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.     

Metabolic syndrome-related sarcopenia is associated with worse prognosis in patients with gastric cancer: A prospective study

ObjectivesSarcopenia and metabolic syndrome (MetS) are associated with the prognosis from malignant tumors. However, evidence of the relationship between sarcopenia and MetS among gastric cancer (GC) patients following radical gastrectomy is lacking. This study assessed the association between preoperative sarcopenia and MetS among GC patients and analyzed the prognosis of patients with different malnutrition statuses.MethodsWe prospectively assessed the preoperative statuses of sarcopenia and MetS among patients who underwent radical gastrectomy from July 2014 to December 2017. We combined sarcopenia and MetS to generate four groups: MetS-related sarcopenia group (MSS), sarcopenia group (S), MetS group (MS), and normal group (N).ResultsA total of 749 patients with resectable GC were included in this study. Preoperative MetS was associated with sarcopenia (p < 0.001). Multivariate logistic regression presented that MetS-related sarcopenia (OR = 2.445; p = 0.010) and sarcopenia alone (OR = 2.117; p = 0.001) were independent predictors of grade Ⅱ and above complications, while MetS alone was not (p = 0.342). Cox regression analysis revealed that MetS-related sarcopenia led to the worst prognosis in the four groups (MSS vs MS: HR = 3.555, p < 0.001; MSS vs N: HR = 2.020, p = 0.003; MSS vs S: HR = 1.763, p = 0.021). However, the MetS group had better prognosis than the normal group (MS vs N: HR = 0.568, p = 0.048).ConclusionPreoperative MetS was associated with sarcopenia among GC patients. MetS-related sarcopenia resulted in a significantly worse prognosis. The long-term prognoses of patients with sarcopenia were impaired by preoperative MetS, while patients without sarcopenia benefited. Thus, patients with both sarcopenia and MetS require more medical interventions.     

肌肉减少症的营养与运动干预研究进展

肌肉减少症是一种与年龄增长有关的渐进性、全身性的骨骼肌疾病,骨骼肌量减少、肌肉力量或肌肉功能减退是其主要表现,与虚弱、跌倒、功能衰退、死亡等风险增加有关。肌肉减少症在很大程度上归因于衰老,但也包括其他一些高危因素,如：肿瘤、骨关节炎、神经系统疾病、活动减少、营养摄入不足或吸收不良、与药物有关的厌食症、营养过剩或肥胖等。肌肉减少症诊断流程为FACS：风险筛查（Find）-评估（Assess）-确诊（Confirm）-严重程度判定（Severity）。营养和运动干预对防治肌肉减少症有显著的积极作用,可不同程度地改善骨骼肌质量、功能及平衡能力。充足的能量摄入,补充富含亮氨酸的蛋白质、维生素D、ω-3多不饱和脂肪酸、益生元、益生菌及与阻抗运动、有氧运动结合,可以延缓、改善甚至逆转肌肉减少症。本文综述肌肉减少症的定义、诊断、发病机制、营养及运动防治方案,以期加强临床医师对肌肉减少症的认识,为我国肌肉减少症的防治处方提供依据。     

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.     

Therapeutic Interventions for Frail Elderly Patients: Part I. Published Randomized Trials

The body of literature for frailty as a prognostic marker continues to grow, yet the evidence for frailty as a therapeutic target is less well defined. In the setting of cardiovascular disease, the prevalence of frailty is elevated and its impact on mortality and major morbidity is substantial. Therapeutic interventions aimed at improving frailty may impart gains in functional status and survival. Randomized clinical trials that tested one or more therapeutic interventions in a population of frail older adults were reviewed. The interventions studied were exercise training in 13 trials, nutritional supplementation in 4 trials, combined exercise plus nutritional supplementation in 7 trials, pharmaceutical agents in 8 trials, multi-dimensional programs in 5 trials, and home-based services in 1 trial. The main findings of these trials are explored along with a discussion of their relative merits and limitations.     

Difference between old and young adults in contribution of β‐cell function and sarcopenia in developing diabetes mellitus

Aims/Introduction

To investigate the difference in contributing factors in developing diabetes between old and young adults.

Materials and Methods

Subjects with recent‐onset diabetes were selected from a nationwide survey data and classified according to age: elderly (age ≥75 years), middle‐age (age 45–64 years) and young (age 25–39 years). The homeostasis model assessment of insulin resistance and β‐cell function were calculated. Sarcopenia was assessed using dual‐energy X‐ray absorptiometry.

Results

The prevalence of recent‐onset diabetes was 13.5%, 8.0%, and 1.4% in patients aged ≥75 years (unweighted n = 1,082), 45–64 years (unweighted n = 6,532), and 25–39 years (unweighted n = 5,178), respectively. Homeostasis model assessment of β‐cell function along with homeostasis model assessment of insulin resistance showed increasing trends as onset age increased in recent‐onset diabetes (P for trend < 0.001 in both). Elderly‐onset diabetic patients had significantly higher homeostasis model assessment of β‐cell function and homeostasis model assessment of insulin resistance compared with the middle‐age‐onset group (P < 0.001 and 0.014, respectively). Multivariate analysis showed that sarcopenia was significantly associated with recent‐onset diabetes only in patients aged ≥75 years (odds ratio [OR] 2.478, 95% confidence interval [CI] 1.379–4.452) but not in patients aged 45–64 years. In the middle‐age group, abdominal obesity (OR 2.933, 95% CI 2.086–4.122), hypertriglyceridemia (OR 1.529, 95% CI 1.078–2.169]) and low high‐density lipoprotein cholesterolemia (OR 1.930, 95% CI 1.383–2.695) were associated with recent‐onset diabetes.

Conclusions

Elderly‐onset diabetic patients had higher insulin resistance and relatively preserved β‐cell function compared with middle‐age‐onset patients. Sarcopenia might play a more important role in developing diabetes in the elderly population.     

11种运动对老年肌少症患者身体功能改善效果的网状Meta分析

目的 通过网状Meta分析评价11种运动训练对老年肌少症患者身体功能、肌肉力量和肌肉质量改善效果的影响。方法 检索Web of Science、Pub Med、Embase、Cochrane Library、CINAHL、中国知网、中国生物医学文献数据库、万方数据库和维普数据库中关于运动训练对老年肌少症患者身体功能、肌肉力量和肌肉质量改善效果的随机对照试验。检索时限为建库至2022年1月。采用Stata 15.0软件进行网状Meta分析。结果 纳入34项研究,共2 199例患者。网状Meta分析结果表明,与非运动对照组相比,阻力训练、小组综合训练、八段锦、全身振动训练、家庭综合训练可改善老年肌少症患者的身体功能（P<0.05）;阻力训练和壶铃训练可改善老年肌少症患者的握力（P<0.05）;阻力训练可改善老年肌少症患者的骨骼肌指数（P<0.05）。结论 在改善老年肌少症患者身体功能、肌肉力量和质量方面,阻力训练是目前最优的运动干预措施,其次为小组综合训练和全身振动训练,但仍需更多研究进一步论证。     

椎旁肌肉减少与经皮椎体后凸成形术后邻近节段再骨折的相关性分析

【摘要】 目的：探讨椎旁肌肉减少与经皮椎体后凸成形术（percutaneous kyphoplasty,PKP）治疗骨质疏松压缩性骨折（osteoporotic vertebral compression fracture,OVCF）术后邻近节段椎体压缩性骨折（adjacent vertebral compression fracture,AVCF）之间的相关性。方法：收集2017年1月~2019年12月在我院接受PKP治疗1年内发生AVCF的OVCF患者的272例患者资料,符合纳入和排除标准的42例患者被选为AVCF组,对照组为同一时期在我院接受PKP治疗1年内未发生AVCF的OVCF患者,根据年龄、性别、体质指数（body mass index,BMI）和首次PKP治疗的节段,与AVCF组中的每例患者进行严格的倾向性评分匹配。两组患者术前进行腰椎MRI检查,在MRI上测量L3和L4水平椎旁肌（paravertebral muscle,PVM）[多裂肌 （multifidus,MF）、竖脊肌（erector spinae,ES）、腰大肌（psoas,PS）]总横截面积（cross-sectional area,CSA）和功能横截面积 （functional cross-sectional area,FCSA）,计算CSA椎体指数、FCSA椎体指数。在矢状位重建CT图像上获取L5 CT值为术前椎体的骨密度（bone mineral density,BMD）;在X线片上测量后凸角（kyphotic angle,KA）、椎体前后壁高度（anterior-to-posterior body height,AP）比值,记录有无骨水泥渗漏入椎间盘等。采用t检验、ROC曲线分析、Delong检验和多因素Logistic回归分析,寻找PKP术后AVCF的独立危险因素。结果：在L3和L4水平,AVCF组MF、ES、PVM和PS 的平均CSA、FCSA及FCSA椎体指数均小于对照组,差异有统计学意义（P＜0.05）。Delong检验显示L4水平ES（0.806 vs 0.900）和PVM（0.861 vs 0.941）的FCSA椎体指数对于预测AVCF的AUC大于L3水平,差异有统计学意义（P＜0.05）。ROC曲线分析显示L4水平PVM的FCSA椎体指数,其AUC为0.941（P<0.001）,敏感性和特异性均为 90.5%。单因素分析显示AVCF组中患者BMD低于对照组 （93.55±14.99HU vs 106.31±10.95HU）;术前后凸角大于对照组（16.02°±17.36° vs 12.87°±6.58°）,差异有统计学意义（P＜0.05）。Logistic回归分析显示,L4水平PVM的FCSA椎体指数减少（OR 0.830;95%CI 0.760~0.906）和BMD降低（OR 0.928;95%CI 0.891~0.966）是PKP术后AVCF的独立危险因素。结论：L4椎旁肌肉减少是OVCF患者PKP术后AVCF的独立危险因素。