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1.
Trials ; 22(1): 621, 2021 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-34526100

RESUMEN

BACKGROUND: Colorectal cancer is associated with secondary sarcopenia (muscle loss) and myosteatosis (fatty infiltration of muscle) and patients who exhibit these host characteristics have poorer outcomes following surgery. Furthermore, patients, who undergo curative advanced rectal cancer surgery such as pelvic exenteration, are at risk of skeletal muscle loss due to immobility, malnutrition and a post-surgical catabolic state. Neuromuscular electrical stimulation (NMES) may be a feasible adjunctive treatment to help ameliorate these adverse side-effects. Hence, the purpose of this study is to investigate NMES as an adjunctive pre- and post-operative treatment for rectal cancer patients in the radical pelvic surgery setting and to provide early indicative evidence of efficacy in relation to key health outcomes. METHOD: In a phase II, double-blind, randomised controlled study, 58 patients will be recruited and randomised (1:1) to either a treatment (NMES plus standard care) or placebo (sham-NMES plus standard care) group. The intervention will begin 2 weeks pre-operatively and continue for 8 weeks after exenterative surgery. The primary outcome will be change in mean skeletal muscle attenuation, a surrogate marker of myosteatosis. Sarcopenia, quality of life, inflammatory status and cancer specific outcomes will also be assessed. DISCUSSION: This phase II randomised controlled trial will provide important preliminary evidence of the potential for this adjunctive treatment. It will provide guidance on subsequent development of phase 3 studies on the clinical benefit of NMES for rectal cancer patients in the radical pelvic surgery setting. TRIAL REGISTRATION: Protocol version 6.0; 05/06/20. ClinicalTrials.gov NCT04065984 . Registered on 22 August 2019; recruiting.


Asunto(s)
Terapia por Estimulación Eléctrica , Neoplasias del Recto , Sarcopenia , Ciclismo , Estimulación Eléctrica , Terapia por Estimulación Eléctrica/efectos adversos , Humanos , Calidad de Vida , Neoplasias del Recto/complicaciones , Neoplasias del Recto/cirugía , Sarcopenia/diagnóstico , Sarcopenia/etiología , Sarcopenia/terapia
2.
Diabetes Metab Syndr ; 15(5): 102235, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34384972

RESUMEN

BACKGROUND AND AIMS: Post Covid-19 syndrome (PCS) is a major cause of morbidity. In this article we intend to review the association and consequences of PCS and diabetes. METHODS: We reviewed all studies on "Long Covid", "Post COVID-19 Syndrome" and diabetes in PubMed and Google Scholar. RESULTS: The symptoms of PCS can be due to organ dysfunction, effects of hospitalisation and drugs, or unrelated to these. Type 2 diabetes mellitus has a bidirectional relationship with COVID-19. Presence of diabetes also influences PCS via various pathophysiological mechanisms. COVID-19 can add to or exacerbate tachycardia, sarcopenia (and muscle fatigue), and microvascular dysfunction (and organ damage) in patients with diabetes. CONCLUSION: PCS in patients with diabetes could be detrimental in multiple ways. Strict control of diabetes and other comorbidities, supervised rehabilitation and physical exercise, and optimal nutrition could help in reducing and managing PCS.


Asunto(s)
COVID-19/complicaciones , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/etiología , COVID-19/terapia , Comorbilidad , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Fatiga/diagnóstico , Fatiga/epidemiología , Fatiga/etiología , Fatiga/terapia , Humanos , SARS-CoV-2/fisiología , Sarcopenia/diagnóstico , Sarcopenia/epidemiología , Sarcopenia/etiología , Sarcopenia/terapia , Taquicardia/diagnóstico , Taquicardia/epidemiología , Taquicardia/etiología , Taquicardia/terapia
3.
Nutrients ; 13(8)2021 Jul 21.
Artículo en Inglés | MEDLINE | ID: mdl-34444645

RESUMEN

Older adults with knee osteoarthritis (KOA) are at high risk of sarcopenia. Protein-rich nutritional composition supplementation (PS) combined with resistance exercise training (RET) improves muscle gains and facilitates physical activity in older adults. However, whether PS augments the effects of RET on muscle mass and PA in patients with KOA remains unclear. Therefore, this study identified the effects of PS on sarcopenic indices and PA in older women with KOA subjected to an RET program. Eligible older women aged 60-85 years and diagnosed as having KOA were randomly assigned to either the experimental group (EG) or the control group (CG). Both groups performed RET twice a week for 12 weeks. The EG received additional PS during this period. Outcome measures included appendicular lean mass index, walking speed, physical activity, and scores on the Western Ontario and McMaster Universities Osteoarthritis Index-WOMAC). All measures were tested at baseline and after intervention. With participant characteristics and baseline scores as covariates, analysis of variance was performed to identify between-group differences in changes in all outcome measures after intervention. Statistical significance was defined as p < 0.05. Compared with the CG, the EG achieved greater changes in appendicular lean mass index (adjusted mean difference (aMD) = 0.19 kg/m2, p < 0.01), physical activity (aMD = 30.0 MET-hour/week, p < 0.001), walking speed (aMD = 0.09 m/s, p < 0.05), and WOMAC global function (aMD = -8.21, p < 0.001) after intervention. In conclusion, PS exerted augmentative effects on sarcopenic indices, physical activity, and perceived global WOMAC score in older women with KOA through 12 weeks of RET.


Asunto(s)
Proteínas en la Dieta/administración & dosificación , Suplementos Dietéticos , Osteoartritis de la Rodilla/terapia , Entrenamiento de Fuerza , Sarcopenia/terapia , Anciano , Anciano de 80 o más Años , Ingestión de Alimentos , Metabolismo Energético , Ejercicio Físico , Femenino , Humanos , Persona de Mediana Edad , Fuerza Muscular , Músculo Esquelético/anatomía & histología , Músculo Esquelético/fisiología , Osteoartritis de la Rodilla/dietoterapia , Osteoartritis de la Rodilla/fisiopatología , Sarcopenia/dietoterapia , Sarcopenia/fisiopatología
4.
Nutrients ; 13(7)2021 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-34371823

RESUMEN

Malnutrition, frailty and sarcopenia are becoming increasingly prevalent among community-dwelling older adults; yet are often unidentified and untreated in community settings. There is an urgent need for community-based healthcare professionals (HCPs) from all disciplines, including medicine, nursing and allied health, to be aware of, and to be able to recognise and appropriately manage these conditions. This paper provides a comprehensive overview of malnutrition, frailty and sarcopenia in the community, including their definitions, prevalence, impacts and causes/risk factors; and guidance on how these conditions may be identified and managed by HCPs in the community. A detailed description of the care process, including screening and referral, assessment and diagnosis, intervention, and monitoring and evaluation, relevant to the community context, is also provided. Further research exploring the barriers/enablers to delivering high-quality nutrition care to older community-dwelling adults who are malnourished, frail or sarcopenic is recommended, to inform the development of specific guidance for HCPs in identifying and managing these conditions in the community.


Asunto(s)
Servicios de Salud Comunitaria/métodos , Fragilidad/epidemiología , Servicios de Salud para Ancianos , Desnutrición/epidemiología , Terapia Nutricional/métodos , Sarcopenia/epidemiología , Anciano , Anciano de 80 o más Años , Femenino , Anciano Frágil , Fragilidad/diagnóstico , Fragilidad/terapia , Humanos , Vida Independiente , Masculino , Desnutrición/diagnóstico , Desnutrición/terapia , Prevalencia , Factores de Riesgo , Sarcopenia/diagnóstico , Sarcopenia/terapia
5.
Nutrients ; 13(7)2021 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-34371826

RESUMEN

BACKGROUND: Sarcopenia is a major health problem in older adults. Exercise and nutrient supplementation have been shown to be effective interventions but there are limited studies to investigate their effects on the management of sarcopenia and its possible underlying mechanisms. Here, we studied T cell gene expression responses to interventions in sarcopenia. METHODS: The results of this study were part of a completed trial examining the effectiveness of a 12-week intervention with exercise and nutrition supplementation in community-dwelling Chinese older adults with sarcopenia, based on the available blood samples at baseline and 12 weeks from 46 randomized participants from three study groups, namely: exercise program alone (n = 11), combined-exercise program and nutrition supplement (n = 23), and waitlist control group (n = 12). T cell gene expression was evaluated, with emphasis on inflammation-related genes. Real-time PCR (RT-PCR) was performed on CD3 T cells in 38 selected genes. Correlation analysis was performed to relate the results of gene expression analysis with lower limb muscle strength performance, measured using leg extension tests. RESULTS: Our results showed a significant improvement in leg extension for both the exercise program alone and the combined groups (p < 0.001). Nine genes showed significant pre- and post-difference in gene expression over 12 weeks of intervention in the combined group. Seven genes (RASGRP1, BIN1, LEF1, ANXA6, IL-7R, LRRN3, and PRKCQ) showed an interaction effect between intervention and gene expression levels on leg extension in the confirmatory analysis, with confounder variables controlled and FDR correction. CONCLUSIONS: Our findings showed that T cell-specific inflammatory gene expression was changed significantly after 12 weeks of intervention with combined exercise and HMB supplementation in sarcopenia, and that this was associated with lower limb muscle strength performance.


Asunto(s)
Suplementos Dietéticos , Ejercicio Físico/fisiología , Expresión Génica/genética , Sarcopenia/terapia , Linfocitos T/metabolismo , Valeratos/administración & dosificación , Anciano , Anciano de 80 o más Años , Terapia Combinada , Análisis Factorial , Femenino , Humanos , Vida Independiente , Extremidad Inferior/fisiopatología , Masculino , Fuerza Muscular/genética , Músculo Esquelético/fisiopatología , Entrenamiento de Fuerza/métodos , Sarcopenia/genética , Resultado del Tratamiento
6.
Trials ; 22(1): 518, 2021 Aug 04.
Artículo en Inglés | MEDLINE | ID: mdl-34348792

RESUMEN

BACKGROUND: Sarcopenia is accompanied by a decline in muscle mass, muscle strength, and muscle function. Resistance training is the most potential training method for the prevention and treatment of sarcopenia. However, the conventional high-load resistance training (CRT) recommended by the American College of Sports Medicine is a challenge for older people with sarcopenia. As a novel training method, low-load resistance training combined with blood flow restriction (LRT-BFR) may elicit similar muscle mass and muscle strength gains as CRT but with less effort. The objectives of this study are to assess and compare the efficacy and safety of 12-week LRT-BFR and CRT on muscle strength, muscle performance, body composition, pulmonary function, blood biomarkers, CVD risk factors, and quality of life in community-dwelling older Chinese people with sarcopenia. METHOD: This is a 12-week, assessor-blinded, 3-arm randomized controlled trial with a non-exercise control group. Community-dwelling people over 65 years will be screened for sarcopenia according to the diagnostic criteria of the Asian Working Group for Sarcopenia (AWGS). Fifty-one subjects will be randomized into a LRT-BFR group (n = 17), a CRT group (n = 17), and a no-strength training control group (n = 17). The primary outcome is lower limb muscle strength. The secondary outcomes are body composition, upper limb muscle strength, pulmonary function, blood biomarkers, CVD risk factors, and quality of life. Post-intervention follow-up will be performed for 12 weeks. These indicators will be assessed at baseline (0 week), after the 12-week intervention (12 weeks), and at follow-up (24 weeks). The adverse events will also be reported. Data will be analyzed for all participants in an intent-to-treat plan. DISCUSSION: This study is the first RCT that will systematically measure and compare the efficacy and safety of LRT-BFR and CRT in older people with sarcopenia on muscle strength, body composition, pulmonary function, blood biomarkers (inflammatory biomarkers, hormone, and growth factors), CVD risk factors, and quality of life. This study can provide an efficient and safe method to prevent the progression of sarcopenia in older people. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100042803 . Registered on 28 January 2021.


Asunto(s)
Entrenamiento de Fuerza , Sarcopenia , Anciano , China , Humanos , Vida Independiente , Fuerza Muscular , Músculo Esquelético , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Sarcopenia/diagnóstico , Sarcopenia/terapia
7.
J Stroke Cerebrovasc Dis ; 30(9): 105958, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34303088

RESUMEN

BACKGROUND: Loss of skeletal muscle is a critical health issue that frequently occurs due to aging and various pathologies. No studies have reported increases in appendicular skeletal muscle mass among elderly patients after stroke. Our hypothesis was that even older individuals after stroke could increase skeletal muscle mass by rehabilitation. OBJECTIVES: This study aimed to evaluate changes to skeletal muscle mass in elderly patients after stroke rehabilitation and to assess factors associated with skeletal muscle mass increases. MATERIALS AND METHODS: Participants in this case-control study were 159 patients ≥ 80 years old in rehabilitation wards after stroke. Body mass index (BMI), appendicular skeletal muscle index (SMI), Functional Independence Measure (FIM), interval from onset to transfer, presence of hemiplegia, National Institutes of Health Stroke Scale (NIHSS), length of hospital stay for rehabilitation, period of exercise therapy per day, and protein intake were examined. Multivariate logistic regression analysis was performed to identify association between these values and SMI increases. RESULTS: SMI at discharge was significantly increased (5.30 kg/m2) compared to baseline (5.20kg/m2; p = 0.002). Multiple logistic regression analysis showed that length of hospital stay and protein intake were significantly associated with SMI increases, with odds ratios of 1.013 (95% confidence interval, 1.005-1.022) and 3.746 (95% confidence interval, 1.077-13.028), respectively. CONCLUSIONS: The SMI of patients ≥ 80 years old increased significantly with rehabilitation after stroke. In addition, length of hospital stay and protein intake were independently associated with increases in SMI.


Asunto(s)
Composición Corporal , Terapia por Ejercicio , Fragilidad/terapia , Músculo Esquelético/fisiopatología , Sarcopenia/terapia , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/terapia , Anciano de 80 o más Años , Estudios de Casos y Controles , Proteínas en la Dieta/administración & dosificación , Impedancia Eléctrica , Femenino , Anciano Frágil , Fragilidad/diagnóstico , Fragilidad/fisiopatología , Hospitalización , Humanos , Pacientes Internos , Tiempo de Internación , Masculino , Tamaño de los Órganos , Sarcopenia/diagnóstico , Sarcopenia/fisiopatología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento
8.
BMJ Open ; 11(7): e045604, 2021 07 02.
Artículo en Inglés | MEDLINE | ID: mdl-34215601

RESUMEN

INTRODUCTION: Osteosarcopenia is defined as the concomitant occurrence of sarcopenia and osteopenia or osteoporosis. Older adults with this syndrome have a greater fragility and mortality risk compared with those without these conditions. Based on separate interventions with individuals with sarcopenia and osteoporosis, exercise has been recommended as a treatment for osteosarcopenia. However, there is no evidence of its efficacy. Our objective is to identify whether physical exercise can improve osteosarcopenia in older adults and lead to good health outcomes. METHODS AND ANALYSIS: We will perform a systematic review in the following databases: PubMed, Embase, Cochrane and Scopus. The criterion of inclusion will be clinical trials involving physical exercise interventions in older adults diagnosed with osteosarcopenia. To assess the risk of bias, the Grading of Recommendations, Assessment, Development and Evaluation and Downs and Black tools will be used. For each search result, the quality of the evidence will ultimately receive one of four grades: high, moderate, low or very low. The outcome of this study is to demonstrate the effectiveness of physical exercise in improving the parameters that lead to the diagnosis of osteosarcopenia (bone mineral density, quality of muscle mass, muscle strength and physical function) in older adults. The possibility of meta-analysis will be assessed according to the homogeneity of the studies, using the methods of fixed or random effects. Sensitivity analyses will be performed, and the funnel plot will be used to assess publication bias. The proposed statistical analyses will be performed using STATA software, V.14.0. ETHICS AND DISSEMINATION: The results of the systematic review will be disseminated via publication in a peer-reviewed journal and presented at a relevant conference. As we will not use individual patient data, ethical approval is not required. TRIAL REGISTRATION NUMBER: CRD42020215659.


Asunto(s)
Enfermedades Óseas Metabólicas , Osteoporosis , Sarcopenia , Anciano , Densidad Ósea , Ejercicio Físico , Humanos , Metaanálisis como Asunto , Osteoporosis/terapia , Sarcopenia/terapia , Revisiones Sistemáticas como Asunto
9.
Ageing Res Rev ; 70: 101401, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34237434

RESUMEN

Malnutrition, in particular protein-energy malnutrition, is a highly prevalent condition in older adults, and is associated with low muscle mass and function, and increased prevalence of physical frailty. Malnutrition is often exacerbated in the residential care setting due to factors including lack of dentition and appetite, and increased prevalence of dementia and dysphagia. This review aims to provide an overview of the available literature in older adults in the residential care setting regarding the following: links between sarcopenia, frailty, and malnutrition (in particular, protein-energy malnutrition (PEM)), recognition and diagnosis of malnutrition, factors contributing to PEM, and the effectiveness of different forms of protein supplementation (in particular, oral nutritional supplementation (ONS) and protein-fortified foods (PFF)) to target PEM. This review found a lack of consensus on effective malnutrition diagnostic tools and lack of universal requirement for malnutrition screening in the residential care setting, making identifying and treating malnutrition in this population a challenge. When assessing the use of protein supplementation in the residential care setting, the two primary forms of supplementation were ONS and PFF. There is evidence that ONS and PFF increase protein and energy intakes in residential care setting, yet compliance with supplementation and their impact on functional status is unclear and conflicting. Further research comparing the use of ONS and PFF is needed to fully determine feasibility and efficacy of protein supplementation in the residential care setting.


Asunto(s)
Fragilidad , Desnutrición , Desnutrición Proteico-Calórica , Sarcopenia , Anciano , Suplementos Dietéticos , Ingestión de Energía , Humanos , Desnutrición/diagnóstico , Desnutrición/epidemiología , Desnutrición/terapia , Estado Nutricional , Desnutrición Proteico-Calórica/diagnóstico , Desnutrición Proteico-Calórica/epidemiología , Desnutrición Proteico-Calórica/terapia , Sarcopenia/diagnóstico , Sarcopenia/epidemiología , Sarcopenia/terapia
10.
J Stroke Cerebrovasc Dis ; 30(9): 105941, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34217068

RESUMEN

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.


Asunto(s)
Composición Corporal , Músculo Esquelético/fisiopatología , Sarcopenia/diagnóstico , Accidente Cerebrovascular/diagnóstico , Anciano , Anciano de 80 o más Años , Evaluación de la Discapacidad , Impedancia Eléctrica , Femenino , Estado Funcional , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Actividad Motora , Tamaño de los Órganos , Valor Predictivo de las Pruebas , Pronóstico , Recuperación de la Función , Sarcopenia/fisiopatología , Sarcopenia/terapia , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia , Rehabilitación de Accidente Cerebrovascular , Factores de Tiempo
11.
Nutrients ; 13(5)2021 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-34062828

RESUMEN

The present study aimed to determine the effect of detraining on muscle quality (MQ) in older men with osteosarcopenia. Forty-three community-dwelling older men (78 ± 4 years) were randomly allocated to a consistently supervised high-intensity resistance exercise training (HIRT) group (n = 21) or a control group (CG, n = 22). The HIRT scheduled a periodized single set protocol twice weekly. After the intervention, the men were subjected to six months of detraining. Muscle quality (MQ), defined as maximum isokinetic hip/leg extensor strength per unit of mid-thigh intra-fascia volume, was determined by magnetic resonance imaging (MRI) or per unit of thigh muscle mass assessed by dual-energy X-ray absorptiometry (DXA). Intention-to-treat analysis with multiple imputations was applied. We observed significant exercise effects for MQ (p = 0.001). During detraining, the HIRT group lost about one-third of the intervention-induced gain and displayed significantly (p = 0.001) higher MQ reductions compared to the CG. Nevertheless, after training and detraining, the overall intervention effect on MQ remained significant (p ≤ 0.004). In summary, six months of absence from HIRT induce a significant deleterious effect on MQ in older osteosarcopenic men. We conclude that intermitted training programs with training breaks of six months and longer should be replaced by largely continuous exercise programs, at least when addressing MQ parameters.


Asunto(s)
Enfermedades Óseas Metabólicas/fisiopatología , Fuerza Muscular/fisiología , Entrenamiento de Fuerza/métodos , Sarcopenia/fisiopatología , Privación de Tratamiento , Absorciometría de Fotón , Anciano , Anciano de 80 o más Años , Enfermedades Óseas Metabólicas/diagnóstico por imagen , Enfermedades Óseas Metabólicas/terapia , Femenino , Estudios de Seguimiento , Humanos , Vida Independiente , Imagen por Resonancia Magnética , Masculino , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/fisiopatología , Sarcopenia/diagnóstico por imagen , Sarcopenia/terapia , Muslo/diagnóstico por imagen , Muslo/fisiopatología , Factores de Tiempo
12.
Nutrients ; 13(5)2021 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-34063269

RESUMEN

Life extension in modern society has introduced new concepts regarding such disorders as frailty and sarcopenia, which has been recognized in various studies. At the same time, cutting-edge technology methods, e.g., renal replacement therapy for conditions such as hemodialysis (HD), have made it possible to protect patients from advanced lethal chronic kidney disease (CKD). Loss of muscle and fat mass, termed protein energy wasting (PEW), has been recognized as prognostic factor and, along with the increasing rate of HD introduction in elderly individuals in Japan, appropriate countermeasures are necessary. Although their origins differ, frailty, sarcopenia, and PEW share common components, among which skeletal muscle plays a central role in their etiologies. The nearest concept may be sarcopenia, for which diagnosis techniques have recently been reported. The focus of this review is on maintenance of skeletal muscle against aging and CKD/HD, based on muscle physiology and pathology. Clinically relevant and topical factors related to muscle wasting including sarcopenia, such as vitamin D, myostatin, insulin (related to diabetes), insulin-like growth factor I, mitochondria, and physical inactivity, are discussed. Findings presented thus far indicate that in addition to modulation of the aforementioned factors, exercise combined with nutritional supplementation may be a useful approach to overcome muscle wasting and sarcopenia in elderly patients undergoing HD treatments.


Asunto(s)
Suplementos Dietéticos , Ejercicio Físico , Desnutrición Proteico-Calórica/fisiopatología , Insuficiencia Renal Crónica/fisiopatología , Sarcopenia/fisiopatología , Anciano , Anciano de 80 o más Años , Fenómenos Fisiológicos Nutricionales del Anciano , Femenino , Humanos , Japón , Masculino , Músculo Esquelético/fisiopatología , Desnutrición Proteico-Calórica/etiología , Desnutrición Proteico-Calórica/terapia , Diálisis Renal/efectos adversos , Insuficiencia Renal Crónica/terapia , Sarcopenia/etiología , Sarcopenia/terapia
13.
Nat Rev Endocrinol ; 17(9): 534-548, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34172940

RESUMEN

The past 50 years have seen a growing ageing population with an increasing prevalence of type 2 diabetes mellitus (T2DM); now, nearly half of all individuals with diabetes mellitus are older adults (aged ≥65 years). Older adults with T2DM present particularly difficult challenges. For example, the accentuated heterogeneity of these patients, the potential presence of multiple comorbidities, the increased susceptibility to hypoglycaemia, the increased dependence on care and the effect of frailty all add to the complexity of managing diabetes mellitus in this age group. In this Review, we offer an update on the key pathophysiological mechanisms associated with T2DM in older people. We then evaluate new evidence relating particularly to the effects of frailty and sarcopenia, the clinical difficulties of age-associated comorbidities, and the implications for existing guidelines and therapeutic options. Our conclusions will focus on the effect of T2DM on an ageing society.


Asunto(s)
Envejecimiento/fisiología , Diabetes Mellitus Tipo 2/terapia , Factores de Edad , Anciano , Anciano de 80 o más Años , Comorbilidad , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Fragilidad/complicaciones , Fragilidad/epidemiología , Fragilidad/terapia , Humanos , Prevalencia , Sarcopenia/complicaciones , Sarcopenia/epidemiología , Sarcopenia/terapia
14.
Geriatr Gerontol Int ; 21(8): 614-622, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34151494

RESUMEN

AIMS: To provide a pathophysiological basis for distinguishing metabolic variants of the frailty phenotype in older adults with type 2 diabetes. METHODS: We have made an in-depth review of the possible mechanisms in diabetes, ageing and frailty that will alter allow us to describe phenotypic changes which might assist in predicting responses to particular glucose-lowering therapy. RESULTS: Our review has enable us to describe with some confidence a sarcopenic obese phenotype and an anorexic malnourished phenotype. CONCLUSIONS: By identifying these two phenotypes we can predict which would be most responsive to certain classes of therapy and where therapies may be ill-advised. This represents the first novel approach in this area. Further work is being planned to develop this hypothesis. Geriatr Gerontol Int 2021; 21: 614-622.


Asunto(s)
Diabetes Mellitus Tipo 2 , Fragilidad , Sarcopenia , Anciano , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/terapia , Anciano Frágil , Fragilidad/diagnóstico , Humanos , Fenotipo , Sarcopenia/diagnóstico , Sarcopenia/terapia
15.
J Frailty Aging ; 10(3): 226-232, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34105705

RESUMEN

Detection of sarcopenia in primary care is a first and essential step in community-dwelling older adults before implementing preventive interventions against the onset of disabling conditions. In fact, leaving this condition undiagnosed and untreated can impact on the individual's quality of life and function, as well as on healthcare costs. This article summarizes the many instruments today available for promoting an earlier and prompter detection of sarcopenia in primary care, combining insights about its clinical management. Primary care physicians may indeed play a crucial role in the identification of individuals exposed to the risk of sarcopenia or already presenting this condition. To confirm the suspected diagnosis, several possible techniques may be advocated, but it is important that strategies are specifically calibrated to the needs, priorities and resources of the setting where the evaluation is conducted. To tackle sarcopenia, nutritional counselling and physical activity programs are today the two main interventions to be proposed. Multicomponent and personalized exercise programs can (and should) be prescribed by primary care physicians, taking advantage of validated programs ad hoc designed for this purpose (e.g., the Vivifrail protocol). It is possible that, in the next future, new pharmacological treatments may become available for tackling the skeletal muscle decline. These will probably find application in those individuals non-responding to lifestyle interventions.


Asunto(s)
Sarcopenia , Anciano , Humanos , Fuerza Muscular , Músculo Esquelético , Atención Primaria de Salud , Calidad de Vida , Sarcopenia/diagnóstico , Sarcopenia/terapia
16.
Medicine (Baltimore) ; 100(24): e26421, 2021 Jun 18.
Artículo en Inglés | MEDLINE | ID: mdl-34128906

RESUMEN

INTRODUCTION: Spinal sarcopenia is a multifactorial disorder associated with the atrophy of and fatty changes to the paraspinal muscles. We previously developed the concept of spinal sarcopenia in community-dwelling older adults and investigated the association between conventional sarcopenic indices and spinal sarcopenia. However, interventional studies of spinal sarcopenia are lacking. This pilot study will aim to evaluate the effectiveness of a combined exercise and nutrition intervention for treating spinal sarcopenia. METHODS AND ANALYSIS: This open-label single-arm prospective study will include 35 community-dwelling older women who were diagnosed with spinal sarcopenia in our previous cohort study. The 12-week combined intervention will consist of back extensor strengthening exercise and nutritional supplementation. The primary outcome of this study will be isometric back extensor strength after the 12-week intervention. All functional and radiographic outcomes will be measured at 0, 12, and 24 weeks post-intervention. The data will be analyzed using the intention-to-treat principle.


Asunto(s)
Suplementos Dietéticos , Terapia por Ejercicio/métodos , Músculos Paraespinales/patología , Entrenamiento de Fuerza , Sarcopenia/terapia , Anciano , Femenino , Humanos , Vida Independiente , Fuerza Muscular , Proyectos Piloto , Sarcopenia/dietoterapia
17.
BMC Geriatr ; 21(1): 314, 2021 05 17.
Artículo en Inglés | MEDLINE | ID: mdl-34001023

RESUMEN

BACKGROUND: The rapidly aging societies worldwide and in Singapore present a unique challenge, requiring an integrated multidisciplinary approach to address high-value targets such as muscle health. We propose pragmatic evidence-based multidisciplinary consensus recommendations for the assessment and multi-modal management of muscle health in older adults (≥65 years) across the continuum of care. METHODS: The recommendations are derived from an in-depth review of published literature by a multidisciplinary working group with clinical experience in the care of the older population in both acute and community settings. RESULTS: The panel recommends screening for muscle impairment using the SARC-F questionnaire, followed by assessment for low muscle strength (handgrip strength or 5-times chair stand test ≥10 s as a surrogate for lower limb strength) to diagnose possible/probable sarcopenia. For uncomplicated cases, lifestyle modifications in exercise and diet can be initiated in the community setting without further assessment. Where indicated, individuals diagnosed with possible/probable sarcopenia should undergo further assessment. Diagnosis of sarcopenia should be based on low muscle strength and low muscle mass (bioimpedance analysis, dual-energy X-ray absorptiometry or calf circumference as a surrogate). The severity of sarcopenia should be determined by assessment of physical performance (gait speed or 5-times chair stand test ≥12 s as a surrogate for gait speed). To treat sarcopenia, we recommend a combination of progressive resistance-based exercise training and optimization of nutritional intake (energy, protein and functional ingredients). High quality protein in sufficient quantity, to overcome anabolic resistance in older adults, and distributed throughout the day to enable maximum muscle protein synthesis, is essential. The addition of resistance-based exercise training is synergistic in improving the sensitivity of muscle protein synthesis response to the provision of amino acids and reducing anabolic resistance. An expected dose-response relationship between the intensity of resistance-based training, lean mass and muscle strength is described. CONCLUSIONS: Reviewed and endorsed by the Society of Rehabilitation Medicine Singapore and the Singapore Nutrition and Dietetics Association, these multidisciplinary consensus recommendations can provide guidance in the formulation of comprehensive and pragmatic management plans to improve muscle health in older adults in Singapore and Asia.


Asunto(s)
Fuerza de la Mano , Sarcopenia , Anciano , Asia , Consenso , Humanos , Fuerza Muscular , Músculo Esquelético/patología , Sarcopenia/diagnóstico , Sarcopenia/patología , Sarcopenia/terapia , Singapur/epidemiología
18.
Nihon Ronen Igakkai Zasshi ; 58(2): 175-182, 2021.
Artículo en Japonés | MEDLINE | ID: mdl-34039791
19.
Exp Gerontol ; 151: 111420, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34029642

RESUMEN

BACKGROUND: In 2018, the European Working Group on Sarcopenia in Older People (EWGSOP) updated the definition and the diagnosis criteria of sarcopenia. Previous systematic reviews have shown the effect of exercise on sarcopenia including people with different sarcopenia diagnostic criteria. OBJECTIVE: This systematic review and meta-analysis aims to summarise and synthesise the evidence about the effect of exercise on muscle mass, strength and physical performance in older adults with sarcopenia according to the EWGSOP criteria. METHODS: Major electronic databases were searched for articles published until September 2020. Randomised controlled trials (RCTs) and non-randomised interventional studies examining the effect of exercise on muscle mass, strength or physical performance in adults older than 60 years with sarcopenia according to the EWGSOP criteria were included. RESULTS: Four RCTs and three non-randomised interventional studies with a total of 235 patients with sarcopenia were included. Five of the seven included studies reported a low risk of bias. Exercise showed a large effect on physical performance (d = 1.21, 95%CI [0.79 to 1.62]; P < 0.001), a medium effect on muscle strength (d = 0.51, 95%CI [0.25 to 0.76]; P < 0.001), and no effect on muscle mass (d = 0.27, 95%CI [-0.05 to 0.58]; P = 0.10). CONCLUSION: The present systematic review showed an effect of exercise on physical performance and muscle strength but an inconsistent effect on muscle mass. The grading of recommendations assessment, development and evaluation criteria showed a low level of evidence in muscle mass, a low or moderate level of evidence in muscle strength and a high level of evidence in physical performance.


Asunto(s)
Sarcopenia , Anciano , Ejercicio Físico , Fuerza de la Mano , Humanos , Fuerza Muscular , Músculo Esquelético , Músculos , Rendimiento Físico Funcional , Sarcopenia/diagnóstico , Sarcopenia/terapia
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