Association between Physical Activity in Rural Life and Sarcopenia in Community-Dwelling Middle-Aged and Older Japanese Adults: A Cross-Sectional Study.

Physical activity is crucial to prevent sarcopenia, but there is scant data on the link between sarcopenia and physical activity in rural communities. Therefore, this study investigated associations of farming activity and snow removal with sarcopenia in a middle-aged and older population in rural Japan. This cross-sectional study enrolled 3,056 residents aged ≥ 40 years (49.2% men; mean age, 64.2 years) in Yuzawa, Japan. Information on farming activity and snow removal were collected via questionnaire from May through November and from December through April, respectively. Sarcopenia was assessed by the SARC-F (strength, ambulation, rising from a chair, stair climbing, and history of falling) score. Associations of farming activity and snow removal with sarcopenia were assessed using multivariable logistic regression analysis with adjustment for potential confounders. Participants who engaged in farming activity, snow removal, and both accounted for 3.8%, 40.5%, and 29.4% of the total, respectively. In the multivariable logistic regression analysis, adjusted odds ratios [95% confidence intervals (CI)] of sarcopenia for farming activity and snow removal were 0.80 (0.63-1.03) and 0.68 (0.53-0.87), respectively. Compared with participants who did not engage in farming activity or snow removal, participants who engaged in both had a significantly lower adjusted odds ratio of sarcopenia [0.63 (95% CI 0.47-0.86)]. Participants who engaged in snow removal and those who engaged in both farming activity and snow removal showed inverse associations with sarcopenia. Our findings further support the importance of physical activity in preventing or mitigating sarcopenia in rural communities.

Phase Angle as an Indicator of Baseline Nutritional Status and Sarcopenia in Acute Stroke.

OBJECTIVES: This study aimed to investigate whether phase angle is an indicator of malnutrition and sarcopenia in acute-phase stroke patients. MATERIALS AND METHODS: We conducted a retrospective observational study of stroke patients in a single acute-care hospital. The phase angle was measured within 5 days after admission, and the correlation between nutritional status and sarcopenia index was investigated. The cut-off point that distinguishes malnutrition and sarcopenia was evaluated using the receiver operating characteristic curve. The effects of the geriatric nutritional risk index (GNRI) and sarcopenia on the phase angle were examined using multivariate linear regression analysis. RESULTS: A total of 211 stroke patients (140 men) with a median age of 74 (65-83) were included in the analysis. Malnutrition was present in 38 (18.0%) patients, and 65 (30.8%) had sarcopenia. The phase angle significantly correlated with GNRI, grip strength, skeletal muscle musss index, and calf circumference in both men and women. The cut-off points for discriminating malnutrition were 5.05 for men and 3.96 for women, while the cut-off points for discriminating sarcopenia were 5.28 for men and 4.62 for women. Multivariate linear regression analysis showed that the GNRI and sarcopenia were independently related to the phase angle. CONCLUSIONS: Phase angle is a useful indicator for distinguishing malnutrition and sarcopenia in patients with acute stroke.

Impact of trunk and appendicular skeletal muscle mass on improving swallowing function in acute stroke patients.

OBJECTIVES: To investigate the effect of trunk and appendicular skeletal muscle mass on the swallowing function at discharge in acute stroke patients. MATERIALS AND METHODS: This retrospective cohort study included patients hospitalized after acute strokes. Skeletal muscle mass was measured by bioelectrical impedance analysis within 5 days of admission. The primary outcome was swallowing function at acute hospital discharge, assessed using the Functional Oral Intake Scale (FOIS). Secondary outcomes were Functional Independence Measure-eating (FIM-eating) scores and length of hospital stay. RESULTS: Data from 231 patients (age 72.2 years; 151 men) were included in the analysis. The median trunk muscle mass index (TMI) was 8.2 and 6.8 kg/m2 in men and women, respectively. The median appendicular skeletal muscle mass index (ASMI) was 7.7 and 5.7 kg/m2 in men and women, respectively. The high TMI group had higher FIM-eating scores at discharge in each sex (p < 0.001). The high ASMI group had higher FOIS (p = 0.039 and 0.048) and FIM-eating scores at discharge (p = 0.046 and 0.047) in men and women, respectively. On multivariate analysis, TMI was independently associated with FIM-eating scores (ß = 0.330, p < 0.001); ASMI was independently associated with FOIS (ß = 0.229, p = 0.039) and FIM-eating scores (ß = 0.111, p = 0.032). CONCLUSIONS: Skeletal muscle mass had site-specific impacts on swallowing function and eating activities. This finding may contribute to the design of more individualized rehabilitation programs.

Metformin slows liver cyst formation and fibrosis in experimental model of polycystic liver disease.

Polycystic liver disease (PLD) is a hereditary liver disease in which the number of cysts increases over time, causing various abdominal symptoms and poor quality of life. Although effective treatment for PLD has not been established, we recently reported that long-term exercise ameliorated liver cyst formation and fibrosis with the activation of AMP-activated protein kinase (AMPK) in polycystic kidney (PCK) rats, a PLD model. Therefore, the aim of this study was to investigate whether metformin, an indirect AMPK activator, was effective in PCK rats. PCK rats were randomly divided into a control (Con) group and a metformin-treated (Met) group. The Met group was treated orally with metformin in drinking water. After 12 wk, liver function, histology, and signaling cascades of PLD were examined in the groups. Metformin did not affect the body weight or liver weight, but it reduced liver cyst formation, cholangiocyte proliferation, and fibrosis around the cyst. Metformin increased the phosphorylation of AMPK and tuberous sclerosis complex 2 and decreased the phosphorylation of mammalian target of rapamycin, S6, and extracellular signal-regulated kinase and the expression of cystic fibrosis transmembrane conductance regulator, aquaporin I, transforming growth factor-ß, and type 1 collagen without changes in apoptosis or collagen degradation factors in the liver. Metformin slows the development of cyst formation and fibrosis with the activation of AMPK and inhibition of signaling cascades responsible for cellular proliferation and fibrosis in the liver of PCK rats.NEW & NOTEWORTHY This study indicates that metformin, an indirect AMPK activator slows liver cyst formation and fibrosis in PLD rat model. Metformin attenuates excessive cell proliferation in the liver with the inactivation of mTOR and ERK pathways. Metformin also reduces the expression of proteins responsible for cystic fluid secretion and liver fibrosis. Metformin and AMPK activators may be potent drugs for polycystic liver disease.

Artificial intelligence improves the accuracy of residents in the diagnosis of hip fractures: a multicenter study.

BACKGROUND: Less experienced clinicians sometimes make misdiagnosis of hip fractures. We developed computer-aided diagnosis (CAD) system for hip fractures on plain X-rays using a deep learning model trained on a large dataset. In this study, we examined whether the accuracy of the diagnosis of hip fracture of the residents could be improved by using this system. METHODS: A deep convolutional neural network approach was used for machine learning. Pytorch 1.3 and Fast.ai 1.0 were applied as frameworks, and an EfficientNet-B4 model (a pre-trained ImageNet model) was used. We handled the 5295 X-rays from the patients with femoral neck fracture or femoral trochanteric fracture from 2009 to 2019. We excluded cases in which the bilateral hips were not included within an image range, and cases of femoral shaft fracture and periprosthetic fracture. Finally, we included 5242 AP pelvic X-rays from 4851 cases. We divided these 5242 images into two images per image, and prepared 5242 images including fracture site and 5242 images without fracture site. Thus, a total of 10,484 images were used for machine learning. The accuracy, sensitivity, specificity, F-value, and area under the curve (AUC) were assessed. Gradient-weighted class activation mapping (Grad-CAM) was used to conceptualize the basis for the diagnosis of the fracture by the deep learning algorithm. Secondly, we conducted a controlled experiment with clinicians. Thirty-one residents;young doctors within 2 years of graduation from medical school who rotate through various specialties, were tested using 300 hip fracture images that were randomly extracted from the dataset. We evaluated the diagnostic accuracy with and without the use of the CAD system for each of the 300 images. RESULTS: The accuracy, sensitivity, specificity, F-value, and AUC were 96.1, 95.2, 96.9%, 0.961, and 0.99, respectively, with the correct diagnostic basis generated by Grad-CAM. In the controlled experiment, the diagnostic accuracy of the residents significantly improved when they used the CAD system. CONCLUSIONS: We developed a newly CAD system with a deep learning algorithm from a relatively large dataset from multiple institutions. Our system achieved high diagnostic performance. Our system improved the diagnostic accuracy of residents for hip fractures. LEVEL OF EVIDENCE: Level III, Foundational evidence, before-after study. CLINICAL RELEVANCE: high.

Impact of Phase Angle on Physical Function in Patients with Acute Stroke.

OBJECTIVE: Phase angle, an assessment of muscle quality, might be a possible predictor of physical function in patients with an acute stroke; however, the evidence for the same is limited. Therefore, this study aimed to investigate whether phase angle is associated with improved physical function at discharge. METHODS: In this observational cohort study, we determined the phase angle in patients with an acute stroke using a portable, noninvasive multifrequency bio-impedance device. The primary objective was the assessment of physical function using the Functional Independence Measure motor (FIM-motor) at discharge in the acute phase. The secondary outcome was home discharge. Multiple regression analysis was used to determine the association between phase angle, FIM-motor score, and home discharge. RESULTS: The study included 129 patients (78 men; mean age 75.2 years). Multiple linear regression analysis showed that the phase angle was independently associated with FIM-motor score at discharge in all models (Model 1: ß= 0.27, p < 0.001; Model 2: ß = 0.234, p < 0.001; Model 3: ß = 0.201, p = 0.017). However, multiple logistic regression analysis showed that the phase angle was not associated with home discharge (p = 0.464). CONCLUSIONS: The phase angle at the onset of a stroke, is an independent predictor of physical function at discharge in the acute phase. Our findings highlight the importance of determining the phase angle in patients with an acute stroke.

Light-sheet microscopy-based 3D single-cell tracking reveals a correlation between cell cycle and the start of endoderm cell internalization in early zebrafish development.

Controlling the initiation of cell migration plays a fundamental role in shaping the tissue during embryonic development. During gastrulation in zebrafish, some mesendoderm cells migrate inward to form the endoderm as the innermost germ layer along the yolk syncytial layer. However, how the initiation of inward migration is regulated is poorly understood. In this study, we performed light-sheet microscopy-based 3D single-cell tracking consisting of (a) whole-embryo time-lapse imaging with light-sheet microscopy and (b) three-dimensional single cell tracking in the zebrafish gastrula in which cells are marked with histone H2A-mCherry (nuclei) and the sox17:EGFP transgene (expressed in endoderm cells). We analyzed the correlation between the timing of cell internalization and cell division. Most cells that differentiated into endoderm cells began to internalize during the first half of the cell cycle, where the length of a cell cycle was defined by the period between two successive cell divisions. By contrast, the timing of other internalized cells was not correlated with a certain phase of the cell cycle. These results suggest the possibility that cell differentiation is associated with the relationship between cell cycle progression and the start of internalization. Moreover, the 3D single-cell tracking approach is useful for further investigating how cell migration is integrated with cell proliferation to shape tissues in zebrafish embryos.

Quantification of the Flavor and Taste of Gonads from the Sea Urchin Mesocentrotus nudus Using GC-MS and a Taste-Sensing System.

Sea urchin gonads are a delicious seafood item of high commercial value. Our past studies have revealed that the gonads of the sea urchin Mesocentrotus nudus fed the basal frond portion of fresh Saccharina kelp (BS) or the sporophylls of fresh Undaria (SU) during May-July are of high-quality. The present study investigated the flavor and taste of BS and SU gonads in comparison with those from non-fed M. nudus (NF) using gas chromatography-mass spectrometry (GC-MS) and gas chromatography (GC)-sniffing techniques, and a taste-sensing system. Data of the estimated intensity of taste (EIT) were compared with assessment of gonads from M. nudus collected from an Eisenia bed (fishing ground) and a barren in July. Gonads from both BS and SU released pleasant green, sour, and fruity aromas characteristic of butyl acetate, which are here recognized essential flavor components of high-quality gonads. The gonads of BS and SU had a strong umami taste compared to those of NF, and the Eisenia bed and the barren. The most marketable M. nudus gonads were assessed to be those with green and fruity aromas from butyl acetate, sweet aroma from benzaldehyde, umami EIT > 13.8, bitterness EIT < 3.1, and without any unpleasant sulfurous odor from sulfur-containing compounds.

[Ruptured Sinus of Valsalva due to Infective Endocarditis Associated with Ventricular Septal Defect].

Rupture of sinus of Valsalva is a rare entity that occurs as a result of penetrating cardiac trauma or as a complication of infective endocarditis, aneurysm of the sinus of Valsalva, or aortic dissection. A 41-year-old man was admitted to our hospital with continual fever and general fatigue. Streptococcus mutans was detected from his blood cultures. Echocardiography showed perimembranous type ventricular septal defect and right Valsalva- right ventricle fistula. We performed surgery after 4 weeks'administration of antibiotics. After radical debridement, we closed ventricular septal defect and Valsalva-right ventricular fistula with double bovine pericardial patches. Postoperative echocardiography showed no aortic regurgitation or shunt flow. There has been no infection relapse for 2 years since surgery.

[Spontaneous Pneumothorax During Pregnancy Successfully Managed with a Thoracic Vent before Surgical Therapy; Report of a Case].

A 34-year-old pregnant woman presented to our department at 31 weeks of gestation after being diagnosed as spontaneous pneumothorax based on chest X-ray findings. We inserted a Thoracic Vent( TV), and she was followed as an outpatient. However, since pneumothorax recurred twice after the TV was removed, she was finally admitted to the Department of Obstetrics because threatened premature delivery was suspected. The collapsed lung did not re-expand, and the surgery for pneumothorax was done before childbirth. After thoracic surgery, she safely gave birth to a girl at 40 weeks of gestation. Outpatient therapy for spontaneous pneumothorax with TV is concerned to be a useful treatment even for pregnant women.

Controlling the excited state and photosensitizing property of a 2-(2-pyridyl)benzo[b]thiophene-based cationic iridium complex through simple chemical modification.

Bis-cyclometalated cationic iridium (Ir) complexes 1-4 comprising two 2-(2-pyridyl)benzo[b]thiophene (btp) ligands and one 2,2'-bipyridyl (bpy) ancillary ligand with different substituents were prepared as new visible light-absorbing sensitizers and examined for their photophysical and electrochemical properties. Complex 1 was prepared as a parent complex without any substituents. Complexes 2-4 contained methyl-, methoxy-, and trifluoromethyl groups at 4,4'-positions on the bpy ancillary ligand. Systematic investigation of these complexes revealed that such a simple chemical modification selectively controls the excited-state lifetime, while the absorption and emission spectral features remain unchanged. Specifically, the phosphorescence lifetimes of complexes 2 and 3 with electron-donating groups (τ = 3.50 µs, 3.90 µs) were found to be much longer than that of complex 1 (τ = 0.273 µs), and complex 4, possessing strong electron-withdrawing trifluoromethyl groups, did not exhibit detectable phosphorescence at room temperature. The large differences in excited-state lifetimes of complexes 1-3, as well as the nonemissive character of complex 4, are attributed to a strong influence of the substituents on the ligand field strength. The increased σ-donating ability of the ancillary ligand in complexes 2 and 3 destabilizes a short-lived, nonemissive triplet metal-centered ((3)MC) state and increases the energy separation between the (3)MC state and emissive triplet ligand-centered ((3)LC) state based on the btp ligand. For complex 4, however, the (3)MC state is close in energy to the (3)LC state because of the decreased σ-donating ability of the ancillary ligand. Additional evidence of the (3)MC state associated with the changeable excited state was also provided via low-temperature phosphorescence measurements and density functional theory calculations. Ir complexes 1-4 were tested as sensitizers in photoinduced electron-transfer reaction of triethanolamine and methylviologen chloride (MVCl2). As a result, complexes 2 and 3 exhibited much better photosensitizing property compared to complex 1 since their long-lived excited states promoted an oxidative quenching pathway. This Study has first demonstrated that simple substitution on the diimine ancillary ligand can control the (3)MC state of the bis-cyclometalated cationic Ir complex to finely tune the excited-state lifetime and photosensitizing property.

Sarcopenia as a Robust Predictor of Readmission within 6 Months among Individuals Experiencing Acute Stroke.

BACKGROUND: Sarcopenia negatively affects the short-term prognosis of hospitalized older adults. However, no evidence currently supports a direct relationship between sarcopenia and readmission among individuals who have experienced an acute stroke. Therefore, we investigated whether sarcopenia is associated with readmission after discharge. METHODS: This retrospective cohort study included patients who had experienced acute stroke. Sarcopenia was defined as the coexistence of low skeletal muscle mass index (SMI) and grip strength. We applied the log-rank test and Cox proportional hazards regression analysis to analyze whether sarcopenia, low SMI, and low grip strength were associated with readmission within 6 months. RESULTS: Among 228 included patients (mean age, 72.8 years; 146 males), the prevalence of sarcopenia was 24.6% (n=56; male 17.8%; female 36.6%). Cox proportional hazards regression analysis using the propensity score as a covariate revealed that sarcopenia (hazard ratio [HR]=7.21; 95% confidence interval [CI] 1.45-35.8; p=0.016) and low skeletal muscle mass (HR=7.40; 95% CI 1.14-48.1; p=0.036), but not low grip strength (HR=1.42; 95% CI 0.281-7.21; p=0.670), were significantly associated with readmission for stroke within 6 months. CONCLUSIONS: Sarcopenia was negatively associated with readmission within 6 months of stroke onset in patients in Japan who had experienced an acute stroke. These findings suggest that the identification of sarcopenia may facilitate prognostic prediction from the acute stage and intervention(s) to prevent rehospitalization.

Mineral supplementation in patients with frailty and sarcopenia-a systematic review.

AIM: Addressing sarcopenia and frailty in aging populations is crucial for enhancing quality of life and reducing healthcare dependence. While the importance of energy, protein, and amino acid supplementation is known, the role of minerals needs further exploration. This systematic review evaluates the effectiveness of these minerals in managing sarcopenia and frailty. METHODS: We analyzed data from the Cochrane Central Register of Controlled Trials, MEDLINE, and Ichu-shi Web from January 2000 to March 2023. Studies were selected if they were interventional or observational, focused on individuals with frailty or sarcopenia who were aged 65 or older, and involved mineral supplementation. The risk of bias in these studies was assessed using the Cochrane Risk of Bias 2 tool. RESULTS: Of the 615 studies identified, seven met the inclusion criteria. These studies mainly focused on the effects of combined nutrient supplements, with few focusing on individual minerals. The findings were mixed, demonstrating some improvements in muscle strength, activity of daily living, and cognitive functions. Notably, minerals appeared to offer benefits as part of multi-nutrient interventions, especially for cognitive and immune health, but had limited impact on muscle mass or strength when used alone. The limited number and variable outcomes of studies precluded a feasible meta-analysis. CONCLUSIONS: The effect of mineral supplementation on sarcopenia and frailty remains uncertain, suggesting a need for tailored nutritional strategies. Future studies should aim for well-designed clinical trials in order to gain a better understanding of the roles of minerals in improving muscle health and functional outcomes, leading to clearer recommendations for clinical practice. Geriatr Gerontol Int 2024; ••: ••-••.

Relationship between nutritional status and clinical outcomes among older individuals using long-term care services: A systematic review and meta-analysis.

BACKGROUND & AIMS: Nutritional status is a significant issue in an aging society; however, the impact of the nutritional status of older individuals using long-term care services on the caregiving burden remains unclear. This systematic review and meta-analysis aimed to investigate the impact of nutritional issues on adverse outcomes in older individuals using long-term care services. METHODS: We used data from the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Web of Science, CINAHL, and Ichu-shi Web databases. Original articles published in English or Japanese between January 2000 and July 2022 were included. The inclusion criteria were interventional and observational studies on individuals using long-term care services with aged ≥65 years and a focus on body weight or weight loss. Data on adverse outcomes related to caregiving burden, including the number of people requiring care, mortality, complications, activities of daily living (ADL), and quality of life, were collected. RESULTS: The literature search yielded 7873 studies, of which 35 were ultimately included. Seven observational studies investigated mortality outcomes, and seven examined ADL outcomes. The meta-analysis revealed significantly higher mortality rates in individuals classified as underweight (BMI <18.5 kg/m2) than in those with BMI ≥18.5 kg/m2 (risk ratio [RR] 1.49; 95 % confidence interval [CI] 1.31 to 1.73, 0.22; I2 93 %). Further, on categorising the participants based on a BMI cutoff of 25 kg/m2, those with a BMI of <25 kg/m2 had a significantly increased mortality rate (RR 1.21; 95 % CI 1.04-1.40; I2 = 98 %). BMI and weight loss did not affect ADL. CONCLUSIONS: Our findings indicate that underweight and weight loss are significantly associated with increased mortality in older individuals using long-term care services. Therefore, appropriate weight management is recommended for this population. However, further research is necessary owing to the high heterogeneity observed in this study.

External validation of a deep learning model for predicting bone mineral density on chest radiographs.

We developed a new model for predicting bone mineral density on chest radiographs and externally validated it using images captured at facilities other than the development environment. The model performed well and showed potential for clinical use. PURPOSE: In this study, we performed external validation (EV) of a developed deep learning model for predicting bone mineral density (BMD) of femoral neck on chest radiographs to verify the usefulness of this model in clinical practice. METHODS: This study included patients who visited any of the collaborating facilities from 2010 to 2020 and underwent chest radiography and dual-energy X-ray absorptiometry (DXA) at the femoral neck in the year before and after their visit. A total of 50,114 chest radiographs were obtained, and BMD was measured using DXA. We developed the model with 47,150 images from 17 facilities and performed EV with 2914 images from three other facilities (EV dataset). We trained the deep learning model via ensemble learning based on chest radiographs, age, and sex to predict BMD using regression. The outcomes were the correlation of the predicted BMD and measured BMD with diagnoses of osteoporosis and osteopenia using the T-score estimated from the predicted BMD. RESULTS: The mean BMD was 0.64±0.14 g/cm2 in the EV dataset. The BMD predicted by the model averaged 0.61±0.08 g/cm2, with a correlation coefficient of 0.68 (p<0.01) when compared with the BMD measured using DXA. The accuracy, sensitivity, and specificity of the model were 79.0%, 96.6%, and 34.1% for T-score < -1 and 79.7%, 77.1%, and 80.4% for T-score ≤ -2.5, respectively. CONCLUSION: Our model, which was externally validated using data obtained at facilities other than the development environment, predicted BMD of femoral neck on chest radiographs. The model performed well and showed potential for clinical use.

A case of infective endocarditis caused by Kocuria rosea in a non-compromised patient.

A 79-year-old male with no history of immunodeficiency was transferred to our hospital complaining of shortness of breath and general fatigue. He was diagnosed with recent myocardial infarction and underwent emergent percutaneous coronary intervention. However, the course of congestive heart failure was poor, and he required respiratory support and renal replacement therapy. Kocuria rosea was detected in blood culture obtained on admission, and then a follow-up echocardiogram revealed infective endocarditis. We administered ampicillin-sulbactam and performed urgent operation. The post-operative course was uneventful with 4-week administration of antimicrobial agents. Learning objectives: Infective endocarditis caused by Kocuria rosea may also occur in non-compromised patients although K. rosea infections have been reported only in compromised hosts. This pathogen is sensitive to a variety of antibiotics. We selected ampicillin-sulbactam to treat infective endocarditis based on a sensitivity examination, and the patient's post-operative clinical course was uneventful. Ampicillin-sulbactam may be a useful treatment option.

Change in phase angle is associated with improvement in activities of daily living and muscle function in patients with acute stroke.

PURPOSE: The phase angle (PhA) is a simple index that reflects nutritional status and muscle quality. This study aimed to investigate the association between PhA changes and activities of daily living (ADL), muscle strength, and muscle mass in patients with acute stroke. METHODS: This retrospective, observational, cross-sectional study included patients hospitalized for acute stroke. The primary outcome was functional independence measure (FIM) of motor gain. The secondary outcomes were changes in handgrip strength and skeletal muscle mass index (SMI) during hospitalization. Multivariate analysis was used to examine whether PhA changes were associated with outcomes, after adjusting for potential confounders. RESULTS: Hundred and sixty one subjects (mean age 74.6 years, 92 men) were included in the study. Multivariate analysis showed that PhA change was significantly and positively correlated with the gain in FIM motor scores, both for men (ß = 0.634, p < 0.001) and women (ß = 0.660, p < 0.001). Furthermore, there were significant associations between PhA change and changes in handgrip strength for men (ß = 0.222, p = 0.030) and women (ß = 0.491, p < 0.001), as well as SMI for men (ß = 0.556, p < 0.001) and women (ß = 0.290, p = 0.025). CONCLUSIONS: An increased phase angle was positively associated with ADL, muscle strength, and muscle mass at discharge in patients with acute stroke.

Hospital-associated sarcopenia and the preventive effect of high energy intake along with intensive rehabilitation in patients with acute stroke.

OBJECTIVES: Hospital-associated sarcopenia is prevalent and associated with poor outcomes in acutely admitted patients. Prevention of developing sarcopenia during hospitalization is an important factor in stroke management. Therefore, this study aimed to investigate whether energy intake and rehabilitation duration contribute to the prevention of hospital-associated sarcopenia in patients with acute stroke. METHODS: Patients with acute stroke were included in this study. Energy intake during the first week of hospitalization was classified as "high" or "low" based on the reported cutoff value. Rehabilitation time during hospitalization was classified as "intense" or "mild" based on the median. The four groups were compared based on the combinations of high or low energy intake and intense or mild rehabilitation. The primary outcome was the development of sarcopenia during hospitalization. The secondary outcome was the Functional Independence Measure motor item gain during hospitalization. Multivariate analysis was performed with the primary or secondary outcome as the dependent variable and the effect of each group on the outcome was examined. RESULTS: A total of 112 participants (mean age = 70.6 y; 63 men) were included in the study. Multivariate analysis found that high × intense (odds ratio = 0.113; P = 0.041) was independently associated with the development of sarcopenia during hospitalization (i.e., hospital-related sarcopenia). High × intense (ß = 0.395; P < 0.001) was independently associated with the gain of Functional Independence Measure motor items. CONCLUSIONS: In patients with acute stroke, the combination of high energy intake and adequate rehabilitation time is associated with prevention of hospital-associated sarcopenia.

Validity of sarcopenia diagnosis defined by calf circumference for muscle mass to predict functional outcome in patients with acute stroke.

OBJECTIVE: This study examined the association between sarcopenia diagnosed by defining muscle mass with calf circumference and physical function at hospital discharge in patients with acute stroke and to perform a comparison with sarcopenia diagnosis according to the Asian Working Group for Sarcopenia. RESEARCH METHODS & PROCEDURES: This retrospective cohort study included patients with acute stroke. We calculated the calf circumference cut-off value defining low skeletal muscle index for the Asian Working Group for Sarcopenia diagnostic criteria and used a combination of low calf circumference and low grip strength to define sarcopenia-calf circumference. A combination of low skeletal muscle index and low grip strength defined sarcopenia-Asian Working Group for Sarcopenia. Associations between sarcopenia-calf circumference, sarcopenia-Asian Working Group for Sarcopenia, and Functional Independence Measure motor score were evaluated using multiple regression analysis. RESULTS: The study included 308 patients (198 men; mean age, 73.2 years). Sarcopenia-calf circumference prevalence was 24.7% in men and 46.4% in women. In men, sarcopenia-calf circumference (ß=-0.178; 95% CI: -0.284, -0.073; p=0.001) and sarcopenia-Asian Working Group for Sarcopenia (ß=-0.228; 95% CI: -0.330, -0.127; p<0.001) were significantly associated with Functional Independence Measure motor score at discharge. CONCLUSIONS: Sarcopenia diagnosed by defining muscle mass with calf circumference was negatively associated with physical function at discharge in male patients with acute stroke. Sarcopenia diagnosed using Asian Working Group for Sarcopenia criteria was superior to sarcopenia-calf circumference for predicting physical function at discharge. Our findings suggest that the use of CC enables assessment of sarcopenia even at facilities where muscle mass measurements may be difficult.

Applicability of the Diagnostic Criteria for Sarcopenic Obesity Defined by ESPEN/EASO Criteria in Acutely Admitted Patients with Stroke: Prevalence and Association with Outcomes.

Few reports have described sarcopenic obesity in patients with stroke. This study aimed to investigate the prevalence of sarcopenic obesity, as defined by the European Society for Clinical Nutrition and Metabolism (ESPEN) and European Association for the Study of Obesity (EASO) consensus statement, in patients with acute stroke and to determine whether it was associated with improved physical function at discharge. This retrospective cohort study was conducted from May 2020 to November 2021 in patients with acute stroke. Sarcopenic obesity was determined using the ESPEN and EASO consensus statement. The main outcome was physical function based on the Functional Independence Measure motor score at discharge. Multiple regression analysis was conducted to evaluate the association between sarcopenic obesity and the Functional Independence Measure motor score. This study included 276 patients (182 men; mean age, 72.4 y). Sarcopenic obesity screened for obesity with body mass index >27.5 was found in 11 (4%) patients. Multiple regression analysis revealed that sarcopenic obesity screened for obesity with body mass index >27.5 was not significantly associated with the Functional Independence Measure motor score at discharge (ß=0.038; 95% confidence interval: -0.046, 0.123; p=0.369). This study revealed a prevalence rate of 4% for sarcopenic obesity diagnosed by the ESPEN and EASO criteria and showed that sarcopenic obesity was not statistically associated with activities of daily living at acute discharge in patients with stroke.