Skeletal Mass Index Research Articles

Computed tomography assessment of body composition in patients with nonmetastatic breast cancer: what are the best prognostic markers?

To correlate body composition measures, based on computed tomography (CT) analysis of muscle mass and adipose tissue, with disease-free survival in breast cancer patients. This single-center retrospective study included 262 female patients with nonmetastatic breast cancer. Body composition was assessed on a pretreatment CT scan (at the L3 level). The analysis included quantification of the areas of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle mass, as well as of the mean skeletal muscle density. The VAT/SAT ratio, skeletal mass index (SMI), and skeletal muscle gauge (SMG) were calculated. Of the 262 patients evaluated, 175 (66.8%) were classified as overweight or obese on the basis of their body mass index. We observed low SMI in 35 patients (13.4%) and elevated VAT in 123 (46.9%). Disease-free survival was significantly shorter in the patients who underwent neoadjuvant chemotherapy (p = 0.044), in those with a low SMI (p = 0.006), in those with low SMG (p = 0.013), and in those with a low VAT/SAT ratio (p = 0.050). In a multivariate analysis, only SMG, the VAT/SAT ratio, and having undergone neoadjuvant chemotherapy retained their statistical significance. Our results confirm that low SMG and the VAT/SAT ratio can be used as imaging biomarkers to assess prognosis in patients with nonmetastatic breast cancer.

PSUN187 Validation of a multi-frequency bioelectrical impedance analysis device for the assessment of body composition in older adults with type 2 diabetes

Abstract Background Aging and type 2 diabetes (T2DM) are associated with an increased risk of developing sarcopenia which is associated with poor outcomes and may necessitate specific treatment. Diagnosis of sarcopenia often requires the referral of patients to dual-energy X-ray absorptiometry (DXA) in specialized settings. Another available method for assessing body composition is direct segmental multi-frequency bioelectrical impedance analysis (DSMF-BIA). In this study, we examine the accuracy of a DSMF-BIA (InBody 770) for assessing body composition in older adults with T2DM when compared to DXA. Methods 84 older adults (49 women, age 71 ± 5 years. Body mass index 30 ± 5.6 kg /m2) with T2DM who were recruited for the CEV-65 study and had both DSMF-BIA and DXA assessments at baseline were included in the analysis. The main analysis included Bland-Altman plots and Intra Class Correlation Coefficients (ICC). Sub-analyses were performed according to gender and following 10 weeks of intervention (diet, circuit resistance training, and Empagliflozin). Results The leg lean mass results according to DSMF-BIA and DXA were 14.76 ± 3.62 kg and 15.19 ± 3.52 kg respectively, however, did not differ between devices according to Bland-Altman analyses (p=0.353). Assessment of appendicular skeletal mass index did not differ between DSMF-BIA and DXA (7.43 vs. 7.47 kg/m2; p=0.84; ICC=0.965, p<0.0001; bias of -0.068, p =0.595). The accuracy of DSMF-BIA was limited when estimating fat mass indices reflected by significant biases according to Bland-Altman analyses. Summary In a sample of older adults with T2DM the degree of agreement between DSMF-BIA and DXA, was high, supporting the use of DSMF-BIA for the diagnosis of low muscle mass. Better accuracy was observed when comparing parameters of lean mass versus parameters of fat mass. Gender as well as three common treatment modalities for T2DM did not modify the accuracy of the DSMF-BIA when compared to DXA. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Role of computed tomography-based evaluation of skeletal muscle area in predicting cardiovascular outcomes in patients with chronic heart failure after cardiac resynchronization therapy.

This study aimed to determine possible associations between sarcopenia and poor cardiovascular outcomes in patients with chronic heart failure after cardiac resynchronization therapy. This retrospective study evaluated 120 patients who underwent cardiac resynchronization therapy between March 2004 and June 2018. In total, 58 patients who underwent computed tomography within 30 days of cardiac resynchronization therapy implantation were eligible for inclusion, and their data were analyzed (25 women; 33 men; mean age 71.6 ± 8.7 years). Skeletal muscle area was measured at the third lumbar vertebra, and skeletal muscle index was calculated. Major adverse cardiovascular events included cardiovascular death, hospitalization due to heart failure, cerebral infarction, acute myocardial infarction and cardiac arrest. During the follow-up period (mean 868 ± 617 days), major adverse cardiovascular events occurred in 22 of 58 patients (38%). The patients were allocated to two groups according to sex-based tertiles of skeletal muscle index. The lowest tertile was defined as the low skeletal muscle index group. Kaplan-Meier survival analysis showed that the low skeletal muscle index group had a higher incidence of major adverse cardiovascular events (log-rank 4.38; P=0.036). Cox proportional hazards regression analysis also showed that low skeletal muscle index values were significantly associated with major adverse cardiovascular events (hazard ratio 3.08; 95% confidence interval 1.26-7.66, P=0.014). Decreases in skeletal mass index on computed tomography might predict the occurrence of major adverse cardiovascular events in patients with chronic heart failure who underwent cardiac resynchronization therapy. Geriatr Gerontol Int 2022; 22: 1013-1018.

Circulating miRNA-1-3p as Biomarker of Accelerated Sarcopenia in Patients Diagnosed with Chronic Heart Failure.

While sarcopenia is an important clinical finding in individuals diagnosed with chronic heart failure (CHF), efforts to identify a reliable biomarker capable of predicting the overall muscular and functional decline in CHF patients have been unsuccessful to date. The objectives of this study were to study the diagnostic utility of MicroRNA (miRNA)-1-3p as a predictor of sarcopenia status in individuals diagnosed with CHF. In total, 80 individuals with heart failure exhibiting a left ventricular ejection fraction < 50% were enrolled in this study. All patients were analyzed to assess miR-1-3p expression levels, with body composition being evaluated through dual-energy X-ray absorptiometry and sarcopenia being defined based on the sum of appendicular lean muscle mass (ALM) divided by height in meters squared and handgrip strength (HGS). In addition, the activation of the Akt/mTOR signaling pathway was evaluated in these individuals. In total, 40 of the enrolled patients (50%) exhibited sarcopenia. Sarcopenic patients presented with increased miR-1-3p expression levels as compared to non-sarcopenic individuals (1.69 ± 0.132 vs. 1.22 ± 0.106; p < 0.05). With respect to sarcopenic indices, appendicular skeletal mass index was most strongly correlated with miR-1-3p expression, which was also strongly correlated with HGS. High levels of Akt/mTOR signaling pathway components were expressed in sarcopenic individuals, highlighting a significant relationship between miR-1-3p activity and signaling through this pathway. Moreover, miR-1-3p was identified as a specific marker for sarcopenia in individuals with CHF. These results suggest that circulating miR-1-3p levels are related to Akt/mTOR pathway activation and can offer valuable insight into the overall physical capacity and muscular integrity of CHF patients as a predictor of sarcopenia. (Rev Invest Clin. 2022;74(5):276-83).

Validation of a multi-frequency bioelectrical impedance analysis device for the assessment of body composition in older adults with type 2 diabetes

BackgroundAging and type 2 diabetes (T2DM) are associated with an increased risk of sarcopenia. Diagnosis of sarcopenia is commonly done using dual-energy X-ray absorptiometry (DXA) in specialized settings. Another available method for assessing body composition is direct segmental multi-frequency bioelectrical impedance analysis (DSMF-BIA). Here, we examine the accuracy of a DSMF-BIA (InBody-770) for assessing body composition in older adults with T2DM when compared to DXA.MethodsEighty-four obese/overweight older adults (49 women, 71 ± 5 years) with T2DM who were recruited for the CEV-65 study and had both DSMF-BIA and DXA assessments at baseline were included. The analysis included Bland–Altman plots and intra class correlation coefficients. Sub-analyses were performed according to gender and following 10 weeks of interventions (diet, circuit training, and Empagliflozin).ResultsThe leg lean mass results according to DSMF-BIA and DXA were 14.76 ± 3.62 kg and 15.19 ± 3.52 kg, respectively, with no difference between devices according to Bland–Altman analyses (p = 0.353). Assessment of appendicular skeletal mass index did not differ between DSMF-BIA and DXA (7.43 vs. 7.47 kg/m2; p = 0.84; ICC = 0.965, p < 0.0001; mean difference −0.068, p = 0.595). Gender and treatment interventions did not modify the accuracy of the DSMF-BIA when compared to DXA.ConclusionsIn older adults with T2DM the degree of agreement between DSMF-BIA and DXA, was high, supporting the use of DSMF-BIA to measure muscle mass.

Diagnostic significance of calf circumference in sarcopenia of healthy korean adult males.

This study aimed to determine the relationship between sarcopenia and physical function, and the best method of diagnosing sarcopenia in healthy adults. Early prevention of sarcopenia is important; however, no studies have been conducted in healthy and relatively young adults. In addition, it remains unclear whether calf circumference is associated with sarcopenia-defined variables. A total of 85 healthy male participants were enrolled, and the mean standard deviation age of the participants was 59.76 (8.12) years. Abdominal computed tomography (CT) was performed to measure muscle areas. All subjects were divided into sarcopenia and non-sarcopenia groups based on skeletal muscle mass index using computed tomography. Sarcopenia showed a tendency to be related to lower grip strength, five times sit-to-stand and timed up and go tests for physical function. This result shows that overweight and obesity in the sarcopenia group had fully adjusted odds ratios of 0.026 (95% CI: 0.002–0.317) and 0.008 (95% CI: 0.001–0.096), respectively. Calf circumference was higher specificity (71.43 and 64.86) better than bioelectrical impedance analysis-based skeletal mass index and had a similar sensitivity (72.09 and 82.35). In conclusion, calf circumference suggests the need to consider its use as a tool for assessing muscle mass in the diagnosis of sarcopenia.

Assessment of body composition, metabolism, and pulmonary function in patients with myotonic dystrophy type 1.

Abnormal body composition in myotonic dystrophy type 1 (DM1) are affected by energy intake above resting energy expenditure (REE). We aim to investigate the characteristics and relationship between body composition, REE, and pulmonary function in patients with DM1, and to examine their changes in 1 year. The study design was a single-center, cross-sectional, and longitudinal study of body composition, REE characteristics, and pulmonary function. Twenty-one male patients with DM1 and 16 healthy volunteers were registered in the study. Body composition was measured using dual-energy X-ray absorptiometry (DEXA). Fat mass (FM) index (kg/m2), fat-FM index (kg/m2), and skeletal mass index (kg/m2) were calculated. The measurements were taken breath by breath with a portable indirect calorimeter. The REE was calculated using the oxygen intake (VO2) and carbon dioxide output (VCO2) in the Weir equation. Basal energy expenditure (BEE) was calculated by substituting height, weight, and age into the Harris-Benedict equation. The study enrolled male patients with DM1 (n = 12) and healthy male volunteers (n = 16). Patients with DM1 (n = 7) and healthy volunteers (n = 14) could be followed in 1 year. The body composition of patients with DM1 was significantly higher in the FM index and significantly lower in the fat-FM index and skeletal mass index. The REE of patients with DM1 was significantly lower and was not associated with body composition. Patients with DM1 had poor metabolism that was not related to body composition. FM was high and lean body mass was low.

DOSAGE OF THERAPEUTIC EXERCISE ACCORDING TO PATIENTS’ RISK CHART DETERMINED BY BIOIMPEDANCE

Introduction. Recommendations regarding the correctness of the therapeutic exercises must take into account the patient's body composition, which can be evaluated by bioimpedance. Material and method. 21 outpatients were assessed using a single-frequency bioelectrical impedance analyzer (SF-BIA). Health outcomes such as fat mass (FM), fat-free mass imbalances (FFM), and skeletal muscle mass (SMM) were determined. SPSS software version 25 was used for statistical analysis. Results and discussions. Of the 21 subjects, there are 52.68% men, and 47.62% women. The mean age is 47.81years ± 18.519 Std. Deviation, Body Mass Index (BMI) mean 26.38 ± 5.768, OneSample T-Test Sig..001. Fat-free mass index (FFMI), fat mass index (FMI), and skeletal mass index (SMI) were computed by adjusting with height square. Measuring the variance by ANOVA with one independent variable - BMI and one response variable (FMI Types, FFMI Types), the results were statistically significant. For FMI TypesF(2,18)=9.255, Sig.0.002, the measure of effect sizeEta Squaredη2=50.7%, Cohen medium effect shows that out of the total variation in BMI, the proportion that can be attributed to FMI Types is 50.7%. For FFMI Types F(2, 18)=10.943, Sig.0.001, the measure of effect size Eta Squaredη2=54.9%, Cohen medium effect shows that out of the total variation in BMI, the proportion that can be attributed to FFMI Types is 54.9%. FMI somatotype components results are 71.43% adipose cases, 19.05% intermediate, and 9.52% lean. One-Sample Chi-Square test applied to FMI Types reveals the statistical significance of .05(.001). FFMI somatotype components recorded 57.14% intermediate cases, 23.81% slender, and 19.05% solid. Regression equation of standard BMI and FMI with scatter plots took into consideration the “chair stand test” for pre-sarcopenia with a result of 84.5% No cases and 72.4% Yes cases.Nine patients exceeded 15 seconds at the chair stand test so probable sarcopenia was identified. Pearson correlation of BMI with FMI (r=.898), FFMI (r=.716) and SMI (r=.772), CI=99% Age (r=.518), CI=95% registered strong direct statistical significance. FMI also correlates with Age (r=.602), CI=95%, and FFMI with SMI (r=.984), CI=99%. Conclusions. Dosage of the therapeutic exercises applied with cardiac parameters monitoring for FMI Adipose (n=15), FFMI Slender, and Intermediate (n=11) includes resistive, concentric exercises, low-medium intensity progressive, pause integration for homeostasis balance, and a long period of rehabilitation for presarcopenia (n=6). For FFMI Solid, eccentric exercise can be added, medium-high intensity, pause integration for homeostasis balance for a short period with cardiac reserve monitoring. The patient's risk chart regarding fat mass and skeletal muscle mass should be included in the rehabilitation process routine to avoid functional impairment and to improve global functionality.

An improved method to assess skeletal muscle mass in patients with liver cirrhosis based on computed tomography images.

Conventionally, the skeletal muscle area with computed tomography (CT) attenuation ranging from -29 to +150 Hounsfield unit (HU) divided by height squared (the conventional skeletal muscle index [SMI]) was used as an index of skeletal muscle mass. However, it includes fat-infiltrated skeletal muscle, which is known to have poor function. This study aims to determine whether the low-fat SMI, which uses skeletal muscle mass with CT attenuation ranging from +30 to +150 HU, or conventional SMI appropriately reflects the function of skeletal muscle. We retrospectively analyzed 120 patients with cirrhosis whose handgrip strength was measured. Among them, 48 patients underwent a physical performance assessment such as liver frailty index (LFI) and short physical performance battery (SPPB), and 80 underwent quality of life (QOL) assessment. The relationships between each SMI and handgrip strength, LFI, SPPB, and QOL were evaluated. Low-fat SMI was significantly correlated with handgrip strength (males, R=0.393, p=0.002; females, R=0.423, p<0.001) and LFI (males, R=-0.535, p=0.035; females, R=-0.368, p=0.039), whereas conventional SMI was not. When using low-fat SMI, patients with low skeletal muscle mass had significantly low handgrip strength, LFI, SPPB, and physical and social-related QOL score than those without. By contrast, no significant differences were found for any items when using conventional SMI. Low-fat SMI is a good index of skeletal muscle mass that appropriately reflects skeletal muscle function.

Visceral-to-subcutaneous fat ratio exhibits strongest association with early post-operative outcomes in patients undergoing surgery for advanced rectal cancer

AimDespite their promise as prognostic factors in colorectal cancer, anthropometric data are frequently contradictory or difficult to interpret, with single body-composition parameters often investigated in isolation or heterogeneous clinical cohorts used in analyses. We sought to assess a spectrum of body-composition parameters in a highly selected cohort with locally advanced rectal cancer in a bid to determine those with strongest prognostic potential in this specific setting.Materials/methodsBetween 2014 and 2020, 78 individuals received neoadjuvant chemotherapy, or chemoradiotherapy, followed by radical surgery in the treatment of locally advanced rectal adenocarcinoma at Oxford University Hospitals Trust. Demographic, treatment-related, perioperative, and short-term outcomes data were assessed. Body-composition parameters included BMI, and those derived from pre-operative computed-tomography imaging: skeletal mass index (SMI), visceral fat area (VFA), subcutaneous fat area (SFA), perinephric fat area (PFA) visceral-to-subcutaneous fat ratio (V/S), sarcopenia, and sarcopenic obesity (SO).ResultsPre-operative body-composition parameters exhibited particularly strong correlation with post-operative outcomes, with VFA (p = 0.002), V/S (p = 0.019), SO (p = 0.012), and PFA (p = 0.0016) all associated with an increased length of hospital stay. Univariate and multivariate analyses demonstrated V/S to be the sole independent body-composition risk factor to be associated with an increased risk of developing Clavien–Dindo complications ≥ 2 (p = 0.033) as well as an increased length of stay (p = 0.005).ConclusionAmong patients with locally advanced rectal cancer, high visceral-to-subcutaneous fat ratio is the body-composition parameter most strongly associated with poor early post-operative outcomes. This should be considered in patient selection and prehabilitation protocols.What does this paper add to the literature?Our study demonstrates that among body composition parameters, high visceral-to-subcutaneous fat ratio is strongly associated with increased risk of post-operative complications and increased length of stay in patients undergoing surgery for advanced rectal cancer.

Evaluation of SARC-F and SARC-CalF for sarcopenia screening in patients with chronic musculoskeletal pain: A prospective cross-sectional study.

Objectives:Early sarcopenia detection using screening tools, such as SARC-F and SARC-CalF, has been proven reliable. However, the relationship between chronic musculoskeletal pain with sarcopenia is unknown. This study assessed sarcopenia morbidity as well as the reliability of sarcopenia screening with SARC-F and SARC-CalF in patients with chronic musculoskeletal pain.Methods:Overall, 172 patients with chronic musculoskeletal pain were included in this cross-sectional study. All participants completed the SARC-F, SARC-CalF, numeric rating scale (NRS), and pain disability assessment scale (PDAS) assessments. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria 2019. Correlations between SARC-F and SARC-CalF scores and each measured variable were evaluated using univariate and multiple linear regression analyses. A receiver operating characteristic curve analysis was conducted, and reliabilities of SARC-F and SARC-CalF scores for diagnosing sarcopenia were compared.Results:Thirty-nine patients were diagnosed with sarcopenia. Among these, 10 patients were <65 years old, and 29 were >65 years old. Both SARC-F and SARC-CalF scores significantly correlated with grip power, gait speed, skeletal mass index, numeric rating scale score, and PDAS score. In multiple linear regression analysis, SALC-F and SALC-CalF scores significantly correlated with PDAS score, skeletal mass index, and gait speed. The area under the curve were 0.70 for SARC-F and 0.88 for SARC-CalF; SARC-CalF had a significantly higher area under the curve than SARC-F.Discussion:Sarcopenia was diagnosed in patients aged <65 years with chronic musculoskeletal pain. SALC-F and SARC-CalF scores showed a significant correlation with disability due to pain and were reliable sarcopenia screening tools for chronic musculoskeletal pain. SARC-CalF was more reliable than SARC-F.

Association of Sarcopenia and A Body Shape Index With Overall and Cause-Specific Mortality.

AimThis observational study aimed to examine the association between the A Body Shape Index (ABSI) and/or sarcopenia and total, cardiovascular, and cancer mortality.MethodsThe associations of sarcopenia and ABSI with all-cause, cardiovascular, and cancer mortality were assessed in 4,488 participants from the 1999–2004 National Health and Nutrition Examination Survey (NHANES) who were followed up until December 31, 2015. Models were analyzed separately for men and women and adjusted for age, race, and other confounding factors. ABSI was assessed as a continuous measurement by quartile for men and women. Population attributable fractions (PAFs) were calculated to assess mortality caused by sarcopenia and/or ABSI in the study population.ResultsWhen ABSI was assessed as a continuous variable, the ABSI quartile showed a linear trend for total (p = 0.0001), cardiovascular (p = 0.04), and cancer (p = 0.02) mortality in men and for total (p = 0.06) and cardiovascular (p = 0.06) mortality in women. The hazard ratios (HRs) of the fourth ABSI quartile were 1.51 [95% confidence interval (CI): 1.20–1.89] in men and 1.23 (95% CI: 0.93–1.64) in women, compared with those in the first quartile. When ABSI was assessed by quartile, the appendicular skeletal mass index (ASMI) was lower in the groups with high ABSI. When high ABSI was combined with sarcopenia, the HRs of all-cause mortality were 2.05 (95% CI: 1.60–2.62) in men and 1.51 (95% CI: 1.19–1.92) in women. In the subpopulation (sarcopenia group or higher ABSI), the PAFs of mortality due to sarcopenia were 26.16% (95% CI: 12.68–37.56) in men and 21.89% (95% CI: 5.64–35.35) in women, and the PAF of mortality due to higher ABSI was 23.70% (95% CI: 12.11–33.77) in men.ConclusionThe ABSI value was significantly associated with all-cause and cardiovascular mortality, and the co-existence of higher ABSI values and sarcopenia can contribute to a more significant death risk in comparison with high ABSI values or sarcopenia. Moreover, the ABSI values in combination with the ASMI can be used to preliminarily evaluate the content and distribution of fat and muscle and to predict the risk of death in obese and sarcopenic populations.

Association between body shape index and risk of mortality in the United States

The body mass index (BMI) neither differentiates fat from lean mass nor does it consider adipose tissue distribution. In contrast, the recently introduced z-score of the log-transformed A Body Shape Index (LBSIZ) can be applied to measure obesity using waist circumference (WC), height, and weight. We aimed to investigate the association between LBSIZ and mortality. We used data from the National Health and Nutrition Examination Survey 1999–2014 and linked the primary dataset to death certificate data from the National Death Index with mortality follow-up through December 31, 2015. A multiple Cox regression analysis was performed to evaluate the hazard ratio (HR) of all-cause and cardiovascular disease (CVD) mortalities with adjustment for baseline characteristics. LBSIZ, WC, and BMI showed positive association with total fat percentage (P < 0.001); however, only WC and BMI were positively associated with appendicular skeletal mass index (ASMI) (P < 0.001). In the multiple Cox regression analysis, only LBSIZ showed a significant HR for all-cause and CVD mortalities. Under restricted cubic spline regression, mortality risk increased with LBSIZ. However, BMI and WC showed a U-shape association. In conclusion, LBSIZ is strongly associated with all-cause and CVD mortalities. Since LBSIZ is independent of BMI, LBSIZ complements BMI to identify high-risk groups for mortality even in individuals with low or normal BMI.

762 FOR OLDER PATIENTS WITH FRAILTY, SIX WEEKS OF ENFORCED IMMOBILITY HAS NO DETRIMENTAL IMPACT ON MUSCLE STRENGTH OR THICKNESS

Abstract Introduction Immobility can lead to rapid reductions in muscle size, strength and function. Understanding these changes could inform interventions to prevent or slow decline. This longitudinal study aimed to assess the extent of muscle changes in older patients admitted with fragility fractures where clinical management was immobilisation (non-weight bearing) of the affected limb for at least 6 weeks. Method Handgrip strength (HGS); knee extensor strength(KES); Vastus Lateralis thickness and cross-sectional area at ultrasound (VLMT, VLCSA); and skeletal mass index (SMI; bioimpedance analysis) were measured in the non-injured limb of 50 patients (88% female) aged ≥70. Pre-existing physical frailty meant patients were limited to transfers only while non-weight bearing. Measurements were performed at hospital admission, 1, 3 and 6 weeks. One-way repeated measures ANOVA was used to assess changes in measurements over time. Additionally, baseline measurements in female patients (n = 36) were compared to 11 healthy, non-frail, non-hospitalised females with comparable BMI, aged ≥70, using independent t-tests. Data are mean + SD. Results Patient Clinical Frailty Score (median, IQR) was 5 (4–6). At hospital admission, female patients were older (84 ± 7 years vs. 77 ± 6 years, p &amp;lt; 0.05), weaker (HGS of 9.2 ± 4.7 kg vs. 19.9 ± 5.8 kg, p &amp;lt; 0.001; KES 4.5 ± 1.5 kg vs. 7.8 ± 1.3 kg, p &amp;lt; 0.001) and had lower VLMT (1.38 ± 0.47 cm vs. 1.75 ± 0.30 cm, p = 0.02) than non-frail female controls. Six weeks immobility had no temporal effect on any variable: HGS (F(2,51) = 1.04,p = 0.38,n = 27), KES (F(3,45) = 3.22,p = 0.81,n = 16), VLMT (F(3,54) = 2.52,p = 0.07,n = 19), VLCSA (F(3,42) = 0.74,p = 0.53,n = 15) and SMI (F(2,59) = 0.09,p = 0.94,n = 26). Conclusion Older patients admitted with fragility fractures were weaker and had lower VLMT compared to healthy, non-frail older people. This, together with the lack of decline in muscle strength and thickness with 6 weeks immobility strongly suggests muscle resilience was attenuated pre-admission, such that immobility had no further detrimental effect. These results differ from muscle changes seen in younger and non-frail cohorts, and warrants assessment of clinical interventions aimed at increasing muscle mass and function specifically in older people with frailty.

Once-Weekly Semaglutide Induces an Early Improvement in Body Composition in Patients with Type 2 Diabetes: A 26-Week Prospective Real-Life Study.

Background: Body weight (BW) loss is an essential therapeutic goal in type 2 diabetes (T2D). Glucagon-like peptide-1 receptor agonists are effective in reducing BW, but their effect on body composition has not yet been fully explored. The study aim was to assess the impact of Semaglutide on body composition in patients with T2D. Methods: Forty patients with T2D were treated with subcutaneous Semaglutide and evaluated at the baseline (T0) and after three (T3) and six (T6) months. Body composition was assessed by a phase-sensitive bioimpedance analyzer. Visceral adipose tissue (VAT) thickness was also measured with an ultrasonographic method (US-VAT). Anthropometric variables, muscular strength, and laboratory tests were analyzed and compared. Results: A significant decrease in VAT, the fat mass index (FMI), and BW loss was observed at all observation times. US-VAT, the skeletal mass index (SMI), the fat-free mass index (FFMI), waist circumferences, and glycated hemoglobin had lessened after three months and remained stable at T6. No variations in muscle strength, the muscle quality index, and body water were found. Discussion: In a real-life setting, Semaglutide provided significant weight loss mainly due to a reduction in the FMI and VAT, with non-clinically relevant changes in the SMI, the FFMI, and muscle strength. Most importantly, the results were obtained after three months of treatment and persisted thereafter.

Sarcopenia in Liver Cirrhosis: A Prospective Study

Background and aim: Liver diseases are associated with low testosterone. However, little is known about risk factors of changes in testosterone. This study determined skeletal mass index in liver cirrhosis and associated risk factors with the abnormal testosterone levels. Methods: In this descriptive hospital-based study, 50 patients with evidence of liver cirrhosis diagnosed on history, imaging and investigations were included for a period of 12 months. Sarcopenia was defined as value of ≤36.5 cm2/m2 in males and ≤30.2 cm2/m2 in females. Results: The mean age was 50.4±10.1 years. The most common symptom was abdominal distension (50%) followed by upper GI bleed (30%), altered sensorium (20%), and jaundice (10%). Majority of the patients (58%) in our study were in CTP class C, followed by 16 patients (32%) in CTP class B, and 5 patients (10%) in CTP class A. 66% of the patients had low skeletal mass index. SMI was not associated with CTP class (P=0.463). Conclusion: There is a significantly higher prevalence of loss of skeletal mass in liver cirrhotic patients in this region

The Benefits of Integrated Exercise Intervention in Osteoporotic Women with Pre-Sarcopenia or Sarcopenia

目的：骨質疏鬆症與肌少症是高齡社會重要健康議題，與跌倒、骨折有高度相關。惟過去研究少以兩者合併個案進行評估，且運動介入模式多為阻力訓練。研究目的為評估整合性運動對骨質疏鬆症女性合併肌少症前期或肌少症（四肢骨骼肌指數，skeletal muscle index, SMI低於5.7kg/m^2）之效益，以作為骨質疏鬆症合併肌少症照護之參考。方法：採準實驗設計，在區域型醫院招募24位骨質疏鬆症併有肌少症前期或肌少症之婦女為研究對象，分成實驗組與控制組。兩組均接受面對面之營養衛教模式；實驗組進行16週整合性中高強度阻力與敏捷性運動訓練（自覺強度維持6－8分），每週一次，每次120分鐘。評估訓練介入前、後組內之身體組成（體脂肪率、上下肢肌肉量）、肌少症指標（SMI、握力）及功能性體適能（上下肢肌力、動靜態平衡）之變化，並控制年齡以單因子共變數或無母數統計進行組間分析。結果：實驗組12位（63.1±7.7歲）與控制組12位（70.1±6.1歲），兩組除年齡外，在基本資料無明顯差異。組內分析，實驗組體脂肪率、上下肢肌肉量、SMI、握力與上肢肌力均顯著改善；而控制組之體脂肪率、軀幹、右腿與左腿肌肉量均顯著變差，上下肢肌力亦明顯退步。組間分析顯示實驗組相較控制組體脂肪率顯著降低，且SMI、握力、上肢肌力、及下肢肌力之變化量均顯著較控制組提升。兩組在動態及靜態平衡上無顯著差異。結論：合併阻力與敏捷性之整合性運動對骨質疏鬆症合併肌少症前期或肌少症之婦女的身體組成、肌少症指標及上下肢肌力表現有實質提升效益，而無介入運動模式下，控制組在16週內體脂肪率增加、肌力下降。未來經更多著重骨質疏鬆症合併肌少症之實證研究，此整合性運動訓練模式或可作為介入和照護方向參考。Objective: Osteoporosis and sarcopenia are two important geriatric issues highly correlated with falls and frailty fractures in the elderly. Studies in the past rarely investigate the combined case of the two syndromes, and emphasis has been placed mainly on resistance training. This study aimed to investigate the benefits of integrated exercise interventions in osteoporotic women with pre-sarcopenia or sarcopenia (Skeletal Mass Index, SMI＜5.7 kg/m^2). Methods: Twenty-four osteoporotic women with pre-sarcopenia or sarcopenia were recruited from a regional hospital to participate in the quasi-experimental study. They were divided into an integrated exercise group (EG) and a control group (CG) with all participants receiving face-to-face nutrition education. The EG group was required to enroll in a 16-week moderate-to-vigorous intensity exercise program in resistance and agility training (Rating of Perceived Exertion maintained at 6-8 points). Each weekly session lasted for 120 minutes. Changes in body composition (body fat percentage, muscle mass), sarcopenia parameters (SMI, grip strength), and physical fitness (muscle strength, static and dynamic balance) before and after the integrated exercise intervention were analyzed with age as a covariate in the analysis. Results: Except for age, there was no significant difference in the basic characteristics between the EG (n=12; 63.1±7.7 years) and CG (n=12; 70.1±6.1 years) groups. Intragroup analysis showed a reduced body fat percentage , along with significant improvement in SMI, grip strength, and upper limb muscle strength in the EG group. In contrast, the CG group reported an increased body fat percentage, and a significant decrease in the muscle mass in the trunk and lower leg, as well as in the muscle strength in the upper and lower limbs. Intergroup analysis showed that the EG group experienced a significant improvement in body fat percentage, SMI, grip strength, and upper and lower limb muscle strength. There was no significant difference in the results of dynamic and static balance tests between the two groups. Conclusion: The integrated exercise intervention combined with resistance and agility training can substantially improve the body composition, sarcopenia parameters, and upper and lower limb muscle strength in osteoporotic women with pre-sarcopenia or sarcopenia. On the contrary, a significant increase in body fat percentage and a decrease in muscle strength in 16 weeks are likely to occur in the absence of the intervention. In the future, more empirical studies focusing on the combined case of osteoporosis and sarcopenia are needed, and the integrated exercise training in this study may serve as a reference for intervention.

Low masseter muscle mass is associated with frailty in community-dwelling older adults: I-Lan Longitudinal Aging Study.

Sarcopenia, defined as age-related diminution of muscle mass and strength, is a key determinant of frailty status and progression. We investigated the hypothesis that changing masseter muscle structure with advancing age may contribute to the development of frailty. Study data were excerpted from the I-Lan Longitudinal Aging Study, a research cohort of community-dwelling residents aged ≥53years from Yilan (I-Lan) County, Taiwan. The study sample comprised 56 subjects classified as frail, 41 pre-frail, and 41 robust, according to Cardiovascular Health Study criteria; all groups were matched by age and sex. Masseter muscle volume was quantified based on T1-weighted magnetic resonance imaging, and adjusted for height to derive the masseter volume index (MVI). Appendicular skeletal muscle mass index (SMI) was determined by dual-energy X-ray absorptiometry, and used to derive the height-adjusted skeletal mass index (SMI). Nutrition status was assessed with the Mini-Nutritional Assessment (MNA) form. The MVI was significantly smaller in frail versus pre-frail subjects. Among frail individuals, only the MVI was significantly correlated with MNA scores. MVI, but not SMI, was associated with increased risk of being frail versus pre-frail. An MVI cut-off score of 9.5cm3/m2 in males discriminated frail from pre-frail status with acceptable sensitivity and specificity. Low MVI was associated with the frailty criteria of slowness. MVI is a potential clinical index for evaluating phenotypic frailty. Diminished masseter muscle volume may predispose pre-frail/frail elders to depletion of physical reserves, consequent to its detrimental effect on oral functioning and nutrient intake.

Significant Loss of Skeletal Muscle Mass Occurs After High-Energy Trauma in Young Adults

ObjectivesSignificant loss of skeletal muscle mass occurs early after high-energy trauma, leading directly to prolonged functional limitations. As we investigate nutrition interventions to reduce loss of muscle mass, we need to quantify changes in muscle mass after these devastating injuries. The aim of this study was to characterize baseline nutrition and changes in muscle mass after high-energy trauma in a young adult population.MethodsWe enrolled patients 18–55 years old indicated for operative fixation of either, an open pelvic or extremity fracture, or ≥2 pelvic and/or extremity fractures due to a high-energy mechanism. Baseline assessment of body composition (Lean Body Mass [LBM], Skeletal Muscle Mass [SMM]), was measured within 72 hours of admission using bioelectrical impedance and repeated 6 weeks after injury. Results are reported as median (IQR). Changes in LBM and SMM were evaluated using Wilcoxon Signed Rank tests. Sarcopenia was defined by gender-specific cutoffs for appendicular skeletal mass index. Dietary intake was evaluated using food frequency questionnaires. Inadequate protein intake was classified using the Estimated Average Requirement cut-point method, while inadequate caloric intake was defined as intake below basal metabolic rate.ResultsSixteen subjects (14 male) age 38.4 ± 9.6 years were enrolled. At baseline, 3 reported inadequate protein intake and 5 reported inadequate caloric intake. Six weeks after injury participants experienced significant losses in LBM (−4.5kg (−8.8 to −1.4), P = 0.019) and SMM (−3.1kg (−5.6 to −0.3), P = 0.043). The injured extremity had significantly greater loss of LBM compared to the uninjured extremity (−4.0 (−17.1–3.5), P = 0.0495). Five were baseline sarcopenic, with one additional participant meeting the criteria by 6 weeks. Baseline protein and calorie deficiency was not significantly associated with muscle loss.ConclusionsThis study documented devastating loss of lean body mass and skeletal muscle mass after high-energy trauma in young adults. These losses are likely a combination of immobilization and catabolic response for wound and fracture healing. Understanding loss of muscle mass after injury is important to design impactful rehabilitative and nutrition interventions in this complicated patient population.Funding SourcesNone.

Body Composition Characteristics of Community-Dwelling Older Adults With Dynapenia or Sarcopenia.

This study aimed to determine the differences in muscle and fat masses of the arm and leg between older adults with dynapenia, sarcopenia, or presarcopenia and normal individuals. The percent body fat, lean body mass, and skeletal mass index were measured with bioelectrical impedance analysis. Muscle function was evaluated using grip strength and walking speed. Participants were classified into four categories. Dynapenia was defined as low muscle function with normal muscle mass. Sarcopenia was defined as the presence of both low muscle mass and low muscle function. Presarcopenia was defined as low muscle mass with normal muscle function. Control was defined as normal muscle mass and function. Multivariate analyses of variance were performed separately for women and men to test the main effect of sarcopenia category on body composition. Among the 356 enrolled participants, 270 were women, and 86 were men. In older women, the dynapenia and sarcopenia groups had significantly less muscle mass in the leg than the control group. In older men, the dynapenia group demonstrated a higher body fat mass in the leg than the control group. These results suggest that different strategies are necessary to prevent dynapenia in women and men.