Quadriceps sarcopenia and visceral obesity are risk factors for postural instability in the middle‐aged to elderly population

Aim: Aging shifts body composition to comprising more fat and less muscle. Sarcopenia, particularly in the knee extensors, and obesity, particularly visceral obesity, either alone or in combination, may exacerbate age‐related physical disability. We investigated the association between age‐related quadriceps (Qc) sarcopenia and visceral obesity, as measured by cross‐sectional area (CSA), on postural instability. Methods: Mid‐thigh muscle CSA and abdominal visceral and subcutaneous fat area at the level of the umbilicus were assessed from computed tomography (CT) images in 410 apparently healthy independent middle‐aged to elderly subjects attending the medical check‐up program in Ehime University Hospital. Static postural instability using a posturograph and one‐leg standing time with eyes open were assessed. Results: Both abdominal visceral fat area and Qc muscle CSA corrected by body weight (BW) were associated with static postural instability, in addition to age and sex, while BW‐corrected Qc muscle CSA predicted a short one‐leg standing time. The combination of Qc sarcopenia, defined as greater than 1 standard deviation below the mean of a young group (age <60 years), and visceral obesity, defined as a visceral fat area of more than 100 cm², were associated with static postural instability, while Qc sarcopenia was related to a higher prevalence of one‐leg standing time of less than 30 s, irrespective of visceral obesity. Conclusion: Thigh Qc sarcopenia and visceral obesity are associated with postural instability in middle‐aged to elderly subjects. These findings suggest that age‐related, site‐specific fat and muscle mass alterations are associated with functional impairment. Geriatr Gerontol Int 2010; 10: 233–243.     

Association between sarcopenia and pneumonia in older people

Pneumonia is a major cause of death in older people, and the number of such deaths is increasing. Present guidelines for pneumonia management are based on a pathogen‐oriented strategy that relies on the optimal application of antibiotics. Older pneumonia inpatients show the high incidence of aspiration pneumonia. The main cause of aspiration pneumonia is an impairment in the swallowing and cough reflexes. These facts suggest a limitation of present management strategies and a requirement for new strategies for aspiration pneumonia. Sarcopenia is the loss of muscle strength and mass, and declining physical function with aging. Recently, a decrease in the mass or strength of the swallowing muscles was suggested to be associated with reduced swallowing function. Accordingly, dysphagia caused by sarcopenia of the systemic and swallowing‐related muscles was named sarcopenic dysphagia. Presently, few studies have shown associations between aspiration pneumonia and sarcopenic dysphagia. As for the cough reflex, strong cough prevents aspiration pneumonia, and its strength is regulated by respiratory muscles. A few studies have reported a relationship between muscles and pneumonia in older people. Sarcopenia is a risk factor for pneumonia in older people, and aspiration pneumonia inpatients with low muscle mass show high mortality rates. Aspiration pneumonia induced muscle atrophy in respiratory, swallowing, and skeletal muscles in an animal model and humans. Associations between respiratory muscle strength and pneumonia are currently under investigation. Evaluation and management of sarcopenia could potentially become a new strategy to prevent and treat pneumonia in older patients, and research has only recently been launched. Geriatr Gerontol Int 2020; 20: 7–13 .     

Association between nonspecific skeletal pain and vitamin D deficiency

Background: Deficiency of vitamin D has been reported in patients with many types of musculoskeletal pain. The present study was designed to determine the association between serum 25‐hydroxyvitamin D [25‐(OH)D] deficiency and nonspecific skeletal pain. Methods: A total of 276 patients with nonspecific skeletal pain at different regions of the skeletal system diagnosed as leg pain, widespread pain, arthralgia, rib pain, back pain and fibromyalgia were compared with 202 matched controls with regard to mean serum 25‐(OH)D level and 25‐(OH)D deficiency. Serum 25‐(OH)D was measured by enzyme‐linked immunosorbent assay method and levels < 20 ng/mL were considered as deficient. Nonparametric one‐way analysis of variance, Kruskal Wallis and Wilcoxon tests were used for group comparisons. Multiple logistic regression analysis with calculation of adjusted odds ratio (OR) and 95% confidence interval (95% CI) were performed to determine associations. Results: In patients with nonspecific skeletal pain the mean 25‐(OH)D was significantly lower (P = 0.0001) and the proportion of 25‐(OH)D deficiency was significantly higher (63.4%vs. 36.1%, P = 0.0001) compared with controls. There was a significantly positive association between 25‐(OH)D deficiency and skeletal pain (OR = 2.94, 95% CI = 1.01–4.3, P = 0.0001). The strength of association varied across the groups with strongest association observed with leg pain (OR = 7.4; 95% CI = 3.9–13.9, P = 0.0001) followed by arthralgia (OR = 3.9, 95% CI = 2.1–7.1, P = 0.0001) and widespread pain (OR = 2.8, 95% CI = 1.1–6.6, P = 0.020) but no association with back pain and fibromyalgia. There was a greater positive associations in women compared with men (OR = 2.1, 95% CI = 1.1–4.3, P = 0.001). Conclusion: The results of this study indicate a positive association of vitamin D deficiency with a variety of nonspecific bone pain, particularly in women. More studies with larger samples are required to confirm these findings. Increasing serum vitamin D to sufficient levels and longitudinal follow‐up of patients may provide further evidence in relation to vitamin D deficiency and skeletal pain.     

The interaction between obesity and visceral hypersensitivity

Obesity has been a worldwide problem associated with numerous chronic diseases such as cardiovascular disease, type 2 diabetes, and metabolic disorders. It may also play a role in visceral hypersensitivity, contributing to irritable bowel syndrome. (i) Adipose tissue secretes various inflammatory mediators, causing intestinal hyperpermeability and nerve endings activation. (ii) Obesity and gastrointestinal microbiota could affect each other, and microbial metabolites can increase sensitivity of the colon. (iii) Vitamin D deficiency contributes to both fat accumulation and disruption of the intestinal mucosal barrier. (iv) Brain-gut axis may be another bridge from obesity to visceral hypersensitivity.     

Obesity and vitamin D deficiency: a systematic review and meta‐analysis

Over the past decade, there have been an increasing number of studies on the association between vitamin D deficiency and anthropometric state. However, we did not identify any meta‐analyses of the relationship between obesity and vitamin D deficiency in different age groups. Thus, we evaluated the association between obesity and vitamin D deficiency. We searched for observational studies published up to April 2014 in PubMed/Medline, Web of Science and Scopus databases. We performed a meta‐analysis in accordance with the random‐effects model to obtain the summary measurement (prevalence ratio, PR). Among the 29,882 articles identified, 23 met the inclusion criteria. The prevalence of vitamin D deficiency was 35% higher in obese subjects compared to the eutrophic group (PR: 1.35; 95% CI: 1.21–1.50) and 24% higher than in the overweight group (PR: 1.24; 95% CI: 1.14–1.34). These results indicate that the prevalence of vitamin D deficiency was more elevated in obese subjects. The vitamin D deficiency was associated with obesity irrespective of age, latitude, cut‐offs to define vitamin D deficiency and the Human Development Index of the study location.     

Association between vitamin D deficiency at one month of age and bronchopulmonary dysplasia

Vitamin D deficiency is common and increases the likelihood of neonatal morbidities in preterm infants. This study assessed vitamin D levels at 1 month of age after 4 weeks of vitamin D supplementation and determined the association between vitamin D levels and neonatal morbidities.This retrospective study included preterm infants with birth weight <1500 g or gestational age <32 weeks born in our hospital between January 2018 and December 2019. They were administered 400 IU of oral vitamin D supplementation after birth according to our policy. The infants were then divided into sufficient (≥20 ng/mL) and deficient (<20 ng/mL) groups according to their serum vitamin D levels at 1 month of age.The vitamin D deficient and sufficient groups included 49 and 41 patients, respectively. The mean gestational age and birth weight. GHT in the vitamin D deficient group were 29.1 ± 2.1 weeks and 1216.1 ± 308.1 g, respectively, and 30.0 ± 1.7 weeks and 1387.6 ± 350.8 g, respectively, in the sufficient group. No significant differences were observed between the 2 groups in demographic and clinical outcomes except for bronchopulmonary dysplasia (BPD), which occurred significantly more often in the vitamin D-deficient group (odds ratio 2.21; 95% confidence interval, 1.85–2.78; P = .02).The results of our study suggest that vitamin D deficiency at 1 month of age is associated with BPD in preterm infants.     

Association between sarcopenia and mortality in healthy older people

Aim: To evaluate the association between loss of fat‐free mass and mortality among older people. Methods: Information of healthy Chilean older people evaluated by dual energy X‐ray absorptiometry was used, identifying those who died in a period of 12 years. A Cox proportional hazards model was used to identify mortality predictors. Life tables were constructed calculating survival using predictive variables. Results: Information from 1413 participants aged 74.3 ± 5.6 years (1001 women), was obtained. During the follow‐up (median 1594 days), 221 participants died. The Cox model identified age and appendicular fat‐free mass as predictors of death (hazard ratios 1.08 and 0.85, respectively). According to life tables, participants in the lower sex‐specific quartile for appendicular fat‐free mass/height had significantly higher mortality. This association was significant among participants aged over 73 years. Conclusion: A low fat‐free mass was predictive of mortality in older people.     

维生素D及其活性代谢物与糖尿病

近年的研究结果显示,维生素D不仅在调节骨和矿物质代谢中起重要作用,而且还与多种慢性疾病密切相关。基础研究发现,维生素D及其活性代谢物参与炎性反应和免疫调节过程。临床研究发现,高血压、肥胖、心血管疾病和糖尿病等现代流行病的发生与发展与维生素D及其活性代谢物有不可分割的联系。本文讨论了维生素D与糖尿病的关系以及维生素D在不同类型糖尿病的预防和治疗中的作用及机制。     

Associations between vitamin D status and pain in older adults: the Invecchiare in Chianti study

OBJECTIVES: To examine cross-sectional associations between vitamin D status and musculoskeletal pain and whether they differ by sex.
DESIGN: Population-based study of persons living in the Chianti geographic area (Tuscany, Italy).
SETTING: Community.
PARTICIPANTS: Nine hundred fifty-eight persons (aged ≥65) selected from city registries of Greve and Bagno a Ripoli.
MEASUREMENTS: Pain was categorized as mild or no pain in the lower extremities and back; moderate to severe back pain, no lower extremity pain; moderate to severe lower extremity pain, no back pain; and moderate to severe lower extremity and back pain (dual region). Vitamin D was measured according to radioimmunoassay, and deficiency was defined as 25-hydroxyvitamin D (25(OH)D) less than 25 nmol/L.
RESULTS: The mean age±standard deviation was 75.1±7.3 for women and 73.9±6.8 for men. Fifty-eight percent of women had at least moderate pain in some location, compared with 27% of men. After adjusting for potential confounders, vitamin D deficiency was not associated with lower extremity pain or dual-region pain, although it was associated with a significantly higher prevalence of at least moderate back pain without lower extremity pain in women (odds ratio=1.96, 95% confidence interval=1.01–3.59) but not in men.
CONCLUSION: Lower concentrations of 25(OH)D are associated with significant back pain in older women but not men. Because vitamin D deficiency and chronic pain are fairly prevalent in older adults, these findings suggest it may be worthwhile to query older adults about their pain and screen older women with significant back pain for vitamin D deficiency.     

Association of mean corpuscular volume with sarcopenia and visceral obesity in individuals without anemia

Aims/IntroductionSarcopenia and visceral obesity are major global public health issues, and higher mean corpuscular volume (MCV) levels are related to adverse outcomes. Nevertheless, no study has determined the association between MCV and body composition. Therefore, we evaluated the association between MCV levels and trunk muscle quality, muscle quantity and visceral fat area.Materials and MethodsIn our cross‐sectional study, we investigated 702 middle‐aged Japanese individuals without anemia and with normal MCV levels who underwent physical checkups. The cross‐sectional area of skeletal muscle or visceral fat was analyzed by computed tomography.ResultsIn the adjusted model, the MCV was independently associated with the visceral fat area index (β = −0.107, P = 0.0007), total skeletal muscle index (β = 0.053, P = 0.0341) and total skeletal muscle density (β = 0.099, P = 0.0012). MCV as a continuous variable was related to the prevalence of sarcopenia (odds ratios [OR] 0.93, 95% confidence intervals (CI) 0.88–0.98, per 1.0 fL increment; P = 0.0097) and visceral obesity (OR 0.91, 95% CI 0.86–0.97, per 1.0 fL increment; P = 0.0046). The highest MCV quartile was independently associated with the prevalence of sarcopenia (OR 0.48, 95% CI 0.27–0.83; P = 0.0089) and visceral obesity (OR 0.49, 95% CI 0.27–0.88; P = 0.0170), compared with the lowest quartile.ConclusionsIn individuals without anemia and with normal MCV levels, a lower MCV was associated with unfavorable body composition, including lower muscle quality, lower muscle quantity, sarcopenia and visceral obesity.     

Functional impact of relative versus absolute sarcopenia in healthy older women

OBJECTIVES: To determine whether adjustment of muscle mass for height² or for body mass represents a more-relevant predictor of physical performance.
DESIGN: Cross-sectional study, using baseline data from a trial comparing upper- and lower-body training.
SETTING: Women recruited from the community and gynecological practices in Connecticut.
PARTICIPANTS: One hundred eighty-nine healthy older (aged 67.5 ± 4.8), active women receiving estrogen for osteoporosis over 2 years.
MEASUREMENTS: Total and appendicular skeletal muscle (ASM) and fat mass (AFM) were determined using dual x-ray absorptiometry. Physical performance, muscle strength, and fitness measures were obtained at baseline.
RESULTS: Adjusting ASM for height² identifies lean women who are sarcopenic according to published standards yet fails to identify overweight and obese women whose ASM adjusted for body mass is low. ASM divided by body mass (ASM/body mass) is a stronger physical performance predictor, explaining 32.5%, 13.5%, 11.6%, 6.3%, and 6.8% of the variance in maximum time on treadmill, 6-minute walk, gait speed, 8-foot walk, and single leg stance, respectively, whereas ASM divided by height in m² (ASM/height²) explained only 2.9%, 0.2%, 2.0%, 0.04%, and 0.1%. Multivariate modeling demonstrated considerable overlap in aspects of ASM/body mass and AFM/body mass associated with performance, with ASM/body mass dominant. In contrast, ASM/height² is a much stronger predictor of leg press 1 repetition maximum and maximum power.
CONCLUSION: The results suggest that relative sarcopenia with ASM adjusted for body mass is a better mobility predictor, with absolute sarcopenia a better indicator of isolated muscle group function in healthy postmenopausal women receiving estrogen replacement.     

维生素D缺乏与高血压相关研究进展

维生素D是一种脂溶性维生素,目前已知其在调节骨骼代谢、钙盐平衡方面起着重要的作用。近年来,虽然许多研究者发现高血压患者中维生素D缺乏的发生率很高,维生素D缺乏可能导致高血压的发生、发展,但是补充维生素D与高血压的研究结果不一致。因此文章就维生素D缺乏与高血压的相关研究进展作一综述。