Total Skeletal Muscle Research Articles

Effects of Health Qigong in Improving the Cervical and Lumbar Disc Disease and Mental Health Status of Sedentary Young and Middle-Aged Faculties.

Background:Shoulder, neck, and back discomforts and abdominal obesity caused by sedentariness are increasingly prominent in young and middle-aged population groups. Health Qigong improves physical functions and strengthens the disease resistance of exercisers. This study aims to explore health Qigong intervention’s effects on the cervical vertebra, lumbar vertebra, and mental status.Methods:A total of 108 sedentary young and middle-aged faculties from Yantai University in China were recruited from July to December 2020 and randomly classified into the experimental and control groups. The former received health Qigong exercises for 12 weeks, and the latter was not intervened. The total general skeletal muscle mass, range of neck joint motion, mental health, and range of waist joint motion of all respondents before and after the intervention were tested and calculated.Results:The body fat rate of the experimental group after intervention was significantly lower than that before intervention (P<0.05). The skeletal muscle mass (SMM) value was significantly higher than that before intervention. The experimental group had lower body fat rate but higher SMM value than the control group after the intervention. In addition, the range of motion (ROM) of the cervical vertebra was significantly higher in the experimental group than in the control group after intervention. Somatization, obsessive/compulsive disorder, interpersonal sensitivity, depression, anxiety, hostility, paranoia, and SCL-90 total score of the experimental group after intervention decreased significantly compared with that before intervention (P<0.05).Conclusion:Health Qigong improves the ROM of cervical and lumbar vertebrae and the mental health status of sedentary young and middle-aged groups.

The effect of body composition on prognosis in critically ill COVID-19 patients

Aim: Although limited risk factors were observed with the accumulated evidence during the SARS-CoV-2 (COVID-19) pandemic, there is still a lack of evidence for markers distinguishing asymptomatic-mild disease from severe disease. In this study, we aimed to evaluate the prognostic impact of sarcopenia and visceral adipose tissue in ICU patients treated for COVID-19. Material and Methods: The study designed as a retrospective cross-sectional study for evaluating the effect of prognostic radiologic features in COVID-19 infected patients. The patient characteristics, intubation status and dates, transfer to ICU, and last control or death dates were recorded. Axial CT images, including all abdominal muscles, total skeletal muscle area, were calculated. The total and psoas sarcopenia index (PSI) was calculated by dividing the square of the patient’s height by the square meter (cm2/m2). Also, axial CT images of the body fat subcutaneous adipose and visceral adipose tissue distribution areas were calculated in cm2 using threshold values of-30 to-190 for adipose tissue. Results: In the study population, there were nine deaths that occurred among male patients. In univariate analysis, chronic obstructive pulmonary disease and PSI were found to be related to prognosis. The median survival was 14 days in PSI low group. The prognostic effect of the PSI was still valid in the male population. Other factors had no relationship with survival in univariate analysis. In multivariate analysis, the prognostic effect of TSI and PSI was related to prognosis, while COPD lost its prognostic effect. Discussion: In this study, we found a new prognostic factor in critically ill COVID-19 patients, which may be a new area of interest. In contrast to other studies, we found no effect of BMI and visceral adipose tissue on mortality in COVID-19 patients treated in ICU. This feasible method needs further evaluation and validation with prospective studies in a large patient population.

The correlation of dietary patterns with low muscle mass, strength and quality in adults from 10 regions of China

Objective: To evaluate the correlation of dietary patterns with low muscle mass, strength and quality in Chinese adults. Methods: Based on the second resurvey of China Kadoorie Biobank, factor analysis was conducted to derive dietary patterns from 20 food groups. Low muscle mass, strength, and quality were defined as the sex-specific lowest quintile of appendicular skeletal muscle mass index (ASMI), total skeletal muscle mass index (TSMI), handgrip strength and arm muscle quality (AMQ) according to Asian Working Group for Sarcopenia recommendations. Logistic regression models were used to evaluate the correlation of dietary patterns with low muscle mass, strength, and quality. Results: Two major dietary patterns were extracted. The balanced dietary pattern was characterized by the intake of a variety of foods, whereas the rice-meat dietary pattern was characterized by high intakes of rice, meat, poultry and fish. Individuals who had the highest quintile score of the balanced dietary pattern were less likely to have low TSMI, handgrip strength or AMQ(OR=0.83, 95%CI: 0.74-0.95 for low TSMI; OR=0.64, 95%CI: 0.56-0.74 for low handgrip strength; OR=0.82, 95%CI: 0.72-0.93 for low AMQ; for trend P<0.05). And those who scored higher on the rice-meat dietary pattern had lower risk of low muscle mass and strength (OR=0.67, 95%CI: 0.55-0.82 for low ASMI; OR=0.69, 95%CI: 0.56-0.85 for low TSMI; OR=0.74, 95%CI: 0.60-0.91 for low handgrip strength; for trend P<0.05). Conclusion: Individuals followed the balanced dietary pattern, as well as those who followed the rice-meat dietary pattern, had better levels of skeletal muscle mass, strength and quality.

Impact of overweight and obesity on mortality in older adults: results of a nine-year prospective the CRYSTAL study

Abstract Introduction. Recently studies showed that a persons aged 65 years and older with body mass index (BMI) ≥ 25 kg/ m2 have the same or lower risk of mortality than older adults with a normal BMI.Objective: to investigate the relationship between baseline body mass index (BMI), total skeletal muscle mass (SMM), muscle strength and all-cause mortality in the Russian population.Methods. The Crystal study is a prospective cohort study of a random sample of people aged 65 years and older.The total follow-up period was 9 years. Main parameters: BMI, nutritional status, anemia, C-reactive protein, skeletal muscle mass (SMM), functional status, depression, dementia and non-communicable diseases.Results. Participants with BMI ≥ 25 kg/m2 had a 34,6% lower risk of all-cause mortality during 5 years of follow-up and a 36,8% lower risk during 9 years of follow-up, regardless of nutritional status, chronic comorbidities, and functional status. This association was linked with higher SMM in participants with BMI ≥ 25 kg/m2. After adjusting for all our covariates, higher SMM, but not BMI, was associated with a 7,4% decrease in mortality during the 5-year follow-up.Conclusion. It is necessary to consider qualitative indicators of body composition, such as SMM and fat percentage during assessing the impact of BMI on mortality. The higher SMM is an independent factor associated with a 7,4% decreasing the risk of all-cause mortality over 5 years of follow-up in the population of people aged 65 years and older.

A Low Total Psoas Muscle Area Index Is a Strong Prognostic Factor in Metastatic Pancreatic Cancer.

The total psoas area index (TPI) is an emerging alternative to the total skeletal muscle area index as a prognostic factor but has never been evaluated in metastatic pancreatic cancer (mPC). Areas were manually recorded, as previously described. Sex-specific cutoffs were identified by optimum stratification of TPI using log-rank χ2 statistic associated with mortality to define sarcopenic psoas. Progression-free survival (PFS) and overall survival (OS) were the primary objectives. Two period groups were used as internal validation. During the period study, 79 patients were treated for mPC. The TPI was correlated with PFS (hazards ratio, 0.81; P = 0.02) and OS (hazards ratio, 0.7; P < 0.001). Optimum thresholds defining sarcopenic psoas were less than 5.73 cm2/m2 in men and less than 4.37 cm2/m2 in women. Patients with sarcopenic psoas (62.0%) had shorter median PFS (2.9 months) compared with the others (6.6 months, adjusted P log-rank = 0.01), independently to the intensity of chemotherapy, weight loss, and performance status greater than 1. Similarly, OS was independently shorter in patients with sarcopenic psoas (7.6 months) versus the others (22.2 months, adjusted P < 0.001). These results were confirmed in the 2 period groups. A low TPI is a stronger independent prognostic factor in mPC.

Relationship between Muscle Mass and Non-Alcoholic Fatty Liver Disease.

Simple SummarySarcopenia and non-alcoholic fatty liver disease share common pathological and physiological mechanisms that can co-occur with aging. Low skeletal muscle mass index and non-alcoholic fatty liver disease were related, regardless of abdominal obesity. Maintenance of muscle mass should be emphasized for prevention of non-alcoholic fatty liver disease. Management of fatty liver also could be an important strategy to preserve muscle mass.Although sarcopenia is known to be a risk factor for non-alcoholic fatty liver disease (NAFLD), whether NAFLD is a risk factor for the development of sarcopenia is not clear. We investigated relationships between NAFLD and low skeletal muscle mass index (LSMI) using three different datasets. Participants were classified into LSMI and normal groups. LSMI was defined as a body mass index (BMI)-adjusted appendicular skeletal muscle mass <0.789 in men and <0.512 in women or as the sex-specific lowest quintile of BMI-adjusted total skeletal muscle mass. NAFLD was determined according to NAFLD liver fat score or abdominal ultrasonography. The NAFLD groups showed a higher hazard ratios (HRs) with 95% confidence intervals (CIs) for LSMI than the normal groups (HRs = 1.21, 95% CIs = 1.05–1.40). The LSMI groups also showed a higher HRs with 95% CIs for NAFLD than normal groups (HRs = 1.56, 95% CIs = 1.38–1.78). Participants with NAFLD had consistently less skeletal muscle mass over 12 years of follow-up. In conclusion, LSMI and NAFLD showed a relationship. Maintaining muscle mass should be emphasized in the management of NAFLD.

Relationship between muscle mass index and LDL cholesterol target levels: Analysis of two studies of the Korean population

Background and aimsDecreased skeletal muscle mass is an important change in body composition with aging. Maintaining the optimal low-density lipoprotein (LDL) cholesterol level is crucial for the prevention of cardiovascular diseases (CVD). We investigated whether muscle mass was associated with dyslipidemia. MethodsWe analyzed the data of 17,546 adults from the 2008–2011 Korean National Health and Nutrition Examination Survey (KNHANES) and 5126 adults from the Korean Genome and Epidemiology Study (KoGES). Participants were classified into the lower skeletal muscle mass index (LSMI) group and normal group. LSMI was defined as body mass index (BMI)-adjusted appendicular skeletal muscle mass <0.789 (men) and <0.512 (women) in the KNHANES, and as sex-specific lowest quintile of the BMI-adjusted total skeletal muscle mass in the KoGES. Participants were defined as having dyslipidemia when the serum LDL cholesterol levels were higher than their LDL cholesterol management targets based on their CVD risk level. ResultsThe odds ratio with 95% confidence interval (CI) for dyslipidemia of the LSMI group was 1.230 (1.016–1.488, p = 0.034) after adjusting for confounding variables compared to the normal group in the 2008–2011 KNHANES. In the KoGES, the hazard ratio with 95% CI for incident dyslipidemia of the LSMI group compared to the normal group was 1.225 (1.101–1.364, p < 0.001). Regardless of abdominal obesity, LSMI was significantly associated with a higher risk of incident dyslipidemia. ConclusionsLSMI was associated with dyslipidemia regardless of abdominal obesity. Prevention of muscle mass loss may be an important strategy for LDL cholesterol management.

Cut-off values of skeletal muscle index and psoas muscle index at L3 vertebra level by computerized tomography to assess low muscle mass

Computerized tomography (CT) is considered the gold standard for the evaluation of total skeletal muscle quantity. Skeletal muscle assessments at the L3 vertebra level revealed significantly correlated with total body muscle measurements. Clinicians need cut-offs to evaluate low muscle mass in various patients who already had CT imaging without any additional cost. This assessment is important to help the physicians to stratify the patients for mortality and other complications. It may also enable the diagnosis of malnutrition by the GLIM criteria. Few studies reported cut-offs in different populations. We aimed to provide cut-off values for total skeletal muscle index (SMI) and psoas muscle mass index (PMI) at the L3 vertebra level in the Turkish population. We assessed the preoperative plain CT images of living adult liver donors who were admitted to a single transplantation center between June 2010 and April 2018. We derived cut-off values with two alternative methods, the 5th percentile value or mean minus two standard deviations and from two groups of study participants, i.e. the total study population and the younger subgroup aged between 18 and 40. The study population involved 601 subjects with a mean age of 32.5±9 (range: 18-59 years) and 326 (54.2%) was male. The younger subgroup was composed of 482 individuals with a mean age of 28.8±5.9 and 55.6% male. In patients aged between 18 and 40, PMI and SMI cut-offs by using the 5th percentile were 5.40cm2/m2, 41.42cm2/m2 for males; and 3.56cm2/m2, 30.70cm2/m2 for females; respectively. The cut-offs of PMI and SMI by using mean minus two standard deviations were 4.62cm2/m2, 38.67cm2/m2 for males; and 2.66cm2/m2, 27.8cm2/m2 for females; respectively. These cut-offs were comparable to the other populations. Our study provided cut-offs to be used in CT images for PMI and SMI. There is a need for further longitudinal studies to verify whether these cut-offs are successful in predicting mortality or other adverse outcomes associated with low muscle mass.

Evaluation of oxygen uptake adjusted by skeletal muscle mass in cardiovascular disease patients with type 2 diabetes.

[Purpose] We aimed to evaluate oxygen uptake adjusted by total skeletal muscle mass in patients with cardiovascular disease with or without type 2 diabetes mellitus. [Participants and Methods] The participants included 54 males ≥50 years of age without heart failure who underwent cardiopulmonary exercise testing during cardiac rehabilitation. We divided the participants into two groups: patients with type 2 diabetes mellitus (DM group) and patients without type 2 diabetes mellitus (NDM group). [Results] We found no significant differences in age, weight, fat mass, or skeletal muscle mass between the groups. There were also no differences in cardiac function, body composition, and heart rate response. The DM group showed significantly lower peak oxygen uptake values adjusted by skeletal muscle mass, despite the absence of significant differences in skeletal muscle mass. A significant positive correlation was found between peak oxygen uptake and age, weight, and skeletal muscle mass. Stepwise regression analysis revealed that age, skeletal muscle mass, and medical history of diabetes were independent predictors of absolute peak oxygen uptake. [Conclusion] Peak oxygen uptake adjusted by skeletal muscle mass in patients with cardiovascular disease and type 2 diabetes mellitus is lower than that in those without type 2 diabetes mellitus.

Effect of Mat Pilates on Body Fluid Composition, Pelvic Stabilization, and Muscle Damage during Pregnancy

In this study, according to the exercise intensity (50–60% of HRmax (Maximum Heart Rate), RPE (Rating of Perceived Exertion: 11–13) proposed by The American Congress of Obstetricians and Gynecologists (ACOG) for pregnant women, mat Pilates exercise is related to body composition, lipid parameters, and pelvic stabilization. The effects on muscle and muscle damage were investigated. The subjects of this study were 16 pregnant women registered at the Cultural Center of Gyeonggi-do C Women’s Hospital, and the gestation period was 16 to 24 weeks. The mat Pilates exercise program (twice a week, 60 min per day, total 12 weeks) changed the Pilates exercise program every 6 weeks according to the subject’s pain level and physical fitness. Body composition before and after exercise, hip flexion, abduction and dilated lipids, inflammation, muscle damage, and stress hormones were measured through blood biochemical analysis. First, the difference in total body water, intracellular water, and skeletal muscle changes (post-pre) increased significantly in the Pilates exercise (PE) group compared to the control (CON) group, while the extracellular/intracellular water ratio significantly decreased. The effect of Pilates on body composition and lipid profile confirmed that, after testing, total body water (TBW), intracellular water (ICW), and extracellular water (ECW) were significantly greater than pre-test values in both groups (TBW: z = −2.286, p = 0.022, r = 0.572; ICW: z = −2.818, p = 0.005, r = 0.705; ECW: z = −1.232, p = 0.218, r = 0.308), whereas the ECW/ICW ratio decreased significantly only in the PE group (z = −2.170, p = 0.030, r = 0.543); while the increases in TBW and ICW were greater in the PE group than in the CON group, the ECW/ICW ratio decreased significantly in the PE group. Blood tests showed significant increases in body weight (BW), body fat mass (BFM), and percentage of body fat (PBF) in both groups post-test as compared to pre-test (BW: z = −1.590, p = 0.112, r = 0.398; BFM: z = −0.106, p = 0.916; PBF: z = −1.643, p = 0.100, r = 0.411). There was a slight increase in creatine kinase (CK) and lactate dehydrogenase (LDH), which are indices of muscle damage, and in the difference between the periods within the group, the CK and LDH of the CON group showed a tendency to increase significantly after inspection compared to the previous values (CK: z = −1.700, p = 0.089, r = 0.425, LDH: z = −2.603, p = 0.009, r = 0.651). Aspartate aminotransferase (AST) decreased significantly in the Pilates exercise group compared to that in the control group, and as a result of confirming the difference in the amount of change in C-reactive protein (CRP), there was no significant difference between the two groups, and the PE group showed a tendency to decrease after inspection compared to the previous period even in the difference between the periods in the group. The CON group showed an increasing trend, but no significant difference was found. Cortisol, a stress hormone, also increased significantly after inspection both groups compared to before (CON group: z = −2.201, p = 0.028; PE group: z = −2.547, p = 0.011). Therefore, the 12 week Pilates exercise program conducted in this study has a positive effect on body water balance and strengthens the muscles related to pelvic stabilization within the range of reducing muscle damage or causing muscle damage and stress in pregnant women. We think that it has an effective exercise intensity.

Association Between Muscle Mass Determined by D3 -Creatine Dilution and Incident Fractures in a Prospective Cohort Study of Older Men.

The relation between a novel measure of total skeletal muscle mass (assessed by D3 -creatine dilution [D3 Cr]) and incident fracture is unknown. In 1363 men (mean age 84.2 years), we determined D3 Cr muscle mass; Fracture Risk Assessment Tool (FRAX) 10-year probability of hip and major osteoporotic (hip, humerus, vertebral, forearm) fracture; and femoral neck bone mineral density (BMD) (by dual-energy X-ray absorptiometry [DXA]). Incident fractures were centrally adjudicated by review of radiology reports over 4.6 years. Correlations adjusted for weight and height were calculated between femoral neck BMD and D3 Cr muscle mass. Across quartiles of D3 Cr muscle mass/weight, proportional hazards models calculated hazard ratios (HRs) for any (n=180); nonspine (n=153); major osteoporotic fracture (n=85); and hip fracture (n=40) after adjustment for age, femoral neck BMD, recurrent fall history, and FRAX probability. Models were then adjusted to evaluate the mediating influence of physical performance (walking speed, chair stands, and grip strength). D3 Cr muscle mass was weakly correlated with femoral BMD (r=0.10, p < 0.001). Compared to men in the highest quartile, those in the lowest quartile of D3 Cr muscle mass/weight had an increased risk of any clinical fracture (HR 1.8; 95% confidence interval [CI], 1.1-2.8); nonspine fracture (HR 1.8; 95% CI, 1.1-3.0), major osteoporotic fracture (HR 2.3; 95% CI, 1.2-4.6), and hip fracture (HR 5.9; 95% CI, 1.6-21.1). Results were attenuated after adjustment for physical performance, but associations remained borderline significant for hip and major osteoporotic fractures (p ≥ 0.05 to 0.10). Low D3 Cr muscle mass/weight is associated with a markedly high risk of hip and potentially other fractures in older men; this association is partially mediated by physical performance. © 2022 American Society for Bone and Mineral Research (ASBMR).

Body composition and weakness of hand grip strength and pinch strength in patients with chronic kidney disease from different ethnic backgrounds.

Chronic kidney disease (CKD) patients commonly report muscle weakness and fatigue. Losing muscle mass increases mortality. Accordingly, we aimed to determine the main factors associated with loss of muscle mass and muscle weakness. Anthropometric measurements were made in CKD patients attending a specialised clinic, along with hand grip strength (HGS), pinch strength (PS) and body composition (muscle mass and fat mass), using segmental bioimpedance assessment. We reviewed the results of 161 CKD patients; 105 male (65.2%), mean (SD) age 70.3(15)years, body mass index (BMI) 28.8(6.7)kgm-2 . In multivariable models, both HGS and PS were independently negatively associated with age [standardised β (St β)=0.35; 95% confidence limits (CL)=-0.32 to-0.14; St β=0.38; 95% CL=-0.65 to-0.02; P<0.001, respectively] and positively with appendicular muscle in the arm tested [St β=0.34; 95% CL=2.5-6.3; St β=0.24; 95% CL=0.17-0.98; P<0.001 and P=0.006, respectively]. In addition, HGS was associated with male gender (St β=0.19; 95% CL=0.7-7.5; P=0.019] and negatively with percentage body fat (St β=0.22; 95% CL=-0.36 to -0.07; P=0.003]. There were 47 (29.2%) Asian patients who had lower total skeletal muscle mass/height ratio and appendicular muscle mass/BMI ratio compared to other ethnicities [9.6(1.8) versus 10.5(1.6)kgm-2 , P<0.01; 0.73(0.23) versus 0.83(0.33) m2 ; P<0.01). In CKD patients, we found that muscle weakness measured by HGS and PS was associated with increasing age and loss of appendicular muscle mass. HGS was also weaker with increasing fat mass and female gender, whereas PS was weaker in patients of Asian ethnicity.

Estimation of skeletal muscle mass by bioimpedance and differences among skeletal muscle mass indices for assessing sarcopenia

It is crucial to assess age-related muscle mass changes and derived indices differences in geriatric medicine. We aimed to develop and validate four bioimpedance analysis (BIA) prediction equations against dual-energy X-ray absorptiometry (DEXA) and magnetic resonance image (MRI) in estimating skeletal muscle mass and to compare the differences among skeletal muscle mass indices, cutoff values, and corresponding prevalence rates of low muscle mass for assessing sarcopenia in Chinese adults. We measured the height (Ht), weight (Wt), appendicular lean mass (ALM) or skeletal muscle mass (ASM), total lean body mass (LBM) or skeletal muscle mass (TSM) obtained using DEXA or MRI, and a multi-frequency BIA (BCA II;50, 250kHz), in 371 adults aged 18.0-87.0 years. We also collected gender, age, Ht, Wt, and impedance indexes (Ht2/R50, Ht2/R250, R50/Ht2, R250/Ht2) from 30,500 adults aged 18-96 years living in China. Multiple regression analyses were used to derive four prediction equations by BIA, and double cross-validation techniques and Bland-Altman analyses were used to test agreement. Various muscle mass indices and prevalence rates were depicted by line plots in regard to age trends. Satisfactory results were found in the four prediction models as they had the larger R2 (0.833-0.930) values and low SEE (1.409-2.335kg) values. The predictive variables included impedance indexes (Ht2/R50, R50/Ht2, R250/Ht2), gender, age, Wt, and Ht. The corresponding prevalence rates of low muscle mass exhibited significant differences according to the various muscle mass indices adjusted for Ht, Wt, or body mass index (BMI), in addition to the cutoff values based on two standard deviations (2SD) of young people or the lower 20% of the study group. The BIA equations have the potential to be applied as a practical method of quantifying skeletal muscle mass in Chinese adults. However, the operational methods that are most appropriate for determining the degree of low muscle mass that actually contributes to sarcopenia remains inconclusive.

A Critical Appraisal of the Definition of Sarcopenia in Patients with Non-Alcoholic Fatty Liver Disease: Pitfall of Adjusted Muscle Mass by Body Weight.

Traditionally, sarcopenia has defined as amount of absolute muscle mass adjusted by height in the elderly people. However, relative muscle mass adjusted by weight has been used extensively in most non-alcoholic fatty liver disease (NAFLD) studies. Here, we attempted to investigate the pitfall of adjusted muscle mass by weight to evaluate association between sarcopenia and NAFLD. Adult subjects (n = 1343) who underwent a health check-up were finally included for analysis. The weight-adjusted skeletal muscle mass index (wSMI) and height-adjusted SMI (hSMI) calculated by dividing the total appendicular skeletal muscle (ASM) by weight or the square of height, respectively. Prevalence of sarcopenia defined by wSMI in the NAFLD group was significantly higher than in the control group (1.3% vs. 8.8%, p < 0.001). However, there was no difference in the prevalence of sarcopenia defined by hSMI between the control and NAFLD groups (2.0% vs. 0.8%, p = 0.055). Since body weight was the most potent independent risk factor for NAFLD in multivariable logistic regression analysis, abnormal rates (<−1 SD) of almost all parameters increased in the NAFLD population, after weight adjustment. However, abnormal rates of non-metabolic parameter did not increase in NAFLD, after height adjustment. Only metabolic parameters showed relationship with NAFLD, after height adjustment. As NAFLD is highly associated with body weight, careful attention should be given in the case of studying the relationship of NAFLD with sarcopenia adjusted by body weight.

Bone mineral density in patients with coronary artery disease and sarcopenia

Objective: to assess the relationship between bone mineral density (BMD) and the muscular apparatus in male patients with coronary heart disease (CHD).Patients and methods. The investigation enrolled 79 male patients (median age, 63 [57; 66] years) with an established diagnosis of CHD verified by coronary angiography.Muscle mass was assessed by multispiral computed tomography, by determining the axial muscle tissue area (cm2 ) at the level of LIII. Muscle strength was measured with a wrist dynamometer. Muscle function was examined using the tests of the Short Physical Performance Battery (SPPB). BMD at the neck and proximal femur as a whole and at the lumbar spine was measured by dual energy X-ray absorptiometry.For comparative analysis, the patients were divided into three groups (EWGSOP, 2010). Group 1 included 31 patients without sarcopenia; Group 2 consisted of 21 patients with presarcopenia; and Group 3 comprised 27 patients with sarcopenia.Results and discussion. Osteopenic syndrome was diagnosed in 34 (43%) patients: osteopenia and osteoporosis in 31 (39%) and 3 (4%) patients, respectively. Normal BMD values were observed in 45 (57%) men. The prevalence of osteopenic syndrome was significantly higher in the patients with sarcopenia than in those with presarcopenia (p=0.050) and was comparable to that in men without sarcopenia (p&gt;0.050). BMD at the neck and proximal femur as a whole was significantly lower in the patients with sarcopenia than in those without sarcopenia or with presarcopenia (p&lt;0.050). There was a direct correlation between BMD and the characteristics of muscle mass and muscle strength. Regression analysis showed that the total skeletal muscle area at the level of LIII had a significant direct impact on BMD at the neck and proximal femur as a whole, and the reverse – walking speed.Conclusion. The relationship between the characteristics of the muscular apparatus and BMD requires further investigation.

Effects of Thyroid Function on Phosphodiester Concentrations in Skeletal Muscle and Liver: An In Vivo NMRS Study.

Thyroid function is clinically evaluated by determination of circulating concentrations of thyrotropin (thyroid-stimulating hormone; TSH) and free thyroxine (fT4). However, a tissue-specific effector substrate of thyroid function is lacking. Energy-rich phosphorus-containing metabolites (PM) and phospholipids (PL) might be affected by thyroid hormone action and can be noninvasively measured by 31P nuclear magnetic resonance spectroscopy (NMRS). To measure the actions of peripheral thyroid hormones on PM and PL tissue concentrations. A longitudinal, prospective pilot study was performed. Nine patients with hyperthyroidism (HYPER) and 4 patients with hypothyroidism (HYPO) were studied at baseline and 3 months after treatment. High-field 1H/31P NMRS was used to assess profiles of PM, PL, and flux through oxidative phosphorylase in liver and skeletal muscle, as well as ectopic tissue lipid content. The concentrations of total skeletal muscle (m-) and hepatic (h-) phosphodiesters (PDE) and one of the PDE constituents, glycerophosphocholine (GPC), were lower in HYPER compared with HYPO (m-PDE: 1.4 ± 0.4 mM vs 7.4 ± 3.5 mM, P = 0.003; m-GPC: 0.9 ± 0.3 mM vs 6.7 ± 3.5 mM, P = 0.003; h-PDE: 4.4 ± 1.4 mM vs 9.9 ± 3.9 mM, P = 0.012; h-GPC: 2.2 ± 1.0 mM vs 5.1 ± 2.4 mM, P = 0.024). Both h-GPC (rho = -0.692, P = 0.018) and h-GPE (rho = -0.633, P = 0.036) correlated negatively with fT4. In muscle tissue, a strong negative association between m-GPC and fT4 (rho = -0.754, P = 0.003) was observed. Thyroxine is closely negatively associated with the PDE concentrations in liver and skeletal muscle. Normalization of thyroid dysfunction resulted in a decline of PDE in hypothyroidism and an increase in hyperthyroidism. Thus, PDE might be a sensitive tool to estimate tissue-specific peripheral thyroid hormone action.

Association between liver fibrosis and appendicular skeletal muscle mass during antiviral therapy in chronic hepatitis B

Background and aimsSarcopenia is associated with fibrotic burden in patients with chronic hepatitis B. We investigated the dynamic association between fibrosis changes and appendicular skeletal muscle mass during antiviral therapy in patients with chronic hepatitis B. MethodsBetween 2015 and 2018, chronic hepatitis B patients who received paired transient elastography to assess fibrotic burden in the liver and bioelectrical impedance analysis to assess appendicular skeletal muscle mass were recruited retrospectively. The sarcopenia index was calculated as total appendicular skeletal muscle mass/body mass index. Significant liver fibrosis was defined as a liver stiffness value≥8 kPa. ResultsIn total, 223 (53.7%) received antiviral therapy, whereas 192 (46.3%) did not. Appendicular skeletal muscle mass decreased significantly in the antiviral therapy group (mean 21.16→21.00 kg, P = 0.01), but not in the non-antiviral therapy group (mean 20.77→20.64 kg, P = 0.134). In a subgroup with significant liver fibrosis, similar findings were observed (mean 20.73→20.54 kg in antiviral therapy group, P = 0.037; mean 21.39→21.07 kg in the non-antiviral therapy group, P = 0.097). Older age, male gender, higher body mass index, and higher aspartate aminotransferase were significantly associated with the increased risk of appendicular skeletal muscle mass reduction (≥5% from the baseline). ConclusionsAppendicular skeletal muscle mass significantly decreased during antiviral therapy in patients with chronic hepatitis B patients.

What are the factors associated with sarcopenia-related variables in adult women with severe obesity?

BackgroundUnderstanding the association between sarcopenia-related variables and several risk factors may help to implement interventions aimed at preventing its occurrence by reducing or controlling the identified risk factors. Although changes in body composition occur in both sexes, in women, muscle loss is accentuated due to decreased estrogen levels following menopause. This study aims to determine the factors associated with sarcopenia-related parameters in middle-aged women identified with class II/III obesity (body mass index [BMI] ≥ 35 kg/m2).MethodsThe study included 104 women with severe obesity (40.23 ± 8.49 years) with an average body fat percentage of 52.45 ± 4.14%. Sarcopenia was assessed using total appendicular skeletal muscle mass (ASMM), appendicular skeletal muscle mass index (ASMMI), and appendicular skeletal muscle mass adjusted by BMI (ASMM/BMI) as evaluated using dual energy X-ray absorptiometry (DXA). Hand grip strength (HGS) and HGS adjusted by BMI (HGS/BMI) were evaluated using dynamometry. Functional performance was assessed using the walking speed test (WS). The explanatory variables were age, lifestyle, comorbidities, food consumption, and metabolic parameters. A multivariate linear regression was performed.ResultsFactors associated with sarcopenia-related variables in 104 severely obese women with a mean BMI of 43.85 kg/m2 were as follows: ASMMI negatively correlated with serum levels of tetraiodothyronine (T4) and tobacco use; ASMM/BMI negatively correlated with age, serum T4 levels, and diabetes; ASMM negatively correlated with T4 serum levels and diabetes; HGS negatively correlated with age and hypercholesterolemia, and positively correlated with low-density lipoprotein cholesterol (LDL-c); HGS/BMI negatively correlated with age and hypercholesterolemia and positively correlated with LDL-c; and WS negatively correlated with hypothyroidism and diabetes.ConclusionIn severely obese women, muscle mass and function were inversely associated with age, smoking status, endocrine parameters, hypercholesterolemia, and comorbidities such as diabetes. Thus, the results of this investigation are relevant in supporting the development of clinical interventions to aid in the prevention of sarcopenia in adult women with severe obesity.

The relationship between computed tomography derived skeletal muscle index, psoas muscle index and clinical outcomes in patients with operable colorectal cancer.

Computed tomography-based measures of body composition are emerging as important prognostic factors for patients with colorectal cancer (CRC). The aim of this study was to examine the relationship between total skeletal muscle index (SMI), psoas muscle index (PMI) and clinical outcomes in patients with operable CRC. A retrospective cohort study of prospectively maintained database at Glasgow Royal Infirmary. CT image at L3 was carried out to assess total skeletal and psoas muscle areas and these were normalized for height squared to calculate SMI and PMI respectively. Patients were classified into high and low groups using calculated optimal thresholds and their relationship to clinical outcomes was studied using logistic regression analysis. Of the 1002 patients included, 55% were male, 50% had low SMI and 42% had low PMI. A moderate correlation was found between total skeletal muscle and psoas areas (rs=0.70, p<0.001). On univariate analysis, low SMI was associated with length of hospital stay (OR, 1.47; 95% CI, 1.15-1.89, p=0.002) and overall survival (HR, 2.29; 95% CI, 1.47-3.58, p<0.001). On multivariate analysis, low SMI was independently associated with length of hospital stay (HR 1.32; 95% CI, 1.02-1.70, p<0.05). On univariate analysis, low PMI was associated with length of hospital stay (OR, 1.34; 95% CI, 1.04-1.73, p<0.05) and overall survival (OR, 1.43; 95% CI, 1.10-1.86 p<0.01). On multivariate analysis, low PMI was not independently significant. The present study shows that though both total skeletal muscle index and psoas muscle index were directly associated and had prognostic value, total skeletal muscle index had independent prognostic value in patients with operable CRC.

Skeletal Muscle Composition Predicts Outcome in Critically Ill Patients.

Exploratory observational cohort study. An urban, academic medical institution. One-hundred fifty-five patients treated for critical illness on a medical ICU. None. We used routine CT scans to assess the patients' individual body composition. The skeletal muscle index as a surrogate for sarcopenia was defined as the total skeletal muscle area at the level of the third lumbar vertebra on axial CT scan, normalized for the patient's height. Myosteatosis was evaluated by assessing the mean skeletal muscle attenuation measured in Hounsfield unit at the same sectional plane. The skeletal muscle index and mean skeletal muscle attenuation at admission to the ICU were significantly higher in patients with long-term survival (180-day or 1-year mortality), while both parameters were comparable between short-term survivors and nonsurvivors (ICU mortality or 30-d mortality). Patients with a skeletal muscle index or mean skeletal muscle attenuation below our established ideal cutoff values (74.95 mm2/cm and 29 Hounsfield unit) showed a significantly reduced overall survival. These findings were confirmed in univariate and multivariate Cox regression analyses. Furthermore, myosteatosis significantly correlated with the time of mechanical ventilation, the duration of hospital stay, and the presence of sepsis. Our data suggest that sarcopenia and myosteatosis represent important prognostic factors in critically ill patients that can be easily obtained from routine CT scans. Both parameters at admission to the ICU yield important information on the patients' long-term outcome and might be used for early clinical decision-making in these patients.