association between anthropometric measurement and body composition with HGS in the elderly population residing in Indonesia. Methods: This is a cross-sectional study on older adults aged between 60 and 82 years who live in the community. Anthropometric parameters assessed in this study comprised the body mass index (BMI), mid-upper arm circumference (MUAC), calf circumference (CC), and waist circumference (WC). Subsequently, body composition measurements, including fat mass (FM), fat-free mass (FFM), muscle mass (MM), skeletal muscle mass (SMM), and the appendicular skeletal mass index (ASMI), were assessed using a body composition analyzer. Last, the measurement of HGS was conducted using a hand dynamometer. Results: A total of 109 participants were involved in this study. Our study demonstrates a significant association between anthropometric parameters, namely CC and HGS. Subsequently, several body composition parameters, including FFM, SMM, ASMI, and MM in the four extremities, are also significantly associated with HGS. However, in a multivariate analysis, only CC and FFM were able to significantly predict HGS. Conclusions: Improving CC and maintaining FFM may enhance muscle strength in older adults. This suggests that targeted exercise and nutrition programs could increase muscle mass and strength, thereby mitigating age-related decline and improving quality of life.

Association between serum vitamin D levels and skeletal muscle indices in an older Japanese population: The SONIC study.

Vitamin D (VD) affects skeletal muscles. The high prevalence of VD deficiency in Japan may lead to decreased skeletal muscle mass and strength, increasing the prevalence of sarcopenia. Therefore, we aimed to investigate the association between serum VD levels and skeletal muscle indices in a Japanese community-dwelling older population. We extracted data from the Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC) study. We analyzed the data for participants in the 70s and 90s age groups. Skeletal mass index (SMI) using bioimpedance analysis, grip strength, walking speed, and serum VD levels using 25-hydroxyvitamin D [25(OH)D] were measured. We analyzed the data of 310 participants in their 70s and 48 in their 90s. Mean serum 25(OH)D levels were 21.6 ± 5.0 ng/mL in the 70s group and 23.4 ± 9.1 ng/mL in the 90s group. In the 70s group, serum 25(OH)D levels correlated with SMI (r = 0.21, P < 0.0001) and grip strength (r = 0.30, P < 0.0001). Serum 25(OH)D levels were independently associated with SMI after adjusting for sex, body mass index, and serum albumin levels. In the 90s group, serum 25(OH)D levels were correlated with SMI (r = 0.29, P = 0.049) and grip strength (r = 0.34, P = 0.018). However, the multivariate analysis showed no independent association between SMI, grip strength, and serum 25(OH)D levels. In a cross-sectional analysis of an older population, serum VD levels were associated with SMI and grip strength, and this association was more pronounced in the 70s group than in the 90s group. Our results suggest that serum VD levels maintain skeletal muscle mass and grip strength. Geriatr Gerontol Int 2024; ••: ••-••.

Improved Physical Performance Parameters in Patients Taking Nicotinamide Mononucleotide (NMN): A Systematic Review of Randomized Control Trials.

Nicotinamide adenine dinucleotide (NAD+) is essential in the proper function of many essential cellular processes in the human body.The purpose of this review is to investigate the effect of nicotinamide mononucleotide (NMN), a NAD+ precursor, on physical performance and evaluate the safety profile of supplementation.A systematic review search criteria following the guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed in four databases for randomized controlled trials on NMN supplementation. Study variables included title, author, publication date, study year, number of patients, dosage, mean age, mean follow-up time, pre- and post-intervention reported outcomes, and rates of complications. Ten studies, including 437 patients, with a mean age of 58.0years (35.1 to 81.1 years) and a mean follow-up time of 9.6 weeks (4 to 12 weeks) were included in this study. NMN dosages ranged from 150 to 1200 mg/day. Mean pre-intervention grip strength (two studies) and skeletal mass index (two studies) were 29.9 kilograms (kg) (range: 21.4-40.1 kg) and 7.4 kg/m2 (range: 6.9-7.65 kg/m2), respectively. Mean post-intervention grip strength and skeletal mass index were 30.5 kg (range: 21.7-41.9 kg) and 7.4 kg/m2 (6.8-7.64 kg/m2), respectively. There were no serious adverse effects observed. Moreover, of the reported side effects, they were determined to be independent of NMN supplementation. Therefore, patients taking NMN supplementation demonstrated non-significantly improved physical performance parameters.NMN is well tolerated with no serious adverse effects observed.

Relationship between sarcopenia and metabolic dysfunction-associated steatotic liver disease (MASLD): A systematic review and meta-analysis

Introduction and ObjectivesMetabolic dysfunction-associated steatotic liver disease (MASLD) formerly known as Nonalcoholic fatty liver disease (NAFLD) is a common chronic disease. Identifying MASLD risk factors could help early intervention and reduce the burden of the disease. Previous studies investigated the association between sarcopenia and NAFLD. Several trials were published after the last meta-analysis with indecisive results. This is an updated meta-analysis which aims to assess the association between sarcopenia, MASLD, and MASLD-related fibrosis. Materials and MethodsRelevant trials published on PubMed, Web of Science, Scopus, and Cochrane Library databases until October 2022 were included. We included studies in which skeletal mass index (SMI) or sarcopenia was compared between patients with and without NAFLD now MASLD. Also, studies comparing fibrosis between MASLD patients with and without sarcopenia were included. Data were pooled as odds ratios (ORs) and 95 % confidence intervals (CIs) using Review Manager Software. ResultsA total of 25 studies were included. The incidence of sarcopenia was significantly higher in MASLD than controls (OR, 1.25; 95 % CI, 1.08-1.44; P = 0.003). SMI odds showed no significant difference between MASLD patients and controls (OR, 1.02; 95 % CI, 0.91-1.15; P = 0.7). MASLD patients with sarcopenia had higher odds of fibrosis than MASLD patients without sarcopenia (OR, 1.49; 95 % CI, 1.03-2.14; P = 0.03). ConclusionsSarcopenia increased MASLD's probability and was associated with a higher probability of liver fibrosis in MASLD patients. However, SMI had no predictive value of MASLD occurrence.

Impact of sarcopenia and obesity on overall survival in patients with head and neck cancer receiving radiotherapy: A longitudinal study

PurposeTo analyze the impact of sarcopenia and obesity on overall survival (OS) in patients with head and neck cancer (HNC) receiving radiotherapy (RT). MethodsThis prospective longitudinal study recruited 494 patients using convenient sampling. Weight and body composition were assessed before RT (T1), and at the end of RT (T2) using bioelectrical impedance analysis (BIA). The appendicular skeletal mass index was used to define sarcopenia, while the body mass index and fat mass index were used to define obesity. Patient OS was followed and described using Kplan-Meier analysis. Cox proportional hazard regression was used to analyze influencing factors of OS. ResultsThe median follow-up time was 26.2 months (IQR: 18.4–34.4 months). Multivariable models indicated that sarcopenia/obesity type assessed at T1 was not significantly associated with OS. Multivariable models involving body composition at T2 showed that age (P < 0.001), tumor site (P = 0.003), tumor stage (P = 0.024), and sarcopenia/obesity type (P = 0.040) were significantly associated with OS, while sarcopenic patients without obesity at T2 had worse OS. ConclusionsPatients with sarcopenia and no obesity at the end of RT might have worse OS. Healthcare professionals should enhance HNC patients’ management during RT, helping them maintain a certain amount of muscle mass and fat mass to improve their survival.

Mild cognitive impairment predicts the onset of Sarcopenia: a longitudinal analysis from the English Longitudinal Study on Ageing

BackgroundMild cognitive impairment (MCI) and sarcopenia are two common conditions in older people. It is not widely known if MCI could predict the onset of sarcopenia. Therefore, we aimed to investigate whether MCI could predict the occurrence of sarcopenia in a population of older adults.MethodsIn the ELSA (English Longitudinal Study on Ageing), MCI was defined as the absence of dementia, preserved functional capacity and low performance in three objective cognitive tests. Sarcopenia was diagnosed as having low handgrip strength and low skeletal muscle mass index during follow-up. The longitudinal association between MCI at the baseline and incident sarcopenia was assessed using a multivariable logistic regression model, reporting the data as adjusted odds ratios (OR) and 95% confidence intervals (95%CI).Results3,106 participants (mean age of 63.1 years; 55.3% males) were included. People with MCI reported significantly lower mean handgrip strength values and Skeletal Mass Index (SMI), as well as a higher prevalence of obesity at baseline. At baseline, 729 people had MCI and during the ten years follow-up period, 12.1% of the initial population included had sarcopenia. On multivariate analysis, adjusted for 18 potential confounders, the presence of MCI (OR = 1.236; 95%CI: 1.090–1.596, p = 0.01) significantly predicted the onset of sarcopenia during follow-up.ConclusionThe presence of MCI at baseline was associated with a higher incidence of sarcopenia at ten-years follow-up, demonstrating a likely role of MCI as a predictor of the onset of sarcopenia in older people.

Relationship between aging and excess body fat with markers of inflammation, skeletal muscle mass and strength in Mexican community-dwelling people

IntroductionAging is accompanied by changes in body composition, such as an increase in fat mass (FM), a decrease in skeletal muscle mass index (SMMI) and muscle strength, combined with a chronic inflammatory process (CI).ObjectiveDetermine the relationship between age and excess body fat with markers of chronic inflammation, skeletal muscle mass and strength.MethodsA cross-sectional alitical study was carried out in a convenience sample of adults 45 to 59 years old (n = 100) and older adults 60 to 74 years old (n = 133). All participants had their body composition measured with an impedance meter. They were subsequently divided into two groups: (i) with excess fat (WEF), (ii) without excess fat (NEF), in order to relate excess fat and age with inflammation, muscle mass and strength.ResultsNEF adults and older adults had similar values of SMMI (9.1 ± 1.5 vs. 8.8 ± 1.3, p > 0.05) and strength (28 ± 8 vs. 27 ± 8.6, p > 0.05). Likewise, WEF adults showed significantly lower values than NEF adults in the SMMI (7.9 ± 0.8 vs. 9.1 ± 1.5, p < 0.05) and strength (28 ± 8 vs. 22 ± 5, p < 0.001). Also, WEF older adults presented significantly lower values in the SMMI (15.9 ± 1.8 vs. 22.8 ± 5.1, p < 0.05) and strength (17.9 ± 4.8 vs. 27 ± 8.6, p < 0.001).ConclusionsOur findings suggest that excess fat mass is a risk factor that has a significantly greater influence than aging per se on the index of skeletal muscle mass and strength.

The Association of Intestinal Leak with Sarcopenia and Physical Disability in Patients with Various Stages of Chronic Kidney Disease.

Sarcopenia is related to disease severity in chronic kidney disease (CKD) patients; however, its pathophysiology remains poorly known. We investigated the associations of biomarkers of intestinal leak with sarcopenia in various stages of CKD. We recruited 61-76-year-old male controls and patients with various stages of CKD (n = 36-57/group) for measuring plasma lipopolysaccharide-binding protein (LBP) and zonulin (markers of intestinal leak), handgrip strength (HGS), skeletal mass index (SMI), and gait speed (markers of sarcopenia), and short physical performance battery (SPPB; marker of physical capacity). CKD stages 4 and 5 were associated with lower HGS, SMI, gait speed, and cumulative SPPB scores and a higher sarcopenia prevalence than controls and patients with CKD stages 1 and 2 (all p < 0.05). CKD patients (stages 1 and 2) had elevated plasma zonulin and LBP when compared with CKD stages 4 and 5. Plasma zonulin and LBP exhibited significant correlations with renal function, HGS, gait speed, SPPB scores, and oxidative stress markers in CKD stages 4 and 5 (all p < 0.05). However, similar relations were not found in early CKD. Collectively, intestinal leak may be contributing to sarcopenia and physical disability in the advanced stages of CKD.

Correlation of plasma GDF15 with aging, organ disfunction, sarcopenia, and postoperative infectious complication in patients with esophageal cancer.

e16088 Background: The age of cancer incidence is increasing every year. Along with it, cancer patients getting has more comorbidity and decreasing muscle strength which may lead to increase postoperative complications. Especially, since esophageal cancer (EC) patients have heavy drinking and smoking history and high age of morbidity, they usually have multiple comorbidities and so that they particularly have high incidence of cachexia. A novel inflammatory marker known as growth differentiation factor 15 (GDF15) has been recently reported relation with cancer cachexia. This study conducted to evaluate correlation between clinical data which suggested cachexia of EC patients and plasma GDF15. Methods: Eighty-one esophageal cancer patients who first visited our outpatient ward from July 2021 to March 2023 were enrolled in this study. After obtaining consent for the study, plasma samples collected before starting any treatment for the cancer. The quantification of GDF15 was performed by ELISA. Clinical information was collected from clinical record including age, comorbidities, biochemical data, Controlling Nutritional Status (CONUT) score, and Skeletal Mass Index (SMI). GDF15 was then evaluated for clinical impact by comparison with postoperative results. Mann-Whitney U test, student-t test, ANOVA were used appropriately to analyze the relationship between the GDF-15 and patient characteristics and post operative complications. Multivariate analysis ware used logistic regression analysis. P-values &lt; 0.05 were considered statistically significant for all statistical analyses. Results: Mean age was 68.3-year-old and 80.3% of these were male. Malnutrition patients diagnosed by using CONUT were 24 (29.6%) and sarcopenia patients diagnosed by using SMI were 21 (25.9%). The median value of GDF15 was 1165 pg/mL with its range were from 298 to 9100 pg/mL. Plasma GDF15 was statistically correlated with age ( P&lt; 0.001), performance status ( P= 0.046), prevalence of hypertension ( P= 0.045) and/or diabetes ( P= 0.018), serum level of aspartate aminotransferase (AST) ( P&lt; 0.001)/ γ-glutamyltransferase (γ-GTP) ( P&lt; 0.001)/ creatinine ( P= 0.004)/ blood sugar ( P= 0.028), and SMI ( P= 0.003). Seventy-two patients underwent curative surgery, and no perioperative death was observed. The patients who occurred anastomotic leakage and infectious complication observed statistically higher GDF15 than those without (P = 0.030, P = 0.016). Optimal cut-off value was detected as 940 ng/mL for detecting infectious complication by ROC-curve with AUC value of 0.68. Conclusions: This study showed GDF15 is potentially suggesting deterioration of general condition, which came from aging, organ disfunction, and decreasing muscle mass, which may lead to cachexia in EC patients. In addition, higher GDF15 patients have risk of postoperative infectious complication.

Differences in the Evaluation of Malnutrition and Body Composition Using Bioelectrical Impedance Analysis, Nutritional Ultrasound, and Dual-Energy X-ray Absorptiometry in Patients with Heart Failure.

Although malnutrition is frequently observed in patients with heart failure (HF), this diagnosis should be performed carefully since HF itself is associated with increased inflammatory activity, which affects body weight, functionality, and some nutritional parameters; thus, its isolated interpretation can erroneously identify surrogate markers of severity as markers of malnutrition. In this context, we aimed to evaluate the prevalence of malnutrition using different classification systems and perform a comprehensive nutritional evaluation to determine the reliability of different diagnostic techniques. Eighty-three patients with a recent hospital admission due to HF were evaluated. GLIM diagnosis criteria and subjective global assessment (SGA) were performed; a comprehensive anthropometric, functional, and biochemical nutritional evaluation was performed, in which bioelectrical impedance analysis (BIA), nutritional ultrasound, and dual-energy X-ray absorptiometry (DXA) were performed. Additionally, mortality and additional admissions due to HF were determined after a mean follow up of 18 months. Malnutrition according to the GLIM criteria (54%) accurately distinguished patients with impaired functionality, lower lean mass, skeletal mass index, and appendicular muscle mass (BIA), as well as lower trunk fat mass, trunk lean mass, fat-free mass (DXA), and decreased albumin and increased C-reactive protein serum levels. According to SGA, there were significant changes in body composition parameters determined by BIA, muscle ultrasound, and functional tests between well-nourished patients and patients with risk of malnutrition (53.7%) or who had malnutrition (7.1%), but not when the last two groups were compared. BIA and DXA showed strong correlations when evaluating muscle and fat mass in HF patients, but correlations with nutritional ultrasound were limited, as well as functional tests. A multivariate analysis showed that no significant association was observed between body composition and mortality, but preperitoneal fat was associated with an increased risk of new hospital admissions (OR: 0.73). GLIM criteria identified a lower percentage of patients with HF and malnutrition compared with SGA; thus, SGA could have a role in preventing malnutrition in HF patients. Nutritional evaluation with BIA and DXA in patients with HF showed reliable results of body composition parameters in HF, and both help with the diagnosis of malnutrition according to the GLIM or SGA criteria and could provide complementary information in some specific cases.

Probiotics Supplements Improve the Sarcopenia-Related Quality of Life in Older Adults with Age-Related Muscle Decline.

A pathological increase in intestinal leak is implicated in age-associated muscle loss, termed sarcopenia, and reduced sarcopenia-related quality-of-life (SarQoL). However, the potential therapies remain elusive. We investigated the effects of probiotic supplementation on sarcopenia and SarQoL in geriatric older adults. We randomized sarcopenic men into placebo (age=71.4±3.9 years, n=63) and probiotic (age=73±4.1 years, n=60) groups for 16weeks. The probiotic used was one capsule daily of Vivomix 112 billion for 16weeks. We measured sarcopenia parameters of handgrip strength (HGS) and skeletal mass index (SMI), plasma zonulin (marker of the intestinal leak), and SarQoL using a targeted questionnaire. Probiotics improved the SarQoL scores for locomotion, functionality, and activities of daily living and prevented a decline in cumulative SarQoL observed in the placebo group (all p<0.05). Probiotic supplementation also reduced plasma zonulin and marker of systemic bacterial load. These changes were accompanied by an increase in HGS and maintenance of gait speed in the probiotic group compared to the placebo group. Correlation analysis revealed significant associations of cumulative SarQoL scores with plasma zonulin and HGS in the probiotic group. Collectively, probiotics improved SarQoL and HGS by repairing pathological intestinal leak. Future studies may further dissect the relation between intestinal leak and SarQoL in older adults taking probiotics.

Sarcopenia Identification Using Alternative Vertebral Landmarks in Individuals with Lung Cancer.

(1)Sarcopenia, or low skeletal mass index (SMI), contributes to higher lung cancer mortality. The SMI at third lumbar vertebrae (L3) is the reference standard for body composition analysis. However, there is a need to explore the validity of alternative landmarks in this population. We compared the agreement of sarcopenia identification at the first lumbar (L1) and second lumbar (L2) to L3 in non-Hispanic Black (NHB) and White (NHW) individuals with lung cancer. (2)This retrospective, cross-sectional study included 214 NHB and NHW adults with lung cancer. CT scans were analyzed to calculate the SMI at L1, L2, and L3. T-tests, chi-square, Pearson's correlation, Cohen's kappa, sensitivity, and specificity analysis were used. (3)Subjects presented with a mean age of 68.4 ± 9.9 years and BMI of 26.3 ± 6.0 kg/m2. Sarcopenia prevalence varied from 19.6% at L1 to 39.7% at L3. Cohen's kappa coefficient was 0.46 for L1 and 0.64 for L2, indicating weak and moderate agreement for the identification of sarcopenia compared to L3. (4)Sarcopenia prevalence varied greatly depending on the vertebral landmark used for assessment. Using L2 or L1 alone resulted in a 16.8% and 23.8% misclassification of sarcopenia in this cohort of individuals with lung cancer.

The Impact of Sarcopenia in the Long-Term Survival of Patients following Complex Endovascular Aortic Surgery for Thoracoabdominal Aortic Aneurysms.

Image-based sarcopenia has been the subject of recent studies, hypothesized as a prognostic factor for patients with thoracoabdominal aortic aneurysms. We conducted a single-center retrospective analysis of patients who underwent complex endovascular repair for thoracoabdominal aortic aneurysms between 2008 and 2016. CT image assessment was performed and patients were classified as sarcopenic and non-sarcopenic using two stratification methods: skeletal mass index (SMI) and total psoas muscle index (TPMI). According to sex, each patient was defined as sarcopenic if their SMI or TPMI was in the lowest third of the study group. The primary endpoint was impact of sarcopenia on perioperative mortality and long-term survival. Secondary endpoints were perioperative complications. From a total of 155 patients, 135 were eligible for study. Overall, in-hospital mortality was 5.9% (8/135). The 30-day, 1-year, 3-year and 5-year mortality was 10.4% (14/135), 20% (27/135), 28.1% (38/135) and 31.1% (42/135), respectively. There was no difference in the long-term mortality rates between sarcopenic and non-sarcopenic patients regardless of the stratification method used (p = 0.4 for SMI and p = 0.2 for TPMI). According to SMI, 30-day mortality of sarcopenic patients was significantly lower in comparison to non-sarcopenic patients (1/45, 2.2% vs. 13/90, 14.4%, p = 0.028). Based on the total psoas muscle index, sarcopenic patients were at higher risk for development of pulmonary complications in comparison to non-sarcopenic patients postoperatively (p = 0.03). Using SMI and TPMI, sarcopenia was not associated with reduced long-term survival in patients undergoing complex endovascular repair for thoracoabdominal aortic aneurysms.