Pathophysiological interactions between sarcopenia and type 2 diabetes: A two-way street influencing diagnosis and therapeutic options.

This review will try to elucidate the interconnected pathophysiology of sarcopenia and type 2 diabetes (T2D) and will try to identify a common pathway to explain their development. To this end, the PubMed and Scopus databases were searched for articles published about the underlying pathophysiology, diagnosis and treatment of both sarcopenia and T2D. The medical subject heading (MeSH) terms 'sarcopenia' AND 'diabetes mellitus' AND ('physiopathology' OR 'diagnosis' OR 'therapeutics' OR 'aetiology' OR 'causality') were used. After screening, 32 papers were included. It was evident that sarcopenia and T2D share multiple pathophysiological mechanisms. Common changes in muscle architecture consist of a shift in myocyte composition, increased myosteatosis and a decreased capacity for muscle regeneration. Further, both diseases are linked to an imbalance in myokine and sex hormone production. Chronic low-grade inflammation and increased levels of oxidative stress are also known pathophysiological contributors. In the future, research efforts should be directed towards discovering common checkpoints in the development of T2D and sarcopenia as possible shared therapeutic targets for both diseases. Current treatment for T2D with biguanides, incretins and insulin may already convey a protective effect on the development of sarcopenia. Furthermore, attention should be given to early diagnosis of sarcopenia within the population of people with T2D, given the sizeable physical and medical burden it encompasses. A combination of simple diagnostic techniques could be used at regular diabetes check-ups to identify sarcopenia at an early stage and start lifestyle modifications and treatment as soon as possible.

Clinical approach to the older person with anorexia.

OBJECTIVE: Anorexia is a challenging problem among older people. Apart from being the consequence of normal ageing, it can also be a symptom of underlying disease. Despite the high prevalence of anorexia, only few recommendations exist on the evaluation in older people. The objective of this study is to summarize evidence and provide guidance through creating a flowchart. METHODS: A systematic literature search was performed through combining following keywords: older people (aged, geriatrics, older adult), anorexia (also loss of appetite, unintentional weight loss) and diagnosis. After removal of duplicates and case-reports, articles were selected based on title and abstract by two reviewers. Guidelines, reviews, studies and relevant publications discussing anorexia or unintentional weight loss were included. Relevant data were extracted and processed into a flowchart. RESULTS: Out of 619 hits, 25 articles were included discussing either the evaluation of anorexia or unintentional weight loss. Consensus in the work-up of unintentional weight loss is to start with a detailed history and physical examination followed by full bloodwork, urinalysis, chest x-ray and a faecal occult blood test. In certain cases, ultrasound and upper endoscopy are further recommended. In the work-up of anorexia, medication, social, psychological, logopaedic and neurocognitive aspects need to be taken into consideration. CONCLUSIONS: One of the main challenges of the evaluation of anorexia in older people is the lack of guidance in existing literature. Therefore, we investigated what is currently known about the management of anorexia and unintentional weight loss as well and combined best practices to form a flowchart.

The association between muscle mass and the degree of myosteatosis of the psoas muscle and mortality in older patients with cancer.

OBJECTIVE: Comprehensive geriatric assessment (CGA) is used for oncological management in older patients. The evaluation of muscle characteristics is currently not included in the CGA. This study investigates whether muscle mass and the degree of myosteatosis is associated with mortality in older patients with cancer. METHODS: CGA was performed in a cohort of older patients with cancer. Cross sectional area (CSA) and mean pixel density (Hounsfield units, HU), as measure for respectively muscle mass and myosteatosis, were obtained from CT images of the psoas muscle at the level of mid L3. Mortality was recorded. Correlation was determined between CSA and HU. Paired sample t-test was used to follow changes in muscle mass and density. Logistic regression was performed to define relevant prognostic factors for mortality. RESULTS: In total, 183 patients were included (86 male and 97 female), 120 patients (66%) died. Mean age was 80 years (range 70-94 years). Mean days of survival was 606 (range 1-2023). There was a significant correlation between CSA and HU (PCC = 0.196) at time of diagnosis and at follow-up (PCC = 0.257). There was a significant decrease in CSA (p = .008) and HU (p = .004) in men at follow-up. No significant changes were observed in women. In multivariate analysis, a higher gender-corrected CSA was linked to a lower mortality rate with an odds ratio of 0.657 (CI = 0.457-0.944, p = .023). No association was found between HU and mortality. CONCLUSIONS: Muscle mass correlated with the degree of myosteatosis. CSA and HU tended to decrease during follow-up. Having a greater CSA was prognostic for a lower mortality rate.

Treatment of Aggressive Pelvic Fibromatosis With Interferon.

BACKGROUND: Fibromatosis is a rare, noninvasive but aggressive tumor. The tumor displaces tissue by "pushing" the normal structures aside. Optimal treatment should be individualized. CASE: A 35-year-old woman presented with a recurrent fibromatosis, which filled the vagina and extended into the pelvis. The classical surgical removal would have had a high morbidity. Therefore, it was decided, after shared decision-making, to opt for treatment with interferon. The side effects of the therapy were tolerable, and a complete regression of the fibromatosis was achieved. At present, 13 years after the diagnosis and 7 years after discontinuation of the therapy, the patient is well with no signs of disease. CONCLUSION: Interferon may be considered as primary treatment for extensive pelvic fibromatosis.