不同方法校正的肌肉质量与老年2型糖尿病躯体功能的相关性比较

目的 探索不同方法校正的肌肉质量与老年2型糖尿病(type 2 diabetes mellitus, T2DM)躯体功能的相关性。方法 纳入首都医科大学宣武医院内分泌科≥60岁的T2DM患者248例,测定血红蛋白(hemoglobin, Hb),糖化血红蛋白(glycosylated hemoglobin A1c, HbA1c)、空腹血糖(fasting plasma glucose, FPG),维生素D、握力、步速、起立行走计时(timed go and up, TUG)测试时间,计算体质量指数(body mass index, BMI)。并用双能X线吸收检测仪测定四肢骨骼肌肌肉质量(appendicular skeletal muscle mass, ASM),分别用身高(height, ht)的平方(ASM/ht²)和BMI(ASM/BMI)两种方法对肌肉质量校正,分析躯体功能的影响因素。结果 偏相关分析结果显示, ASM/BMI均与握力、步速、TUG时间显著相关(分别为r=0.636, P<0.001;r=0.191, P=0.003;r=- 0.143, P=0.026),而ASM/ht²仅与握力相关(r=0.513, P<0.001)。多元Logistic回归分析结果显示,低ASM/BMI显著影响患者的步速和TUG时间(分别为OR=4.73,95%CI: 1.54~14.60,P=0.007; OR=2.92,95%CI: 1.12~7.63,P=0.029),而ASM/ht²对患者躯体功能无显著影响。结论 低ASM/BMI而不是低ASM/ht²与老年T2DM患者差的躯体功能相关,ASM/BMI可能是更适合于T2DM患者的肌肉质量校正方法。     

家庭远程锻炼指导在社区老年肌少症危险人群中的应用效果

目的:观察家庭远程锻炼指导在社区老年肌少症危险人群中的应用效果。方法:选取110名社区老年肌少症危险人群为研究对象,按照随机数字表法将其分为对照组与观察组各55名。对照组给予常规健康教育,观察组在对照组基础上采用家庭远程锻炼指导,比较两组教育前后体质量指数(BMI)、肌肉率、脂肪率、握力水平、步速、5次起坐时间、运动功能[老年人运动功能量表(GLFS-25)]评分和跌倒效能[跌倒效能量表(FES)]评分。结果:教育后,两组肌肉率比较,差异无统计学意义(P>0.05);观察组BMI高于对照组,脂肪率低于对照组,差异有统计学意义(P<0.05);观察组握力水平和步速均高于对照组,5次起坐时间短于对照组,差异有统计学意义(P<0.05);观察组GLFS评分低于对照组,FES评分高于对照组,差异均有统计学意义(P<0.05)。结论:在常规健康教育基础上采用家庭远程锻炼指导可提高社区老年肌少症危险人群BMI、握力水平和步速,缩短5次起坐时间,以及降低脂肪率、GLFS评分,提高FES评分,其效果优于单纯常规健康教育。     

Work,retirement, and muscle strength loss in old age

Reduced muscle strength is an accurate predictor of functional limitations, disability, and mortality. Hence, understanding which socio‐economic factors contribute to preserve muscle strength in old age is central to the design of social policies that help reducing these health risks. Using data on handgrip strength collected by the Survey of Health, Ageing and Retirement in Europe for the population of Europeans aged 50+ and the exogenous variation in pension eligibility age across countries over time, we estimate that the retirement transition has a short‐term positive causal effect on muscle strength. However, this protective effect is not persistent, as retirement speeds up the age‐related trend in muscle strength loss, especially for blue‐collar workers and males. The “holy grail” of early retirement may not be such a good deal for retirees' longevity and physical functioning late in life.     

Ultrasonography to Measure Swallowing Muscle Mass and Quality in Older Patients With Sarcopenic Dysphagia

Background

Sarcopenic dysphagia is characterized by difficulty swallowing due to a loss of whole-body skeletal and swallowing muscle mass and function. However, no study has reported on swallowing muscle mass and quality in patients with sarcopenic dysphagia.

Sarcopenia and body mass index predict sunitinib-induced early dose-limiting toxicities in renal cancer patients

Background:

Little is known on factors predicting sunitinib toxicity. Recently, the condition of low muscle mass, named sarcopenia, was identified as a significant predictor of toxicity in metastatic renal cell cancer (mRCC) patients treated with sorafenib. We investigated whether sarcopenia could predict early dose-limiting toxicities (DLTs) occurrence in mRCC patients treated with sunitinib.

Methods:

Consecutive mRCC patients treated with sunitinib were retrospectively reviewed. A DLT was defined as any toxicity leading to dose reduction or treatment discontinuation. Body composition was evaluated using CT scan obtained within 1 month before treatment initiation.

Results:

Among 61 patients eligible for analysis, 52.5% were sarcopenic and 32.8% had both sarcopenia and a body mass index (BMI)<25 kg m⁻². Eighteen patients (29.5%) experienced a DLT during the first cycle. Sarcopenic patients with a BMI<25 kg m⁻² experienced more DLTs (P=0.01; odds ratio=4.1; 95% CI: (1.3–13.3)), more cumulative grade 2 or 3 toxicities (P=0.008), more grade 3 toxicities (P=0.04) and more acute vascular toxicities (P=0.009).

Conclusion:

Patients with sarcopenia and a BMI<25 kg m⁻² experienced significantly more DLTs during the first cycle of treatment.     

Genetics of the Musculoskeletal System: A Pleiotropic Approach

The risk of osteoporotic fracture can be viewed as a function of loading conditions and the ability of the bone to withstand the load. Skeletal loads are dominated by muscle action. Recently, it has become clear that bone and muscle share genetic determinants. Involution of the musculoskeletal system manifests as bone loss (osteoporosis) and muscle wasting (sarcopenia). Therefore, the consideration of pleiotropy is an important aspect in the study of the genetics of osteoporosis and sarcopenia. This Perspective will provide the evidence for a shared genetic influence on bone and muscle. We will start with an overview of accumulating evidence that physical exercise produces effects on the adult skeleton, seeking to unravel some of the contradictory findings published thus far. We will provide indications that there are pleiotropic relationships between bone structure/mass and muscle mass/function. Finally, we will offer some insights and practical recommendations as to the value of studying shared genetic factors and will explore possible directions for future research. We consider several related questions that together comprise the general paradigm of bone responses to mechanical loading and the relationship between muscle strength and bone parameters, including the genetic factors that modulate these responses. We believe that further progress in understanding the common genetic etiology of osteoporosis and sarcopenia will provide valuable insight into important biological underpinnings for both conditions and may translate into new approaches to reduce the burdens of both conditions through improved diagnosis, prevention, and early targeted treatment.