Home-Based Trimodal Prehabilitation in Patients with Peritoneal Carcinomatosis Undergoing Cytoreductive Surgery: Effect on Functional Walking Capacity and Skeletal Muscle Mass.

BACKGROUND: Patients with peritoneal carcinomatosis often suffer from loss of skeletal muscle mass and require extensive surgery. Multimodal prehabilitation may improve physical status but its benefits for these specific patients remain unknown. This study aimed to evaluate the effect of prehabilitation on functional walking capacity and skeletal muscle mass, as well as its association with postoperative complications. PATIENTS AND METHODS: A prospective study of patients with peritoneal carcinomatosis following a home-based trimodal prehabilitation program was carried out. Functional walking capacity was assessed with the 6-min walk test (T6MWT), and by the appendicular skeletal muscle index (ASMI) estimated by bioelectrical impedance analysis. Data were collected at the first medical appointment and on the day before surgery. A 90-day postoperative morbidity was registered according to the Clavien-Dindo classification. RESULTS: A total of 62 patients were included in the analysis. Women were more prevalent (77.4%) and peritoneal metastasis from ovarian origin accounted for 48.4%. Clavien II-V grades occurred in 30 (57.7%) patients. After prehabilitation, functional walking capacity improved by 42.2 m (39.62-44.72 m) compared with baseline data (p < 0.001), but no improvement was observed in the ASMI (p = 0.301). Patients able to walk at least 360 m after prehabilitation suffered fewer Clavien-Dindo II-V postoperative complications (p = 0.016). A T6MWT of less than 360 m was identified as an independent risk factor in the multivariable analysis (OR 3.99; 1.01-15.79 p = 0.048). CONCLUSIONS: This home-based trimodal prehabilitation program improved functional walking capacity but not ASMI scores in patients with peritoneal metastasis before surgery. A T6MWT of less than 360 m was found to be a risk factor for postoperative complications.

Distribution of daily protein intake and appendicular skeletal muscle mass in healthy free-living Chinese older adults.

AIMS: Evidence regarding impact of protein intake distribution on skeletal muscle mass in older adults is limited and inconsistent. This study aims to investigate the relationship of evenness of dietary protein distribution and number of meals exceeding a threshold with appendicular skeletal muscle mass (ASM) in healthy and free-living Chinese older adults. METHODS: Repeated measured data of 5689 adult participants aged ≥ 60 years from the China Health and Nutrition Survey (CHNS) 2015 and 2018 waves were analyzed. Mixed-effects linear regression model was performed to examine the relationship between coefficient of variance (CV) of protein intake across meals, number of meals ≥ 0.4 g protein/kg BW and ASM, respectively. Analyses were conducted separately for male and female. RESULTS: The average CV of protein intake in each wave was in the range of 0.34-0.35. More than 40% male and female participants in each wave had no meal reaching 0.4 g protein/kg BW. Female participants in the highest quartile of protein intake CV had significantly lower ASM (ß = -0.18, 95%CI = -0.32, -0.04) compared with those in the lowest quartile, after adjustment for multiple confounders. Significant negative trends were observed across dietary protein CV quartiles with ASM both in male (P trend = 0.043) and female (P trend = 0.007). Significant positive association between number of meals exceeding 0.4 g protein /kg BW and relative ASM were observed in females (2 meals vs. 0 meal: ß = 0.003, 95%CI = 0.0007,0.006;≥3 meals vs. 0 meal: ß = 0.008, 95%CI = 0.003,0.013), after adjusting for multiple covariates. CONCLUSIONS: A more even-distributed protein intake pattern and more meals reaching protein intake threshold were respectively associated with higher appendicular skeletal muscle mass in healthy and free-living older Chinese adults. Prospective studies and intervention trials are needed to confirm these cross-sectional findings.

Bioelectrical impedance-derived phase angle (PhA) in people living with obesity: Role in sarcopenia and comorbidities.

BACKGROUND AND AIM: Obesity is characterized by alterations in fat and muscle mass. Phase angle (PhA) is considered an index of muscle mass, and is related to comorbidities in SO. This work aimed to assess the relationship between PhA, muscle mass, inflammation, and comorbidities in obesity. METHODS AND RESULTS: We included 198 outpatients with obesity (BMI≥30) divided into tertiles according to PhA distribution (<5°, 5°-6°, >7°). Body composition was analyzed using bioimpedance (Tanita MC-780P Multi-Frequency Segmental Body Composition Analyzer). Quantitative variables were compared using the Kruskal-Wallis test and qualitative variables using the chi-square test. A correspondence analysis was built to show the influence of qualitative variables on subjects in each tertile. Patients in the lowest tertile had the lowest skeletal muscle mass and appendicular skeletal muscle mass index (ASMI); the highest inflammatory index (albumin and derived neutrophil-to-lymphocyte ratio, Alb-dNLR); and the highest percentage of individuals with a history of type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and heart failure (HF). The correspondence analysis showed an association between the lowest tertile and presence of HF with preserved ejection fraction (HFpEF) and CKD. On the logistic regression model, ASMI (OR 0.9, 95%CI 0.85-0.95, p = 0.0004), Alb-dNLR (OR 1.04, 95%CI 1.04-16.4, p = 0.04) and HFpEF and T2DM were significantly associated with the lowest PhA. CONCLUSIONS: Identifying high-risk individuals living with obesity is a priority. These results show that lower PhA is related to inflammation, poorer skeletal muscle mass and consequently, their impact on obesity-related comorbidities and clinical outcomes.

Association of changes in appendicular skeletal muscle mass with weight loss and visceral fat reduction after laparoscopic sleeve gastrectomy.

PURPOSE: Laparoscopic sleeve gastrectomy (LSG) drastically affects body composition. However, studies focusing on the association between the changes in the pre-and postoperative muscle mass and postoperative results are limited. We evaluated the association between changes in the muscle mass and weight loss and fat reduction. METHODS: This retrospective study included 29 consecutive patients who underwent both LSG and a bioelectrical impedance analysis (BIA) consecutively. We investigated changes in the body composition on the BIA and visceral fat area (VFA) on computed tomography and correlational changes in muscle mass with weight loss and fat reduction. RESULTS: The total weight loss (%TWL) 12 months after surgery was 30.9%. The VFAs pre- and postoperatively were 224 and 71.0 cm2, respectively. The fat mass (FM), percentage of FM, appendicular skeletal muscle mass (ASM), and skeletal muscle mass index (SMI) decreased from pre- to postoperatively (54.8 vs. 32.2 kg; 49.0 vs. 41.2%, 26.7 vs. 23.9 kg, 9.24 vs. 8.27, respectively), whereas the percentage of ASM (%ASM) increased (22.1 vs. 28.0%). The rate of change in %ASM positively correlated with weight loss and fat reduction (%TWL, rs = 0.65; %VFA loss, rs = 0.62). CONCLUSION: The rate of change in %ASM was positively correlated with weight loss and fat reduction.

Dual-Frequency Bioelectrical Impedance Analysis is Accurate and Reliable to Determine Lean Muscle Mass in The Elderly.

BACKGROUND: Dual-frequency bioelectrical impedance analysis (DF-BIA) devices are more accessible and affordable than dual-energy X-ray absorptiometry (DXA); however, no studies have reported the accuracy of DF-BIA in body composition measurement, especially in the Thai elderly. The aims of this study were to (1) compare the accuracies of lean muscle masses measured by DF-BIA devices and DXA and (2) assess the reliability of the DF-BIA device. METHODS: This cross-sectional study was conducted on participants older than 60 years who visited the Orthopedic Clinic of Siriraj Hospital. Whole-body and appendicular skeletal muscle masses (ASMs) were measured using DF-BIA (Tanita RD-545), with DXA (GE Lunar iDXA) as the standard reference. The test-retest reliability of the DF-BIA and the agreement between the devices were assessed using the intraclass correlation coefficient (ICC) and Bland-Altman plots. Regression analysis was used to develop an equation to estimate ASM values from BIA close to those from DXA. RESULTS: The mean age of 88 participants was 73.8 (SD 8.0) years, with women predominating (84.1%). The agreement of BIA and DXA was very high for whole-body lean mass (ICC = 0.954) and ASM (ICC = 0.954), but the mean difference in muscle mass from DF-BIA was overestimated. The ICCs of test-retest reliability for whole-body muscle mass and ASM were 0.987 and 0.988, respectively. The equation for corrected ASM was formulated from a linear equation (R2 = 0.93). CONCLUSIONS: Although lean muscle mass from DF-BIA was minimally overestimated relative to DXA, this device had high accuracy and reliability for lean muscle mass evaluation in the elderly. DXA and DF-BIA are interchangeable for the assessment of muscle mass.

Shear Wave Elastography for Detecting Calf Muscle Stiffness: An Effective Tool for Assessing Sarcopenia.

OBJECTIVES: To explore the feasibility of shear wave elastography for evaluating sarcopenia. METHODS: The shear wave velocities (SWV) of the tibialis anterior, medial gastrocnemius, and soleus were measured in 130 subjects in the Second Affiliated Hospital of Fujian Medical University from January 2021 to June 2022. Consistency was evaluated in 20 cases using the intraclass correlation coefficient. According to the 2019 Asian Working Group for Sarcopenia（AWGS） diagnostic criteria, the patients were divided into a healthy and a sarcopenia group. The differences in SWV between the two groups were compared, and their correlation between calf muscles and muscle mass, grip strength, and pace were analyzed. The diagnostic cutoff value of calf muscle SWV for sarcopenia was obtained using receiver operating characteristic (ROC) curves, and the diagnostic efficacy of different ROC curves was compared. RESULTS: The SWV inter-group and intra-group correlation coefficients of the three lower limbs muscles were all greater than 0.85. Moreover, the corresponding SWV in the sarcopenia group were significantly smaller than those in the healthy control group (P < .05). Further, SWV were positively correlated with the appendicular skeletal muscle mass index (ASMI), grip strength, and gait speed. Finally, the SWV of the anterior tibialis and medial gastrocnemius muscles were 3.02 and 2.26 m/s, respectively, and their diagnostic efficacy for sarcopenia did not differ significantly (Z = 0.190, P = .8497). CONCLUSION: SWE can be used to detect the hardness of the anterior tibialis and medial gastrocnemius, calculate their muscle mass as an effective tool to evaluate sarcopenia.

Characteristics of Age Classification into Five-Year Intervals to Explain Sarcopenia and Immune Cells in Older Adults.

Background and Objectives: This study focused on investigating sarcopenic factors and immune cells in older adulthood. To achieve this, the variables related to sarcopenia and immune cells in people living in the same community were analyzed. Materials and Methods: A total of 433 elderly individuals aged 61 to 85 years were randomly categorized as follows in 5-year intervals: 68 in the youngest-old group (aged 61-65), 168 in the young-old group (aged 66-70), 127 in the middle-old group (aged 71-75), 46 in the old-old group (aged 76-80), and 19 in the oldest-old group (aged 81-85). Results: With the progression of age, calf circumference (-8.4 to -11.05%; p = 0.001) and grip strength (-9.32 to -21.01%; p = 0.001) exhibited a noticeable reduction with each successive 5-year age bracket. Conversely, the capability to complete the five-time chair stand demonstrated a clear incline (32.49 to 56.81%; p = 0.001), starting from the middle-aged group. As for appendicular skeletal muscle mass, there was an evident tendency for it to decrease (-7.08 to -26.62%; p = 0.001) with increasing age. A gradual decline in natural killer cells became apparent within the old-old and oldest-old groups (-9.28 to -26.27%; p = 0.001). The results of the post hoc test revealed that CD3 T cells showcased their peak levels in both the youngest-old and young-old groups. This was followed by the middle-old and old-old groups, with slightly lower levels. This pattern was similarly observed in CD4 T cells, CD8 T cells, and CD19 B cells. Conclusions: This study reaffirmed that sarcopenia and immune cell function decline with each successive 5-year increase in age. Considering these findings, the importance of implementing programs aimed at ensuring a high-quality extension of life for the elderly is strongly underscored.

Sex influences the association between appendicular skeletal muscle mass to visceral fat area ratio and non-alcoholic steatohepatitis in patients with biopsy-proven non-alcoholic fatty liver disease.

Sarcopenic obesity is regarded as a risk factor for the progression and development of non-alcoholic fatty liver disease (NAFLD). Since male sex is a risk factor for NAFLD and skeletal muscle mass markedly varies between the sexes, we examined whether sex influences the association between appendicular skeletal muscle mass to visceral fat area ratio (SVR), that is, an index of skeletal muscle mass combined with abdominal obesity, and the histological severity of NAFLD. The SVR was measured by bioelectrical impedance in a cohort of 613 (M/F = 443/170) Chinese middle-aged individuals with biopsy-proven NAFLD. Multivariable logistic regression and subgroup analyses were used to test the association between SVR and the severity of NAFLD (i.e. non-alcoholic steatohepatitis (NASH) or NASH with the presence of any stage of liver fibrosis). NASH was identified by a NAFLD activity score ≥5, with a minimum score of 1 for each of its categories. The presence of fibrosis was classified as having a histological stage ≥1. The SVR was inversely associated with NASH in men (adjusted OR 0·62; 95 % CI 0·42, 0·92, P = 0·017 for NASH, adjusted OR 0·65; 95 % CI 0·43, 0·99, P = 0·043 for NASH with the presence of fibrosis), but not in women (1·47 (95 % CI 0·76, 2·83), P = 0·25 for NASH, and 1·45 (95 % CI 0·74, 2·83), P = 0·28 for NASH with the presence of fibrosis). There was a significant interaction for sex and SVR (Pinteraction = 0·017 for NASH and Pinteraction = 0·033 for NASH with the presence of fibrosis). Our findings show that lower skeletal muscle mass combined with abdominal obesity is strongly associated with the presence of NASH only in men.

Low serum creatinine to cystatin C ratio is independently associated with sarcopenia and high carotid plaque score in patients with type 2 diabetes.

BACKGROUND AND AIMS: Low serum creatinine (Cr) to cystatin C (cysC) ratio has been suggested to be associated with low muscle mass and strength and poor prognosis in various chronic disease. We investigated the associations of CCR with sarcopenia and carotid plaque score (PS) in patients with type 2 diabetes mellitus. METHODS AND RESULTS: A total of 1577 patients with type 2 diabetes were enrolled. High PS was defined as PS ≥ 3. Sarcopenia was assessed by the measurement of appendicular skeletal muscle mass (ASM) and grip strength (GS). Compared to the highest CCR group, the lowest tertile group was older; had higher C-reactive protein levels, CIMT, and PS, but lower cysC-based estimated glomerular filtration rate (cysC-eGFR), ASM/BMI, and GS. Positive correlations between CCR and ASM/BMI (r = 0.239 in men and 0.303 in women, p < 0.001) and GS (r = 0.282 in men and 0.270 in women, p < 0.001) were observed in both genders. Odds ratios and 95% confidence intervals for high PS after adjusting for age and sex were 1.22 (0.92-1.61, p = 0.18) in the middle and 1.74 (1.31-2.30, p < 0.001) in the lowest tertiles, respectively, with those of the lowest tertile remaining significant after further adjusting for multiple confounders. CONCLUSIONS: Low CCR was independently associated with sarcopenia and high PS in patients with type 2 diabetes mellitus, especially after adjusting for ASM/BMI and GS.

Association of Appendicular Skeletal Muscle to Trunk Fat Ratio with Type 2 Diabetes Mellitus in Older Adults.

INTRODUCTION: Mounting evidence has demonstrated that skeletal muscle and visceral adiposity play crucial roles in glucose metabolism. The purpose of this study was to investigate whether the appendicular skeletal muscle mass index (ASMI) to trunk fat mass (TFM) ratio (ASMI/TFM) is a more specific and identifiable factor for type 2 diabetes mellitus (T2DM) in older adults than conventional anthropometric measures. METHODS: This cross-sectional study included 1,370 older adults from the Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) cohort. ASMI and TFM were measured by using a bioelectrical impedance analyzer, and T2DM was defined with the criteria of the American Diabetes Association. Odds ratios (ORs) were evaluated using multivariable logistic analysis. RESULTS: The prevalence of T2DM is 20.0% in this study. The multivariable-adjusted ORs (95% confidence interval) of T2DM for increasing categories of ASMI/TFM, BMI, and waist circumference (WC) were 1.00 (reference), 0.70 (0.49, 1.02), 0.61 (0.42, 0.89), and 0.45 (0.30, 0.67; p for trend <0.0001); 1.00 (reference), 1.15 (0.83, 1.60), and 1.37 (0.94, 2.01; p for trend = 0.10); and 1.00 (reference) and 1.78 (1.19, 2.74; p < 0.01), respectively. CONCLUSIONS: Higher ASMI/TFM was associated with a lower prevalence of T2DM in this study of older adults. The T2DM predictive value of ASMI/TFM may be stronger than BMI and WC in this population.

Two-megahertz impedance index prediction equation for appendicular lean mass in Korean older people.

BACKGROUND: Whole-body bioelectrical impedance analysis (BIA) has been accepted as an indirect method to estimate appendicular lean mass (ALM) comparable to dual-energy X-ray absorptiometry (DXA). However, single or limited frequencies currently used for these estimates may over or under-estimate ALM. Accordingly, there is a need to measure the impedance parameter with appendicular lean-specific across multiple frequencies to more accurately estimate ALM. We aimed to validate muscle-specific frequency BIA equation for ALM using multifrequency BIA (MF-BIA) with DXA as the reference. METHODS: 195 community-dwelling Korean older people (94 men and 101 women) aged 70 ~ 92y participated in this study. ALM was measured by DXA and bioimpedance measures at frequencies of 5 kHz ~ 3 MHz were assessed for independent predictive variables. Regression analyses were used to find limb-specific frequencies of bioimpedance, to develop the ALM equations and to conduct the internal cross-validation. The six published equations and the final equation of MF-BIA were externally cross-validated. RESULTS: 195 participants completed the measurements of MF-BIA and DXA. Using bivariate regression analysis, the 2 MHz impedance index explained R2 = 91.5% of variability (P < 0.001) in ALM and predictive accuracy of standard error of estimate (SEE) was 1.0822 kg ALM (P < 0.001). Multiple stepwise regression analysis obtained in the development group had an adjusted R2 of 9.28% (P < 0.001) and a SEE of 0.97 kg ALM. The cross-validation group had no significant difference between the measured ALM and the predicted ALM (17.8 ± 3.9 kg vs. 17.7 ± 3.8 kg, P = .486) with 93.1% of R2 (P < 0.001) and 1.00 kg ALM of total error. The final regression equation was as follows: ALM = 0.247ZI@2 MHz + 1.254SEXM1F0 + 0.067Xc@5 kHz + 1.739 with 93% of R2 (P < 0.001), 0.97 kg ALM of SEE (Subjective Rating as "excellent" for men and "very good" for women). In the analysis of the diagnostic level for sarcopenia of the final regression, the overall agreement was 94.9% (k = 0.779, P < 0.001) with 71.4% of sensitivity, 98.8% of specificity, 91.3 of positive prediction value and 95.3% of negative prediction value. CONCLUSION: The newly developed appendicular lean-specific high-frequency BIA prediction equation has a high predictive accuracy, sensitivity, specificity, and agreement for both individual and group measurements. Thus, the high-frequency BIA prediction equation is suitable not only for epidemiological studies, but also for the diagnosis of sarcopenia in clinical settings.

Correlation between parameters related to sarcopenia and gray matter volume in patients with mild to moderate Alzheimer's disease.

BACKGROUND: Alzheimer's disease (AD) is a neurodegenerative disease characterized by brain atrophy and closely correlated with sarcopenia. Mounting studies indicate that parameters related to sarcopenia are associated with AD, but some results show inconsistent. Furthermore, the association between the parameters related to sarcopenia and gray matter volume (GMV) has rarely been explored. AIM: To investigate the correlation between parameters related to sarcopenia and cerebral GMV in AD. METHODS: Demographics, neuropsychological tests, parameters related to sarcopenia, and magnetic resonance imaging (MRI) scans were collected from 42 patients with AD and 40 normal controls (NC). Parameters related to sarcopenia include appendicular skeletal muscle mass index (ASMI), grip strength, 5-times sit-to-stand (5-STS) time and 6-m gait speed. The GMV of each cerebral region of interest (ROI) and the intracranial volume were calculated by computing the numbers of the voxels in the specific region based on MRI data. Partial correlation and multivariate stepwise linear regression analysis explored the correlation between different inter-group GMV ratios in ROIs and parameters related to sarcopenia, adjusting for covariates. RESULTS: The 82 participants included 40 NC aged 70.13 ± 5.94 years, 24 mild AD patients aged 73.54 ± 8.27 years and 18 moderate AD patients aged 71.67 ± 9.39 years. Multivariate stepwise linear regression showed that 5-STS time and gait speed were correlated with bilateral hippocampus volume ratios in total AD. Grip strength was associated with the GMV ratio of the left middle frontal gyrus in mild AD and the GMV ratios of the right superior temporal gyrus and right hippocampus in moderate AD. However, ASMI did not have a relationship to any cerebral GMV ratio. CONCLUSIONS: Among parameters related to sarcopenia, 5-STS time and gait speed were associated with bilateral hippocampus volume ratios at different clinical stages of patients with AD. Five-STS time provide an objective basis for early screening and can help diagnose patients with AD.

Prevalence of sarcopenia in community dwelling outpatient postmenopausal Hungarian women.

BACKGROUND: Ageing is an inherent feature of life and as per the United Nations, in the year 2020, 985 million women were ≥ 50 years of age worldwide, and the figure is expected to rise to 1.65 billion by 2050. Preservation of health and well-being in the elderly are challenging, and on the same note generalized changes in the musculoskeletal system contribute to this scenario. Musculoskeletal changes with ageing are referred to as sarcopenia. Reduced muscle mass and physical performance are hallmarks of sarcopenia, exclaimed with difficulty in independent activity and poor quality of life. Knowing that there is a hiatus in our knowledge as regards to the prevalence of sarcopenia in Hungary, the aim of this study was to determine the prevalence of sarcopenia in a community dwelling outpatient postmenopausal Hungarian cohort using the EWGSOP2 consensus recommendation. METHODS: In this cross-sectional study, women arriving for routine bone densitometry examination at the Regional Osteoporosis Center, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen were invited to participate in the study. A total of a 100 community-dwelling women were recruited who confirmed to the inclusion criteria of self-reported postmenopausal status, ≥ 50 years of age and gave written informed consent. The study procedures included the self-administered SARC-F questionnaire, followed by assessment of muscle strength, muscle quantity and physical preformance. Muscle strength was determined with the hand grip strength (HGS), appendicular skeletal muscle mass was assessed using dual energy X-ray absorptiometry and physical performance was determined by the gait speed (GS) test. RESULTS: As per the EWGSOP2 definition, the percentage of study participants with probable sarcopenia (low muscle strength), sarcopenia (low muscle strength and low muscle quantity) and severe sarcopenia (low muscle strength, muscle quantity and low physical performance) was 36, 31 and 8%, respectively. Multiple linear regression analysis revealed that height, weight, HGS and GS were all independent predictors of appendicular skeletal muscle mass. CONCLUSION: The 31% prevalence of sarcopenia in the studied post-menopausal women highlights the need for adequate assessment of the condition in the elderly. Our findings most probably bear public health implications and may accelerate formulation of policies promoting healthy ageing.

Muscle mass and grip strength in relation to carotid intima-media thickness and plaque score in patients with type 2 diabetes.

BACKGROUND AND AIMS: In this study, we examined the relationships of appendicular skeletal muscle mass (ASM) and grip strength (GS) with carotid intima-media thickness (CIMT) and plaque score (PS) in patients with type 2 diabetes. METHODS AND RESULTS: A total of 1185 patients were recruited. High CIMT and high PS were defined as ≥ 75 percentile of maximal CIMT of each sex and PS ≥ 3. Patients in the lowest ASM/body mass index (BMI) or GS/BMI tertile were older and had lower HDL cholesterol, and eGFR, but higher BMI, waist circumference (WC), HOMA-IR, and C-reactive protein than those in the highest tertile. Meanwhile, individuals in the lowest ASM or GS tertile group had lower BMI and WC than those in the highest one. CIMT and PS and the prevalence of high CIMT, carotid plaques, and high PS gradually increased with decreasing tertiles of ASM, ASM/BMI, GS, and GS/BMI (p < 0.001). After adjusting for age and sex, odds ratios (ORs) and 95% confidence intervals (CIs) for high CIMT and high PS were 0.98 (0.68-1.42), 1.64 (1.14-2.36), 2.000 (1.33-3.01), and 1.77 (1.22-2.58) and 1.63 (1.16-2.30), 1.78 (1.28-2.54), 1.91 (1.33-2.75), and 1.61 (1.13-2.28) in the lowest tertile of ASM, ASM/BMI, GS, and GS/BMI, respectively. After further adjusting for potential confounders, ORs and 95% CI for high CIMT and high PS remained significant in the lowest tertile group. CONCLUSIONS: Low ASM and low GS may be independent risk factors for high CIMT and high PS in patients with type 2 diabetes.

Validation of skeletal muscle mass estimation equations in active young adults: A preliminary study.

We analyzed the validity of the estimation equations for skeletal muscle mass (SMM) using mass of appendicular lean soft tissue (ALST), evaluated by dual-energy X-ray absorptiometry (DXA), in healthy young males undergoing training, and compared it with the results obtained using whole-body magnetic resonance imaging (MRI). We hypothesized that a novel variable, that is, trunk and trunk-to-appendicular ratio of lean soft tissues (trunk/ALST), would be useful in reducing estimation errors in athletes or physically active participants. We analyzed the data of 30 participants (mean age 19.9 ± 1.8 years). SMM was measured using whole-body MRI, while mass of trunk and ALST was assessed using DXA. Three previously utilized estimation equations were retrieved from the literature and used for comparison. The estimated SMM values using previous equations highly correlated with measured SMM, which was determined by MRI, but the mean estimated SMM values were significantly lower than the measured-SMM values. Stepwise regression analysis revealed that mass of ALST, trunk/ALST ratio, and percent body fat were significant predictors of SMM and were incorporated as the new suggested variables. This equation accounted for 90.3% of the variance in SMM. While the previous equations' estimated SMM correlated with measured-SMM in participants with trunk/ALST ratios ≤1.05, they underestimated SMMs in those with trunk/ALST ratios >1.05. The present study confirms that the previously used equations underestimate the actual SMM, particularly in participants with high trunk/ALST ratios (>1.05). The current equation may be used in healthy and active young males, including athletes, as a preliminary tool.

Using Virtual Reality-Based Rehabilitation in Sarcopenic Older Adults in Rural Health Care Facilities-A Quasi-Experimental Study.

Because of a shortage of health care providers, providing rehabilitation in health care facilities is difficult. Virtual reality-based rehabilitation is effective in older populations. There are only a few studies among patients with sarcopenia. This is a quasi-experimental, single-group, pretest-posttest design evaluating the clinical effectiveness of virtual reality-based progressive resistance training among residents aged over 60 years with sarcopenia in rural care facilities. The authors used Oculus Rift with headsets to provide the virtual reality-based progressive resistance training. The authors administered the program twice per week, 30 min per session, for 12 weeks. The primary outcomes were dominant handgrip strength, walking speed, and appendicular skeletal muscle mass index. Data from 30 participants were analyzed. Significant improvements in handgrip strength and walking speed were observed. Although an increasing trend in appendicular skeletal muscle mass index was observed, it did not reach statistical significance. The authors concluded that the virtual reality-based progressive resistance training is partially effective in older sarcopenic adults in health care facilities.

The Association between Serum Uric Acid and Appendicular Skeletal Muscle Mass and the Effect of Their Interaction on Mortality in Patients on Peritoneal Dialysis.

BACKGROUND: Serum uric acid (SUA) has been revealed to be positively associated with the body composition parameters in hemodialysis patients, but few studies have investigated that in patients on peritoneal dialysis (PD). The aim of this study was to identify the relationship between SUA and appendicular skeletal muscle mass (ASM) and the effect of their interaction on mortality in PD patients. METHODS: This was a single-center retrospective cohort study. Patients who underwent multifrequency bioelectrical impedance analysis between January 1, 2013, and December 31, 2016, and had data on SUA values were enrolled. All patients were followed up until December 31, 2019. RESULTS: In total, 802 prevalent PD patients (57.9% male), with mean age of 46.2 ± 14.2 years were enrolled. The average SUA and ASM were 6.8 ± 1.3 mg/dL and 21.2 ± 4.9 kg. According to multiple linear regression models, SUA was positively associated with relative ASM in middle-aged and older PD patients (standardized coefficients [ß] 0.117; 95% confidence interval [CI] 0.027, 0.200; p = 0.010). Further sex-stratified analysis showed that the association existed only in males (ß 0.161; 95% CI 0.017, 0.227; p = 0.023). Moreover, the presence of hyperuricemia was found to predict lower risk of all-cause mortality (hazard ratio [HR] 0.514, 95% CI 0.272, 0.970; p = 0.040) only in patients with lower relative ASM. And, the adjusted HR of every 1 mg/dL elevated SUA level was 0.770 (95% CI 0.609, 0.972; p = 0.028) for all-cause mortality in the lower relative ASM subgroup. CONCLUSIONS: There exists a positive association between the SUA and ASM, and the ASM significantly affected the association between SUA and all-cause PD mortality.

Nutrient and food group intakes and skeletal muscle index in the Japanese elderly: a cross-sectional analysis of the NHNS 2017.

OBJECTIVE: To examine nutrient and food intakes according to the levels of skeletal muscle mass index (SMI) in the elderly. DESIGN: Cross-sectional study. SETTING: Data were derived from the 2017 National Health and Nutrition Survey in Japan. SMI was calculated by dividing appendicular skeletal muscle (or lean) mass (kg) by height squared (m2). We calculated the multivariable-adjusted means of individuals' dietary intake. Dietary intake of energy, nutrients and food categories was assessed by examining dietary records using a semi-weighed method and compared according to the sex-specific quartiles of SMI. PARTICIPANTS: Men and women aged ≥60 years. RESULTS: Among 797 men and 969 women, individuals with a higher SMI consumed more energy and more nutrients than did those with a lower SMI after adjusting for age, lifestyle and physical activity factors. After further adjusting for energy intake, total dietary fibre, vitamin A, vitamin B6, K, Fe and Cu were positively associated with higher SMI in men (Pfor trend < 0·05). For food categories, men with a higher SMI consumed more vegetables and meats, but the associations were attenuated after adjustment for energy and remained significant for vegetable only (Pfor trend = 0·018). CONCLUSIONS: Japanese elderly people with a higher SMI consumed more energy and nutrients and more vegetables than did those with a lower SMI. This finding shows that diet is important in preventing muscle loss among the elderly in an ageing society.

Value of appendicular skeletal muscle mass to total body fat ratio in predicting obesity in elderly people: a 2.2-year longitudinal study.

BACKGROUND: Obesity is a disease characterized by much fat accumulation and abnormal distribution, which was related to cardiovascular diseases, diabetes mellitus (DM) and muscular skeletal diseases. The aim of this study was to evaluate the usefulness of appendicular skeletal muscle mass to total body fat ratio (ASM/TBF) in screening for the risk of obesity in elderly people. METHODS: A prospective study was carried out with 446 participants (non-obese elderly people with body mass index (BMI) < 28 kg/m2) who underwent baseline and an average around 2.2-year follow-up health check-up examinations. RESULTS: The mean age at baseline was 63.6 years. The incidence of new obesity was 5.4% during follow-up. Linear regression demonstrated that baseline ASM/TBFs were negatively correlated with follow-up BMIs in both men and women (ß = - 1.147 (- 1.463--0.831) for men and - 4.727 (- 5.761--3.692) for women). The cut-off points of baseline ASM/TBF in elderly people for obesity were 1.24 in men and 0.90 in women which were identified by Classification and Regression Tree (CART). Logistic regression showed that both men and women with decreased ASM/TBF had higher risks of obesity over the follow-up period (Relative Risk (RRs) = 5.664 (1.879-17.074) for men and 34.856 (3.930-309.153) for women). CONCLUSIONS: Elderly people with a low ASM/TBF had a higher risk of new obesity, which suggested that ASM/TBF should be considered in obesity management in the elderly.

Changes in the bioelectrical impedance parameters estimating appendicular skeletal muscle mass in healthy older persons.

BACKGROUND AND AIMS: As population ageing, it is necessary to use inexpensive and widely available methods of monitoring healthy ageing to earlier detect the risk of potential ageing-related diseases. As an alternative to the reference methods, bioelectrical impedance analysis (BIA) enables one to quickly and easily estimate appendicular skeletal muscle mass, which in the case of older persons is an indicator of their physical fitness. The aim of this study was to evaluate the actual bio-impedance parameters used to estimate body composition, as possible markers of changes in the mass of the appendicular skeletal muscles in the course of ageing. METHODS: Four hundred and thirty-five persons (including 107 men and 328 women) aged 50-87 years (65.6 ± 6.4 years) participated in the study. Anthropometric measurements and measurements of the bioelectrical impedance components (resistance, reactance, and phase angle) were carried out. Using the prediction equations, appendicular muscle mass and appendicular skeletal muscle mass were estimated. RESULTS: Differences in the bio-impedance parameters between older persons aged 65 + and persons on average 10 years younger have been demonstrated and the impedance components have been shown to be correlated with age, the correlations being stronger in the persons after the 65th year of life. CONCLUSIONS: The actual bioelectrical impedance parameters measured directly using the BIA method of estimating body composition are good identifiers of the changes in the mass of the appendicular skeletal muscles in older persons in the course of ageing.