Appendicular and mid-thigh lean mass are associated with muscle strength,physical performance,and dynamic balance in older persons at high risk of falls

BackgroundFalls in older persons are associated with muscle mass and strength alterations, which may also affect balance parameters. However, the most appropriate combined approach to assess muscle and balance components that predict falls in older persons is still lacking.Research questionWe hypothesized that appendicular lean and/or mid-thigh mass and muscle strength and performance are positively associated with balance indices and fall risk in older persons.MethodsCross-sectional analyses of retrospective data from 260 participants with risk and/or history of falls examined at a Falls and Fracture Clinic. Assessments included a comprehensive clinical exam, bone densitometry and body composition by DXA, grip strength, gait speed, posturography, timed up and go (TUG) and four-square step (FSST) tests. Retrospective falls and fracture history was collected. Associations between appendicular and mid-thigh lean mass and muscle strength/performance vs balance indicators were determined before and after adjusting for age and gender.ResultsMean age of participants was 78 ± 6.7 (65−96) years. Both appendicular and mid-thigh lean masses corrected for BMI (but not for height²), and muscle strength and performance measures are associated with better dynamic balance. Conversely, static balance indicators showed less consistent associations with lean mass. Only TUG and sit to stand time consistently showed significant associations with most static balance indicators.SignificanceCombined with strength and performance parameters, ALM and mid-thigh estimates adjusted by BMI strongly correlate with dynamic balance parameters and could become practical elements of falls risk assessment as well as markers of therapeutic response to falls prevention interventions.     

血清维生素D水平对维持性血液透析患者下肢肌力减退的预测作用

目的探讨维持性血液透析(MHD)患者血清维生素D水平对下肢肌力减退的预测作用。 方法横断面研究设计，选择2018年9月至10月于战略支援部队特色医学中心血液净化中心的95例MHD患者，检测其血清25-羟维生素D₃[25(OH)D₃]水平，采用5次站立-坐下实验(5-STS)评价其下肢肌力。根据5-STS完成时间将MHD患者分为下肢肌力正常组(n＝85)与减退组(n＝10)，比较两组患者人口学特征、实验室指标。采用多因素Logistic回归分析下肢肌力减退的影响因素，绘制受试者工作特征(ROC)曲线分析上述因素预测MHD患者发生下肢肌力减退的特异度和敏感度。 结果95例MHD患者血清25(OH)D₃水平为11.00~99.50 nmol/L，中位数31.23(19.90~43.30)nmol/L；5-STS完成时间为3.55 s~18.71 s，中位数9.81(7.12，12.43)s，下肢肌力减退者10例(10.53%)。多因素Logistic回归分析显示，血清25(OH)D₃是MHD患者下肢肌力减退的保护性因素[OR＝0.761，95%CI(0.592~0.978)，P＝0.033]。进一步ROC曲线分析显示，25(OH)D₃对应的ROC曲线下面积为0.815，其预测MHD患者发生下肢肌力减退的敏感度为80.00%，特异度为80.00%。 结论MHD患者血清25(OH)D₃水平普遍较低，下肢肌力减退者更为明显；血清维生素D水平对MHD患者是否存在下肢肌力减退具有较好的预测价值。     

Loss of skeletal muscle density during neoadjuvant chemotherapy in older women with advanced stage ovarian cancer is associated with postoperative complications

ObjectiveTo assess the association between loss of lumbar skeletal muscle mass and density during neoadjuvant chemotherapy (NACT) and postoperative complications after interval cytoreductive surgery (CRS) in older patients with ovarian cancer.Materials and methodsThis multicenter, retrospective cohort study included patients aged 70 years and older with primary advanced stage ovarian cancer (International Federation of Gynecology and Obstetrics stage III-IV), treated with NACT and interval CRS. Skeletal muscle mass and density were retrospectively assessed using Skeletal Muscle Index (SMI) and Muscle Attenuation (MA) on routinely made Computed Tomography scans before and after NACT. Loss of skeletal muscle mass or density was defined as >2% decrease per 100 days in SMI or MA during NACT.ResultsIn total, 111 patients were included. Loss of skeletal muscle density during NACT was associated with developing any postoperative complication ≤30 days after interval CRS both in univariable (Odds Ratio (OR) 3.69; 95% Confidence Interval (CI) 1.57–8.68) and in multivariable analysis adjusted for functional impairment and WHO performance status (OR 3.62; 95%CI 1.27–10.25). Loss of skeletal muscle density was also associated with infectious complications (OR 3.67; 95%CI 1.42–9.52) and unintended discontinuation of adjuvant chemotherapy (OR 5.07; 95%CI 1.41–18.19). Unlike loss of skeletal muscle density, loss of skeletal muscle mass showed no association with postoperative outcomes.ConclusionIn older patients with ovarian cancer, loss of skeletal muscle density during NACT is associated with worse postoperative outcomes. These results could add to perioperative risk assessment, guiding the decision to undergo surgery or the need for perioperative interventions.     

Association between sarcopenia and diabetes in community dwelling elderly in the Amazon region – Viver Mais Project

BackgroundStudies indicate the intrinsic relationship between sarcopenia and diabetes mellitus (DM) pathophysiological mechanisms. Changes in insulin and muscular metabolism are features of diabetic patients and can interact as sarcopenic accelerators. Conversely, sarcopenic patients feature lower glucose tolerance and higher serum insulin levels, predisposing them to DM.ObjectiveTo study the association between sarcopenia and DM in a community-dwelling elderly population of the Amazon region.MethodsCross-sectional study, performed in Belém, Brazil, with 1078 patients aged above 60 years old from the Viver Mais Project (VMP). The definition of sarcopenia was based in the European Working Group on Sarcopenia in Older People (EWGSOP). Calf circumference >31 cm was considered normal, muscle strength was discriminated by BMI and measured with the hand grip test, and gait speed <0.8 m/s configured low performance. DM was diagnosed when reported by the patient or medical form, use of hypoglycemic medications/insulin and in the presence of fasting glucose >126 mg/dl or glycated hemoglobin (HbA1c) >6.5% on two occasions. Other medical and socio-demographic data were extracted from medical forms.ResultsThe frequency of sarcopenia was 9.4%, while DM was present in 36.87% of the patients, and had an increased occurrence in the sarcopenic group. Female sex, advanced age, DM, coronary insufficiency, osteoporosis, body mass index, waist circumference, triglycerides and functionality were associated with sarcopenia. In multivariate analysis, sarcopenia remained strongly associated with DM (OR: 3.208, 95%CI: 1.784–5.769).ConclusionThis study describes strong and independent association between sarcopenia and DM. To further clarify these findings, broader prospective cohorts are necessary.