Thigh Muscle Thickness Research Articles

Relationship of Thenar and Hypothenar Muscle Thickness with Clinical Factors, Thigh Muscle Thickness and Physical Performance in Female Patients with Rheumatoid Arthritis

Relationship of Thenar and Hypothenar Muscle Thickness with Clinical Factors, Thigh Muscle Thickness and Physical Performance in Female Patients with Rheumatoid Arthritis

Role of Muscle Ultrasound for the Study of Frailty in Elderly Patients with Diabetes: A Pilot Study.

Sarcopenia and diabetes contribute to the development of frailty. Therefore, accessible methods, such as muscle ultrasounds (MUSs), to screen for sarcopenia should be implemented in clinical practice. We conducted a cross-sectional pilot study including 47 patients with diabetes (mean age: 77.72 ± 5.08 years, mean weight: 75.8 kg ± 15.89 kg, and body mass index: 31.19 ± 6.65 kg/m2) categorized as frail by the FRAIL Scale or Clinical Frailty Scale and confirmed by Fried's Frailty Phenotype or Rockwood's 36-item Frailty Index. We used the SARC-F questionnaire to identify sarcopenia. The Short Physical Performance Battery (SPPB) and the Timed Up and Go (TUG) tests were used to assess physical performance and the risk of falls, respectively. In addition, other variables were measured: fat-free mass (FFM) and Sarcopenia Risk Index (SRI) with the bioimpedance analysis (BIA); thigh muscle thickness (TMT) of the quadriceps with MUS; and hand-grip strength with dynamometry. We observed correlations between the SARC-F and FFM (R = -0.4; p < 0.002) and hand-grip strength (R = -0.5; p < 0.0002), as well as between the TMT and FFM of the right leg (R = 0.4; p < 0.02) and the SRI (R = 0.6; p < 0.0001). We could predict sarcopenia using a logistic regression model with a ROC curve (AUC = 0.78) including FFM, handgrip strength, and TMT. The optimal cut-off point for maximum efficiency was 1.58 cm for TMT (sensitivity = 71.4% and specificity = 51.5%). However, we did not observe differences in the TMT among groups of greater/less frailty based on the SARC-F, SPPB, and TUG (p > 0.05). MUSs, which correlated with the BIA (R = 0.4; p < 0.02), complemented the diagnosis, identifying regional sarcopenia of the quadriceps in frail patients with diabetes and improving the ROC curve to AUC = 0.78. In addition, a TMT cut-off point for the diagnosis of sarcopenia of 1.58 cm was obtained. Larger studies to validate the MUS technique as a screening strategy are warranted.

Association Between the Medial-Lateral Quadriceps and Hamstring Muscle Thickness and the Knee Kinematics and Kinetics During Single-Leg Landing.

Muscle thickness can influence the joint kinematics and/or kinetics during dynamic activities. The relationship between the muscle thickness of individual quadriceps and hamstrings or medial-to-lateral thigh muscle thickness ratio and the knee kinematics/kinetics with respect to anterior cruciate ligament (ACL) injury risk remains unclear. Higher medial-to-lateral thigh muscle thickness ratio would be associated with lower knee valgus angle/moment and lower tibial internal rotation angle/moment during single-leg landing. Cross-sectional. Level 4. Muscle thickness of the vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), and semitendinosus (ST) of 30 healthy participants (16 males and 14 females) were measured using ultrasound. Knee joint kinematics and kinetics during single-leg landing were obtained. Stepwise multiple regression analysis, a follow-up Fisher's r to z test to examine the sex as a moderator, and independent t tests to evaluate sex difference were performed. Both knee valgus moment (R2 = 0.466, P < 0.001) and tibial external rotation moment (R2 = 0.330, P < 0.001) at peak anterior tibial shear force during single-leg landing were negatively correlated with medial-to-lateral (ie, (VM+ST):(VL+BF)) thickness ratio regardless of sex, whereas medial-to-lateral thigh muscle thickness ratio was not correlated with knee valgus and tibial external rotation angles. Male participants exhibited higher (VM+ST):(VL+BF) thickness ratio than female participants (P = 0.005), and lower knee valgus moment (P = 0.04) and tibial external rotation moment (P = 0.05), as well. The knee joint moments in frontal and transverse planes during single-leg landing were associated with the medial-to-lateral thigh muscle thickness ratio; thus, the medial-lateral thigh muscle thickness could be a potential contributor to frontal and transverse plane knee joint loading during dynamic movement. Strength training that aims to selectively strengthen the medial/lateral thigh muscles might be considered in a new ACL injury prevention training program to alter the biomechanical parameters associated with ACL injuries.

Comparison of Differences in Thigh Muscle Morphology and Function according to Post-anterior Cruciate Ligament Surgery Period

PURPOSE: Quadriceps muscle weakness caused by muscle atrophy is a typical feature of individuals who undergo anterior cruciate ligament reconstruction. Although many studies have suggested an acceptable timing for returning to sports after anterior cruciate ligament reconstruction, there are still many controversies. Therefore, this study aimed to present an evidence-based recommendation for returning to sports after anterior cruciate ligament reconstruction by evaluating muscle size and function 9 months after the reconstruction.METHODS: Eighteen patients who underwent anterior cruciate ligament reconstruction were evaluated for quadricep thickness and isokinetic knee extension strength in both limbs. The Mann-Whitney U test was used to compare the differences 1) in thigh muscle thickness and isokinetic knee extension strength between the reconstructed limbs in “more than 9 months after surgery” and “less than 9 months after surgery” groups and 2) between the limb symmetry index of the two groups.RESULTS: The main findings were that the vastus medialis thickness and isokinetic knee extension strength for the reconstructed limbs were significantly greater in the more than 9 months after surgery group (vastus medialis: Z=12.00, &lt;i&gt;p&lt;/i&gt;=.014; strength: Z=16.00, &lt;i&gt;p&lt;/i&gt;=.034). The vastus medialis and vastus intermedius thicknesses in the more than 9 months after surgery group also showed a significant increase compared to those in the less than 9 months after surgery group (vastus medialis: Z=10.00, &lt;i&gt;p&lt;/i&gt;=.006; vastus intermedius: Z= 10.00, &lt;i&gt;p&lt;/i&gt;=.006).CONCLUSIONS: After anterior cruciate ligament reconstruction, selective muscle atrophy and weakness in the quadriceps muscles were observed. This study emphasizes the need for targeted early rehabilitation of specific quadriceps muscles to prevent muscle atrophy and weakness after anterior cruciate ligament reconstruction.

Usefulness of Ultrasound in Assessing the Impact of Bariatric Surgery on Body Composition: a Pilot Study

BackgroundBariatric surgery (BS) has a significant impact on body composition. The purpose of the study is to evaluate the usefulness of musculoskeletal ultrasound (MUS) to bioelectrical impedance (BIA) in the follow-up of patients undergoing BS in terms of body composition and quality of life (QoL).MethodsThis is a prospective pilot study including 32 subjects (75% female, mean age: 49.15 ± 1.9 years) who underwent BS. Fat mass (FM), lean mass (LM), and skeletal muscle index (SMI) were calculated by BIA. MUS measured subcutaneous fat (SF) and thigh muscle thickness (TMT) of the quadriceps. QoL was assessed by the Moorehead-Ardelt questionnaire. All these measurements were performed 1 month prior to BS and at 12-month follow-up.ResultsThe mean BMI decreased by 6.63 ± 1.25 kg/m2 (p=0.001). We observed significant reductions in FM (p=0.001) and SF (p=0.007) and in LM (p=0.001) but not in SMI and TMT. We found a correlation between the FM and SF (pre-surgical, r=0.42, p=0.01; post-surgical, r=0.52, p=0.003) and between SMI and TMT (pre-surgical, r=0.35, p=0.04; post-surgical, r=0.38, p=0.03). QoL test showed significant improvement (p=0.001). In addition, a correlation between the QoL questionnaire and TMT post-surgery (r=0.91, p=0.019) was observed. However, we did not find any statistically significant correlation between QoL assessment and SMI or LM.ConclusionsOur results suggest that MUS can be complementary to BIA for the evaluation and the follow-up of body composition after BS. TMT of quadriceps can provide relevant information about regional sarcopenia and has a significant correlation with QoL.Graphical

Association of Sonographic Sarcopenia and Falls in Older Adults Presenting to the Emergency Department

To determine the association between point-of-care-ultrasonography (POCUS)-measured sarcopenia and grip strength, as well as the history of prior-year falls among older adults admitted to the emergency department observation unit (EDOU). This cross-sectional observational study was conducted over 8 months at a large urban teaching hospital. A consecutive sample of patients who were 65 years or older and admitted to the EDOU were enrolled in the study. Using standardized techniques, trained research assistants and co-investigators measured patients' biceps brachii and thigh quadriceps muscles via a linear transducer. Grip strength was measured using a Jamar Hydraulic Hand Dynamometer. Participants were surveyed regarding their history of falls in the prior year. Logistic regression analyses assessed the relationship of sarcopenia and grip strength to a history of falls (the primary outcome). Among 199 participants (55% female), 46% reported falling in the prior year. The median biceps thickness was 2.22 cm with an Interquartile range [IQR] of 1.87-2.74, and the median thigh muscle thickness was 2.91 cm with an IQR of 2.40-3.49. A univariate logistic regression analysis demonstrated a correlation between higher thigh muscle thickness, normal grip strength, and history of prior-year falling, with an odds ratio [OR] of 0.67 (95% conference interval [95%CI] 0.47-0.95) and an OR of 0.51 (95%CI 0.29-0.91), respectively. In multivariate logistic regression, only higher thigh muscle thickness was correlated with a history of prior-year falls, with an OR of 0.59 (95% CI 0.38-0.91). POCUS-measured thigh muscle thickness has the potential to identify patients who have fallen and thus are at high risk for future falls.

P351 Validation of anterior thigh ultrasound for screening of sarcopenia and elevated body fat in Inflammatory Bowel Disease

Abstract Background Sarcopenia (low muscle mass, strength and function) and visceral obesity are associated with adverse outcomes in inflammatory bowel disease (IBD). US measurement of thigh muscle thickness as a biomarker of muscle loss in IBD has not been validated to date. Our aim is to validate anterior thigh US for measurement of total muscle thickness (TMT) and fat thickness (FT) in IBD patients and to identify muscle thickness values associated with sarcopenia using bioelectrical impedance analysis (BIA). Methods A prospective study of muscle function and mass was carried out using handgrip strength testing, sit-to-stand test, B-mode US and bioelectrical impedance analysis (BIA) (SECA mBCA 525) in IBD patients attending outpatients in our centre. Sarcopenia was confirmed by ASM/H2. Stata was used for statistical analysis, p ≤ 0.05 denoted statistical significance. Results A total of 52 patients were included, 42% (n=22) were females with a mean age of 45.5 years. CD patients accounted for 75% (n=39). Mean BMI of females was 29.64 (SD 5.88) vs males 26.2 (SD 3.8), p=0.014. Sarcopenia was diagnosed in 16 patients (31%), 10/16 were female with a significantly lower TMT vs non-sarcopenic females (mean 3.56cm vs 4.32cm, p=0.05). ASM/H2 was lower in sarcopenic patients (mean 4.67 kg/h2 vs 8.97 kg/h2, p&amp;lt;0.001). Handgrip strength was lower in sarcopenic patients (mean 24.4 vs 32.1 kg, p=0.25), sit-to-stand did not differ significantly (mean 18.84 vs 13.13sec, p=0.027). Physical activity levels were insignificantly lower in the sarcopenia group (mean PAL 1.78 vs 1.85, p=0.089). TMT strongly correlated with ASM/H2 (r=0.385,p=0.005), skeletal muscle mass (mm) (r=0.368, p0.008), right leg MM (r=0.404, p0.003), handgrip strength (0.29, 0.035) and BMI (r=0.39, 0.005). FT strongly correlated with body fat (kg) (r=0.699, p&amp;lt;0.001), body fat % (r=0.76, p&amp;lt;0.001), body fat index (r=0.67, p&amp;lt;0.001), waist circumference (r=0.35,p0.01) and BMI (r=0.68, p&amp;lt;0.001). Of the sarcopenic patients, 62.5% had high body fat (n=10) which trended toward but did not reach statistical significance (p=0.08). Visceral fat was high overall with higher levels in men (3.6L vs 2.0L, p=0.009), it did not correlate with SF (r=-0.074, p=0.6). Finally, the intra-rater reliability for TMT and SF were both excellent (r=0.97, p&amp;lt;0.001 and 0.979 p&amp;lt;0.001 respectively). Conclusion Sarcopenia is prevalent in IBD patients. Anterior thigh US correlates with BIA and can be used as a screening tool for early loss of muscle mass in IBD patients in addition to screening for high visceral adiposity. The presence of increased visceral adiposity was high, which may have deleterious outcomes for CD patients, given its association with transmural inflammation and post-operative recurrence.

Reproducibility and feasibility of a handheld ultrasound device compared to a standard ultrasound machine in muscle thickness measurements.

To test the feasibility and reproducibility of a handheld ultrasound device (HUD) compared to a standard ultrasound machine for muscle thickness measurements in healthy participants. A prospective cross-sectional study was designed where two novice operators tested the thickness of the vastus lateralis, rectus femoris, and vastus intermedius muscles on recruited asymptomatic participants with no history of muscle diseases. The anterior-posterior thickness of each muscle was measured three times per operator to evaluate intra-operator reproducibility and using two machines to evaluate inter-system reproducibility. Scanning started using the HUD followed by the standard system. Intraclass correlation coefficients (ICC) and simple linear regression were used to test for reproducibility and proportional bias respectively. A total of 33 male participants volunteered to take part in this study with a mean age of 22.7 years (6.8). Intra-operator reproducibility was almost perfect for both operators on both machines (ICC > 0.80). The measurements difference percentage between the machines ranged from 1.8% to 6.6% and inter-system reproducibility ICC ranged from 0.815 to 0.927 showing excellent reproducibility. Inter-operator reproducibility was poor to moderate on both machines (ICC: 0.522-0.849). Regression analysis showed no proportional bias in the measurements. All measurements were completed successfully using the HUD. The HUD demonstrated excellent accuracy compared to the standard ultrasound machine for measuring thigh muscle thickness.

The relationship between sarcopenia-related measurements and osteoporosis: The SARCOP study.

As muscle and bone are two closely related tissues, we aimed to investigate the association between sarcopenia-related measurements (i.e., sonographic anterior thigh muscle thickness, grip strength, chair stand test (CST), gait speed) and clinical factors, lumbar/femoral BMD, and the presence of osteoporosis (OP) in postmenopausal women. Community dwelling postmenopausal women from two physical and rehabilitation medicine outpatient clinics were consecutively included in this cross-sectional study. Demographic data, age, weight, height, education/exercise status, smoking, and comorbidities were registered. BMD measurements were performed from lumbar vertebrae (L1-4) and femoral neck using dual energy X-ray absorptiometry (DXA). A T-score of ≤ -2.5 SD in the lumbar vertebrae (L1-L4) and/or femoral neck was accepted as OP. Anterior thigh muscle thickness (MT) at the midthigh level was measured sonographically using a linear probe. Grip strength was measured from the dominant side. Physical performance was assessed by CST and gait speed. Among 546 postmenopausal women, 222 (40.7%) had OP. Among sarcopenia-related parameters, grip strength and anterior thigh MT were positively associated with lumbar vertebral BMD. CST performance was positively associated with femoral neck BMD. After adjusting for confounding factors, low grip strength (< 22kg) increased 1.6 times the risk of OP. Loss of muscle mass/function (i.e., sarcopenia) can coexist with loss of trabecular and cortical bone. To this end, grip strength and anterior thigh MT seem to be associated with the lumbar vertebral BMD, while CST is associated with the femoral neck BMD. Lastly, low grip strength might have an association with postmenopausal OP.

Reevaluation of the topographical anatomy of the mid-thigh: A magnetic resonance and ultrasound imaging study.

Adductor canal (AC) and sciatic nerve (SN) blockades are commonly used during total knee arthroplasties for postoperative pain control. Medical professionals have begun to utilize single injection combined regional anesthesia methods due to increased patient comfort. In this study, we examined the topographical anatomy of the mid-thigh, which is recommended as the appropriate intervention level for combined AC and SN blockades, in order to provide a safe approach for clinicians. We examined 184 thigh magnetic resonance images (MRI) from 98 patients. We measured the diameter of the mid-thigh, anterior thigh muscle thickness, subcutaneous adipose tissue thickness, and SN depth on the MRIs. We obtained ultrasound (US) images of the vastoadductor membranes (VAM) of 26 volunteers, and measured the vertical distances between the greater trochanter and the adductor tubercle (A) and the greater trochanter and the upper edge of the VAM (B). We then proportioned B to A in order to determine in which part of the thigh the AC was located. The AC was in the distal third of the thigh, and the SN's depth was located in the third quarter of the thigh's diameter. Only the adductor magnus, and no neurovascular structure, was at risk of injury between the AC and the SN. The upper edge of the VAM was 6.5 cm below the mid-thigh, therefore it is not appropriate to suggest performing an AC blockade at mid-thigh. We think that it is safe to perform a combined AC and SN blockade in a single injection in selected patients.

Muscle Evaluation and Hospital-Associated Disability in Acute Hospitalized Older Adults.

ObjectivesWe aimed to examine the association of muscle evaluation, including muscle ultrasound, with hospital-associated disability (HAD), focusing on ADL categories.DesignA prospective observational cohort study.Setting and ParticipantsWe recruited patients aged 65 years or older who were admitted to the geriatric ward of an acute hospital between October 2019 and September 2021.MeasurementsHandgrip strength, bioimpedance analyzer-determined skeletal muscle mass, bilateral thigh muscle thickness (BATT), and the echo intensity of the rectus femoris on muscle ultrasound were performed as muscle assessments. HAD was evaluated separately for mobility impairments and self-care impairments.ResultsIn total, 256 individuals (mean age, 85.2 years; male sex, 41.8%) were analyzed. HAD in mobility was more common than HAD in self-care (37.5% vs. 30.0%). Only BATT was independently associated with HAD in mobility in multiple logistic regression analysis. There was no significant association between muscle indicators and HAD in self-care.ConclusionA lower BATT was associated with a higher prevalence of HAD in mobility, suggesting the need to reconsider muscle assessment methods in hospitalized older adults. In addition, approaches other than physical may be required, such as psychosocial and environmental interventions to improve HAD in self-care.Electronic Supplementary MaterialSupplementary material is available for this article at 10.1007/s12603-022-1814-8 and is accessible for authorized users.

Ultrasound for thigh muscle thickness is a valuable tool in the diagnosis of sarcopenia in Indian patients with predialysis chronic kidney disease

ObjectivesPatients with chronic kidney disease (CKD) are known to develop sarcopenia, an aging-related disorder, with low muscle mass, strength and physical performance. Ultrasound-derived thigh muscle and rectus femoris thickness (TMT and RFT) can be measured easily in clinical practice, but need validation for use in predialysis CKD (stages III through V) for muscle mass estimation. The study aims to compare ultrasound-derived TMT and RFT with bioelectrical impedance analysis (BIA)-derived muscle mass estimation in the diagnosis of sarcopenia in predialysis CKD. MethodsPatients with stable CKD stage III, IV, V and not yet on dialysis were recruited, and underwent anthropometric assessment, BIA and ultrasound examination of midthigh region. Appendicular skeletal muscle index (ASMI)/height2 derived from BIA was taken as a standard for the diagnosis of low muscle mass. Gait speed and handgrip were also measured. The Asian Working Group criteria were applied. Cutoff values for low muscle mass by TMT and RFT were obtained using receiver operator curve (ROC) analysis. ResultsOf the total of 117 enrolled study participants, 52 (45%) had low muscle mass, 34 (29%) had sarcopenia, of whom 79% were male, majority (38%) were CKD stage IV and had a mean age of 58 years. Using ROC analysis, TMT cutoffs of 19 mm in males and 17 mm in females were computed. Comparison of TMT cutoffs and ASMI/h2 showed good agreement between the 2 methods using Bland-Altman plots. ConclusionsUltrasound-derived TMT and RFT can be used for muscle mass estimation in the diagnosis of sarcopenia.

Usefulness of Muscle Ultrasound to Study Sarcopenic Obesity: A Pilot Case-Control Study.

Background and objectives: Sarcopenic obesity (SO) is an emerging problem, especially in candidates for bariatric surgery (BS). We hypothesized that musculoskeletal ultrasound (MUS), a simple and accessible method, could be a reliable index of SO. Materials and Methods: A cross-sectional pilot study including 122 subjects (90 cases and 32 controls, 73% female, mean age: 51.2 years) who underwent BS was conducted at University Hospital Mútua Terrassa. The lean mass (LM) was calculated by bioelectrical impedance analysis (BIA) and the thigh muscle thickness (TMT) by MUS. To identify the subjects with SO by BIA, we used skeletal muscle index (SMI). The validity of MUS was determined using the ROC curve. Results: The mean BMI in the obesity group was 44.22 kg/m2. We observed a correlation between the LM and SMI assessed by BIA and the TMT assessed by MUS (R = 0.46, p < 0.001). This correlation was maintained at significant levels in the SO group (n = 40): R = 0.79; p = 0.003). The TMT assessed by MUS was able to predict SMI using BIA (AUC 0.77; 95% CI: 0.68242 to 0.84281). The optimal cut-off point for maximum efficiency was 1.57 cm in TMT (sensitivity = 75.6% and specificity = 71.1%). Conclusions: The TMT of the quadriceps assessed by US is a useful tool for identifying subjects with SO. Larger studies to validate this simple low-cost screening strategy are warranted.

Effect of a 12-week home-based exercise training program on aerobic capacity, muscle mass, liver and spleen stiffness, and quality of life in cirrhotic patients: a randomized controlled clinical trial

BackgroundPhysical inactivity and sarcopenia are two important predictors associated with increased morbidity and mortality in patients with cirrhosis. At present, the benefit of a home-based exercise training program is not well established in cirrhotic patients. The main objective of this study was to evaluate the effect of a 12-week home-based exercise training program on aerobic capacity in cirrhotic patients.MethodsThis is a randomized controlled study. Patients with compensated cirrhosis were randomized by a block of 4 with concealed allocation to the home-based exercise training (n = 20) or control (n = 20). Both groups received protein supplementation (9 g/day) for 12 weeks. The home-based exercise training program included several aerobic/isotonic moderate-intensity continuous training exercises for 40 min per session, at least four times a week, with a total duration of 12 weeks. The heart rate was continuously monitored using a Garmin® watch. In the control group, patients received exercise instruction without active encouragement and continuous monitoring. The primary outcome was a change in the 6-min walk test from baseline. Secondary outcomes were the difference in thigh muscle thickness, liver stiffness, spleen stiffness, and quality of life.ResultsA total of 40 patients were enrolled prospectively. The mean age was 56.3 ± 7.8 years, with a male predominance of 65%. The mean body mass index was 25.23 ± 3.0 kg/m2, and all were Child–Pugh A. Chronic hepatitis B or C was the primary cause of cirrhosis. The baseline values were a 6-min walk test of 475 ± 70 m, liver stiffness of 15.3 ± 9.3 kPa, spleen stiffness of 29.8 ± 21.7 kPa, and thigh muscle thickness (average compression index) of 0.64 ± 0.2 cm/m2. All baseline characteristics between the two groups were not different except the mean muscle mass which was significantly higher in the home-based exercise training group (p = 0.03, 95% CI 0.01 to 0.17). At the end of the study, no significant difference in the 6-min walk test was observed (p = 0.36, 95% CI −15.5 to 41.7). Liver stiffness measurement significantly improved in both groups, but no significant difference between groups was demonstrated (p = 0.77, 95% CI −1.3 to 1.8). Thigh muscle thickness was not different between groups. The fatigue domain of the quality of life index was significantly improved in the home-based exercise training group compared with the control group (p = 0.05, 95% CI 0.00 to 0.67). No adverse events occurred in a home-based exercise training program.ConclusionsA 12-week moderate-intensity home-based exercise training program in compensated cirrhotic patients significantly improved the fatigue domain of the quality of life index without an increase in adverse events. However, no benefit in terms of aerobic capacity, thigh muscle mass, liver stiffness, and spleen stiffness was demonstrated.Trial registration: Thai Clinical Trials Registry number TCTR20190926002, 26/09/2019 (Retrospectively registered).

P170 Point-of-care ultrasound accurately quantifies skeletal muscle index in patients with Inflammatory Bowel Disease

Abstract Background Body composition is frequently altered in patients with Inflammatory Bowel Disease (IBD) and difficult to quantify without expensive and radiation-prone techniques. Low skeletal muscle index (SMI) has been associated with increased surgical complications and poor quality of life. Aim: To develop a portable ultrasound (US) protocol to estimate SMI, to compare this with SMI from paired whole-body dual-energy X-ray absorptiometry (DXA) in patients with IBD and controls, and to assess its responsive to change over time. Methods Adult patients with IBD and gender-matched controls underwent prospective assessment of body composition by US (Philips Lumify) and DXA (GE Lunar Prodigy) for which low SMI was defined as men ≤7.26 kg/m2 and women ≤5.45 kg/m2. Sonographic muscle thickness of the dominant arm and bilateral thighs (Figure 1) were multiplied by respective bone lengths (humerus or femur) and described in cm2. Results were analysed by Spearman correlation and receiver operating characteristic (ROC) curves using just arm measurements (USarm) or combined arm and thigh measurements (UScombined). A subgroup of patients with active IBD (faecal calprotectin of ≥150 µg/g) were assessed again ≥14 weeks after initiating biologic induction therapy. Response was defined with faecal calprotectin reduction of ≥50%. Results 48 patients with IBD had similar SMI compared with 30 controls (7.1 vs 7.7 kg/m2), but a higher proportion had low SMI (19% vs. 3%, p=0.048). In both IBD and control participants, DXA-derived SMI was strongly associated with USarm measurements (r=0.89 and r=0.88, p&amp;lt;0.0001) and UScombined measurements (r=0.90 and r=0.87, p&amp;lt;0.0001). On ROC analysis in patients with IBD, low SMI was identified best with USarm &amp;lt;73 cm2 in women (AUC 0.93, sensitivity 100%, specificity 89%) and &amp;lt;117 cm2 in men (AUC 0.88, sensitivity 100%, specificity 81%). In 7 of 14 patients who responded to biologic induction, only DXA-SMI increased significantly (7.9 to 9 kg/m2) compared to USarm (109 to 124 cm2, p=0.249) and UScombined (270 to 323 cm2, p=0.080). Including both responders and non-responders, change in UScombined correlated well with change in DXA-SMI (r=0.77, p=0.007). Conclusion Sonographic measurement of the dominant arm ± bilateral thigh muscle thickness accurately assesses DXA-derived SMI at the point-of-care. In preliminary evaluation, it was responsive to change after biologic induction therapy, but larger sample sizes and longer follow up are needed to evaluate its monitoring role.

Assessment of the significance of new phenotype parameters of Russian meat merino sheep by principal component analysis

Phenotype assessment is an important process in breeding practice and for studying the influence of genes that shape the productive qualities of sheep. As a result of many years of selection and breeding work, the existing indicators fixed in the breed have lost their supposed potential, which dictates the need to search for new indicators that more accurately characterize the meat productivity of sheep. The aim of the work is to assess the informativeness of phenotype parameters in Russian meat merino sheep by the method of principal component analysis, for further use in genomic selection programs, as well as applicable for in vivo assessment of meat productivity. For the first time, new methods of assessing the exterior and interior for the study of meat productivity have been proposed and their efficiency has been determined for russian meat merino (RMM) sheep. The possibility of determining the size of individual muscle groups using such parameters as the girth of the shoulder, forearm and thigh by instrumental methods, as well as measuring the thigh muscle thickness and fat thickness (TMT and FT) in the lumbar region using ultrasound was studied. The object of the study was the one-year -old rams (n = 50) of the Russian Meat Merino (RMM) breed. To assess the significance of the proposed measurements, in comparison with those used in existing practice, the principal component method and correlation analysis were used. In the course of the work carried out, it was found that measurements: thigh volume, forearm girth had the most significant correlations with all parameters describing the exterior of the PMM breed. Based on the analysis of the main components, it was determined that the first six components in our study explained more than 80% of phenotypic variability. Thus, the proposed parameters determined by ultrasound: TMT and FT are advisable to use for the phenotypic assessment of the conformation of sheep of the RMM breed, especially when searching for genomic associations with productive qualities.

Sarcopenia in patients with multiple sclerosis

Background: Multiple sclerosis (MS) is an autoimmune neurodegenerative disease of the central nervous system. Sarcopenia, which is characterized by the loss of physical performance and poor outcomes, has recently become the focus of research. However, the relationship between sarcopenia and MS has not yet been investigated. This study aims to determine the prevalence of sarcopenia in MS patients and investigate the factors associated with sarcopenia.Methods: One hundred and one MS patients who can walk without assistance and 55 healthy controls were included. Handgrip strength (HGS) and gait speed tests were applied to all participants. Additionally, anterior thigh muscle thickness (anterior TMT) and skeletal muscle mass index (SSMI) were estimated by ultrasound and bioelectrical impedance analysis (BIA), respectively. According to these tests, MS patients were grouped as either sarcopenic or non-sarcopenic. The groups were compared using clinical and laboratory data, handgrip strength and performance test, Modified Fatigue Impact Scale (MFIS), and the Godin leisure-time exercise questionnaire (GLTEQ).Results: HGS, gait speed, fat free mass (FFM), SMMI, anterior TMT, and sonographic thigh adjustment ratio (STAR) values in patients with MS were significantly lower than healthy controls for both sexes (for female, p:0.001, p:0.001, p:0.010, p:0.049, p:0.001, and p:0.101, respectively; for male, all p:0.001). Compared with healthy controls, MS patients had a significantly lower GLTEQ score (p:0.001), while the MFIS score (p:0.001) was higher. According to STAR, HGS, and gait speed, sarcopenia was diagnosed in 12 (17.64%) female and 7 (21.21%) male patients with MS. Whole-body sarcopenia was diagnosed in only 11 (10.9%) of the patients by BIA. HGS, gait speed, FFM, anterior TMT, and STAR values in sarcopenic MS patients were significantly lower than in non-sarcopenic for females (p:0.001, p:0.001, p:0.004, p:0.001, and p:0.001, respectively) and males (p:0.001, p:0.001, p:0.011, p:0.003, and p:0.001, respectively). MFIS score was significantly higher in sarcopenic patients than non-sarcopenic for both females (p:0.001) and males (p:0.036), but only the physical fatigue subscale was significantly higher. While the physical fatigue score was negatively correlated with GLTEQ in MS patients (r:-0.276, p:0.005), it was positively correlated with the expanded disability status scale (r:0.409, p:0.001).Conclusion: We detected that approximately one-fifth of MS patients have sarcopenia. Regional sarcopenia was more prevalent than whole body sarcopenia. We found a high degree of fatigue and lack of exercise in sarcopenic MS patients.

Screening for sarcopenia and obesity by measuring thigh muscle and fat thickness by ultrasound in patients with rheumatoid arthritis

ObjectivesSarcopenia is relatively common in rheumatoid arthritis (RA) patients. Thicknesses of the quadriceps muscle and fat are easily measured by ultrasound (US) and are known to be related to skeletal muscle mass and fat mass, respectively. MethodsEighty-four patients enrolled in the prospective correlation research of sarcopenia, skeletal muscle, and disease activity in rheumatoid arthritis study (UMIN000023744) underwent US examinations of anterior thigh muscle thickness (MT) and fat thickness (FT). Muscle and body fat (BF) mass were also examined by a body composition analyzer. Whether MT and FT were related to sarcopenia and obesity was examined. ResultsMT was significantly lower in RA patients with sarcopenia than in those without (23.8 vs 28.2 mm, P = 0.001). MT was related to sarcopenia (men: r = 0.56, P = 0.02, women: r = 0.32, P = 0.01). The cut-off value of MT for sarcopenia was 24.7 mm in men and 19.7 mm in women on receiver operating characteristic curve analyses. FT was correlated with BF percentage (%BF; men: r = 0.66, P < 0.01, women: r = 0.62, P < 0.001), which was estimated by 2.04xFT+8.53 in men and 1.2xFT+17.42 in women by a simple linear regression model. This means that FT ≥ 8.1 mm in men and FT ≥ 14.6 mm in women indicated obesity. ConclusionsUS examination of the anterior thigh was useful to detect sarcopenia and obesity in RA patients.

Cut-off Values for Lower Limb Muscle Thickness to Detect Low Muscle Mass for Sarcopenia in Older Adults.

PurposeUltrasound-based prediction methods for the detection of low muscle mass for sarcopenia in older adults have been explored previously; however, the muscle that most accurately predicts it is unclear. This study aimed to clarify prediction accuracy and cut-off values for ultrasound-derived thigh and lower leg muscle thickness (MT) to detect low skeletal muscle mass index (SMI) in older adults and to estimate cut-off values based on two standard deviations (SD) below younger adult means for the corresponding muscles as an early detection tool for site-specific low muscle mass.MethodsThis study included 204 community-dwelling older (64 males, 140 females, mean age: 75.4 years) and 59 younger (31 males, 28 females, mean age: 22.3 years) adults. The MT of the rectus femoris, vastus intermedius, gastrocnemius, and soleus muscles was measured using ultrasound; SMI was measured using bioelectrical impedance analysis.ResultsThe prevalence of a low SMI among older adults was 20.3% (n=13) for males and 21.4% (n=30) for females. The receiver operating characteristic analysis revealed that the total MT for the four muscles measured presented the highest area under the curve (AUC) value to predict low SMI for males (0.849) and females (0.776). The AUC value was the highest for the total MT of the gastrocnemius and soleus muscles for males and the gastrocnemius for females (0.836, 0.748; cut-off value: 5.67 cm, 1.42 cm, respectively). Muscle-specific differences between the low SMI-predicting and SD-based cut-off values were observed. The SD-based value for the rectus femoris (1.85 cm) was substantially higher than the low SMI-predicting value (1.51 cm) in males.ConclusionUltrasound measurement of lower leg muscles may be a simple, robust measure to detect low muscle mass for sarcopenia. Additionally, cut-off values for site-specific muscle mass loss may not always agree with those for whole-limb muscle mass loss.

Echo intensity is more useful in predicting hospital-associated complications than conventional sarcopenia-related parameters in acute hospitalized older patients.

Hospital-associated complications are associated with adverse outcomes after discharge, and a method to help predict the occurrence of these complications needs to be established. Sarcopenia is thought to be one of the factors associated with hospital-associated complication, but sarcopenia assessment in hospitalized patients is often difficult. Focus has recently been placed on morphological and qualitative evaluation of muscle by ultrasound as an index of sarcopenia. Therefore, in this study, we sought to clarify the association of hospital-associated complication with muscle thickness or echo intensity measured by ultrasound and with commonly used sarcopenia-related parameters. This is a prospective observational cohort study with 156 hospitalized older patients recruited over a year. Bilateral thigh muscle thickness of rectus femoris and vastus intermedius, echo intensity and corrected echo intensity of rectus femoris were measured by ultrasound. Also measured were the sarcopenia-related parameters of handgrip strength, skeletal muscle index, and maximum calf circumference. Hospital-associated complication was defined as the occurrence of any of the following complications: delirium, functional decline, incontinence, falls, pressure injuries, and nosocomial infections. Of 156 patients enrolled at admission, hospital-associated complication was observed in 70 (54.3%). With-hospital-associated complication group had a higher prevalence of emergency admission and a higher corrected echo intensity than without-hospital-associated complication group. Multivariate logistic regression analysis showed that only higher corrected echo intensity was associated with hospital-associated complication (odds ratio 1.036; 95% confidence interval, 1.001-1.072), while handgrip strength, bilateral thigh muscle thickness, skeletal muscle index, and maximum calf circumference were not. Corrected echo intensity might be a useful parameter to help predict hospital-associated complication in acute hospitalized older patients and might contribute to establishing a strategy to prevent hospital-associated complication.