Sarcopenia in cirrhosis: Unraveling the prevalence and relationships with liver disease severity and complications.

BACKGROUND AND OBJECTIVES: Sarcopenia in cirrhosis is associated with poor survival and adverse pre and post-transplant outcomes. The study aimed at determining the prevalence of sarcopenia and its association with the severity, complications and etiology of liver disease. METHODS: As many as 416 cirrhotic patients who met the inclusion criteria underwent muscle strength testing using a dynamometer. As many as 109 probable sarcopenia patients underwent computed tomography (CT) scan to measure skeletal muscle index (SMI) at the L3 vertebral level and gait-speed testing. The gender-specific cut-offs used to define sarcopenia were an SMI of 36.54 cm2/m2 in males and 30.21 cm2/m2 in females. A gait speed ≤ 0.8 m/s was taken as a cut-off to define severe sarcopenia in both genders. RESULTS: The mean age was 54.7 ± 9.51 years and male:female ratio was 2.2:1.The mean body mass index (BMI) was 24.2 ± 1.34 kg/m2. Alcohol and non-alcoholic steatohepatitis (NASH) were the two most common etiologies (45.9% and 31.2%). The proportion of patients belonging to Child-Pugh class A, B and C was 26.6%, 48.6% and 24.8%, respectively. Forty out of 109 (36.7%) patients had a model for end-stage liver disease (MELD) > 14. Ascites, upper gastrointestinal bleeding and hepatic encephalopathy (HE) were present in 59 (54.1%), 60 (55.0%) and 24 (22.0%) patients, respectively. The prevalence of probable sarcopenia, sarcopenia and severe sarcopenia was found to be 26.20%, 10.09% and 6.73%, respectively. Sarcopenia and severe sarcopenia were associated with Child-Pugh class (p < 0.001, p < 0.001), MELD (p = 0.007, 0.002), upper gastrointestinal bleed (p = 0.007, 0.004), ascites (p = 0.038, 0.025) and HE (0.001, < 0.001). CONCLUSION: The prevalence of sarcopenia and severe sarcopenia was found to be 10.09% and 6.73%, respectively. Sarcopenia and severe sarcopenia had a significant association with the severity and complications of cirrhosis. However, no association was observed with etiology of liver disease.

Kidney function and other associated factors of sarcopenia in community-dwelling older adults: The SCOPE study.

AIM: Sarcopenia is associated with several factors and medical conditions among older adults, though previous research has shown limitations and inconsistencies, especially regarding chronic kidney disease (CKD). We investigated the clinical and laboratory variables associated with sarcopenia and severe sarcopenia in older adults, focusing on kidney function measures. METHODS: Data from community-dwelling adults aged ≥75 years participating in the SCOPE multicenter prospective cohort study were assessed cross-sectionally. Comprehensive geriatric assessment was conducted; sociodemographic and lifestyle factors, clinical variables and comorbidities, anthropometric and bioelectrical impedance analysis, blood and urine laboratory variables were collected. EWGSOP2 revised criteria were used to define sarcopenia and its severity. Estimated glomerular filtration rate (eGFR) was calculated using creatinine and non-creatinine-based equations, and CKD stages were defined accordingly. RESULTS: 1420 participants were included, prevalence of sarcopenia was 10.6 %, and 6 % had severe sarcopenia. Multivariate logistic regression analysis showed that age [OR =1.14; 95 %CI (1.09-1.19)], body mass index (BMI) [0.83 (0.79-0.88)], disability performing instrumental activities of daily living (IADL) [2.61 (1.69-4.06)], Mini Mental State Examination (MMSE) score <24 [2.75 (1.62-4.67)], osteoporosis [2.39 (1.55-3.67)], and stage 4 CKD defined by CKD-EPIBTP-B2M, a non-creatinine-based eGFR equation [2.88 (1.11-7.49)], were independently associated with sarcopenia; as were specifically with severe sarcopenia, with more pronounced associations. CONCLUSIONS: In community-dwelling older adults, sarcopenia is a relevant condition and is associated with severe CKD, older age, IADL, cognitive impairments, osteoporosis and low BMI. These factors should be assessed for proper identification and management of older patients with sarcopenia, and even more so with severe sarcopenia.

Cut-off points of the Ishii test to diagnosing severe sarcopenia among multi-ethnic middle-aged to older adults: results from the West China Health and Aging Trend study.

Objective: This study was designed to establish the cut-off value and diagnostic utility of the Ishii test, which gauges the odds of severe sarcopenia based on the results of an equation based upon age, grip strength, and calf circumference among middle-aged and older adults in Western China. Methods: This study incorporated adults ≥ 50 years of age from the West China Health and Aging Trend (WCHAT) study. Severe sarcopenia was defined as per the Asian Working Group for Sarcopenia: 2019 Consensus (AWGS2019) recommendations, with the odds of severe sarcopenia being estimated with the Ishii test score chart. The diagnostic utility of the Ishii test in this patient cohort was assessed by analyzing its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the ROC curve (AUC). Results: In total, 4,177 individuals ≥ 50 years of age were included in this study including 2668 females (63.9%) and 1,509 males (36.1%). These included 568 (13.6%) participants affected by severe sarcopenia, of whom 237 were male (15.7%) and 331 were female (12.4%). Optimal Ishii test cut-off values established based on Youden's index were ≥ 114 for males and ≥ 120 for females when using the AWGS2019 reference standard. The sensitivity/specificity/PPV/NPV of the Ishii test when screening for severe sarcopenia were 89.45%/77.15%/0.42/0.98 in males and 90.03%/77.05%/0.36/0.98 in females. The AUC values for the Ishii test in males and females were 0.899 (95% CI, 0.883-0.916) and 0.905 (95% CI, 0.892-0.917), respectively. Conclusion: These data indicate that the Ishii test offers value as a candidate diagnostic test that can be used to screen for severe sarcopenia, with recommended diagnostic cut-off values of ≥ 114 for males and ≥ 120 for females.

Two Cases of Acute Urinary Retention Associated With Acute Sarcopenia in Older Women.

Acute urinary retention during hospitalization is a poor prognostic predictor. Therefore, prevention of the same is important. Herein, we describe two cases of acute urinary retention in older women admitted to the hospital for acute illness, with severe sarcopenia being the only predisposing cause. Both women developed urinary problems shortly after admission. In both, acute urinary retention was preceded by an in-hospital period of poor nutritional intake and a lack of progress in rehabilitation. There was no evidence of genitourinary disorder, neurological disease, drug-induced dysuria, bone fracture, or pain. Both patients presented with severe sarcopenia and severe frailty.Although the loss of mass in the voiding muscles is difficult to detect, the possibility of dysuria as one of the complications of acute and severe sarcopenia was indicated in our patients. Of note, however, is that many patients with severe sarcopenia do not develop dysuria. Therefore, accumulating evidence on the possible association between severe sarcopenia and dysuria is needed to inform prevention.

Association between the Severity of Sarcopenia and Pneumonia in Patients with Stable Schizophrenia: A Prospective Study.

OBJECTIVES: This study investigates the associations between the severity of sarcopenia and pneumonia in patients with stable schizophrenia. MATERIALS AND METHODS: This is a prospective study that includes patients from the rehabilitation wards of two mental health centres in western China, who were diagnosed with stable schizophrenia. Baseline data were collected from these patients between September 1 and September 30, 2020, while patients' data associated with pneumonia, diagnosed and treated by clinicians, were collected between October 2020 and October 2021. The severity of sarcopenia was diagnosed according to the diagnostic criteria defined by the Asian Working Group for Sarcopenia (AWGS) 2019. The association between the severity of sarcopenia and pneumonia in patients with schizophrenia was analyzed with the use of logistic regression analysis. RESULTS: Three hundred and thirty-five patients with stable schizophrenia were enrolled in the prospective study, among whom 242 (72.24%) were≥60 years old, and 229 (68.36%) were males. Among the patients with stable schizophrenia, 130 (38.8%) were diagnosed with non-severe sarcopenia, whereas 47 (14.0%) had severe sarcopenia. Eighty-two (24.5%) of patients with schizophrenia fought pneumonia. Our study showed that the severe sarcopenia group had the highest incidence of pneumonia, followed by the non-severe sarcopenia group (severe sarcopenia vs. non-severe sarcopenia vs. normal, 38.3% vs. 28.46% vs. 17.09%, p=0.005). Compared with the normal group, the non-severe sarcopenia group (OR=1.93, 95%CI: 1.1-3.389) and the severe sarcopenia group (OR=3.011, 95%CI: 1.467-6.183) had a higher risk of pneumonia. We further adjusted the potential confounders such as sex, smoking history, chronic obstructive pulmonary disease (COPD), Patient Health Questionnaire (PHQ-9) score, and benzhexol and confirmed that only the severe sarcopenia group had an increased risk of pneumonia (OR=2.366, 95%CI: 1.078-5.191). CONCLUSIONS: We have demonstrated that severe sarcopenia was associated with pneumonia in patients diagnosed with stable schizophrenia.

Metabolomic profiles to explore biomarkers of severe sarcopenia in older men: A pilot study.

BACKGROUND: The pathophysiology of sarcopenia is complex and multifactorial; however, it has not yet been fully elucidated. Identifying metabolomic profiles may help clarify the mechanisms underlying sarcopenia. OBJECTIVE: This pilot study explored potential noninvasive biomarkers of severe sarcopenia through metabolomic analysis in community-dwelling older men. METHODS: Twenty older men (mean age: 81.9 ± 2.8 years) were selected from the Korean Frailty and Aging Cohort Study. Participants with severe sarcopenia (n = 10) were compared with non-sarcopenic, age- and body mass index-matched controls (n = 10). Severe sarcopenia was defined as low muscle mass, low muscle strength, and low physical performance using the Asian Working Group for Sarcopenia 2019 criteria. Non-targeted metabolomic profiling of plasma metabolites was performed using capillary electrophoresis time-of-flight mass spectrometry and absolute quantification was performed in target metabolites. RESULTS: Among 191 plasma metabolic peaks, the concentrations of 10 metabolites significantly differed between severe sarcopenia group and non-sarcopenic controls. The plasma concentrations of L-alanine, homocitrulline, N-acetylserine, gluconic acid, N-acetylalanine, proline, and sulfotyrosine were higher, while those of 4-methyl-2-oxovaleric acid, 3-methyl-2-oxovaleric acid, and tryptophan were lower in participants with severe sarcopenia than in non-sarcopenic controls (all, p < 0.05). Among the 53 metabolites quantified as target metabolites, L-alanine (area under the receiver operating characteristic curve [AUC] = 0.760; p = 0.049), gluconic acid (AUC = 0.800; p = 0.023), proline (AUC = 0.785; p = 0.031), and tryptophan (AUC = 0.800; p = 0.023) determined the presence of severe sarcopenia. CONCLUSIONS: Plasma metabolomic analysis demonstrated that L-alanine, gluconic acid, proline, and tryptophan may be potential biomarkers of severe sarcopenia. The identified metabolites can provide new insights into the underlying pathophysiology of severe sarcopenia and serve as the basis for preventive interventions.

Accuracy of SARC-F, SARC-CalF, and Ishii Test in Assessing Severe Sarcopenia in Older Adults in Nursing Homes.

OBJECTIVES: We aimed to assess the comparative accuracy of using SARC-F, as well as the SARC-F in tandem with calf circumference (SARC-CalF) and Ishii test, to screen severe sarcopenia in older adults residing in nursing homes. METHOD: In this cross-sectional study, the AWGS2019 criteria were used as diagnostic standards. We adopted an "exclusion" screening test, focusing on sensitivity and the negative predictive value (NPV) combined with AUC, to assess the accuracy of the screening tools. RESULTS: We studied 199 people aged 60 and older, of whom 67 (33.7%) had severe sarcopenia, including 40 males (41.2%) and 27 females (26.5%). Among all participants, the sensitivities and NPV of SARC-F, SARC-CalF, and Ishii test were 85.1%/0.88, 68.7%/0.82, and 89.6%/0.94, respectively. For males, the SARC-F, SARC-CalF, and Ishii test sensitivities and NPV were 77.5%/0.78, 47.5%/0.7, and 85%/0.88, respectively. Among females, the SARC-F, SARC-CalF, and Ishii test sensitivities and NPV were 74.1%/0.9, 81.5%/0.92, 96.3%/0.99, respectively. There were no statistical differences between the AUCs of SARC-F or SARC-CalF for all participants or for the male or female groups; however, in terms of the AUC, the Ishii test was superior compared with the other two screening methods. CONCLUSION: The Ishii test is more suitable for screening severe sarcopenia in older adults in nursing homes compared to SARC-F and SARC-CalF, and 130 points are recommended as the cut-off value of the Ishii test for screening severe sarcopenia.

Diagnostic accuracy of quadriceps strength-based criteria compared to handgrip-based criteria for diagnosing sarcopenia and severe sarcopenia in older adults.

AIM: . Handgrip strength (HS) is an established parameter for sarcopenia diagnosis; however, a considerable proportion of older adults have some kind of hand abnormality or limitation that can prevent reliable hand muscle power testing. This study set forth to investigate the diagnostic accuracy of quadriceps strength (QS)-based criteria compared to handgrip strength (HS)-based criteria for diagnosing sarcopenia and severe sarcopenia in older adults. SETTING AND PARTICIPANTS: . A total of 381 subjects aged ≥60 years who attended the outpatient geriatric clinic at Siriraj Hospital (Bangkok, Thailand) during 2015-2017 were recruited via convenience sampling. Patients who were ambulatory, able to communicate, and without metallic prosthesis or pacemaker were eligible for inclusion. METHODS: . All consenting subjects underwent HS and QS testing, muscle mass measurement by bioelectrical impedance analysis, and gait speed analysis. The Asian Working Group for Sarcopenia (AWGS) 2019 consensus criteria were used as reference standard. RESULTS: . The prevalence of sarcopenia and severe sarcopenia by HS-based criteria was 13.9% and 6.8%, respectively. In comparison, the prevalence of sarcopenia and severe sarcopenia by QS-based criteria was 14.7% and 10.2%, respectively. The sensitivity and specificity of QS-based criteria for diagnosing sarcopenia was 100% (95% confidence interval [CI]: 93.3-100%) and 99.1% (95%CI: 97.4-99.8%), respectively. The sensitivity and specificity of QS-based criteria for diagnosing severe sarcopenia was 88.5% (95%CI: 69.9-97.6%) and 95.5% (95%CI: 92.8-97.4%), respectively. CONCLUSIONS: . With very high sensitivity and specificity, QS-based diagnostic criteria could be used to diagnose sarcopenia and severe sarcopenia in older adults whose HS measurements could not be reliably obtained. THAI CLINICAL TRIALS REGISTRY REGISTRATION NUMBER: . TCTR 20200717004.