5种肌肉减少症筛查工具在胃癌患者术前营养评定中的应用比较

目的比较5种不同肌肉减少症筛查工具在胃癌患者术前营养评定中的应用效果。方法便利选取2020年5月—10月江苏省某三级甲等医院收治的拟行胃癌手术的患者270例,分别应用肌肉减少症五条目问卷、改良版肌肉减少症五条目(Strength,Assis tance with walking,Rise from a Chair,Climb Stairs,Falls and Calf Circumference,SARC-CalF)问卷、Ishii评分、迷你肌肉减少症风险评估-7条目问卷和迷你肌肉减少症风险评估-5条目问卷对其进行评估,并基于2019年亚洲肌肉减少症工作组(Asian Working Group for Sarcopenia,AWGS 2019)提出的诊断标准,采用SPSS 20.0和MedCalc 19.0.4软件计算灵敏度、特异度和预测值,绘制受试者操作特征曲线,计算曲线下面积,并通过计算Youden指数,确定各筛查工具的最佳截断值。结果依据AWGS 2019提出的诊断标准,胃癌患者术前肌肉减少症的发生率为8.76%,使用5种评估工具得出存在肌肉减少症风险的发生率为3.42%～73...     

Indicators predicting the development and improvement of sarcopenia in older adults requiring long-term care

[Purpose] This study aimed to identify factors associated with sarcopenia development and improvement among older adults requiring long-term care. [Participants and Methods] This prospective observational study included 118 older adults requiring long-term care in a single facility. Sarcopenia was assessed according to the 2019 diagnostic criteria of the Asian Working Group for Sarcopenia at baseline and after 6 months. Nutritional status was measured using calf circumference and the Mini Nutritional Assessment-Short Form to examine the association between sarcopenia onset and improvement. [Results] Risk of malnutrition and lower calf circumference at baseline were significantly associated with sarcopenia development. The study also showed that a non-risk of malnutrition, higher calf circumference, and higher skeletal muscle mass index were significantly associated with improved sarcopenia. [Conclusion] The Mini Nutritional Assessment-Short Form and calf circumference were able to predict sarcopenia development and improvement in older adults requiring long-term care.     

社区慢性病共病老年患者肌少症筛查工具的比较研究

目的 比较指环测试与小腿围对社区慢性病共病老年患者肌少症的筛查效果。方法 2022年2月—5月,采用方便抽样法,选取河南省郑州市15个社区的慢性病共病老年患者330例,分别应用指环测试、小腿围对其进行评估,基于2019年亚洲肌肉减少症工作组提出的诊断标准,采用SPSS 26.0软件计算灵敏度、特异度和预测值,绘制受试者操作特征曲线,计算曲线下面积,并通过约登指数,确定小腿围的最佳截断值。结果 最终纳入320例社区慢性病共病老年患者,肌少症的发生率为20.63%,指环测试、小腿围的筛查率分别为28.13%、21.25%。2种肌少症筛查工具在社区慢性病共病老年患者中的灵敏度为68.2%、73.0%,特异度为82.3%、80.0%,受试者操作特征曲线下面积为0.752、0.810,小腿围对应的最佳截断值为男性<34.5 cm、女性<33.5 cm。结论 小腿围对社区慢性病共病老年患者肌少症的筛查更具灵敏度和准确性。     

指环测试在社区老年人肌少症筛查中的应用

目的 评价指环测试在社区老年人肌少症筛查中的应用价值.方法 对符合标准的303名社区老年人,应用指环测试进行肌少症评估,以亚洲肌少症工作组提出的肌少症诊断标准为依据,使用灵敏度、特异度、约登指数、似然比、预测值、Kappa系数等指标评估指环测试的准确性.结果 根据亚洲肌少症工作组提出的诊断标准,肌少症老年人80名,非肌...     

AWGS2019 vs EWGSOP2 for diagnosing sarcopenia to predict long-term prognosis in Chinese patients with gastric cancer after radical gastrectomy

BACKGROUNDSarcopenia is a nutrition-related disease and has a profound effect on the long-term overall survival (OS) of patients with gastric cancer. Its diagnostic criterion is critical to clinical diagnosis and treatment. However, previous research reported widely differing sarcopenia prevalence due to different criteria. AWGS2019 and EWGSOP2 are the two latest and widely adopted criteria.AIMTo compare the effects of AWGS2019 and EWGSOP2 on the long-term OS of Chinese gastric cancer patient after radical gastrectomy.METHODSAn observational study was conducted from July 2014 to January 2017, which included 648 consecutive gastric cancer patients who underwent radical gastrectomy. The sarcopenia elements (skeletal muscle index, handgrip strength, and gait speed) were measured within 1 mo or 7 d before surgery. The patients were followed at fixed intervals to gain the outcomes. Multivariate Cox regression analysis was performed to determine the association between sarcopenia and the long-term OS of these patients according to the two criteria separately. The predictive performance of the models with AWGS2019 and EWGSOP2 were evaluated by the concordance index (C-index) and area under the time-dependent receiver operating characteristic curve (AUC). The Akaike information criterion (AIC) was applied to compare model fits.RESULTSThe prevalence of sarcopenia was 20.5% and 11.3% according to AWGS2019 and EWGSOP2, respectively. Sarcopenia was an independent risk factor for the long-term OS no matter based on AWGS2019 or EWGSOP2, but AWGS2019-sarcopenia in multivariate model had a higher hazard ratio (HR) [2.150 (1.547-2.988)] than EWGSOP2-sarcopenia [HR 1.599 (1.092-2.339)]. Meanwhile, the model with AWGS2019-sarcopenia [C-index 0.773 (0.742-0.804); AIC 2193.7; time-dependent AUC 0.812 (0.756-0.867) for 1-year OS, 0.815 (0.778-0.852) for 3-year OS, and 0.809 (0.759-0.859) for 5-year OS] had better predictive power and model fits than the model with EWGSOP2-sarcopenia [C-index 0.762 (0.729-0.795); AIC 2215.2; time-dependent AUC 0.797 (0.741-0.854) for 1-year OS, 0.804 (0.767-0.842) for 3-year OS, and 0.799 (0.748-0.850) for 5-year OS].CONCLUSIONSarcopenia is an independent risk factor for the long-term OS in Chinese gastric cancer patients undergoing radical gastrectomy. The prediction model with AWGS2019-sarcopenia has better predictive power and model fits than the prediction model with EWGSOP2-sarcopenia. AWGS2019 may be more appropriate for diagnosing sarcopenia in these Chinese patients than EWGSOP2.     

Anthropometric indicators as screening tools for sarcopenia in older adult women

ObjectiveTo investigate the association between sarcopenia and different anthropometric indicators, and identify the best indicator to discriminate sarcopenia in community-dwelling older adult women.MethodData from 173 older adult women (≥60 years), living in Lafaiete Coutinho, a small-sized city in northeastern Brazil, were analyzed. Sarcopenia was defined based on the European consensus on definition and diagnosis using three components: muscle mass, muscle strength and performance. The association between sarcopenia and anthropometric indicators (body mass index, corrected arm muscle area and calf perimeter) was tested using the binary logistic regression technique.ResultsThe adjusted regression model indicated that all anthropometric indicators were inversely associated with sarcopenia, and an increase by one unit in body mass index, corrected arm muscle area or calf circumference decreased the probability of sarcopenia in older adult women by approximately 85%, 16% and 72%, respectively.ConclusionAll the studied anthropometric indicators can be used as discriminators of sarcopenia in an older adult women population. To this end body mass index exhibited better sensitivity and calf circumference better specificity. The results of the study may improve nursing practice and that of other healthcare professionals, enabling sarcopenia screening in older adult women from simple and low-cost anthropometric indicators.     

Impact of sarcopenia on the progress of cardiac rehabilitation and discharge destination after cardiovascular surgery

[Purpose] To investigate the factors that affect the progress of cardiac rehabilitation, length of stay in the hospital, and discharge destination after cardiovascular surgery. [Participants and Methods] This was a prospective observational study. Sixty-seven patients scheduled to undergo open-heart surgery were included in the study. We evaluated physical and psychiatric functions pre- and post-surgery. Sarcopenia was defined as a short physical performance battery score of <9.5. [Results] Sarcopenia was a significant factor of delay of the day of the first rehabilitation, independence in 100-m walking, and exercise training at the rehabilitation gym. Comparisons between pre- and post-surgery were performed in the sarcopenia group. No significant decreases in physical and psychiatric functions were found. The discharge transfer rate was significantly different between the sarcopenia and non-sarcopenia groups. Sarcopenia and the decline in balance score significantly correlated with discharge transfer. [Conclusion] Cardiac rehabilitation can achieve recovery of physical and psychiatric functions even in patients with sarcopenia; however, the discharge transfer rate among the patients with sarcopenia was high. Improving balance ability may result in early home discharge.Key words: Cardiovascular surgery, Sarcopenia, Discharge destination     

Association between skeletal muscle mass index and lung function/respiratory muscle strength in older adults requiring long-term care or support

[Purpose] We focused on skeletal muscle mass index, one of the biomarkers of sarcopenia, and investigated the association between skeletal muscle mass index and the parameters of lung function and respiratory muscle strength. [Participants and Methods] After applying the exclusion criteria, we included, in this cross-sectional study, 120 community-dwelling older adults aged ≥65 years who required long-term care/support and underwent ambulatory rehabilitation under the long-term care insurance system in Japan. We measured the skeletal muscle mass index, forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow rate, maximum expiratory pressure, and maximum inspiratory pressure. The data were analyzed using Pearson correlation coefficient and multiple regression analysis. [Results] The skeletal muscle mass index was positively correlated with only maximum expiratory pressure for both male and female participants by Pearson’s correlation coefficient. With the skeletal muscle mass index as a dependent variable, only the maximum expiratory pressure was significant for both male and female participants by the multiple regression analysis. [Conclusion] Therefore, the findings of this study suggested that compared with lung function tests, maximum expiratory pressure, which is an indicator of respiratory muscle strength, is related to muscle mass. Maximum expiratory pressure might be the most useful indicator for sarcopenia.Key words: Maximum expiratory pressure, Sarcopenia, Skeletal muscle mass index     

Features of older community-dwelling adults with osteosarcopenia requiring support or care

[Purpose] This study aimed to investigate the problems associated with osteosarcopenia and its effect on physical performance, nutritional status, and support or care required by older community-dwelling adults. [Participants and Methods] This study investigated 141 older community-dwelling adults requiring support or care using an ambulatory rehabilitation service. The patients were divided into a control, osteopenia only, sarcopenia only, and osteosarcopenia group. We investigated the associations of each condition with the baseline information, grip strength, gait speed, Mini Nutritional Assessment-Short Form score, and support or care level required. [Results] The osteosarcopenia group consisted of 43.3% of the total study participants. Osteosarcopenia was more closely associated with body mass index, support or care level, grip strength, gait speed, skeletal muscle mass index, and Mini Nutritional Assessment-Short Form score than osteopenia or sarcopenia alone. [Conclusion] Osteosarcopenia is highly prevalent in older community-dwelling adults requiring support or care, which may suggest a greater effect on physical performance, nutritional status, and support or care required than that exerted by osteopenia or sarcopenia alone.     

Prevalence of and factors associated with sarcopenia among elderly individuals with hypertension

PurposeSarcopenia is a major health problem in community-dwelling elderly individuals. Hypertension is postulated to aggravate sarcopenia. The present study was performed to estimate the prevalence of and factors associated with sarcopenia among elderly individuals with hypertension.MethodsThis study involved 165 Chinese individuals with hypertension aged ≥60 years who were evaluated for sarcopenia using the Asian Working Group for Sarcopenia criteria. Data on their sociodemographic information, physical illnesses, and clinical and functional status were collected.ResultsThe overall prevalence of sarcopenia among elderly individuals with hypertension was 20.2%. The factors significantly associated with sarcopenia were an age of ≥70 years (adjusted odds ratio (OR), 3.01; 95% confidence interval (CI), 1.17–5.39), diabetes (OR, 4.45; 95% CI, 1.32–11.16), osteoporosis (OR, 2.52; 95% CI, 1.13–5.37), drinking (OR, 3.28; 95% CI, 1.26–7.85), and a body mass index of 24.0 to 27.9 kg/m² (OR, 0.74; 95% CI, 0.59–0.91).ConclusionsThis study revealed a very high prevalence of sarcopenia among elderly individuals with hypertension (20.2%). Sarcopenia may be associated with advanced age, drinking, diabetes, the body mass index, and osteoporosis. The longitudinal relationship between clinic visits and sarcopenia should be further evaluated.     

Sarcopenia influences fall-related injuries in community-dwelling older adults

This study aimed to determine the relationship between sarcopenia and fall-related injuries in community-dwelling older adults in Korea. The study population comprised 2848 subjects aged 65 years or older who participated in the Korea National Health and Nutrition Examination Surveys during 2010–2011. Sarcopenia was considered to be present if the subject's appendicular skeletal muscle mass divided by his or her weight was less than 29.9% in men, or less than 25.1% in women. The incidence of fall-related injuries during the past year among all the respondents was 4.3%, and the prevalence of sarcopenia was 32.2%. After controlling for sociodemographic variables and morbidity due to chronic diseases, the incidence of fall-related injuries remained significantly elevated among older adults with sarcopenia (odds ratio = 1.61, 95% confidence internal = 1.01–2.54). Sarcopenia should be considered when investigating means of preventing of fall-related injuries in community-dwelling older adults. To prevent falls among these persons, it is vital to implement intervention programs that increase muscle mass.     

Limitations of the L3 skeletal muscle index and the Asian Working Group for Sarcopenia 2019 consensus diagnostic criteria for sarcopenia evaluation in a case of diffuse large B‐cell lymphoma

Sarcopenia is an adverse prognostic factor for diffuse large B‐cell lymphoma. A case of diffuse large B‐cell lymphoma whose diagnosis, severity, and therapeutic effect of sarcopenia were difficult to determine owing to lymphoma cell infiltration into the psoas major and femoral bone marrow is reported. At presentation, the cross‐sectional area of left psoas major at L3 was enlarged owing to lymphoma cell infiltration; thus, sarcopenia evaluation was impossible by L3 skeletal muscle index. The patient was bedridden; thus, sarcopenia evaluation was impossible by the Asian Working Group for Sarcopenia 2019 consensus diagnostic criteria at presentation. At the terminal stage, she could not walk due to bilateral anterior thigh pain caused by lymphoma infiltration into femoral marrow; thus, sarcopenia evaluation was impossible by the Asian Working Group for Sarcopenia 2019 consensus diagnostic criteria. Although the L3 skeletal muscle index and the Asian Working Group for Sarcopenia 2019 consensus diagnostic criteria are representative sarcopenia evaluation systems, they cannot be used to evaluate sarcopenia in some diffuse large B‐cell lymphoma patients.     

Association of sarcopenia with swallowing problems,related to nutrition and activities of daily living of elderly individuals

[Purpose] The purpose of the current study was to clarify problems associated with swallowing, related to nutrition and activities of daily living (ADL), in elderly individuals with sarcopenia. [Subjects and Methods] Seventy-seven subjects were assigned to a sarcopenia or a non-sarcopenia group according to a definition used by the European Working Group on Sarcopenia in Older People. Analyses were conducted including and excluding subjects with a central nervous system disorders in order to focus on the influence of sarcopenia. The swallowing ability, ADL, and nutrition levels were compared between the 2 groups. [Results] Swallowing function as well as ADL and nutrition levels were significantly lower in the sarcopenia group than in the non-sarcopenia group. [Conclusion] It is important to include dimensions of swallowing, nutrition, and ADL in the assessment and treatment of swallowing problems in elderly individuals with sarcopenia.Key words: Elderly, Dysphagia, Sarcopenia     

小腿围在评估维持性血液透析患者骨骼肌质量下降中的效果研究

目的 探讨维持性血液透析患者小腿围与骨骼肌质量指数、握力、步速的关系,分析小腿围在评估肌少症中的效果,为护理人员筛查维持性血液透析患者肌少症高危人群提供参考。方法 2020年5月—9月,采用便利抽样法,选取江苏省连云港市和徐州市2所三级甲等医院的613例维持性血液透析患者进行横断面研究,其中男379例,女234例。采用生物电阻抗法测量患者的骨骼肌质量指数,并进行握力、步速、小腿围等指标的测量。分析小腿围与骨骼肌质量指数、握力、步速之间的关系,采用受试者工作特征曲线得出小腿围的最佳截断值。 结果 小腿围与骨骼肌质量指数、握力、步速呈正相关。小腿围与骨骼肌质量下降的受试者工作特征曲线显示,男性小腿围的最佳截断值为32.7 cm（曲线下面积为0.909,灵敏度为0.889,特异度为0.799）;女性小腿围的最佳截断值为30.2 cm（曲线下面积为0.837,灵敏度为0.744,特异度为0.808）。小腿围与肌少症的受试者工作特征曲线显示,男性小腿围的最佳截断值为32.7 cm（曲线下面积为0.889,灵敏度为0.907,特异度为0.745）;女性小腿围的最佳截断值为29.7 cm（曲线下面积为0.844,灵敏度为0.766,特异度为0.797）。结论 维持性血液透析患者小腿围与骨骼肌质量指数、握力、步速均呈正相关,当男性<32.7 cm,女性<29.7 cm时,提示患者有可能存在骨骼肌质量下降及发生肌少症,护理人员可通过测量小腿围筛查维持性血液透析患者肌少症高危人群,早期采取预防性干预措施。     

Prevalence of sarcopenia and its association with diet and physical activity in older adults with type 2 diabetes: A cross-sectional study

This cross-sectional study explored the prevalence of sarcopenia in older adults with type 2 diabetes and investigated the effects of diet and physical activity on sarcopenia. In total, 577 older adults with diabetes were recruited from a teaching hospital in Taiwan. Diet and physical activity were assessed using self-rated questionnaires, including the Healthy Diet Inventory, the Mini Nutritional Assessment-Short Form, and the International Physical Activity Questionnaire-Short Form. Sarcopenia was defined in accordance with the Asian Working Group for Sarcopenia 2019 guidelines. In total, 51.12% of participants had either possible sarcopenia, sarcopenia, or severe sarcopenia. Participants who were female, old age, prolonged sedentary times, poor nutritional status, and lower level of moderate-to-vigorous physical activity were identified as risk factors for possible to severe sarcopenia. Older adults with diabetes and possible to severe sarcopenia had poor nutrition status and engaged in inadequate physical activity. The findings indicate that sarcopenia may be related to nutrition status and physical activity, especially in older adults with diabetes.     

Short Physical Performance Battery (SPPB) score as a discriminator of dynapenic abdominal obesity among community-dwelling older adults

The aim of this study is to verify the utility of using physical performance to discriminate the presence of dynapenic abdominal obesity (DAO) in older adults. This cross-sectional study was conducted with 382 community-dwelling older adults. DAO was identified when dynapenia (cut-off points of <26 kilogram-force [kgf] for men and <16 kgf for women) was detected together with abdominal obesity (waist circumference >102 cm for men and >88 cm for women). Physical performance was assessed with the Short Physical Performance Battery (SPPB). SPPB scores and DAO were inversely associated even after adjustment (OR: 0.69; 95%CI: 0.58–0.83). Cut-off points of ≤9 for SPPB scores were the most efficient for discriminating the presence of DAO in both men (AUC= 0.836; 95%CI: 0.76–0.89; sensitivity: 90.91% and specificity: 60.33%) and women (AUC= 0.677; 95%CI: 0.62–0.73; sensitivity: 73.33% and specificity: 40.91%). Physical performance assessed with SPPB can discriminate DAO and be useful for the timely identification and management of this condition in older adults.     

上臂围和小腿围在社区老年肌少症患者筛查诊断中的应用

目的 探讨上臂围和小腿围与肌肉量的相关关系及其对肌量减少和肌少症的筛查诊断效果和最佳诊断截断值.方法 2020年3月至8月,方便抽取831例社区老年人(≥60岁)作为研究对象,采用身体成分测试仪检测肌肉量等指标,同时进行上臂围和小腿围的测量,握力及步速测试.上臂围、小腿围与肌肉量等指标的相关性行Pearson相关分析,...     

维持性血液透析合并肌少症患者运动干预方案的构建及应用

目的 构建维持性血液透析合并肌少症患者透析中运动干预方案并评价其应用效果.方法 基于证据总结和德尔菲专家函询法,构建维持性血液透析合并肌少症患者透析中运动干预方案.将2021年3月—7月在连云港市某三级甲等医院行维持性血液透析合并肌少症的51例患者随机分为试验组25例和对照组26例,试验组在常规护理的基础上实施透析中运...     

北京市社区老年人潜在不适当用药的调查分析

目的 调查北京市社区老年人潜在不适当用药(potentially inappropriate medication,PIM)现状.方法 采用自我报告方式,收集北京市社区215名老年人用药信息,根据2019版美国老年人PIM标准(Beers criteria for PIM use in older adults,Beers标准)和中国老年人潜在不适当用药判断标准(中国PIM标准)评价并做描述性分析.结果 根据2019版Beers标准发现66人(30.7%)存在84例次PIM,其中中枢神经系统药物(36例次)、血液系统药物(14例次)、内分泌系统药物(11例次)导致的PIM最多;采用中国PIM标准发现53人(24.7%)存在73例次PIM,前三位分别为:中枢神经系统药物(31例次),血液系统药物(17例次),解热、镇痛、抗炎与抗风湿药(17例次).结论 社区老年人PIM发生率较高,特别是中枢神经系统和血液系统用药需要引起关注.Beers标准和中国PIM标准可相互补充,且需不断更新完善.     

The Association of Calf Circumference with Resting Pulse Rate in Community-dwelling Healthy Elderly Women —Pilot Study—

[Purpose] High resting blood pressure and heart rate are associated with the risk of cardiovascular events. In patients with decreasing amounts of slow twitch muscle fiber, hypertension may develop and resting heart rate may increase. Measurement of the amount of slow twitch muscle fiber and capillary density using muscle biopsy is inconvenient and expensive. Therefore, a better screening test is required to determine these parameters for prevention of cardiovascular events. In this study, relationships among calf circumference, resting blood pressure, and pulse rate in the soleus muscle were investigated. [Subjects] Healthy elderly women (n= 19, 61–84 years of age) living in the community were the subjects of this study. [Methods] Blood pressure was measured using an automatic hemodynamometer on the left arm. The calf circumference was measured, and pulse rate was measured on the left radial artery for 1 min by palpation. [Results] No correlations were observed between calf circumference, resting systolic or diastolic pressure, pulse pressure, or mean blood pressure. However, an inverse correlation was observed between calf circumference and resting pulse rate. [Conclusion] Calf circumference measurement may be used as a screening test for resting pulse rate. This test may be useful for the prevention of cardiovascular events.