Skeletal Muscle Mass In Patients Research Articles

High correlation of temporal muscle thickness with lumbar skeletal muscle cross-sectional area in patients with brain metastases.

ObjectivesThis study aimed to assess the correlation of temporal muscle thickness (TMT), measured on routine cranial magnetic resonance (MR) images, with lumbar skeletal muscles obtained on computed tomography (CT) images in brain metastasis patients to establish a new parameter estimating skeletal muscle mass on brain MR images.MethodsWe retrospectively analyzed the cross-sectional area (CSA) of skeletal muscles at the level of the third lumbar vertebra on computed tomography scans and correlated these values with TMT on MR images of the brain in two independent cohorts of 93 lung cancer and 61 melanoma patients (overall: 154 patients) with brain metastases.ResultsPearson correlation revealed a strong association between mean TMT and CSA in lung cancer and melanoma patients with brain metastases (0.733; p<0.001). The two study cohorts did not differ significantly in patient characteristics, including age (p = 0.661), weight (p = 0.787), and height (p = 0.123). However, TMT and CSA measures differed significantly between male and female patients in both lung cancer and melanoma patients with brain metastases (p<0.001).ConclusionOur data indicate that TMT, measured on routine cranial MR images, is a useful surrogate parameter for the estimation of skeletal muscle mass in patients with brain metastases. Thus, TMT may be useful for prognostic assessment, treatment considerations, and stratification or a selection factor for clinical trials in patients with brain metastases. Further studies are needed to assess the association between TMT and clinical frailty parameters, and the usefulness of TMT in patients with primary brain tumors.

The relationship between computed tomography-derived body composition, systemic inflammatory response, and survival in patients undergoing surgery for colorectal cancer.

IntroductionColorectal cancer is the fourth leading cause of cancer mortality in developed countries. There is evidence supporting a disproportionate loss of skeletal muscle as an independent prognostic factor. The importance of the systemic inflammatory response as a unifying mechanism for specific loss of skeletal muscle mass in patients with cancer is increasingly recognized. The aim of the present study was to delineate the relationship between the systemic inflammatory response, skeletal muscle index (SMI), skeletal muscle density (SMD), and overall survival in patients with colorectal cancer.Materials and methodsThe study included 650 patients with primary operable colorectal cancer. Computed tomography scans were used to define the presence of visceral obesity, sarcopenia (low SMI), and myosteatosis (low SMD). Tumour and patient characteristics were recorded. Survival analysis was carried out using univariate and multivariate Cox regression.ResultsA total of 650 patients (354 men and 296 women) were included. The majority of patients were over 65 years of age (64%) and overweight or obese (68%). On univariate survival analysis, age, ASA, TNM stage, modified Glasgow Prognostic Score (mGPS), body mass index, subcutaneous fat index, visceral obesity, SMI, and SMD were significantly associated with overall survival (all P < 0.05). A low SMI and SMD were significantly associated with an elevated mGPS (<0.05). On multivariate analysis, SMI (Martin) [hazard ratio (HR) 1.50, 95% confidence interval (CI) 1.04–2.18, P = 0.031], SMD (Xiao) (HR 1.42, 95% CI 0.98–2.05, P = 0.061), and mGPS (HR 1.44, 95% CI 1.15–1.79, P = 0.001) were independently associated with overall survival. SMD but not SMI was significantly associated with ASA (P < 0.001).ConclusionsThis study delineates the relationship between the loss of quantity and quality of skeletal muscle mass, the systemic inflammatory response, and survival in patients with operable colorectal cancer.

Correlation analysis of sagittal alignment and skeletal muscle mass in patients with spinal degenerative disease

We investigated how skeletal muscle mass (SMM) affects spinal sagittal balance (radiographic parameters) in symptomatic spinal patients. The first purpose of this study was to evaluate the body composition and the spinal sagittal alignment in symptomatic spinal patients. The second purpose of this study was to compare whether the body composition and the spinal sagittal alignment is different in patients with cervical spine disease and lumbar spine disease. We retrospectively evaluated 313 patients who were hospitalized for surgery to treat spinal degenerative disease, who were divided into cervical and lumbar spine disease groups. All patients underwent full-length standing whole-spine radiography and bioimpedance analysis (BIA) before surgery. We used standard measurements to assess the sagittal vertical axis (SVA), cervical lordosis (CL; C2–C7), lumbar lordosis (LL; T12–S1), thoracic kyphosis (TK; T5–12), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). We also analyzed radiological and body composition parameters, patient characteristics, and the correlation between SMM and each sagittal parameters. In the overall cohort, the mean age at the time of operation was 66.5 ± 15.3 years and 59.2% of the patients were men. The correlation coefficients (r) between SMM and PT were negative weak correlation (r = −0.343, P < 0.001). The correlation with SMM for other LL, PI, SS, and SVA was statistically significant, but the correlation was none. In addition, our results also suggested strong correlations (r > 0.5) between LL and SS (r = 0.744), between LL and SVA (r = −0.589), between PT and SS (r = −0.580), and LL and PT (r = −0.506). Fifty-seven patients (18.2%, cervical group) had cervical spine disease and 256 patients (81.8%, lumbar group) had lumbar spine disease. No significant differences in age, height, body weight, and body mass index were observed between the two groups. The SMM of patients with cervical and lumbar spine disease also did not differ significantly. In the lumbar group, correlations were found between SMM and PT (r = −0.288, P < 0.001), between SMM and LL (r = 0.179, P < 0.01), and between SMM and SS (r = 0.170, P < 0.01), while only PT (r = −0.480, P < 0.001) was negatively correlated with SMM in the cervical group. This analysis indicated that PT is the sagittal parameter most closely related to SMM in patients with the spinal degenerative disease. The SMM might be one of the important factors that influenced the posterior inclination of the pelvis in symptomatic spinal patients, especially in cervical spine disease.

Increased hospital costs are associated with low skeletal muscle mass in patients undergoing elective open aortic surgery

ObjectiveLow psoas muscle area is shown to be an indicator for worse postoperative outcome in patients undergoing vascular surgical. Additionally, it has been associated with longer durations of hospital stay in patients with cancer who undergo surgery and subsequently greater health care costs in Europe and the United States. We sought to evaluate this effect on hospital expenditure for patients undergoing vascular repair in a health care system with universal access. MethodsSkeletal muscle mass was assessed on preoperative abdominal computed tomography scans of patients undergoing open aortic aneurysm repair in a retrospective fashion. The skeletal muscle index (SMI) was used to define low muscle mass. Health care costs were obtained for all patients and the relationship between a low SMI and higher costs was explored using linear regression and cross-sectional analysis. ResultsWe included 156 patients (81.5% male) with a median age of 72 years undergoing elective surgery for infrarenal abdominal aortic aneurysm in this analysis. The median SMI for patients with low skeletal muscle mass was 53.21 cm2/kg and for patients without, 70.07 cm2/kg. Hospital duration of stay was 2 days longer in patients with low skeletal muscle mass as compared with patients with normal (14 days vs 11 days; P = .001), as was duration of intensive care stay (3 days vs 1 day; P = .01). The median overall hospital costs were €10,460 higher for patients with a low SMI as compared with patients with a normal physical constitution (€53,739 [interquartile range, €45,007-€62,471] vs €43,279 [interquartile range, €39,509-€47,049]; P = .001). After confounder adjustment, a low SMI was associated with a 14.68% cost increase in overall hospital costs, for a cost increase of €6521. ConclusionsLow skeletal muscle mass is independently associated with higher hospital as well as intensive care costs in patients undergoing elective aortic aneurysm repair. Strategies to reduce this risk factor are warranted for these patients.

Change of skeletal muscle mass in patients with pheochromocytoma.

The effects of catecholamine excess due to pheochromocytoma on body composition, including skeletal muscle mass, are unknown. Here, we investigated the effects of catecholamine metabolites on body composition in subjects with pheochromocytoma. After body compositions using bioelectrical impedance analysis, urinary metanephrine (UM), and urinary normetanephrine (UNM) were measured in 16 patients with pheochromocytoma and 224 patients with nonfunctioning adrenal incidentaloma (NFAI), we compared skeletal muscle mass and fat mass (FM) between the two groups. After adjustments for confounders, UM (β = - 0.171, P = 0.006) and UNM (β = - 0.249, P < 0.001) levels were correlated inversely with skeletal muscle mass index (SMI), but not FM or percentage FM (pFM), in all subjects. Patients with pheochromocytoma had lower ASM by 7.7% (P = 0.022) and SMI by 6.6% (P = 0.001) than patients with NFAI. Conversely, FM and pFM were not statistically different between the two groups. The odds ratio for low skeletal muscle mass in the presence of pheochromocytoma was 10.33 (95% confidence interval, 2.65-40.22). Our results indicate that patients with pheochromocytoma have a reduced skeletal muscle mass and suggest that catecholamine excess has adverse effects on skeletal muscle metabolism.

Creatinine Excretion as a Determinant of Accelerated Skeletal Muscle Loss with Critical Illness.

The 24-h urinary creatinine excretion rate has been used as an approximation of the skeletal muscle (SM) mass in non-intensive care unit (ICU) settings. The study goal or aim was to determine reductions in SM mass in patients with recurrent critical illness who are admitted to a medical ICU. Retrospective ICU patient records between 2013 and 2015 were reviewed. Inclusion of ICU patients with repeat 24-h urinary creatinine excretion levels at two different ICU admissions done routinely as part of care. The study design is a case series with patients as their own control. Three patients were found to have data on two separate ICU admissions. The reduction in creatinine excretion among ICU patients was correlated with estimated SM mass. All patients had >50% reduction in creatinine excretion and ≥47% reduction in estimated SM mass over 4 months. All patients were bed-bound after the first ICU admission and met the definition of sarcopenia by the second ICU admission; all patients died during the second ICU admission. The final SM mass in all patients was <4 kg m-2. Patients with chronic critical illness admitted to the medical ICU, who become bed bound, can experience up to 50% reduction in SM mass as gleaned from creatinine excretion within 4 months. Low SM mass may predispose patients to increased mortality. Measurement of 24-h urinary creatinine excretion may be a useful ICU biomarker to determine SM mass for diagnostic and prognostic purposes.

Modified creatinine index and risk for cardiovascular events and all-cause mortality in patients undergoing hemodialysis: The Q-Cohort study

Background and aimsThe modified creatinine (Cr) index, calculated by age, sex, pre-dialysis serum Cr levels, and Kt/V for urea, reflects skeletal muscle mass in patients on hemodialysis. Whether the modified Cr index is associated with cardiovascular events and all-cause mortality remains unknown. MethodsA total of 3027 patients registered in the Q-Cohort Study, a multicenter, prospective study of patients on hemodialysis in Japan, were analyzed. The main outcomes were cardiovascular events and all-cause mortality. Associations between sex-specific quartiles of the modified Cr index and outcomes were analyzed by the Cox proportional hazard models and the Fine–Gray proportional subdistribution hazards model. ResultsThe modified Cr index was correlated with known nutritional and inflammatory markers. During a 4-year follow-up, 499 patients died of any cause, 372 experienced heart disease, and 194 developed stroke. The risk for all-cause mortality was significantly higher in the lower quartiles (Q1 and Q2) than in the highest quartile (Q4) as the reference group (hazard ratios and 95% confidence intervals: Q1, 2.65 [1.69–4.25], Q2, 1.92 [1.27–2.94], and Q3, 1.31 [0.87–2.02]). The risk of heart disease was significantly higher in Q1 than in Q4 (hazard ratios and 95% confidence intervals: Q1, 1.64 [1.04–2.61], Q2, 1.34 [0.91–2.00], and Q3, 1.04 [0.71–1.52]). The risk of stroke was not associated with the modified Cr index. ConclusionsA lower modified Cr index is associated with an increased risk for heart disease and all-cause mortality, but not with the risk for stroke in patients on hemodialysis.

Chapter 3 Prevention of sarcopenia.

Chapter 3 Prevention of sarcopenia.

Alteration in skeletal muscle mass in women with subclinical hypercortisolism.

Despite the well-known deleterious effects of cortisol on skeletal muscle, whether subtle cortisol excess in subclinical hypercortisolism (SH) affects skeletal muscle mass is unknown. Our objective was to understand the effects of the cortisol level on skeletal muscle mass in patients with SH. We compared skeletal muscle mass and fat mass (FM) between 21 patients with SH (12 women and 9 men) and 224 controls (67 women and 157 men) with nonfunctioning adrenal incidentaloma (NFAI). Medical records were reviewed, and we measured body composition parameters using bioelectrical impedance analysis and serum cortisol levels after the overnight 1-mg dexamethasone suppression test (DST). After adjusting for confounding factors, 1-mg DST levels were inversely correlated with appendicular skeletal muscle mass (ASM) (γ = -0.245, P = 0.040), lower limb ASM (γ = -0.244, P = 0.040), and appendicular skeletal muscle index (ASMI; height-adjusted ASM) (γ = -0.229, P = 0.048) in all women, but not men. ASM and ASMI were significantly lower by 6.2% (P = 0.033) and 5.9% (P = 0.046), respectively, in women with SH compared with those with NFAI, but not men. Conversely, FM and percent fat mass were similar between the two groups. Compared with women with NFAI, among those with SH, lower limb, but not upper limb, ASM was lower by 6.8% (P = 0.020). This study showed that women with SH had lower skeletal muscle mass, especially of the lower limb, and suggested that subtle cortisol excess also has adverse effects on skeletal muscle metabolism.

Visceral obesity, skeletal muscle mass and resistin in metabolic syndrome development.

Background: obesity implies an increase in the visceral adipose tissue (VAT), which is a risk factor for various metabolic diseases. VAT releases proinflammatory mediators, like resistin. In addition, it has been noted that the skeletal muscle mass (SMM) is involved in the development of metabolic syndrome (MS). Objective: this study was designed to determine the relationship of body components (VAT and SMM) with MS and resistin in patients with obesity. Methods: body composition and anthropometric and biochemical measurements to assess MS, and ELISA tests for resistin were carried out in 40 patients aged 18-40 years. Results: overweight and obesity were observed in 72% of patients; visceral obesity was found in 53% and 35% had MS. A positive correlation between VAT and SMM in patients with MS was detected. In the entire population, an increase of 1 kg of SMM was found to be associated with an increase of 3 cm2 of VAT, and an increase of 4 cm2 of VAT was observed in individuals with MS. According to resistin, people with increased VAT had higher concentration than persons with normal VAT. Furthermore, an increase of 1 cm2 of VAT accounted for a person entertaining a 3.3 fold greater risk of MS for different values of SMM and resistin. Conclusion: the transcendence and significance of VAT as a main factor in triggering the chronic inflammatory process and MS, the SMM and resistin were also related.

Loss of skeletal muscle mass in patients with chronic liver disease is related to decrease in bone mineral density and exercise tolerance.

This study aimed to identify the relationship between loss of skeletal muscle mass and clinical factors such as osteoporosis in patients with chronic liver disease. The subjects were 112 patients (85 men and 27 women) with hepatocellular carcinoma who were scheduled to undergo hepatectomy. Skeletal muscle reduction was diagnosed according to the cut-off level of the skeletal mass index (SMI) for Asians (men <7.0kg/m2 , women <5.4kg/m2 ). Osteoporosis was diagnosed according to T-score ≤-2.5 standard deviation. The SMI and T-score were assessed using the results of dual-energy X-ray absorption. Peak oxygen consumption (PeakVO2 ), an index of exercise tolerance, was evaluated using the cardiopulmonary exercise test. The characteristics of patients with low SMI (low SMI group) were compared with those of patients whose SMI was not low (control group). Outcomes are presented as median (interquartile range). The T-score was significantly lower in the low SMI group (control vs. low SMI -1.1 [1.8] vs. -1.6 [1.9], P = 0.049). T-score positively correlated with SMI (r = 0.409, P < 0.0001). PeakVO2 was significantly decreased in the low SMI group (17.7 [6.3] vs. 14.4 [4.5], P = 0.006). In multivariate logistic regression analysis, T-score (odds ratio [OR], 3.508; 95% confidence interval [CI], 1.074-11.456; P = 0.038) and PeakVO2 (OR, 3.512; 95% CI, 1.114-11.066; P = 0.032) were significantly related to SMI, independent of age and sex. Skeletal muscle reduction in chronic liver disease is closely related to exercise tolerance and osteoporosis, and these factors are believed to be associated with physical inactivity in daily life.

Dipeptidyl peptidase 4 inhibitors attenuates the decline of skeletal muscle mass in patients with type 2 diabetes.

Activation of dipeptidyl peptidase 4 has been reported to be associated with impairment of insulin signalling in skeletal muscle, presumably leading to loss of muscle function. This study was aimed to investigate whether the use of dipeptidyl peptidase 4 inhibitors (DPP4i) could attenuate the progressive loss of muscle mass in patients with type 2 diabetes. A total 105 patients with type 2 diabetes (mean age 62±12 years; 39% female) were studied in this retrospective observational study. To reduce the bias due to confounding variables, propensity-score matching analysis was performed. Change in skeletal muscle index measured by the whole body dual-energy X-ray absorptiometry at 1-year follow-up was evaluated. One-year changes in visceral and subcutaneous fat area and liver attenuation index were also determined by abdominal computed tomography. Overall, 37 of 105 (35.2%) patients were treated with DPP4i. The estimated change in skeletal muscle index in patients with DPP4i was significantly higher than that in patients without (0.05±0.06 vs -0.10±0.04 kg, P=.046). In a propensity-matched population (N=48), the same finding was observed (0.04±0.03 in DPP4i versus -0.12±0.03kg in non-DPP4i, P=.033). There were no significant differences in changes of visceral and subcutaneous fat area and liver attenuation index between patients with DPP4i and those without. Our data suggest the potential of DPP4i to prevent the progressive loss of muscle mass with ageing in patients with type 2 diabetes.

O6-1 - Gender Differences in Prognostic Impact of Appendicular Skeletal Muscle Mass in Patients with Acute Heart Failure

Background: Clinical significance of skeletal muscle mass in patients with acute heart failure (AHF) remains unclear. Methods: We assessed lean body mass by dual energy X-ray absorptiometry in 108 hospitalized patients with AHF (age 72 ± 11, male 62%). Low appendicular skeletal muscle mass index (ASMI, appendicular skeletal muscle mass/height2) was defined according to the Asia Working Group for Sarcopenia criteria (<7.0 kg/m2 in male, <5.4 kg/m2 in female). AHF patients were followed until occurring cardiovascular (CV) events (CV death, nonfatal myocardial infarction, ischemic stroke, unstable angina, HF re-hospitalization, or coronary revascularization). Results: The prevalence of low-ASMI was 56% (n=61) in whole cohort and higher in male compared with female (64% versus 44%, P=.04). Forty eight patients developed CV events (median follow-up, 17 months). The incidence of CV events was significantly higher in female AHF patients with low-ASMI than in those with normal-ASMI, but not male (female: 72% versus 17%, P=.001, male: 51% versus 38%, P=.32, log-rank test). Low-ASMI significantly correlated with the future CV events in female AHF patients (female: unadjusted hazard ratio 5.79, P=.002, male: unadjusted hazard ratio 1.48, P=.32, p for interaction=0.04). Multivariate Cox hazard analysis demonstrated that low-ASMI was an independent predictor for CV events in female AHF patients (hazard ratio 29.5, 95%-confidence interval 4.1–211.4, P=.001). Conclusions: Low-ASMI could predict the future CV events in female patients with AHF.

Skeletal muscle depletion predicts survival of patients with advanced biliary tract cancer undergoing palliative chemotherapy.

BackgroundNo prior study has investigated the dynamics of body weight with body muscle mass as a prognostic factor in advanced biliary tract cancer (BTC) patients undergoing palliative chemotherapy. We investigated whether low skeletal muscle mass affects survival in patients with BTC, with a co-analysis of body weight loss and body mass index (BMI).ResultsBy multivariate analysis, low skeletal muscle mass at diagnosis and decreased SMI during chemotherapy (p = 0.008 and p < 0.001, respectively) were poor prognostic factors for overall survival (OS). Subgroup analysis revealed that low skeletal muscle mass patients who were overweight or obese (BMI ≥ 25 kg/m2) showed worse OS (p < 0.001). Additionally, patients with both decreased BMI and SMI during chemotherapy had worse OS (p < 0.001). Furthermore, patients with decreased SMI had shorter survival regardless of change in BMI. However, for patients with SMI maintained during chemotherapy, decreased BMI had no effect on survival (p = 0.576).Materials and MethodsWe consecutively enrolled 524 patients with advanced BTC who received palliative chemotherapy between 2003 and 2013. Total muscle cross-sectional area (cm2) at the L3 level assessed by computed tomography was analyzed. We defined low skeletal muscle mass as a skeletal muscle index (SMI) < 48.5 cm2/m2 (men) and < 39.5 cm2/m2 (women) using ROC curves.ConclusionsLow skeletal muscle mass, obesity and muscle depletion during palliative chemotherapy are meaningful prognostic factors in advanced BTC. Considering muscle depletion with weight change could help to more accurately predict prognoses of patients with BTC.

Adverse Effects of Low Preoperative Skeletal Muscle Mass in Patients Undergoing Gastrectomy for Gastric Cancer.

The aim of this study was to determine the impact of preoperative skeletal muscle mass on short- and long-term outcomes of patients with gastric cancer (GC) who undergo gastrectomy. A total of 569 patients subjected to gastrectomy for GC at our institution between January 2007 and December 2013 were reviewed and skeletal muscle index (SMI) was measured via cross-sectional, image-based muscle assessment. Computed tomography (CT) and the volume analyzer SYNAPSE VINCENT were required. Patients were divided into two groups, with the first quartile serving as the cut-point for both men and women. Clinicopathologic features and short- and long-term outcomes were compared. In multivariate analysis, SMI emerged as an independent predictor of 5year overall survival (OS) and cancer-specific survival (CSS) in patients with GC. In subgroup analysis, by stage, patients with stage I disease and low (vs. high) SMI demonstrated significantly worse 5year OS. The incidence of postoperative complications did not differ significantly by group. Preoperative SMI, measured in cross-section using CT, is a useful nutritional determinant that may predict OS and CSS in patients with GC who undergo gastrectomy. In our view, nutritional support for sarcopenic patients with stage I GC, aimed at retaining or adding skeletal muscle mass, may improve survival. Our analysis showed no relationship between preoperative SMI and postoperative complications.

Diagnosing Sarcopenia on Thoracic Computed Tomography: Quantitative Assessment of Skeletal Muscle Mass in Patients Undergoing Transcatheter Aortic Valve Replacement

This study aims to assess the use of skeletal muscle mass measurements at two thoracic levels to diagnose sarcopenia on computed tomography (CT) chest examinations and to analyze the impact of these measurements on clinical outcome parameters following transcatheter aortic valve replacement. This study retrospectively included 157 patients who underwent preoperative CT examinations. The total muscle area was measured on transverse CT images at the 3rd lumbar and 7th and 12th thoracic levels with skeletal muscle indices (SMIs) calculated at each level. SMIs were then compared to clinical outcome parameters, and thoracic cutoff values for sarcopenia at the 7th and 12th thoracic levels were calculated. Correlation between SMIs at the third lumbar vertebra (L3) and the 12th thoracic vertebra (T12) was stronger (r = 0.724, P < 0.001) than that between L3 and the seventh thoracic vertebra (T7) (r = 0.594, P < 0.001). SMIs at L3 and T12 significantly correlated with prolonged length of stay. Thoracic cutoff values for the 12th thoracic level were 42.6 cm2/m2 (men) and 30.6 cm2/m2 (women), and those for the 7th thoracic level were 46.5 cm2/m2 (men) and 32.3 cm2/m2 (women). Skeletal muscle measurements at the T12 level could permit the diagnosis of sarcopenia and could be used to correlate sarcopenia with outcome parameters in patients undergoing CT limited to the chest.

Development of a simple predictive model for decreased skeletal muscle mass in patients with compensated chronic liver disease.

To develop and validate a simple predictive model using easily obtained clinical parameters to predict decreased skeletal muscle mass (DSMM) in chronic liver disease (CLD) patients (n = 652). Study subjects were divided into a training set (n = 326) and a validation set (n = 326). Decreased skeletal muscle mass was diagnosed based on skeletal muscle mass index measured by bioimpedance analysis. Variables significantly associated with DSMM were identified using univariate and multivariate analyses in the training set and used to construct a predictive formula. Receiver operating characteristic (ROC) curve analysis was carried out and the predictive model was validated in the validation set. Subgroup analyses were undertaken based on gender, age, or cirrhosis status of patients. Body mass index (BMI), age, serum albumin, and branched-chain amino acid to tyrosine ratio (BTR) were determined to be significant predictive factors for DSMM. A composite formula "BALB score" was constructed [-7.740 + (0.539 × BMI) + (-0.112 × age) + (1.358 × albumin) + (-0.264 × BTR)]. The BALB score had the best predictive characteristics among all variables in both population sets (area under the ROC curve, 0.877-0.898). Patients with DSMM were stratified into three BALB score categories (>4, 0-4, and <0). Subgroup analyses also showed that BALB scoring was predictive of DSMM irrespective of gender, age, or cirrhosis status. The BALB score significantly correlated with psoas muscle index on computed tomography (rs = 0.6083 for men; rs = 0.6814 for women). The BALB scoring system based on routinely used clinical parameters offers a convenient and non-invasive method for predicting DSMM in compensated CLD patients with high accuracy.

Muscle Mass, Strength, Mobility, Quality of Life, and Disease Severity in Ankylosing Spondylitis Patients: A Preliminary Study.

ObjectiveTo determine if there is muscle mass reduction in patients with ankylosing spondylitis (AS) compared to the general population and to examine the relationship between skeletal muscle mass, quality of life (QOL), strength, and mobility in patients with AS.MethodsA total of 30 AS patients were enrolled in this study. Skeletal muscle mass was measured by bioelectrical impedance analysis, and it was expressed as the skeletal muscle mass index (SMI). QOL was assessed using the EuroQOL (EQ-5D). To measure mobility, the modified Schöber test and chest expansion test were used. To measure grip strength as a measure of muscle strength, we used the hydraulic hand dynamometer. Additionally, we divided the patients into two groups according to the degree of X-ray finding and compared the differences between the two groups.ResultsThere was no significant reduction in skeletal muscle mass in patients with AS compared to the general population. Also, there was no significant correlation between SMI and QOL. On the other hand, there was a significant positive correlation between SMI and mobility, and grip strength. A significant positive correlation was found between mobility and QOL. Additionally, there was a statistically significant difference in mobility between the two groups according to the degree of X-ray finding.ConclusionMaintaining muscle mass in AS patients may not be helpful for improving QOL, but it may contribute to achieving adequate mobility and strength.

Abstract 13518: Low Skeletal Muscle Mass Index is Associated With Cardiovascular Events in Patients After ST-segment Elevation Myocardial Infarction

Introduction: Although it has been implicated the association between low skeletal muscle mass and cardiovascular diseases, the prognostic value of skeletal muscle mass in patients with ST-segment elevation myocardial infarction (STEMI) is unclear. Hypothesis: We assessed the hypothesis that low skeletal muscle mass index (SMMI) is associated with an increased risk of secondary cardiovascular events in patients with STEMI. Methods: A total of 200 patients with STEMI were enrolled. SMMI was estimated from dual-energy X-ray absorptiometry scan before discharge, and calculated by dividing appendicular skeletal muscle mass (kg) by height squared (m 2 ). The patients were divided into low and high SMMI groups using the first tertile of SMMI. Low SMMI was defined as ≤6.843 kg/m 2 for men and ≤5.321 kg/m 2 for women. All patients were followed for cardiovascular events, which consist of cardiovascular deaths, nonfatal myocardial infarctions, nonfatal ischemic strokes, and congestive heart failure. Results: During follow-up (median 340 days [interquartile ranges 298 and 389]), 15 patients experienced cardiovascular events (1 cardiovascular death, 6 myocardial infarction, 6 stroke, and 3 congestive heart failure). The event rate at 1 year after STEMI was significantly higher in patients with low SMMI (15.5%) than with high SMMI (2.5%) (log-rank p&lt;0.001) (Figure). Even after adjustment for the propensity score which was calculated with age, gender, height, weight, risk factors and medications, patients with low SMMI had 5.8-fold higher risk of subsequent cardiovascular events compared to those without (Adjusted hazard ratio 5.86, 95% confidence interval 1.18 to 35.28, p=0.03). Conclusion: Among patients with STEMI, low SMMI was significantly and independently associated with an increased risk of future cardiovascular events.

Relationship between skeletal muscle mass and swallowing function in patients with Alzheimer's disease.

The present study verified the hypothesis that decreased skeletal muscle in older adults with Alzheimer's disease is related to Alzheimer's disease progression and decreased oral or swallowing function. We investigated 232 patients with Alzheimer's disease (31 men, 201 women, average age 85.4 ± 5.9 years) in two regions in Japan. The patients provided basic information (sex and age), and were assessed for skeletal muscle index, dementia severity (clinical dementia rating), activities of daily living, nutritional status, oral status and swallowing function. Stratification by clinical dementia rating was as follows: clinical dementia rating 0.5:21 patients (9.0%), clinical dementia rating 1:85 patients (36.6%), clinical dementia rating 2:88 patients (37.9%) and clinical dementia rating 3:38 patients (16.3%). Alzheimer's disease severity was significantly related to skeletal muscle index. Logistic regression analysis showed that clinical dementia rating 3 (odds ratio 11.68, 95% confidence interval 4.52-30.20), body mass index < 18.5 (odds ratio 3.18, 95% confidence interval 1.27-8.00), calf circumference <30.5 cm (odds ratio 9.33, 95% confidence interval 2.01-43.27) and poor swallowing function (odds ratio 4.93, 95% confidence interval 1.10-22.04) had a significant effect on decreased skeletal muscle index. Therefore, decreased skeletal muscle mass in patients with Alzheimer's disease requires strategies to manage swallowing dysfunction. Geriatr Gerontol Int 2016; 17: 402-409.