Investigating the impact of fluid status on the ultrasound assessment of muscle quantity and quality in the diagnosis of sarcopenia – a multidimensional cross-sectional study

Fathi M., Heshmat R., Ebrahimi M., Salimzadeh A., Ostovar A., Fathi A., Razi F., Nabipour I., Moghaddassi M., Shafiee G.

Osteosarcopenia is referred to as co-incidence of osteoporosis/osteopenia and sarcopenia which is defined as a geriatric syndrome with a significant prevalence that increases morbidity and mortality. There are some relevant factors that can show an increased risk of incidence of osteosarcopenia. We aimed to consider the association of bone turnover markers such as Osteocalcin (OC), C-terminal cross-linked telopeptide (CTX), Tartrate Resistant acid Phosphatase (TRAP), Bone Alkaline Phosphatase (BALP) and also other factors like vitamin D, calcium, phosphorous, and ALP with osteosarcopenia in elderly. We carried out a cross-sectional study on a random sample including 400 elder participants of Bushehr Elderly Health (BEH) study, in Iran. Osteopenia/ osteoporosis was defined as a T-score ≤ -1.0 standard deviation below the mean values of a young healthy adult. We defined sarcopenia as low muscle strength (handgrip strength<26 kg for men and <18 kg for women) with reduced skeletal muscle mass [Skeletal muscle index (SMI) < 7.0 kg/m2 for male and <5.4 kg/m2 for female]. Osteosarcopenia was considered as the presence of both osteopenia/osteoporosis and sarcopenia. We estimated the age-standardized prevalence of osteosarcopenia for men and women, separately. We used multivariable logistic regression to address the factors associated with osteosarcopenia. The results showed that there was a statistically significant difference in OC), CTX, TRAP were between the osteosarcopenia (-) and osteosarcopenia (+) groups. No statistically significant difference was observed in BALP, vitamin D, calcium, phosphorous, and ALP between the compared groups. In the multivariable logistic regression model, OC and CTX were associated with increased likelihood of osteosarcopenia [adjusted OR= 1.023(1.002-1.045 for OC, 4.363(1.389-15.474 for CTX)]. Furthermore, TRAP increases the odds of osteosarcopenia in crude model [OR= 1.333 (1.070- 1.660)]. We observed the association between bone turnover markers particularly OC, CTX and osteosarcopenia. Given the rapid growth of the aging population, we should focus on geriatric diseases such as musculoskeletal disorders. Bone turnover markers maybe improve the early diagnosis, screening and assess the response to therapies in people with osteosarcopenia.

Welch C., Greig C., Majid Z., Masud T., Moorey H., Pinkney T., Jackson T.

To assess the feasibility of conducting acute sarcopenia research in complex populations of hospitalised older adults. Recruitment rates were higher in elective surgery patients compared to emergency surgery or medical patients. Drop-out rates were not affected by age or frailty of participants. Completion rates of ultrasound quadriceps were higher than other procedures. Acute sarcopenia research represents unique challenges but is feasible provided protocol adaptations are incorporated. Assessment of muscle quantity and quality should be included in early-stage clinical research studies to provide mechanistic insights underpinning interventions, especially where physical performance testing may not be possible or reliable. To assess feasibility of conducting acute sarcopenia research in complex populations of hospitalised older adults. Patients ≥ 70 years old were recruited to three cohorts: elective colorectal surgery, emergency (abdominal) surgery, medical patients with infections. Participants were recruited to the elective cohort in preoperative assessment clinic, and acutely admitted participants from surgical and medical wards at the Queen Elizabeth Hospital Birmingham. Serial measures of muscle quantity (ultrasound quadriceps, bioelectrical impedance analysis), muscle function (hand grip strength, physical performance), and questionnaires (mini-nutritional assessment, physical function) were performed at baseline, within 7 (± 2) days of admission/surgery, and 13 (± 1) weeks post-admission/surgery. Feasibility outcomes were assessed across timepoints including recruitment and drop-out rates, and procedure completion rates. Eighty-one participants were recruited (mean age 79, 38.3% females). Recruitment rates were higher in elective (75%, 24/32) compared to emergency surgery (37.2%, 16/43), and medical participants (45.1%, 41/91; p = 0.003). Drop-out rates varied from 8.3 to 19.5% at 7 days, and 12.5–43.9% at 13 weeks. Age and gender did not differ between patients assessed for eligibility, approached, or recruited. Completion rates were highest for ultrasound quadriceps (98.8%, 80/81 across all groups at baseline). Gait speed completion rates were lower in medical (70.7%, 29/41) compared to elective participants (100%, 24/24) at baseline. Higher participation refusal and drop-out rates should be expected for research involving recruitment of participants from the acute setting. Assessment of muscle quantity/quality through ultrasound is recommended in early-stage trials in the acute setting, where completion rates of physical performance testing are expected to be lower.

Welch C., Greig C.A., Masud T., Pinkney T., Jackson T.A.

Older adults are vulnerable to the effects of acute sarcopenia (acute muscle insufficiency) following hospitalisation. However, this condition remains poorly characterised to date. It is hypothesised that acute sarcopenia arises due to a combination of bed rest and inflammatory surge. This study aims to characterise changes in muscle quantity and function, determining which factors (clinical and biological) are most predictive, and how these relate to change in physical function at 13 weeks. This study will include three groups of patients aged 70 years and older; patients undergoing elective colorectal surgery, patients admitted for emergency abdominal surgery, and patients admitted under general medicine with acute bacterial infections. Changes in muscle quantity (Bilateral Anterior Thigh Thickness with ultrasound and bioelectrical impedance analysis) and muscle function (muscle strength, physical performance) within 1 week of hospitalisation or surgery will be characterised, with follow-up of patients at 13 weeks. Physical function will be measured using the Patient Reported Outcome Measures Information System, and the Short Physical Performance Battery (or gait speed alone within 1 week of surgery). This study will fully characterise changes in muscle quantity and function in hospitalised older adults and enable risk stratification towards targeted interventions in clinical practice. The results of this study will inform further research involving interventions to ameliorate changes. ClinicalTrials.gov Identifier: NCT03858192 ; Prospectively registered 28th February 2019.

Wilson D.V., Moorey H., Stringer H., Sahbudin I., Filer A., Lord J.M., Sapey E.

Objectives To develop an ultrasonographic scanning protocol that included an assessment of muscle size [the proposed Bilateral Anterior Thigh Thickness (BATT)] and quality (echogenicity) to support the diagnosis of sarcopenia in a clinical setting. To determine the relationship of BATT and ultrasound echogenicity with physical function parameters of sarcopenia and test the reliability of ultrasound echogenicity measurements. Design Observational study. Setting and participants The BATT criteria were determined from a reference population of 113 healthy younger adults and tested in 39 healthy older adults and 31 frail older adults. Methods Ultrasonography was used to measure the thickness of rectus femoris and vastus intermedius bilaterally; the thickness measurements were summed to calculate the BATT. Diagnostic criteria for low muscle size were calculated from the reference population. Echogenicity was assessed using freeze-frame images. All individuals underwent anthropological, frailty, and physical performance assessments. Results The mean (standard deviation) BATTs for the subsamples were as follows: healthy young women (n = 54), 60.6 mm (±11.1); healthy young men (n = 59), 75.8 mm (±10.71); healthy older women (n = 27), 38.4 mm (±7.18); healthy older men (n = 13), 47.5 mm (±10.8); frail older women (n = 17), 29.2 mm (±11.4); and frail older men (n = 14), 27.3 mm (±13.9). The calculated cutoffs for low muscle size in older adults using the BATT criteria were 38.5 mm in women and 54.4 mm in men in this population. The BATT was correlated with grip strength (ρ = 0.750, P  Conclusions/Implications The data support the use of ultrasonography to identify low muscle size in sarcopenia. Ultrasonography provides a pragmatic diagnostic tool that is noninvasive, without radiation exposure, and usable in both community and hospital settings. The proposed BATT criteria could be used to identify low muscle size in clinical practice and research, and in this study have excellent correlation with physical parameters of muscle health. However, this now needs testing in a validation cohort. Ultrasound echogenicity has been demonstrated to be an important surrogate marker of muscle health, but difficulties with reproducibility preclude its widespread clinical use.

Yeung S.S., Reijnierse E.M., Pham V.K., Trappenburg M.C., Lim W.K., Meskers C.G., Maier A.B.

Sarcopenia is a potentially modifiable risk factor for falls and fractures in older adults, but the strength of the association between sarcopenia, falls, and fractures is unclear. This study aims to systematically assess the literature and perform a meta-analysis of the association between sarcopenia with falls and fractures among older adults. A literature search was performed using MEDLINE, EMBASE, Cochrane, and CINAHL from inception to May 2018. Inclusion criteria were the following: published in English, mean/median age ≥ 65 years, sarcopenia diagnosis (based on definitions used by the original studies' authors), falls and/or fractures outcomes, and any study population. Pooled analyses were conducted of the associations of sarcopenia with falls and fractures, expressed in odds ratios (OR) and 95% confidence intervals (CIs). Subgroup analyses were performed by study design, population, sex, sarcopenia definition, continent, and study quality. Heterogeneity was assessed using the I2 statistics. The search identified 2771 studies. Thirty-six studies (52 838 individuals, 48.8% females, and mean age of the study populations ranging from 65.0 to 86.7 years) were included in the systematic review. Four studies reported on both falls and fractures. Ten out of 22 studies reported a significantly higher risk of falls in sarcopenic compared with non-sarcopenic individuals; 11 out of 19 studies showed a significant positive association with fractures. Thirty-three studies (45 926 individuals) were included in the meta-analysis. Sarcopenic individuals had a significant higher risk of falls (cross-sectional studies: OR 1.60; 95% CI 1.37-1.86, P 

Trethewey S.P., Brown N., Gao F., Turner A.M.

In the critically ill, sarcopenia is associated with a variety of adverse outcomes however there is no consensus regarding its management. This study aimed to systematically review the evidence for interventions for the management and prevention of sarcopenia in critically ill patients.Bibliographic databases were searched according to pre-specified criteria (PROSPERO-CRD42018086271). Randomised controlled trials (RCTs) investigating interventions to preserve muscle mass and/or function in critically ill patients were included. Two independent authors selected the articles and assessed bias using the Cochrane Risk of Bias Tool.Twenty-two eligible RCTs were identified comprising 2792 patients. Three main groups of interventions were implemented in these trials: neuromuscular electrical stimulation (NMES), exercise-based and nutritional. Both the interventions and outcomes measured varied significantly between studies. NMES was most frequently studied as an intervention to preserve muscle mass whilst exercise-based treatments were evaluated as interventions to preserve muscle function. There was significant variation in the efficacy of the interventions on sarcopenia markers and secondary outcomes.NMES and exercise-based interventions may preserve muscle mass and function in patients with critical illness. There is a lack of consistency seen in the effects of these interventions. Further, large, high quality RCTs are required.

Welch C., Greig C.A., Hassan-Smith Z.K., Pinkney T.D., Lord J.M., Jackson T.A.

To explore variability in acute changes in muscle mass and function in older patients undergoing elective colorectal surgery, as well as feasibility of measures, in order to refine study processes to inform the protocol for a larger study. Results are presented for seven participants recruited to this pilot study. It is possible to perform serial measurements of bilateral anterior thigh thickness (BATT) and handgrip strength prior to, within 24 h of surgery, and 1 week postoperatively. Gait speed can be reliably measured preoperatively and at 1 week postoperatively. In this pilot study, BATT and gait speed declined at 1 week postoperatively (median BATT 4.17 cm, 3.47 cm, p = 0.028; median gait speed 0.89 m/s, 0.83 m/s, p = 0.043). Baseline hsCRP correlated with change in BATT (τb = 0.73, p = 0.04) and baseline DHEA-S correlated with change in gait speed (τb = 0.87, p = 0.02). This pilot study has assisted to refine the protocol for our larger study, which will further characterise these changes.

Samoni S., Bonilla-Reséndiz L.I.

Accurate fluid management in patients admitted to the intensive care unit (ICU) is still one of the most challenging and important tasks for critical care physicians. Despite the incredible development of technology applied to medicine, the correct assessment of hydration status in critically ill patients is still complex. Studies from literature have reported prevalence of fluid overload (FO) between 62% and 64.8%; it is widely accepted that FO is associated with adverse outcomes and increased mortality in ICU patients. The gold standard method, isotope dilution, is impractical and mostly unavailable in clinical settings. Therefore critical care physicians should rely on other methods to classify patients according to fluid balance to prevent worse outcomes and diminish mortality. Noninvasive methods such as physical examination, fluid balance recording, and chest radiography are widely available, but their use can lead to inaccurate data and misled decisions, especially when used alone. Other noninvasive methods such as bioimpedance and diverse ultrasonography techniques have demonstrated their diagnostic value. The information provided by these methods has been correlated correctly with fluid status. The concomitant use of diverse noninvasive methods could be the best approach to correct fluid status assessment.

Zhang X., Wang C., Dou Q., Zhang W., Yang Y., Xie X.

ObjectivesThis study aims to review the evidence of sarcopenia as a predictor of all-cause mortality among nursing home residents.DesignSystematic review and meta-analysis of observational cohort studies.Data sourcesPubMed, EMBASE and the Cochrane Library databases were searched for relevant articles.ParticipantsNursing home residents.Primary and secondary outcome measuresAll-cause mortality.Data analysisSummary-adjusted HRs or risk ratios (RRs) were calculated by fixed-effects model. The risk of bias was assessed by Newcastle-Ottawa Scale.ResultsOf 2292 studies identified through the systematic review, six studies (1494 participants) were included in the meta-analysis. Sarcopenia was significantly associated with a higher risk for all-cause mortality among nursing home residents (pooled HR 1.86, 95% CI 1.42 to 2.45, p<0.001, I2=0). In addition, the subgroup analysis demonstrated that sarcopenia was associated with all-cause mortality (pooled HR 1.87,95% CI 1.38 to 2.52, p<0.001) when studies with a follow-up period of 1 year or more were analysed; however, this was not found for studies with the follow-up period less than 1 year. Furthermore, sarcopenia was significantly associated with the risk of mortality among older nursing home residents when using bioelectrical impedance analysis to diagnosis muscle mass (pooled HR 1.88, 95% CI 1.39 to 2.53, p<0.001); whereas, it was not found when anthropometric measures were used to diagnosis muscle mass.ConclusionSarcopenia is a significant predictor of all-cause mortality among older nursing home residents. Therefore, it is important to diagnose and treat sarcopenia to reduce mortality rates among nursing home residents.PROSPERO registration numberCRD42018081668

Cruz-Jentoft A.J., Bahat G., Bauer J., Boirie Y., Bruyère O., Cederholm T., Cooper C., Landi F., Rolland Y., Sayer A.A., Schneider S.M., Sieber C.C., Topinkova E., Vandewoude M., Visser M., et. al.

Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

Perkisas S., Baudry S., Bauer J., Beckwée D., De Cock A., Hobbelen H., Jager-Wittenaar H., Kasiukiewicz A., Landi F., Marco E., Merello A., Piotrowicz K., Sanchez E., Sanchez-Rodriguez D., Scafoglieri A., et. al.

Measurement of muscle mass is paramount in the screening and diagnosis of sarcopenia. Besides muscle quantity however, also quality assessment is important. Ultrasonography (US) has the advantage over dual-energy X-ray absorptiometry (DEXA) and bio-impedance analysis (BIA) to give both quantitative and qualitative information on muscle. However, before its use in clinical practice, several methodological aspects still need to be addressed. Both standardization in measurement techniques and the availability of reference values are currently lacking. This review aims to provide an evidence-based standardization of assessing appendicular muscle with the use of US. A systematic review was performed for ultrasonography to assess muscle in older people. Pubmed, SCOPUS and Web of Sciences were searched. All articles regarding the use of US in assessing appendicular muscle were used. Description of US-specific parameters and localization of the measurement were retrieved. Through this process, five items of muscle assessment were identified in the evaluated articles: thickness, cross-sectional area, echogenicity, fascicle length and pennation angle. Different techniques for measurement and location of measurement used were noted, as also the different muscles in which this was evaluated. Then, a translation for a clinical setting in a standardized way was proposed. The results of this review provide thus an evidence base for an ultrasound protocol in the assessment of skeletal muscle. This standardization of measurements is the first step in creating conditions to further test the applicability of US for use on a large scale as a routine assessment and follow-up tool for appendicular muscle.

Mijnarends D.M., Luiking Y.C., Halfens R.J., Evers S.M., Lenaerts E.L., Verlaan S., Wallace M., Schols J.M., Meijers J.M.

To assess the association between muscle parameters (mass, strength, physical performance) and activities of daily living (ADL), quality of life (QoL), and health care costs. Cross-sectional Maastricht Sarcopenia Study (MaSS). Community-dwelling, assisted-living, residential living facility. 227 adults aged 65 and older. Muscle mass, hand grip strength and physical performance were assessed by bio-electrical impedance, JAMAR dynamometer and the Short Physical Performance Battery, respectively. Health outcomes were measured by the Groningen Activity Restriction Scale (disability in ADL) and the EQ-5D-5L (QoL). Health care costs were calculated based on health care use in the past three months. Muscle strength and physical performance showed a strong correlation with ADL, QoL, and health care costs (P<.01); for muscle mass no significant correlations were observed. Regression analyses showed that higher gait speed (OR 0.06, 95%CI 0.01-0.55) was associated with a lower probability of ADL disability. Furthermore, slower chair stand (OR 1.23, 95%CI 1.08-1.42), and more comorbidities (OR 1.58, 95%CI 1.23-2.02) were explanatory factors for higher ADL disability. Explanatory factors for QoL and costs were: more disability in ADL (OR 1.26, 95%CI 1.12-1.41 for QoL; B = 0.09, P<.01 for costs) and more comorbidities (OR 1.44, 95%CI 1.14-1.82 for QoL; B = 0.35, P<.01 for costs). Lower gait speed and chair stand were potential drivers of disability in ADL. Disability in ADL and comorbidities were associated with QoL and health care costs in community-dwelling older adults. Improving physical performance may be a valuable target for future intervention and research to impact health burden and costs.

Seccombe A., Sapey E.

A. Jackson T., M. Lord J., A. Greig C., K. Hassan-Smith Z., Welch C.

Nijholt W., Scafoglieri A., Jager-Wittenaar H., Hobbelen J.S., van der Schans C.P.

This review evaluates the reliability and validity of ultrasound to quantify muscles in older adults. The databases PubMed, Cochrane, and Cumulative Index to Nursing and Allied Health Literature were systematically searched for studies. In 17 studies, the reliability (n = 13) and validity (n = 8) of ultrasound to quantify muscles in community-dwelling older adults (≥60 years) or a clinical population were evaluated. Four out of 13 reliability studies investigated both intra-rater and inter-rater reliability. Intraclass correlation coefficient (ICC) scores for reliability ranged from −0.26 to 1.00. The highest ICC scores were found for the vastus lateralis, rectus femoris, upper arm anterior, and the trunk (ICC = 0.72 to 1.000). All included validity studies found ICC scores ranging from 0.92 to 0.999. Two studies describing the validity of ultrasound to predict lean body mass showed good validity as compared with dual-energy X-ray absorptiometry (r2 = 0.92 to 0.96). This systematic review shows that ultrasound is a reliable and valid tool for the assessment of muscle size in older adults. More high-quality research is required to confirm these findings in both clinical and healthy populations. Furthermore, ultrasound assessment of small muscles needs further evaluation. Ultrasound to predict lean body mass is feasible; however, future research is required to validate prediction equations in older adults with varying function and health.

de Araújo Alves C.C., de Melo P.F., Vieira L., Mathur S., Burtin C., Maldaner V.Z., Durigan J.L., de Araujo C.N., de Souza V.C., Cipriano G.F., Chiappa G.R., Rodrigues G.L., Silva P.E., Cipriano Junior G.

The present study aims to describe initial changes in muscle thickness and composition, muscle growth signaling mediators, and systemic inflammation in critically ill patients after major trauma. This observational study was carried out in a Level-I nonprofit trauma center. Thirty adults requiring mechanical ventilation were assessed within 24 h post-admission. Skeletal muscle wasting was evaluated using ultrasound for muscle thickness and echogenicity along with circulating insulin-like growth factor 1 (IGF-1) and inflammatory cytokines over five consecutive days. Changes over time were assessed using ANOVA repeated-measures analysis with a Bonferroni post-hoc test. Bivariate correlations were evaluated using Pearson or Spearman coefficients. Over five days, a significant decrease (11%) in rectus femoris thickness (3.91 ± 0.86 to 3.47 ± 0.64, cm, p = 0.01) and an increase (29%) in echogenicity (62.1 ± 13.1 to 80.4 ± 17.3, AU, p < 0.01) were observed among the 30 patients included in this study. Circulating levels of IGF-1 exhibited a 38% reduction (68.8 ± 43.6 to 42.4 ± 29.4, ng/mL, p = 0.01). Furthermore, pro-inflammatory cytokine (IFN-y) increased by 17% (4.83 ± 1.39 to 5.66 ± 1.61, pg./mL, p = 0.02) from day 1 to day 5. These findings reveal substantial thickness and muscle composition alterations within 48 h post-admission, worsening over five days. Despite standard rehabilitation care, changes in IGF-1 and IFN-y levels suggest early declines in muscle growth stimulus and increased inflammation.

Wei A., Zou Y., Tang Z., Guo F., Zhou Y.

Abstract Background The correlation between calf circumference（CC）and sarcopenia has been demonstrated, but the correlation between calf maximum muscle circumference (CMMC) measured by ultrasound and sarcopenia has not been reported. We aims to construct a predictive model for sarcopenia based on CMMC in hospitalized older patients. Methods This was a retrospective controlled study of patients > 60 years of age hospitalized in the geriatric department of Hunan Provincial People’s Hospital. The patients were thoroughly evaluated by questionnaires, laboratory, and ultrasound examinations, including measuring muscle thickness and calf muscle maximum circumference using ultrasound. Patients were categorized into sarcopenia and non-sarcopenia groups according to the consensus for diagnosis of sarcopenia recommended by the Asian Working Group on Sarcopenia 2019 (AWGS2). Independent predictors of sarcopenia were identified by univariate and multivariate logistic regression analyses, and a predictive model was developed and simplified. The prediction performance of the models was assessed using sensitivity, specificity, and area under the curve (AUC) and compared with independent predictors. Results We found that patient age, albumin level (ALB), brachioradialis muscle thickness (BRMT), gastrocnemius lateral head muscle thickness (Glh MT), and calf maximum muscle circumference (CMMC) were independent predictors of sarcopenia in hospitalized older patients. The prediction model was established and simplified to Logistic P = -4.5 + 1.4 × age + 1.3 × ALB + 1.6 × BR MT + 3.7 × CMMC + 1.8 × Glh MT, and the best cut-off value of the model was 0.485. The sensitivity, specificity, and AUC of the model were 0.884 (0.807–0.962), 0.837 (0.762–0.911), and 0.927 (0.890–0.963), respectively. The kappa coefficient between this model and the diagnostic criteria recommended by AWGS2 was 0.709. Conclusion We constructed a sarcopenia prediction model with five variables: age, ALB level, BR MT, Glh MT, and CMMC. The model could quickly predict sarcopenia in older hospitalized patients.

Soto Mejía K.L., Luján Hernández I.

Frailty in older adults is a geriatric syndrome that has gained importance in the last decade. However, there is still no consolidated information regarding diagnostic tools that allow timely identification, and therefore, provide an appropriate therapeutic approach. The objective is to determine the Thickness of the Rectus Femoris Muscle (GMRF) and Thickness of the Vastus Intermedius Muscle (GMVI) in older Mexican adults with frailty and sarcopenia.

Vieira Maroun E., Argente Pla M., Pedraza Serrano M.J., Muresan B.T., Ramos Prol A., Gascó Santana E., Martín Sanchis S., Durá De Miguel Á., Micó García A., Cebrián Vázquez A., Durbá Lacruz A., Merino-Torres J.F.

Background: Disease-related malnutrition (DRM) and sarcopenia are prevalent conditions in gastrointestinal cancer patients, whose early diagnosis is essential to establish a nutritional treatment that contributes to optimizing adverse outcomes and improving prognosis. Phase angle (PhA) and rectus femoris ultrasound measurements are considered effort-independent markers of muscle wasting, which remains unrecognized in oncology patients. Objective: This study aimed to evaluate the potential utility of PhA, rectus femoris cross-sectional area (RFCSA), and rectus femoris thickness (RF-Y-axis) in predicting malnutrition and sarcopenia in patients with esophagogastric cancer (EGC). Methods: This was a cross-sectional study of patients diagnosed with EGC. PhA was obtained using bioelectrical impedance vector analysis (BIVA) along with ASMMI. The RFCSA and RF-Y-axis were measured using nutritional ultrasound (NU®). Muscle capacity was assessed using handgrip strength (HGS), and functionality by applying the Short Physical Performance Battery (SPPB). Malnutrition and sarcopenia were determined according to the GLIM and EWGSOP2 criteria, respectively. Results: Out of the 35 patients evaluated, 82.8% had malnutrition and 51.4% had sarcopenia. The RFCSA (r = 0.582) and RF-Y-axis (r = 0.602) showed significant, moderate correlations with ASMMI, unlike PhA (r = 0.439), which displayed a weak correlation with this parameter. However, PhA (OR = 0.167, CI 95%: 0.047–0.591, p = 0.006), RFCSA (OR = 0.212, CI 95%: 0.074–0.605, p = 0.004), and RF-Y-axis (OR = 0.002, CI 95%: 0.000–0.143, p = 0.004) all showed good predicting ability for sarcopenia in the crude models, but only the RF-Y-axis was able to explain malnutrition in the regression model (OR = 0.002, CI 95%: 0.000–0.418, p = 0.023). Conclusions: The RF-Y-axis emerged as the only independent predictor of both malnutrition and sarcopenia in this study, likely due to its stronger correlation with ASMMI compared to PhA and RFCSA.

Rollinson T.C., Connolly B., Denehy L., Hepworth G., Berlowitz D.J., Berney S.

Background and aimsMuscle wasting results in weakness for patients with critical illness. We aim to explore ultrasound-derived rates of change in skeletal muscle in the intensive care unit (ICU) and following discharge to the post-ICU ward.DesignPost hoc analysis of a multicentre randomised controlled trial of functional–electrical stimulated cycling, recumbent cycling, and usual care delivered in intensive care.MethodParticipants underwent ultrasound assessment of rectus femoris at ICU admission, weekly in the ICU, upon awakening, ICU discharge, and hospital discharge. The primary outcome was rate of change in rectus femoris cross-sectional area (ΔRFCSA) in mm2/day in the ICU (enrolment to ICU discharge) and in the post-ICU ward (ICU discharge to hospital discharge). Secondary outcomes included rate of change in echo intensity (ΔEI), standard deviation of echo intensity (ΔEISD), and the intervention effect on ultrasound measures. Echo intensity is a quantitative assessment of muscle quality. Elevated echo intensity may indicate fluid infiltration, adipose tissue, and reduced muscle quality.Results154 participants were included (mean age: 58 ± 15 years, 34% female). Rectus femoris cross-sectional area declined in the ICU (−4 mm2/day [95% confidence interval {CI}: −9 to 1]) and declined further in the ward (−9 mm2/day [95% CI: −14 to −3]) with a mean difference between ICU and ward of −5 mm2/day ([95% CI: −2, to 11]; p = 0.1396). There was a nonsignificant difference in ΔEI between in-ICU and the post-ICU ward of 1.2 ([95% CI: −0.1 to 2.6]; p = 0.0755), a statistically significant difference in ΔEISD between in-ICU and in the post-ICU ward of 1.0 ([95% CI, 0.5 to 1.5]; p = 0.0003), and no difference in rate of change in rectus femoris cross-sectional area between groups in intensive care (p = 0.411) or at hospital discharge (p = 0.1309).ConclusionsMuscle wasting occurs in critical illness throughout the hospital admission. The average rate of loss in muscle cross-sectional area does not slow after ICU discharge, even with active rehabilitation.

Wu H., Xie R., Zhao F., Dong H.

The development of public health is closely related to life expectancy, and population aging and changing patterns of disease prevalence pose significant challenges to further improving life expectancy in China. Exploring the impact of the healthcare industry’s development on changes in life expectancy is significant for optimizing healthcare resource allocation and improving the health level of residents. This study took the period from 2000 to 2020 as the research timeframe and used data from the Chinese Population Census of 2000, 2010, and 2020 and the China Health Statistics Yearbook of 2001, 2011, and 2021. Province-level relevant indicators were selected to construct a three-period panel dataset from China, and an individual fixed-effects model was applied to analyze the impact of the healthcare sector’s development on life expectancy. The life expectancy of women in provincial areas was higher than that of men, and the sex gap in life expectancy widened over time. A decrease in the proportion of provincial health expenditure to total expenditure had a negative impact on life expectancy in China (P < 0.05), based on the control of population size, illiteracy rate, and the proportion of people aged 65 and above.A decrease in the average medical treatment cost per outpatient visit in comprehensive hospitals had a positive effect on life expectancy (P < 0.05). Additionally, the number of hospital beds per thousand people had a significant positive effect only on life expectancy of women (P < 0.05). The proportion of healthcare expenditure to total expenditure is a fundamental factor affecting life expectancy, and the supply level of hospital beds demonstrates a sex-based difference in life expectancy.The decrease in outpatient costs significantly impacts the improvement of life expectancy.

Ooi H., Welch C.

Esposto G., Borriello R., Galasso L., Termite F., Mignini I., Cerrito L., Ainora M.E., Gasbarrini A., Zocco M.A.

The condition of sarcopenia, defined as a progressive loss of musculoskeletal mass and muscular strength, is very common in patients with hepatocellular carcinoma (HCC) and presents a remarkable association with its prognosis. Thus, the early identification of sarcopenic patients represents one of the potential new approaches in the global assessment of HCC, and there is increasing interest regarding the potential therapeutic implications of this condition. The gold standard for the quantification of muscle mass is magnetic resonance imaging (MRI) or computed tomography (CT), but these techniques are not always feasible because of the high-cost equipment needed. A new possibility in sarcopenia identification could be muscle ultrasound examination. The measurement of specific parameters such as the muscle thickness, muscular fascicles length or pennation angle has shown a good correlation with CT or MRI values and a good diagnostic accuracy in the detection of sarcopenia. Recently, these results were also confirmed specifically in patients with chronic liver disease. This review summarizes the role of imaging for the diagnosis of sarcopenia in patients with HCC, focusing on the advantages and disadvantages of the diagnostic techniques currently validated for this aim and the future perspectives for the identification of this condition.

Yoshida T., Watanabe Y., Yokoyama K., Kimura M., Yamada Y.

AimThe Asian Working Group for Sarcopenia 2019 consensus reported that evidence for the diagnosis of sarcopenia based on ultrasonography findings is lacking. The revised European Working Group on Sarcopenia in Older People consensus stated that ultrasonography is reliable and valid for assessing muscle size in older adults. The present study aimed to determine the predictive accuracy of ultrasonography for sarcopenia in older adults in Japan.MethodsA total of 1229 participants aged 65–91 years were included in this cross‐sectional study. The thickness of the anterior compartment of the right thigh was assessed using B‐mode ultrasonography. The measurement position was at the midpoint of the thigh. In addition, the grip strength, gait speed, Five‐Time Sit‐to‐Stand Test, Short Physical Performance Battery score and skeletal muscle mass index were evaluated. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia 2019 algorithm. We calculated the area under the receiver operating characteristic curve.ResultsThe area under the receiver operating characteristic curves (95% confidence intervals) and cutoff values for the thigh muscle thickness in sarcopenia were 0.901 (0.856–0.946) and 4.0 cm in men, respectively, and 0.923 (0.851–0.995) and 3.1 cm in women, respectively. The area under the receiver operating characteristic curve for each subdomain of sarcopenia, such as grip strength and gait speed, ranged from 0.618 to 0.872.ConclusionsIn the present study, the suggested cutoff mid‐thigh muscle thicknesses on ultrasonography for predicting sarcopenia were 4.0 cm in men and 3.1 cm in women. Geriatr Gerontol Int 2023; ••: ••–••.