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Muscle weakness as an additional criterion for grading sarcopenia-related prognosis in patients with cancer.
Cereda, E, Tancredi, R, Klersy, C, Lobascio, F, Crotti, S, Masi, S, Cappello, S, Stobäus, N, Tank, M, Cutti, S, et al
Cancer medicine. 2022;(2):308-316
Abstract
BACKGROUND Low muscle strength has been pointed out as a key characteristic of sarcopenia, but the prognostic significance of muscle function next to reduced skeletal muscle mass (SMM) in patients with cancer has been scantily investigated. METHODS Data on muscle strength by handgrip (HG) dynamometry and total-body SMM estimated by bioelectrical impedance analysis (BIA) of Italian and German patients with cancer observed prospectively until death or censoring were analysed (N = 1076). Patients were stratified in four risk categories based on low HG (<10th percentiles of age and gender-specific normative values) and low total-body SMM according to SMM index cutoffs (<10.75 and <6.75 kg/m2 in men and women, respectively). RESULTS During a median follow-up of 58 months [25th-75th percentile, 37-60], 566 patients had died. Patients presenting low HG in combination or not with low SMM were characterised by shorter median survival (12.7 vs. 27.2 months, respectively; p < 0.001) compared to those with low SMM/normal HG and normal SMM/normal HG (>60 months for both). After adjusting for sex, age, body mass index and percentage of weight loss, disease's stage, performance status and type of cancer, compared to reference category (normal HG and SMM; N = 210) the hazard ratios were: low SMM/normal HG (N = 342), 0.83 [95% confidence interval, CI, 0.67-1.02] (p = 0.073); normal SMM/low HG (N = 158), 1.19 [95% CI, 1.07-1.32] (p = 0.002); low SMM/low HG (N = 366), 1.39 [95% CI, 1.27-1.53] (p < 0.001). CONCLUSIONS Muscle weakness was found to be a more powerful predictor of survival than BIA-estimated SMM and should be considered as an additional key feature of sarcopenia in patients with cancer.
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Multifactorial Mechanism of Sarcopenia and Sarcopenic Obesity. Role of Physical Exercise, Microbiota and Myokines.
Bilski, J, Pierzchalski, P, Szczepanik, M, Bonior, J, Zoladz, JA
Cells. 2022;(1)
Abstract
Obesity and ageing place a tremendous strain on the global healthcare system. Age-related sarcopenia is characterized by decreased muscular strength, decreased muscle quantity, quality, and decreased functional performance. Sarcopenic obesity (SO) is a condition that combines sarcopenia and obesity and has a substantial influence on the older adults' health. Because of the complicated pathophysiology, there are disagreements and challenges in identifying and diagnosing SO. Recently, it has become clear that dysbiosis may play a role in the onset and progression of sarcopenia and SO. Skeletal muscle secretes myokines during contraction, which play an important role in controlling muscle growth, function, and metabolic balance. Myokine dysfunction can cause and aggravate obesity, sarcopenia, and SO. The only ways to prevent and slow the progression of sarcopenia, particularly sarcopenic obesity, are physical activity and correct nutritional support. While exercise cannot completely prevent sarcopenia and age-related loss in muscular function, it can certainly delay development and slow down the rate of sarcopenia. The purpose of this review was to discuss potential pathways to muscle deterioration in obese individuals. We also want to present the current understanding of the role of various factors, including microbiota and myokines, in the process of sarcopenia and SO.
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Associations of accelerometer-determined physical activity and sedentary behavior with sarcopenia and incident falls over 12 months in community-dwelling Swedish older adults.
Scott, D, Johansson, J, Gandham, A, Ebeling, PR, Nordstrom, P, Nordstrom, A
Journal of sport and health science. 2021;(5):577-584
Abstract
PURPOSE This study was aimed to determine associations of accelerometer-determined time and bouts of sedentary behavior, light physical activity (LPA), and moderate-to-vigorous PA (MVPA) with sarcopenia and incident falls over 12 months. METHODS A total of 3334 Swedish 70-year-olds were assessed for sarcopenia, as defined by the revised definition of the European Working Group on Sarcopenia in Older People. Assessments were based on low scores for appendicular lean mass (dual-energy X-ray absorptiometry), hand grip strength, and the Timed Up and Go test. For 7 days after baseline, total time and total number of bouts (≥10 min of continuous activity at a given intensity) of activity performed at sedentary, LPA, and MVPA intensities were assessed by accelerometer. Incident falls were self-reported 6 months and 12 months after baseline. RESULTS Only 1.8% of participants had probable or confirmed sarcopenia. After multivariable adjustment for other levels of activity, only greater MVPA time was associated with a decreased likelihood of having low appendicular lean mass, low hand grip strength, and slow Timed Up and Go time as defined by the European Working Group on Sarcopenia in Older People criteria (all p < 0.05), and only MVPA time was associated with lower likelihood of probable or confirmed sarcopenia (odds ratio = 0.80, 95% confidence interval: 0.71-0.91 h/week). Similar associations were identified for total number of bouts, with no evidence of threshold effects for longer duration of bouts of MVPA. A total of 14% of participants reported ≥1 fall, but neither total time nor bouts of activity was associated with incident falls (all p > 0.05). CONCLUSION Higher amounts of accelerometer-determined MVPA are consistently associated with a decreased likelihood of sarcopenia and its components, regardless of the length of bouts or amounts of sedentary behavior.
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Non-Pharmacological Interventions in Osteosarcopenia: A Systematic Review.
Atlihan, R, Kirk, B, Duque, G
The journal of nutrition, health & aging. 2021;(1):25-32
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Abstract
BACKGROUND Osteosarcopenia is a geriatric syndrome defined by the concomitant presence of osteopenia/osteoporosis (loss of bone mineral density (BMD)) and sarcopenia (loss of muscle mass and/or function), which increases the risk of falls, fractures, and premature mortality. OBJECTIVE To examine the efficacy of non-pharmacological (exercise and/or nutritional) interventions on musculoskeletal measures and outcomes in osteosarcopenic adults by reviewing findings from randomized controlled trials (RCTs). METHODS This review was registered at PROSPERO (registration number: CRD42020179292) and conducted in accordance with the PRISMA guidelines. Electronic databases were searched for RCTs assessing the effect of at least one non-pharmacological intervention (any form of exercise and/or supplementation with protein, vitamin D, calcium or creatine) on any musculoskeletal measure/outcome of interest (BMD, bone strength/turnover, muscle mass and strength, physical performance, falls/fractures) in adults with osteosarcopenia as defined by any proposed criteria. RESULTS Two RCTs (of n=106 older osteosarcopenic adults (≥65 years)) assessing the effects of progressive resistance training (RT) (via resistance bands or machines; 2-3 times/week; ~60 minutes in duration) were eligible for inclusion. The two RCTs demonstrated moderate quality evidence that RT increases muscle mass, strength, and quality, with changes in strength and quality occurring before muscle mass (12 vs 28 weeks). There was low quality evidence that RT increases lumbar spine BMD and maintains total hip BMD when performed for 12 and 18 months, respectively, and moderate quality evidence that RT has no effect on markers of bone turnover or physical performance. No major adverse effects were recorded in either of the RCTs. There were no eligible RCTs examining the impact of nutritional interventions. CONCLUSION Chronic RT is safe and effective at potentiating gains in muscle mass, strength, and quality, and increasing or maintaining BMD in older osteosarcopenic adults. No RCT has examined the effects of protein, vitamin D, calcium, or creatine against a control/placebo in this high-risk population.
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Sarcopenia in Inflammatory Bowel Disease: A Narrative Overview.
Dhaliwal, A, Quinlan, JI, Overthrow, K, Greig, C, Lord, JM, Armstrong, MJ, Cooper, SC
Nutrients. 2021;(2)
Abstract
Malnutrition is a common condition encountered in patients with inflammatory bowel disease (IBD) and is often associated with sarcopenia (the reduction of muscle mass and strength) which is an ever-growing consideration in chronic diseases. Recent data suggest the prevalence of sarcopenia is 52% and 37% in Crohn's disease and ulcerative colitis, respectively, however it is challenging to fully appreciate the prevalence of sarcopenia in IBD. Sarcopenia is an important consideration in the management of IBD, including the impact on quality of life, prognostication, and treatment such as surgical interventions, biologics and immunomodulators. There is evolving research in many chronic inflammatory states, such as chronic liver disease and rheumatoid arthritis, whereby interventions have begun to be developed to counteract sarcopenia. The purpose of this review is to evaluate the current literature regarding the impact of sarcopenia in the management of IBD, from mechanistic drivers through to assessment and management.
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COVID-19-induced sarcopenia and physical deconditioning may require reassessment of surgical risk for patients with cancer.
Casey, P, Ang, Y, Sultan, J
World journal of surgical oncology. 2021;(1):8
Abstract
BACKGROUND The long-term physiological consequences of SARS-CoV-2 (severe acute respiratory syndrome coronavirus) infection are not known. The ability of COVID-19 to cause chronic illness, sarcopenia, and physical deconditioning may be underestimated and go beyond the anticipated respiratory sequelae. Myalgia, lethargy, and anorexia are common symptoms even in mild to moderate cases and have the potential to exacerbate frailty. How this impacts on risk-stratification for patients requiring surgery for time-critical conditions, such as malignancy, requires further urgent investigation. MAIN BODY The deleterious effect of sarcopenia and poor physical capacity are well recognised in cancer surgery. This review commentary highlights current evidence which suggests skeletal muscle as an under recognised cause of COVID-19-related functional deconditioning. The mechanisms behind this are via direct (viral induced myositis, nutritional decline, cytokine-mediated myopathy) and indirect mechanisms (social isolation, inactivity, and psychological consequences). CONCLUSION Further mechanistic research is required to explore the processes behind the deconditioning effects of SARS-CoV-2 infection and how this impacts on treatment of malignant disease.
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Sarcopenia and Appendicular Muscle Mass as Predictors of Impaired Fasting Glucose/Type 2 Diabetes in Elderly Women.
Buscemi, C, Ferro, Y, Pujia, R, Mazza, E, Boragina, G, Sciacqua, A, Piro, S, Pujia, A, Sesti, G, Buscemi, S, et al
Nutrients. 2021;(6)
Abstract
Elderly women exhibit a high risk of type 2 diabetes (T2D), but no definitive data exist about the possible role of postmenopausal increases in visceral adiposity, the loss of lean body mass, or decreases in the sum of the lean mass of arms and legs (appendicular skeletal muscle mass (ASMM)). This retrospective, longitudinal study investigated whether body composition (bioelectrical impedance analysis) predicted the development of impaired fasting glucose (IFG) or T2D in a cohort of 159 elderly women (age: 71 ± 5 years, follow-up: 94 months) from southern Italy (Clinical Nutrition and Geriatric Units of the "Mater Domini" University Hospital in Catanzaro, Calabria region, and the "P. Giaccone "University Hospital in Palermo, Sicily region). Sarcopenia was defined in a subgroup of 128 women according to the EWGSOP criteria as the presence of low muscle strength (handgrip strength <16 kg) plus low muscle mass (reported as appendicular skeletal muscle mass <15 kg). Participants with a low ASMM had a higher IFG/T2D incidence than those with a normal ASMM (17% vs. 6%, p-adjusted = 0.044); this finding was independent of BMI, fat mass, waist circumference, and habitual fat intake (OR = 3.81, p = 0.034). A higher incidence of IFG/T2D was observed in the subgroup with sarcopenia than those without sarcopenia (33% vs. 7%, p-adjusted = 0.005) independent of BMI and fat mass (OR = 6.75, p = 0.007). In conclusion, this study demonstrates that elderly women with low ASMM had a higher probability of developing IFG/T2D. Further studies are needed to confirm these results in men and in other age groups.
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Strategies to Prevent Sarcopenia in the Aging Process: Role of Protein Intake and Exercise.
Rogeri, PS, Zanella, R, Martins, GL, Garcia, MDA, Leite, G, Lugaresi, R, Gasparini, SO, Sperandio, GA, Ferreira, LHB, Souza-Junior, TP, et al
Nutrients. 2021;(1)
Abstract
Sarcopenia is one of the main issues associated with the process of aging. Characterized by muscle mass loss, it is triggered by several conditions, including sedentary habits and negative net protein balance. According to World Health Organization, it is expected a 38% increase in older individuals by 2025. Therefore, it is noteworthy to establish recommendations to prevent sarcopenia and several events and comorbidities associated with this health issue condition. In this review, we discuss the role of these factors, prevention strategies, and recommendations, with a focus on protein intake and exercise.
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Bioelectrical impedance analysis (BIA) -derived phase angle in sarcopenia: A systematic review.
Di Vincenzo, O, Marra, M, Di Gregorio, A, Pasanisi, F, Scalfi, L
Clinical nutrition (Edinburgh, Scotland). 2021;(5):3052-3061
Abstract
BACKGROUND & AIMS Bioelectrical impedance analysis-derived phase angle (PhA) has been gaining attention in the clinical evaluation of nutritional status because it is thought to be a proxy of water distribution and body cell mass; it is also associated to muscle strength and is an effective predictor of different clinical outcomes. Since an association may be expected between PhA and sarcopenia (defined by low skeletal muscle mass and impaired muscle function), the aim of this systematic review was to evaluate: a) changes in PhA due to sarcopenia; b) prevalence of sarcopenia according to PhA values; c) derivation of phase angle cut-offs for detecting sarcopenia; d) sarcopenia and PhA as predictors of clinical outcomes. METHODS A systematic research on electronic databases (PubMed, Embase, Scopus and Web of Science) from inception to January 31st, 2020 was performed according to PRISMA checklist. Using PICOS strategy, "P" corresponded to participants of any age, gender or ethnicity, "I" designated diagnosis of sarcopenia, "C" indicated subjects without sarcopenia, "O" corresponded to PhA, and "S" selected all study types. Methodological quality was assessed using the National Institute of Health (NIH) quality assessment tool. RESULTS Through the initial literature search and after removing duplicates and excluding papers by screening titles and abstracts, 79 potentially relevant studies were examined. Thirteen studies (7668 subjects) met the inclusion criteria. The overall risk of bias was low. Sarcopenia was associated with a significant lower PhA in seven studies out of eight, while five studies out of six reported a high prevalence of sarcopenia was in patients with low PhA. Different cut-off point values from 4.05 to 5.05° have been derived for the identification of sarcopenia. PhA and sarcopenia were independent predictors of survival in cancer patients and geriatric hospitalized patients. CONCLUSIONS Data from the selected papers demonstrate that PhA is decreased in sarcopenic subjects and the prevalence of sarcopenia is higher in subjects with low PhA. Further studies are needed to determine to what extent PhA may be valuable in detecting low muscle quality and/or identifying sarcopenia.
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The Prevalence of Sarcopenia in Chinese Older Adults: Meta-Analysis and Meta-Regression.
Chen, Z, Li, WY, Ho, M, Chau, PH
Nutrients. 2021;(5)
Abstract
Sarcopenia, with risk factors such as poor nutrition and physical inactivity, is becoming prevalent among the older population. The aims of this study were (i) to systematically review the existing data on sarcopenia prevalence in the older Chinese population, (ii) to generate pooled estimates of the sex-specific prevalence among different populations, and (iii) to identify the factors associated with the heterogeneity in the estimates across studies. A search was conducted in seven databases for studies that reported the prevalence of sarcopenia in Chinese older adults, aged 60 years and over, published through April 2020. We then performed a meta-analysis to estimate the pooled prevalence, and investigated the factors associated with the variation in the prevalence across the studies using meta-regression. A total of 58 studies were included in this review. Compared with community-dwelling Chinese older adults (men: 12.9%, 95% CI: 10.7-15.1%; women: 11.2%, 95% CI: 8.9-13.4%), the pooled prevalence of sarcopenia in older adults from hospitals (men: 29.7%, 95% CI:18.4-41.1%; women: 23.0%, 95% CI:17.1-28.8%) and nursing homes (men: 26.3%, 95% CI: 19.1 to 33.4%; women: 33.7%, 95% CI: 27.2 to 40.1%) was higher. The multivariable meta-regression quantified the difference of the prevalence estimates in different populations, muscle mass assessments, and areas. This study yielded pooled estimates of sarcopenia prevalence in Chinese older adults not only from communities, but also from clinical settings and nursing homes. This study added knowledge to the current epidemiology literature about sarcopenia in older Chinese populations, and could provide background information for future preventive strategies, such as nutrition and physical activity interventions, tailored to the growing older population.