Association of nutrition and immune-endocrine dysfunction with muscle mass and performance in cognitively impaired older adults

BackgroundWith lean mass declining early in Alzheimer’s disease, muscle quality beyond quantity is relevant to physical performance. We sought to identify potentially modifiable factors for the differential loss of muscle mass (pre-sarcopenia) and its performance (sarcopenia) in older adults with mild cognitive impairment (MCI) and mild-to-moderate Alzheimer’s disease (AD).MethodsThis is a cross-sectional study of 108 community-dwelling older adults with MCI and mild-to-moderate AD. Participants were categorized as: (i) No sarcopenia (normal muscle mass), (ii) Pre-sarcopenia (low muscle mass without weakness or slowness), (iii) Sarcopenia (low muscle mass AND weak grip strength and/or slow gait speed) using Asian cut-offs. Muscle quality was defined as the ratio of grip and knee extension strength to average arm and leg lean mass respectively. We measured cognitive, functional and physical (Short Physical Performance Battery, SPPB) performance; physical activity level; nutritional status; and blood biomarkers of inflammation and endocrine dysfunction.ResultsSPPB (p = 0.033) and activity level (p = 0.010) were highest in the pre-sarcopenic group. Pre-sarcopenic group had highest arm muscle quality [10.6 (7.7–12.2) vs 13.9 (12.6–15.7) vs 11.3 (9.7–12.8), p < 0.001], despite significantly lower appendicular lean mass than non-sarcopenic group. In multi-nomial logistic regression reference to non-sarcopenic group, malnutrition independently increased risk for both pre-sarcopenia (Relative risk = 7.53, 95% C.I 1.20–47.51, p = 0.032) and sarcopenia (Relative risk = 11.91, 95% C.I 2.85–49.77, p = 0.001). A combined pro-inflammatory and endocrine deficient state significantly increased the risk of sarcopenia (Relative risk = 5.17, 95% C.I 1.31–20.37, p = 0.019).ConclusionMalnutrition is a precursor for progressive loss of muscle mass, but a pro-inflammatory and endocrine deficient state may potentially aggravate decline in muscle quality to culminate in frank sarcopenia.     

Predictors of sarcopenia in young hospitalized patients living with HIV

The prevalence of sarcopenia in hospitalized people living with HIV is underdiagnosed, as assessment instruments are not always available. This study aimed to identify factors related to sarcopenia, correlating their anthropometric and clinical markers in hospitalized people living with HIV. This was an observational cross-sectional clinical study, carried out from September 2018 through October 2019. Handgrip strength, muscle mass index, calf circumference and gait speed test were evaluated in recruited patients within three days of hospital admission. The sample consisted in 44 patients, mostly men (66%), black (68%), young adults (41.65 ± 12.18 years) and immunodeficient (CD4 cell count 165 cells/mm³ [34.25–295.5]). Sarcopenia was present in 25% of the sample. Calf circumference showed a significant correlation with CD4 cell count and viral load (p < 0.05) while handgrip strength and gait speed test did not. Calf circumference > 31 cm and gait speed test > 0.8 m/s reduced the chance of sarcopenia by 60% (OR = 0.396 [−1.67 to −0.18]; p < 0.05) and 98% (OR = 0.02 [−8.16 to 0.13]; p < 0.05) respectively. Calf circumference > 31 cm and gait speed test > 0.8 m/s are associated with a reduced chance of sarcopenia in hospitalized HIV patients.     

The use of magnetic resonance imaging to characterize abnormal body composition phenotypes in youth with Prader–Willi syndrome

IntroductionMagnetic resonance imaging (MRI) provides detailed assessment of body composition compartments. No studies have employed state-of-the-art MRI methods to accurately examine abdominal adipose tissue (AT) and skeletal muscle in youth with Prader–Willi syndrome (PWS). Therefore, this study aimed to describe AT distribution and skeletal muscle in the abdominal region of youth with PWS using MRI.MethodsAnthropometric measures and whole-abdominal T1-weighted MRI were performed in sixteen (5 males and 11 females) youth diagnosed with PWS, and seventeen (10 males and 7 females) youth who did not have PWS (controls). Volume of subcutaneous, visceral, intermuscular, and total AT, and skeletal muscle in the abdominal region were quantified using a semiautomatic procedure. Results were summarized using median and interquartile range (IQR, 25th–75th), and ANCOVA test was used (with age and sex as covariates) to examine differences in body composition compartments between PWS and control group.ResultsPWS group had similar age (10.5, 6.6–13.9 vs. 12.8, 10.0–14.4 years; P = 0.14) and BMI z-score (0.5, 0.2–1.3 vs. 0.2, − 0.3 to 1.0; P = 0.33) when compared with controls. Significant differences were observed in absolute volumes of total AT (PWS: 4.1, 2.0–6.6 L; control: 2.9, 2.0–4.5 L; P = 0.01), subcutaneous AT (PWS: 2.8, 1.4–4.8 L; control: 1.8, 1.1–3.2 L; P = 0.01), and intermuscular AT (PWS: 0.3, 0.1–0.4 L; control: 0.3, 0.2–0.3 L; P < 0.005). Visceral AT/subcutaneous AT was lower in PWS (0.4, 0.3–0.5) compared to controls (0.5, 0.4–0.6), P = 0.01. In addition, skeletal muscle volume was lower in PWS (1.5, 1.0–2.6 L) compared to controls (3.1, 1.6–3.9 L), P = 0.03. Ratios of abdominal AT compartments to skeletal muscle were all higher in PWS compared to controls (all P < 0.005).ConclusionsPWS youth have greater abdominal adiposity, particularly subcutaneous AT and intermuscular AT, and lower volume of skeletal muscle compared to controls. The decreased ratio of visceral AT/subcutaneous AT in youth with PWS suggests an improved metabolic profile for the level of adiposity present; however, elevated ratios of AT to skeletal muscle suggest a sarcopenic obesity-like phenotype, which could lead to worse health outcomes.     

Sarcopenia is associated with non-alcoholic fatty liver disease in men with type 2 diabetes

AimsRecent epidemiological studies have suggested an association between sarcopenia and non-alcoholic fatty liver disease (NAFLD) in the general population, prompting our investigation into the gender-specific association between sarcopenia and NAFLD in patients with type 2 diabetes mellitus (T2DM).MethodsIn this cross-sectional study, 4210 patients with T2DM were recruited from the Seoul Metabolic Syndrome Cohort. Appendicular skeletal muscle mass (ASM) was estimated from bioimpedance analysis measurements, and the skeletal muscle mass index (SMI) was calculated by dividing the sum of ASM by body weight. Sarcopenia was defined as a gender-specific SMI value > 2 standard deviations (SDs) below the mean for healthy young adults. NAFLD was defined as the presence of hepatic steatosis on ultrasonography with no other causes of chronic liver disease.ResultsAmong the entire study population (mean age: 57.4 ± 10.8 years), 1278 (30.4%) had NAFLD and 1240 (29.5%) had sarcopenia, and the prevalence of NAFLD was significantly higher in those with sarcopenia: 46.2% vs 25.1% (P < 0.001) in men; 38.3% vs 25.4% (P < 0.001) in women. Sarcopenia was significantly associated with higher risk of NAFLD in men (adjusted odds ratio [OR]: 1.58, 95% confidence interval [CI]: 1.15–2.17), whereas the association was attenuated in women after adjusting for clinical risk factors.ConclusionSarcopenia is independently associated with NAFLD in men with T2DM, which suggests that sarcopenia may be a risk factor for NAFLD in men with T2DM.     

Phenotype of sarcopenic obesity in older individuals with a history of falling

BackgroundAlthough sarcopenic obesity is associated with disability in middle-aged community-dwelling individuals, the phenotype of sarcopenic obesity in people 65 and older, especially those with a history of falls, remain unknown. To fill this knowledge gap, the goal of this study was to obtain a comprehensive phenotype of sarcopenic obesity in this high-risk population.MethodsCross-sectional study of 680 subjects (mean age = 79 ± 9, 65% female) assessed between 2009 and 2013 at the Falls and Fractures Clinic, Nepean Hospital (Penrith, Australia). The assessment included a comprehensive examination, posturography, gait velocity, grip strength, bone densitometry and body composition by DXA, and blood tests for biochemical status. Patients were divided into four groups based on DXA and clinical criteria: 1) sarcopenic obese; 2) non-sarcopenic obese; 3) sarcopenic and; 4) non-sarcopenic/non-obese. The difference between groups was assessed by one-way ANOVA, chi-square analysis, and multivariable linear regression.ResultsSarcopenic obese subjects were older (81.1 ± 7.3), mostly female and more likely to have lower bone mineral density, lower grip strength, slower gait velocity, and poor balance. Sarcopenic obese individuals also showed significantly higher parathyroid hormone and lower vitamin D.ConclusionsWe identified a particular set of clinical and biochemical characteristics in our subgroup of sarcopenic obese older fallers. Identification of these particular characteristics in the clinical setting is essential in order to prevent poor outcomes in this high-risk population.     

Higher uric acid serum levels are associated with better muscle function in the oldest old: Results from the Mugello Study

BackgroundSarcopenia is the progressive loss of muscle mass and strength that occurs with advancing age and plays a pivotal role in the causal pathway leading to frailty, disability and, eventually, to death among older persons. As oxidative damage of muscle proteins has been shown to be a relevant contributory factor, in this study we hypothesized that uric acid (UA), a powerful endogenous antioxidant, might exert a protective effect on muscle function in the oldest old and we tested our hypothesis in a group of nonagenarians who participated in the Mugello Study.Methods239 subjects, 73 men and 166 women, mean age 92.8 years ± SD 3.1, underwent the assessment of UA serum level and isometric handgrip strength, a widely used clinical measure of sarcopenia.ResultsMean UA serum level was 5.69 mg/dL ± SD 1.70 and mean handgrip strength was 15.0 kg ± SD 6.9. After adjusting for relevant confounders, higher UA serum levels remained independent positive predictors of isometric handgrip strength (β 1.24 ± SE(β) 0.43, p = 0.005).ConclusionOur results show that higher UA serum levels are associated with better muscle function in the oldest old and, accordingly, might slow down the progression of sarcopenia.     

Relationship between quadriceps echo intensity and functional and morphological characteristics in older men and women

The age-related decrease in human skeletal muscle mass; i.e. sarcopenia, has received much attention, but an age-related increase in the ratio of adipose tissue to muscle tissue has received noticeably less. A few studies have shown that ultrasonographic echo intensity, an index of the adipose-to-muscle ratio, is negatively associated with functional capacity, but the best parameters by which to predict this ratio have not yet been established for older individuals. The purpose of this study was to assess the relationships between quadriceps femoris (QF) echo intensity and demographic, functional and morphological characteristics of older men and women. Sixty-four healthy men (n = 27) and women (n = 37) aged 62–88 years (72.0 ± 5.0 years) participated in this study. The echo intensity and muscle thickness of the QF were calculated using ultrasonography. Sit-up, supine-up, sit-to-stand, 5-m maximal walk and 6-min walk tests were performed. There were no significant differences in QF echo intensity between sexes, but QF echo intensity was significantly correlated with QF muscle thickness. Stepwise multiple regression analysis with QF echo intensity as a dependent variable revealed QF muscle thickness, sit-to-stand test in men and age, and QF muscle thickness and sit-to-stand test in women, to be significant variables. These results suggest that QF echo intensity can be explained by QF muscle thickness, sit-to-stand and/or age in older men and women; however, an “age” effect was present only in men.     

Assessment of synovitis in early rheumatoid arthritis by CXCL13 serum levels and power Doppler ultrasonography: Correlation with disease activity

Aim of the workAssessment of synovitis in rheumatoid arthritis (RA) is a major issue for proper treatment; it has been proven that high resolution ultrasound (US) examination could be of valuable help. The B-cell chemokine, CXCL13, is a proposed serum biomarker of synovitis in RA. We aimed to find out the presence of synovitis in patients with recent-onset RA and its correlation with disease activity.Patients and methodsWe evaluated 30 patients with early RA for the presence and degree of synovitis by performing high resolution US and obtaining serum CXCL13 levels. In addition, we correlated these results with disease activity score 28 (DAS 28). Results of high resolution US and serum CXCL13 were also obtained for 20 healthy age- and sex-matched volunteers and served as controls.ResultsSerum CXCL13 level was significantly increased in early RA patients vs. controls (p < 0.001). High resolution US revealed that RA patients had a significant increased synovial thickness and high power Doppler US score. In RA patients, DAS 28 had a significant correlation with serum CXCL13 (r = 0.42, p = 0.02), synovial thickness (r = 0.39, p = 0.03) and power Doppler US score (r = 0.43, p = 0.02). Serum CXCL13 level correlated with synovial thickness (r = 0.63, p = 0.001) and power Doppler US score (r = 0.69, p = 0.001).ConclusionRecent-onset RA patients suffer from synovitis as evidenced by significantly increased serum CXCL13 and by high resolution US. Serum CXCL13 is a reliable marker of synovial inflammation which correlates better with synovial thickening and power Doppler US scores than DAS28.     

Anthropometric,functional capacity,and oxidative stress changes in Brazilian community-living elderly subjects. A longitudinal study

ObjectiveTo examine the changes and relationships among anthropometric, functional and plasma oxidative stress markers in elderly.Designlongitudinal study.Settingmeasurements in 2008 and 2010.Participants103 community-dwelling men and women aged 67–92.MeasurementsAnthropometric parameters [waist, hip, arm and calf circumferences; waist-hip ratio, triceps skinfold thickness and others], basic (ADL) and instrumental activities of daily living (IADL)] and plasma oxidative stress markers (α-tocopherol, β-carotene and malondialdehyde) were assessed in 2008 and 2010.ResultsADL, IADL, body weight, skinfold thickness and circumferences of calf and arm decreased and waist and waist-hip ratio increased from 2008 to 2010. α-Tocopherol decreased and malondialdehyde plasma levels increased during the study period. In multiple logistic regression analyses, increased age (OR = 1.12; IC: 1.02–1.23; p = 0.02), female gender (OR = 8.43; IC: 1.23–57.58; p = 0.03), hypertension (OR = 0.22; IC: 0.06–0.79; p = 0.02), arthritis/arthrosis (OR = 0.09; IC: 0.009–0.87; p = 0.04) and depression (OR = 0.20; IC: 0.04–1.03; p = 0.05) were independent risk factors for functional decline.ConclusionFat reduction, muscle loss, central obesity increase, functional decline and worsening of plasma oxidative stress were observed during 2-year follow-up. Some of the risk factors that were identified could be modified to help prevent functional decline in elderly. The factors deserving attention include hypertension, arthritis/arthrosis and depression.     

Measurement of muscle insulin sensitivity in obese men

AimsIn 2007, a novel estimate of skeletal muscle insulin sensitivity was derived from the oral glucose tolerance test (OGTT). The aim of this investigation is to assess whether and to what extent the proposed index of skeletal muscle insulin sensitivity derived from the OGTT was associated with muscle insulin sensitivity measured using the hyperinsulinemic-euglycaemic clamp technique.MethodsForty-six middle-aged, abdominally obese men (age 44 ± 8 years, waist circumference 107.4 ± 6.2) were studied. Each participant participated in a 2-hour, 75-g OGTT and a 3-hour hyperinsulinemic-euglycaemic clamp protocol.ResultsThe OGTT-derived index of muscle insulin sensitivity correlated with muscle insulin sensitivity measured with the insulin clamp (r = 0.55, P < 0.01), however, the standard error of estimate (SEE) when predicting muscle insulin sensitivity by the OGTT-derived index was 5.3 (50%).ConclusionOur findings suggest that despite a statistically significant association between the two methods, the OGTT approach lacks precision and is not a useful method for estimating skeletal muscle insulin sensitivity in abdominally obese men.     

Association of adiponectin with peripheral muscle status in elderly patients with heart failure

BackgroundReduced peripheral muscle mass was demonstrated in patients with chronic heart failure (HF). Adipokines may have potent metabolic effects on skeletal muscle. The associations between adipokines, peripheral muscle mass, and muscle function have been poorly investigated in patients with HF.MethodsWe measured markers of fat and bone metabolism (adiponectin, leptin, 25-hydroxy vitamin D, parathyroid hormone, osteoprotegerin, RANKL), N-terminal pro B-type natriuretic peptide (NT-pro-BNP) in 73 non-cachectic, non-diabetic, male patients with chronic HF (age: 68 ± 7 years, New York Heart Association class II/III: 76/26%, left ventricular ejection fraction 29 ± 8%) and 20 healthy controls of similar age. Lean mass as a measure of skeletal muscle mass was measured by dual energy X-ray absorptiometry (DEXA), while muscle strength was assessed by hand grip strength measured by Jamar dynamometer.ResultsSerum levels of adiponectin, parathyroid hormone, osteoprotegerin, RANKL, and NT-pro-BNP were elevated in patients with chronic HF compared to healthy controls (all p < 0.0001), while no difference in serum levels of leptin, testosterone or SHBG was noted. Levels of 25-hydroxy vitamin D were reduced (p = 0.002) in HF group. Peripheral lean mass and hand grip strength were reduced in patients with HF compared to healthy subjects (p = 0.006 and p < 0.0001, respectively). Using backward selection multivariable regression, serum levels of increased adiponectin remained significantly associated with reduced arm lean mass and muscle strength.ConclusionsOur findings may indicate a cross-sectional metabolic association of increased serum adiponectin with reduced peripheral muscle mass and muscle strength in non-cachectic, non-diabetic, elderly HF patients.     

Significance of serum levels of angiopoietin-2 and its relationship to Doppler ultrasonographic findings in rheumatoid arthritis patients

BackgroundAngiopoietin-2 (Ang-2) is connected to angiogenesis in synovial regions, but the significance of its levels in patients with rheumatoid arthritis (RA) is still unclear.Aim of the workTo evaluate the significance of serum levels of Ang-2 in patients with RA. Also, to determine Ang-2 relationship to the findings of joints Doppler ultrasonographic findings.Patients and methodsThis study included 40 patients with RA, and 25 matched healthy controls. All patients were subjected to assessment of pain using visual analogue scale (VAS), assessment of personal activity using the Health Assessment Questionnaire (HAQ) score, and calculation of disease activity score (DAS 28). Laboratory assays of complete blood count (CBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF) titre, and measurement of serum levels of Ang-2 by ELISA. Doppler ultrasonography (US) assessment for eight joints, with calculation of synovial thickness and total signal score (TSS), was done.ResultsSerum Ang-2 levels were significantly higher among patients (3191.3 ± 594.9 pg/ml) than controls (1771.7 ± 103.1 pg/ml) (p < 0.001). Serum Ang-2 levels were significantly correlated with ESR, CRP, DAS28, and duration of morning stiffness (p < 0.001, p < 0.001, p < 0.001, and p = 0.025, respectively). There was a significant correlation between serum Ang-2 levels and findings of US, regarding joint synovial thickness, and TSS (p < 0.001, for both).ConclusionPatients with RA had significantly higher levels of serum Ang-2 versus controls. In those patients, serum Ang-2 levels were significantly correlated with disease activity markers (ESR, CRP), DAS28, and duration of morning stiffness. Moreover, these levels were significantly correlated with synovial thickness, and TSS. The role of Ang-2 in RA pathogenesis might open the door to the development of new therapeutic strategies, particularly which target angiogenesis.     

Ultrasonographic evaluation of lower limb enthesis in patients with early spondyloarthropathies

IntroductionThe enthesopathy of seronegative spondyloarthropathies (SpA) is the hallmark of these diseases, the ultrasound examination of these entheses confirms the frequency of their involvement.Aim of the workTo detect entheseal abnormalities with ultrasound (US) in the lower limb of patients with early spondyloarthropathy (SpA) and to evaluate US as a valuable tool in detecting early enthesis.Patients and methodsA total of 45 patients with early disease duration of 11.7 ± 8.5 months, including 10 patients with psoriatic arthritis (PsA), 10 patients with ankylosing spondylitis (AS), 10 patients with reactive arthritis (ReA), eight patients with ulcerative colitis (UC) and seven patients with Crohn’s disease and 20 healthy controls of matched age and sex underwent ultrasonographic evaluation of Achilles, quadriceps, patellar entheses and plantar aponeurosis. Ultrasonographic findings were scored according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS).ResultsOn US examination a total of 290/450 (64.4%) of the entheseal sites were abnormal. Mean GUESS score was significantly higher in patients with SpA as compared with controls (p < 0.001), with a higher mean value in patients with PsA, ReA and AS. The mean thickness of all tendons examined was significantly higher in SpA patients than in controls (p < 0.0001) as well as the mean number of enthesophytes and bursitis in all sites examined (p = 0.002, p = 0.003), with a higher prevalence amongst patients with PsA and ReA. The GUESS score was correlated to duration of the disease and the anti-tumour necrosis factor alpha medications.ConclusionEnthesis involvement occurs early in spondyloarthritis, the enthesis US score appears to be reliable and useful for improving the diagnostic accuracy of early SpA, further studies are needed as US is an evolving technique.     

Waist circumference,visceral abdominal fat thickness and three components of metabolic syndrome

ObjectiveThe relationships between the waist circumference (WC), visceral adipose tissue (VAT) thickness and three components of metabolic syndrome (MetS) were explored to verify which of the obesity indices might be superior.MethodsA cross-sectional study was conducted of 1256 subjects (840 males and 416 females) aged 26–89 years, who were individuals undergoing intensive health checkup. The three components of MetS examined were high blood pressure, glucose intolerance and dyslipidemia. Receiver-operating characteristic (ROC) curve analysis and multiple logistic regression analysis were used for the analyses.ResultsThe mean values of the WC and VAT thickness were significantly higher in the subject group positive for each of the metabolic syndrome components than in the subject group that was negative for all the components (p < 0.001). ROC curve analysis showed that the WC showed an advantage over the VAT thickness only for predicting high blood pressure in men. Logistic regression analysis revealed increase of the odds ratios of the WC for glucose intolerance (p < 0.001), high blood pressure (p < 0.001) and dyslipidemia (p < 0.01) in men. In contrast, the odds ratio of the VAT thickness was significantly increased only for dyslipidemia (p < 0.01) in men. In women, the odds ratios of the WC for glucose intolerance (p < 0.01) and dyslipidemia (p < 0.001) were significantly increased, and odds ratio of the VAT thickness for high blood pressure (p < 0.01) was significantly increased.ConclusionThis survey presented an advantage of WC over VAT thickness as an obesity index for identifying all the three components of metabolic syndrome, although sex differences in the study outcomes were found.     

Components of metabolic syndrome and the incidence of type 2 diabetes in an elderly Taiwanese cohort

AimsMetabolic syndrome (MetS) is at great risk of developing type 2 diabetes (T2DM). This study aimed to explore the association between the major MetS components and the T2DM incidence in an elderly Taiwanese population.Methods1738 subjects, aged 65–84 years, were enrolled from the Taiwan MJ health check-up in 2000 and 2001 and were again investigated in 2005 and 2006. Factor analysis was conducted and factor scores for the baseline of non-diabetic individuals were used as independent variables in logistic regression models to determine risk factors predicting the development of diabetes.ResultsMetS was common among the elderly residents receiving long-term health check-up in Taiwan. Sex-specific factor analyses yielded five separate factors including obesity, etc., accounting for 65.9% and 65.3% of the total variance in non-diabetic men and women, respectively. There were 56 males (6.44%) and 44 females (6.32%) without diabetic at baseline, developed diabetes during the mean 4.95 years follow-up. For non-diabetic men, blood lipids/FPG was strongly associated with diabetes incidence (RR = 2.22, 95% CI 1.69–2.92), while for women, FPG/inflammation factor had biggest RR (RR = 1.94, 95% CI 1.47–2.56). Among factor patterns, obesity was major cluster and as the common determinant of the diabetes risk for two sexes (RR = 1.33, 95% CI 1.02–1.73 and RR = 1.72, 95% CI 1.27–2.31, for men and women, respectively), but the BP was not associated with prediction of diabetes both in two genders.ConclusionsIdentification of five unique factors with different associations with incidence of diabetes suggests that the correlations among these variables reflect distinct metabolic processes rather than one single underlying entity in the elderly Taiwan cohort, and that the blood lipids/FPG and FPG/inflammation factor in both sexes predicting progression to T2DM beyond obesity alone.     

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.     

Association between physical function and the load pattern during stepping-up motion in community-dwelling elderly women

ObjectiveStepping-up motion is challenging task for elderly people in daily life. The present study investigated the relationship between the load pattern during stepping-up motion at maximum speed and physical function in elderly women.MethodsThe subjects comprised 109 community-dwelling elderly women (age 72.5 ± 5.3 years). The load pattern (maximum load, rate of load production, and stepping-up time) during ascending a 30 cm step at maximum speed was measured, using a step up platform that measures the load at the lower and upper level. Physical function, including hip and knee extensor strength and performance on the vertical jump test, one-legged stance test, timed “Up & Go” (TUG) test, and stepping test were measured.ResultsPearson’s correlation analysis showed that stepping-up time was correlated with the maximum load at the lower level (r = −0.51), but not with the maximum load at the upper level. A multiple regression analysis showed that hip extensor strength and performance on the vertical jump, TUG, and stepping tests were significant determinants of the load pattern during stepping-up motion in the elderly women.ConclusionsOur study revealed that rapid stepping-up ability was more closely related to the maximum load during push-off at the lower level rather than that during weight loading on the upper level, and that the load pattern during stepping-up motion in elderly women was associated with various physical functions such as the hip extensor strength, leg muscle power, dynamic balance function, and agility.     

The effect of obstacle gait training on the plantar pressure and contact time of elderly women

ObjectiveThe aim of the present study was to examine the effect of gait training using obstacle on the plantar pressure and contact time in elderly women.MethodsA total of 24 elderly women who were residing in communities in D city, South Korea aged 79.9 ± 2.2, 154.5 ± 7.6 cm in height, and 56.2 ± 5.2 kg in weight participated in this study. The participants conducted obstacle gait training for 8 weeks and foot contact time and foot pressure right before and after crossing the obstacle were measured for 3 times: before the intervention, at the 4 weeks, and 8 weeks using F-scan (Tekscan, USA).ResultsThe results show that foot contact time did not decrease right before crossing the obstacle but decreased right after crossing the obstacle (p < 0.05). Foot pressure moved from the end of the frontal foot to the midfoot (MF) and heel (HL) right before crossing the obstacle (p < 0.05). Foot pressure increased in lesser toe (LT) right after crossing the obstacle (p < 0.05).ConclusionThese results indicate proper weight distribution in feet, increased foot stability due to increased muscle power and flexibility, and improved strategy to cope with the obstacle. The obstacle gait training may be helpful to the elderly who would either fear for or limit outdoor activities due to the risk of falls based on the result of this study.