Sex differences in sarcopenia and frailty among community-dwelling Korean older adults with diabetes: The Korean Frailty and Aging Cohort Study

Aims/IntroductionWe aimed to examine the prevalence of sarcopenia and frailty in Korean older adults with diabetes compared with individuals without diabetes.Materials and MethodsWe analyzed the data of 2,403 participants aged 70–84 years enrolled in the Korean Frailty and Aging Cohort Study. Sarcopenia was defined using the Asian Working Group for Sarcopenia and the Foundation for the National Institutes of Health. Frailty was assessed by the Cardiovascular Health Study frailty phenotype criteria.ResultsThe mean age of the participants was 76.0 ± 3.9 years, and 47.2% were men. The prevalence of diabetes was 30.2% in men and 25.8% in women. Adults with diabetes showed a lower muscle mass index (appendicular skeletal muscle mass/body mass index) and handgrip strength in both sexes, but only the women showed decreased physical performance. Women with diabetes presented a higher prevalence of sarcopenia diagnosed by the Foundation for the National Institutes of Health criteria, and frailty compared with participants without diabetes (sarcopenia 14.7% vs 8.5%, P = 0.001; frailty 9.5% vs 4.9%, P = 0.003). Men in the high and middle tertiles for homeostatic model assessment of insulin resistance presented a significantly higher prevalence of sarcopenia, compared with men in the low tertile homeostatic model assessment of insulin resistance (high tertile 16.6%, middle tertile 13.3%, low tertile 8.6%).ConclusionsIn older adults with diabetes, muscle mass index and muscle strength were lower than in those without diabetes. However, the prevalence of sarcopenia and frailty was higher and physical performance was lower only in women with diabetes.     

Global research in sarcopenia: High-cited papers,research institutions,funding agencies and collaborations, 1993–2022

Background and aimsThis bibliometric analysis aims to analyze the high-cited papers (HCPs), those which have received >100 citations) on Sarcopenia to provide insight into publication performances and research characteristics of the literature.MethodsGlobal HCPs on Sarcopenia research were identified from the Scopus database from January 1993 to August 2022. VOSviewer, and Biblioshiny software were used to visualize the collaborative interaction among most productive countries, organizations, authors, and keywords. Select bibliometric measures were applied to evaluate the publication productivity and their influence in this area.ResultsOut of 6219 publications on Sarcopenia only 398 were HCPs. These HCPs received an average of 271.7 citations per publication (CPP). The most productive organizations were the Università Cattolica del Sacro Cuore, Italy, and Jean Mayer USDA Human Nutrition Center on Aging, USA. The most impactful organizations in terms of CPP and relative citation index were CHU de Toulouse, France, and Università Cattolica del Sacro Cuore, Italy. The most productive authors were Landi F and Morley JE, and Anker SD from Italy and Germany respectively. The most impactful authors were: Cederholm T (Sweden), Cruz JAJ (Spain) and Rolland Y (France). There were few/no HCPs from South America, Africa, South Asia, and USSR.ConclusionSarcopenia research has been predominantly done in USA, Europe, and China, and rarely from low and middle-income countries. Further focus of research should be on its etiopathogenesis (especially at the molecular level), prevalence in different communities, methods to diagnose it in early stages, and its cost-effective management.     

太极拳锻炼对老年慢性肾脏病并发肌少症患者的功能改善作用

目的探讨太极拳锻炼对老年慢性肾脏病并发肌少症患者运动和平衡功能的改善作用及对肾功能的影响。 方法选取2018年12月至2020年5月在浙江医院就诊的73例老年慢性肾脏病并发肌少症患者为研究对象。其中36例给予常规内科治疗（对照组）,37例在此基础上给予太极拳锻炼干预12周（观察组）。比较干预前后两组患者四肢骨骼肌质量指数（ASMI）、握力指数、6 m步行速度、功能性步态评价（FGA）评分、血肌酐、估算的肾小球滤过率（eGFR）以及尿微量白蛋白等指标。计量资料的组间比较采用t检验,计数资料的比较采用χ²检验。 结果干预12周后,观察组患者ASMI、握力指数、6米步行速度、FGA评分较干预前均有明显提升,且明显高于对照组患者（t=2.876、4.375、4.982、4.582,P<0.01）。干预前后,观察组患者仅尿微量白蛋白水平的差异有统计学意义（F=5.396,P<0.05）,其中干预12周后的尿微量白蛋白水平明显低于干预前和首次干预24 h后（P<0.01）。干预12周后,观察组患者尿微量白蛋白水平明显低于对照组患者（t=2.557,P<0.01）。 结论太极拳运动能够提高老年慢性肾脏病并发肌少症患者的肌肉质量,改善平衡功能,保护肾功能,提高生活质量。     

Limitations of SARC-F in the diagnosis of sarcopenia in community-dwelling older adults

PurposeThe SARC-F is a recommended screening tool for sarcopenia; however, its sensitivity is reported to be very low. This study aimed to confirm the diagnostic efficacy of the SARC-F and whether it is affected by population characteristics.MethodsIn this study, 2 cohorts of 1060 community-dwelling older adults, who were monitored by the Tokyo Metropolitan Institute of Gerontology, were included. In addition to the overall dataset, receiver operating characteristic curve analysis was performed to obtain the SARC-F results for sarcopenia among the datasets for only those older in age (over 75 years), those with higher frailty points (above the median total score for the Kihon Checklist points), those with lower grip strength (below the median), lower gait speed (below the median), and those with comorbidities (hypertension, cerebral vascular disease, heart disease, and diabetes mellitus).ResultsIn the overall dataset, sensitivity and specificity were 3.9% and 97.3%, respectively. In analyzing the area under the curve, sensitivity and specificity for older age and low physical function datasets were significant, but had low values. The diabetes dataset had higher values but did not effectively diagnose sarcopenia at a cutoff value of 4.ConclusionThe SARC-F had high specificity for the diagnosis of sarcopenia in community-dwelling older adults with low physical function. However, its sensitivity was low. Despite these limitations, it may be used as a screening tool for sarcopenia in selected populations, such as adults in hospitals or nursing homes.     

Respiratory chain deficiency in aged spinal motor neurons

Sarcopenia, muscle wasting, and strength decline with age, is an important cause of loss of mobility in the elderly individuals. The underlying mechanisms are uncertain but likely to involve defects of motor nerve, neuromuscular junction, and muscle. Loss of motor neurons with age and subsequent denervation of skeletal muscle has been recognized as one of the contributing factors. This study investigated aspects of mitochondrial biology in spinal motor neurons from elderly subjects. We found that protein components of complex I of mitochondrial respiratory chain were reduced or absent in a proportion of aged motor neurons–a phenomenon not observed in fetal tissue. Further investigation showed that complex I-deficient cells had reduced mitochondrial DNA content and smaller soma size. We propose that mitochondrial dysfunction in these motor neurons could lead to the cell loss and ultimately denervation of muscle fibers.     

Interrelationship among muscle,fat, and bone: Connecting the dots on cellular,hormonal, and whole body levels

While sarcopenia and sarcopenic obesity have been recognized in the last decade, a combined concept to include decreased muscle mass and strength, as well as decreased bone mass with coexistence of adiposity is discussed here. We introduce a new term, osteopenic obesity, and operationalize its meaning within the context of osteopenia and obesity. Next, we consolidate osteopenic obesity with the already existing and more familiar term, sarcopenic obesity, and delineate the resulting combined condition assigning it the term osteosarcopenic obesity. Identification and possible diagnosis of each condition are discussed, as well as the interactions of muscle, fat and bone tissues on cellular level, considering their endocrine features. Special emphasis is placed on the mesenchymal stem cell commitment into osteoblastogenic, adipogenic and myogenic lineages and causes of its deregulation. Based on the presented evidence and as expounded within the text, it is reasonable to say that under certain conditions, osteoporosis and sarcopenia could be the obesity of bone and muscle, respectively, with the term osteosarcopenic obesity as an encompassment for all.     

少肌性肥胖合并脂肪性肝病的诊断与治疗

目的 非酒精性脂肪性肝病(NAFLD)是所有种族的儿童和成人最常见的慢性肝病.肌肉减少症是指因持续骨骼肌量流失、强度和功能下降而引起的综合征.随着肌肉减少症的进展,体质量不断减少,脂肪含量则不断增加,从而形成少肌性肥胖.少肌性肥胖与NAFLD及其疾病进展有关.既往大多数研究已证实肌肉减少症与NAFLD的正相关关系,但肌...     

Psoas muscle size,possible sarcopenia and frailty,and long-term survival in elderly patients after isolated surgical aortic valve replacement for aortic stenosis

PurposeThis study investigated the use of psoas muscle area index (PAI) as an indicator of mortality risk in relation to survival in elderly patients after isolated surgical aortic valve replacement (SAVR) for aortic valve stenosis (AS).MethodsBetween January 2005 and March 2015, 140 patients with AS, aged ≥ 70 years, and with preoperative abdominal computed tomography scans, underwent elective, primary, isolated SAVR. PAI showed the ratio of the psoas muscle cross-sectional area at the fourth lumbar vertebral level to body surface area, and PAI less than the gender-specific lowest 20th percentile we called “low PAI” for the purposes of this study. Patients were classified as low PAI (n = 29) or normal PAI (n = 111).ResultsThe mean age in the low-PAI group was significantly older than in the normal-PAI group (81.0 vs. 77.3 years; p = 0.001). The mean follow-up was 4.25 years. The low-PAI group had a lower survival rate than the normal-PAI group at 1 year (89.7 ± 5.7% vs. 96.3 ± 1.8%), at 3 years (71.6 ± 9.3% vs. 91.5 ± 2.7%), and overall (53.0 ± 13.4% vs. 76.0 ± 5.6%; p = 0.039). The prognostic factors of mortality included low PAI (hazard ratio 2.95; 95% confidence interval 1.084–8.079; p = 0.034).ConclusionsPAI was associated with reduced overall survival after isolated SAVR in elderly people. PAI measurement may help to predict patient risks.     

Current approach to treatment of minimal hepatic encephalopathy in patients with liver cirrhosis

Minimal hepatic encephalopathy (MHE) corresponds to the earliest stage of hepatic encephalopathy (HE). MHE does not present clinically detectable neurological-psychiatric abnormalities but is characterized by imperceptible neurocognitive alterations detected during routine clinical examination via neuropsychological or psychometrical tests. MHE may affect daily activities and reduce job performance and quality of life. MHE can increase the risk of accidents and may develop into overt encephalopathy, worsening the prognosis of patients with liver cirrhosis. Despite a lack of consensus on the therapeutic indication, interest in finding novel strategies for prevention or reversion has led to numerous clinical trials; their results are the main objective of this review. Many studies address the treatment of MHE, which is mainly based on the strategies and previous management of overt HE. Current alternatives for the management of MHE include measures to maintain nutritional status while avoiding sarcopenia, and manipulation of intestinal microbiota with non-absorbable disaccharides such as lactulose, antibiotics such as rifaximin, and administration of different probiotics. This review analyzes the results of clinical studies that evaluated the effects of different treatments for MHE.