A case of gastric adenocarcinoma with pyloric gland-type infiltrating submucosa.

BACKGROUND: The development of immunohistochemical staining has revealed that gastric adenocarcinoma with the gastric phenotype can be divided into the foveolar, fundic gland, and pyloric gland phenotypes. Gastric adenocarcinoma of the pyloric gland type is difficult to diagnose using biopsy because of its low atypia and rarity. Herein, we describe a case of gastric adenocarcinoma of the pyloric gland type that was diagnosed immunohistochemically after endoscopic resection. CASE PRESENTATION: A 67-year-old man was referred to our hospital for the diagnosis and treatment of a 30-mm elevated lesion on the lesser curvature side of the middle of the gastric body. Although four biopsies were performed, it was difficult to determine whether the lesion was benign or malignant. Therefore, endoscopic submucosal dissection was performed, and the presence of tumor cells infiltrating the submucosa with venous invasions was identified. Immunohistochemical staining revealed that the tumor cells were positive for MUC5AC and MUC6 and negative for Pepsinogen I and H + /K + -ATPase. From the above findings, he was diagnosed as having gastric adenocarcinoma with pyloric gland type. The patient underwent a laparoscopic distal gastrectomy and was discharged without any adverse events. CONCLUSIONS: Gastric adenocarcinoma of the pyloric gland type is a rare disease, and endoscopic resection can serve as a viable diagnostic option for this condition when it is difficult to diagnose using biopsy. Immunohistochemical pathology images can aid in the diagnosis of gastric adenocarcinoma of the pyloric gland type.

Association between adductor pollicis muscle thickness and low skeletal muscle mass index in community-dwelling older women undergoing outpatient rehabilitation.

OBJECTIVE: The performance of sarcopenia diagnosis using adductor pollicis muscle thickness (APMT) has been reported. However, the relationship between APMT and low skeletal muscle mass index (SMI) is unclear. The purpose of this study is to investigate the relationship between APMT and low SMI and APMT performance to diagnose low SMI in community-dwelling older women undergoing outpatient rehabilitation. METHODS: This study included 65 older women (mean age: 86.4 years). Subjects were received outpatient rehabilitation one to three times a week. The main outcomes were low SMI as diagnosed using the Asian working group for sarcopenia 2019 and APMT. Logistic regression analysis was performed with low SMI as the dependent variable, APMT, and propensity score calculated using age, sex, number of medications, and updated Charlson comorbidity index as the independent variable. A receiver operating characteristic (ROC) curve of APMT for low SMI was created. A cut-off value was calculated using the Youden index. RESULTS: Among the 65 subjects, 45 (69.2 %) had low SMI. The results of the logistic regression analysis showed a significant association between APMT and low SMI (odds ratio: 0.482 {95 % confidence interval [CI]: 0.313-0.744}). The cut-off value of APMT calculated from the ROC curve was 13 mm. The sensitivity and specificity of this cut-off value were 0.800 (95 % CI: 0.654-0.904) (36 out of 45 subjects) and 0.850 (95 % CI: 0.621-0.968) (17 out of 20 subjects), respectively. The positive predictive value, negative predictive value, and area under the curve were 0.923 (95 % CI: 0.791-0.984), 0.654 (95 % CI: 0.443-0.828), and 0.843 (95 % CI: 0.731-0.955), respectively. The APMT cut-off value of 13 mm is good to identify low SMI. CONCLUSIONS: The results of this study show that APMT is associated with low SMI. Furthermore, the cut-off value of APMT for diagnosing low SMI was 13 mm. The APMT cut-off value of 13 mm is good to identify low SMI. Our findings indicate that measuring APMT is useful for diagnosing low SMI in community-dwelling older women undergoing outpatient rehabilitation.

Influence of aging on extracellular water-to-total body water ratio in community-dwelling females.

BACKGROUND & AIMS: The European Working Group of Sarcopenia in Older People 2 has emphasized the significance of evaluating not only muscle mass but also muscle quality as a diagnostic criterion for sarcopenia. The extracellular water-to-total body water ratio (ECW/TBW), measured using bioelectrical impedance analysis (BIA), has recently received attention as an indicator of muscle quality. However, the influence of aging on the ECW/TBW remains unclear. If ECW/TBW increases with age, it is important to know whether the timing of the decrease in SMI and the increase in ECW/TBW are the same or different. This study aimed to investigate the influence of aging on ECW/TBW in community-dwelling females. METHODS: This cross-sectional study included 237 community-dwelling females aged 20-89 years who could perform activities of daily living independently. ECW/TBW and SMI were measured using BIA. Multiple linear regression analyses of ECW/TBW and SMI were conducted. Age, body mass index (BMI), number of medications, pain, and medical history were considered independent variables in the multiple linear regression. The participants were divided into three (20-39, 40-64, and 65-89 years) or four (20-39, 40-64, 65-74, and 75-89 years) groups based on age. Analysis of covariance adjusted for the BMI, number of medications, pain, and medical history was conducted to determine the differences in ECW/TBW and SMI among the three or four groups. RESULTS: In the multiple linear regression analysis, age was significantly and independently associated with ECW/TBW and SMI. When the participants were divided into three groups based on age, an increase in ECW/TBW and a decrease in SMI in the 65-89-year group were confirmed compared with the 20-39 and 40-64-year groups. When the participants were divided into four groups based on age, an increase in ECW/TBW in the 75-89-year group was confirmed compared with the 65-74-year group. However, there were no significant differences in SMI among the four groups. CONCLUSIONS: This study revealed that ECW/TBW increases with aging in community-dwelling females. Moreover, the negative influences of aging were confirmed earlier in ECW/TBW than in SMI. Assessing muscle mass alone may not be adequate to capture the influences of aging on muscle composition, and evaluating ECW/TBW may be crucial for diagnosing sarcopenia.

Association between anorexia as assessed by simplified nutritional appetite questionnaire and sarcopenia in community-dwelling older adults using outpatient rehabilitation: A cross-sectional study.

OBJECTIVE: A previous study reported an association between sarcopenia and anorexia determined by the simplified nutritional appetite questionnaire (SNAQ) in community-dwelling older adults. However, it is unclear in the community-dwelling older adults who are using outpatient rehabilitation. The purpose of this study was to investigate the relationship between anorexia and sarcopenia as judged by SNAQ in community-dwelling older adults using outpatient rehabilitation. METHODS: This study included 120 older adults (72.5% female). Subjects were provided outpatient rehabilitation one to three times a week. The main outcome was sarcopenia as determined using the Asian working group for sarcopenia 2019. The simplified nutritional appetite questionnaire (SNAQ) was used to assess anorexia. The SNAQ total score range from 4 (worst) to 20 (best), with 13 score and lower considered to indicate anorexia. Statistical analysis was performed by forced-entry logistic regression analysis with sarcopenia as the dependent variable, body mass index (BMI), food intake level scale, anorexia, and propensity score calculated using age, sex, number of medications, updated Charlson comorbidity index as the independent variable. RESULTS: Sarcopenia was observed in 79 of 120 subjects (65.8%). Anorexia was observed in 28 subjects (23.3%). Logistic regression analysis revealed BMI (odds ratio: 0.71 [95% CI: 0.61-0.84]), anorexia (odds ratio: 5.35 [95% CI: 1.24-23.2]) were extracted as a significant variable. CONCLUSIONS: The results of this study show that anorexia as determined by the SNAQ is associated with sarcopenia in community-dwelling older adults using outpatient rehabilitation. This indicates the importance of understanding anorexia in assessing sarcopenia in community-dwelling older adults who are using outpatient rehabilitation.

Increased intramuscular adipose tissue of the quadriceps at admission is more strongly related to activities of daily living recovery at discharge compared to muscle mass loss in older patients with aspiration pneumonia.

BACKGROUND: Recent studies reported that an increase in intramuscular adipose tissue of the quadriceps in older patients negatively affects the recovery of activities of daily living (ADL) more than the loss of muscle mass. However, whether intramuscular adipose tissue of the quadriceps in older patients with aspiration pneumonia is related to ADL recovery remains unclear. This study aimed to determine the relationship between intramuscular adipose tissue of the quadriceps and ADL recovery in older patients with aspiration pneumonia. METHODS: Thirty-nine older inpatients who were diagnosed with aspiration pneumonia participated in this prospective study. The main outcome of this study was ADL at discharge. ADL were assessed using the Barthel Index (BI). The intramuscular adipose tissue and muscle mass of the quadriceps were evaluated at admission using echo intensity and muscle thickness observed on ultrasound images. A multiple linear regression analysis was performed to confirm whether the quadriceps echo intensity was related to the BI score at discharge, even after adjusting for confounding factors. RESULTS: The medians [interquartile range] of the BI score at admission and discharge were 15.0 [0.0-35.0] and 20.0 [5.0-55.0], respectively. The BI score at discharge was significantly higher than that at admission (p = 0.002). The quadriceps echo intensity (ß = - 0.374; p = 0.036) and BI score at admission (ß = 0.601; p < 0.001) were independently and significantly related to the BI score at discharge (R2 = 0.718; f2 = 2.546; statistical power = 1.000). In contrast, the quadriceps thickness (ß = - 0.216; p = 0.318) was not independently and significantly related to the BI score at discharge. CONCLUSIONS: Increased intramuscular adipose tissue of the quadriceps at admission is more strongly and negatively related to ADL recovery at discharge than the loss of muscle mass among older patients with aspiration pneumonia. Interventions targeting the intramuscular adipose tissue of the quadriceps may improve ADL among these patients.

Increase in protein intake is related to decreasing intramuscular adipose tissue of the quadriceps in older inpatients: A longitudinal study.

BACKGROUND & AIM: Several randomized controlled trials indicated that an increase in protein intake decreases intramuscular adipose tissue of the thigh in mobility-limited or pre-frail older persons and stroke patients. However, whether the increase in protein intake in older inpatients is related to decreasing intramuscular adipose tissue remains unclear. The aim of this study was to examine the longitudinal relationship between intramuscular adipose tissue of the quadriceps and protein intake in older inpatients. METHODS: This longitudinal study included 193 older inpatients (aged ≥65 years) (median [IQR] age: 83.0 [77.0-88.0]). The primary outcomes were changes in intramuscular adipose tissue of the quadriceps and protein intake. Intramuscular adipose tissue and muscle mass of the quadriceps were examined using ultrasound images (i.e., quadriceps echo intensity and thickness). The changes in quadriceps echo intensity and protein intake were calculated by subtracting the quadriceps echo intensity and protein intake at admission from those values at discharge. Multiple linear regression analysis adjusting for confounding factors was used to determine whether the change in protein intake was independently and significantly related to changes in quadriceps echo intensity and thickness. RESULTS: Quadriceps echo intensity at discharge (81.3 ± 20.6 [a.u.]) was significantly lower than at admission (84.0 ± 20.5 [a.u.]). Protein intake at discharge (1.2 [1.0-1.4] g/kg/day) was significantly higher than at admission (1.2 [0.9-1.4] g/kg/day). Change in protein intake was negatively and significantly related to the change in quadriceps echo intensity. In contrast, change in protein intake was not independently and significantly related to change in quadriceps thickness. CONCLUSIONS: Our results indicate that an increase in protein intake is related to a decrease in intramuscular adipose tissue of the quadriceps in older inpatients. Nutritional intervention for increasing protein intake in older inpatients may be essential for decreasing intramuscular adipose tissue of the quadriceps.

Relationship between Nutritional Status Evaluated by Mini Nutritional Assessment Short-Form and Activities of Daily Living after 1 Year in Community-Dwelling Older Adults Using Outpatient Rehabilitation.

OBJECTIVE: This study aimed to investigate the association between nutritional status assessed by the Mini Nutritional Assessment Short-Form (MNA-SF) and activities of daily living (ADL) after 1 year and changes in ADL among community-dwelling older adults. METHODS: This study included 95 community-dwelling older adults using outpatient rehabilitation (74.7% female). ADL was assessed using the Barthel index (BI), and the MNA-SF was used to assess nutritional status. Multiple regression analysis was performed with the BI after 1 year as the objective variable and MNA-SF, age, sex, updated Charlson comorbidity index, number of medications, body mass index, Food Intake Level Scale (FILS), and baseline BI as independent variables. Logistic regression analysis was performed with improvement or deterioration in ADL as the objective variable. RESULTS: The results of multiple regression analysis with BI after 1 year as the objective variable indicated that baseline BI, FILS, and MNA-SF were significant variables (R2 = 0.835). The results of the logistic regression analysis with ADL improvement/deterioration as the objective variable indicated only MNA-SF as a significant variable (odds ratio: 0.663 [95% CI: 0.528-0.923]). CONCLUSIONS: These results indicate that the MNA-SF was related to changes in ADL and ADL after 1 year among community-dwelling older adults.

Greater intramuscular adipose tissue of the quadriceps in older inpatients at post-acute hospital admission is more strongly related to a low rate of home discharge than a loss of muscle mass.

This study aimed to examine the relationships between intramuscular adipose tissue and muscle mass of the quadriceps at post-acute hospital admission and the low rate of home discharge. This prospective study included 389 inpatients aged ≥ 65 years. Patients were divided into two groups according to the destination: home discharge (n = 279) and no-home discharge (n = 110) groups. The primary outcome was hospital discharge destination (home discharge or not). Intramuscular adipose tissue and muscle mass of the quadriceps were assessed at post-acute hospital admission using echo intensity and muscle thickness on ultrasound images, respectively. Logistic regression analysis was used for determining whether quadriceps echo intensity is related to home discharge. Quadriceps echo intensity was significantly and independently associated with home discharge (odds ratio [per 1 SD increase] = 1.43, p = 0.045). Quadriceps thickness was not associated with home discharge (odds ratio [per 1 SD increase] = 1.00, p = 0.998). Our study indicates that greater intramuscular adipose tissue of the quadriceps in older inpatients at post-acute hospital admission is more strongly related to a low rate of home discharge than a loss of muscle mass.

Main causes of death in advanced biliary tract cancer.

BACKGROUND: There are no previous reports on the main causes of death in biliary tract cancer (BTC) patients. This study aimed to evaluate the main causes of death and survival rates in patients with BTC. METHODS: We retrospectively evaluated 143 patients who were diagnosed with unresectable BTC between August 2010 and March 2020. We classified the main causes of death based on laboratory data, imaging studies, and medical records. The main causes of death evaluated included liver failure, cholangitis, cachexia, other causes associated with tumor progression, and complications. We also analyzed survival rates for each main cause of death. RESULTS: After excluding patients who were lost to follow-up, living patients, and patients who had no records of laboratory data within 30 days before the date of death, 108 patients were analyzed. The main cause of death was cholangitis in 33 (30.6%), cachexia in 22 (20.4%), liver failure in 10 (9.3%), other causes associated with tumor progression in 18 (16.7%), and complications in 25 (23.2%) patients. Median overall survival (OS) was 334.0 days in the chemotherapy group and 75.0 days in the best supportive care (BSC) group. Survival analyzed according to the main cause of death was significantly different between the chemotherapy and BSC groups; OS for cachexia, cholangitis, liver failure, other causes associated with tumor progression, and complications, respectively, were 453.0, 499.0, 567.0, 205.0, and 327.5 days (p = 0.003) in the chemotherapy group and 219.0, 69.0, 34.0, 93.0, and 56.0 days (p = 0.001) in the BSC group. CONCLUSION: The main causes of death in patients with advanced BTC are cholangitis, cachexia, liver failure, other causes associated with tumor progression, and complications. Other causes associated with tumor progression in the chemotherapy group, and liver failure in the BSC group as the main causes of death shortened the survival of BTC patients.

Longitudinal relationship between muscle mass and intramuscular adipose tissue of the quadriceps in older inpatients at different activities of daily living levels.

BACKGROUND & AIMS: Whether there is a longitudinal relationship between muscle mass and intramuscular adipose tissue of the quadriceps at different activities of daily living (ADL) levels remains unclear. This study aimed to examine the longitudinal relationship between muscle mass and intramuscular adipose tissue of the quadriceps in older inpatients at different ADL levels. METHODS: This prospective cohort study was hospital-based and included 198 inpatients aged ≥65 years. Ultrasound images were acquired using B-mode ultrasound imaging. Muscle mass and intramuscular adipose tissue of the quadriceps were assessed based on muscle thickness and echo intensity, respectively. The changes in quadriceps thickness and echo intensity were calculated by subtracting these baseline values from these values at discharge. ADL were assessed at admission using the Barthel Index (BI). The participants were divided into the low BI (BI score <60) and high BI (BI score ≥60) groups in accordance with the BI score. Multiple regression analysis was performed to examine whether the change in quadriceps echo intensity was independently and significantly related to change in quadriceps thickness, even after adjusting for confounding factors in the total participants and high and low BI groups. RESULTS: The number of the high and low BI groups were 54 and 144. Change in quadriceps echo intensity was independently and significantly related to changes in quadriceps thickness of the total participants (ß = -0.53, p < 0.01) and low BI (ß = - 0.51, p < 0.01) and high BI (ß = -0.70, p < 0.01) groups. CONCLUSIONS: The results of this study indicate that there is a longitudinal negative relationship between muscle mass and intramuscular adipose tissue of the quadriceps in older inpatients regardless of ADL level. Intramuscular adipose tissue may be an important contributing factor for muscle mass.

Accuracy of determining sarcopenia using SARC-CalF in community-dwelling older adults aged 75 years and older.

OBJECTIVE: The accuracy of sarcopenia determination using SARC-CalF in community-dwelling older adults has been clarified in previous studies. However, this accuracy is unknown for subjects older than 75 years old. If this becomes clear, it will show the usefulness of using SARC-CalF in determining sarcopenia in community-dwelling older adults aged ≥75 years old. Thus, this study aimed to investigate the accuracy of sarcopenia determination using SARC-CalF in community-dwelling older adults aged ≥75 years old. METHODS: This study included 102 older adults aged ≥75 years old (74.5% female). Subjects were provided outpatient rehabilitation one to three times a week. The Asia Working Group for Sarcopenia 2019 standard was used to determine sarcopenia in participants. Logistic regression analysis was performed with sarcopenia as the dependent variable, and age, sex, and SARC-CalF as independent variables. When SARC-CalF was extracted as a significant variable, a receiver operating characteristic (ROC) curve was created. The cut-off value was calculated using the Youden index. RESULTS: Sarcopenia was observed in 65 of 102 subjects. Logistic regression analysis showed that only SARC-CalF was extracted as a significant variable (odds ratio: 1.18 [95% CI: 1.09-1.29]). The cut-off value calculated from the ROC curve was seven points. The sensitivity and specificity were 94.7% and 92.3%, respectively, and the area under the curve was 0.98. CONCLUSIONS: Our results indicate that SARC-CalF can accurately determine sarcopenia in older adults. A SARC-Calf cut-off value of seven may be more useful than 11 in determining sarcopenia in community-dwelling older adults aged ≥75 years old.

The degree of recovery in swallowing ability in older inpatients with aspiration pneumonia is related to intramuscular adipose tissue of the quadriceps than to muscle mass.

BACKGROUND & AIM: A recent study reported that the increase in intramuscular adipose tissue of the quadriceps in older inpatients is related to a decreasing degree of recovery in swallowing ability compared to the loss of muscle mass. However, whether the association remains true in case of aspiration pneumonia is unclear. Therefore, this study aimed to examine the relationship between the degree of recovery in swallowing ability and intramuscular adipose tissue in the quadriceps of older inpatients with aspiration pneumonia. METHODS: This prospective study included 39 older patients with aspiration pneumonia. Swallowing ability was assessed using the Food Intake Level Scale (FILS). The indicators for the degree of recovery in swallowing ability were FILS at discharge and change in FILS. A greater change in FILS indicates a greater improvement in swallowing ability. Intramuscular adipose tissue and muscle mass of the quadriceps were evaluated at admission using echo intensity and muscle thickness on ultrasound images, respectively. Multiple regression analysis was used to determine whether the echo intensity of the quadriceps was independently and significantly related to FILS at discharge and the change in FILS. Independent variables were age, sex, days from disease onset, echo intensity and muscle thickness of the quadriceps, subcutaneous fat thickness of the thigh, FILS at admission, and number of units of rehabilitation therapy. RESULTS: Echo intensity of the quadriceps (ß = -0.363, p = 0.012) and FILS at admission (ß = 0.556, p < 0.001) were independently and significantly associated with FILS at discharge (R2 = 0.760, f2 = 3.167, statistical power = 1.000). Similar variables (echo intensity of the quadriceps [ß = -0.498, p = 0.012] and FILS at admission [ß = -0.635, p < 0.001]) were independently and significantly related to change in FILS (R2 = 0.547, f2 = 1.208, statistical power = 0.998). Quadriceps muscle thickness was not independently and significantly related to FILS at discharge and change in FILS. CONCLUSION: Our results indicate that intramuscular adipose tissue of the quadriceps in older inpatients with aspiration pneumonia is more strongly related to the degree of recovery in swallowing ability (that is, swallowing ability at discharge and change in swallowing ability) than muscle mass, and patients who have high intramuscular adipose tissue of the quadriceps at admission have a lower degree of recovery in swallowing ability.

Increase in muscle mass of the quadriceps is related to decrease in intramuscular adipose tissue in convalescent stroke patients: A longitudinal study.

BACKGROUND & AIMS: A previous study indicated that an increase in muscle mass is related to a decrease in intramuscular adipose tissue in older peoples. However, the longitudinal relationship between muscle mass and intramuscular adipose tissue of stroke patients remains unclear. This study aimed to examine the longitudinal relationships between muscle mass and intramuscular adipose tissue of the quadriceps on the paretic and non-paretic sides in convalescent stroke patients. METHODS: This longitudinal study included 24 convalescent stroke patients. Ultrasound images were acquired at hospital admission and discharge using B-mode ultrasound imaging. Muscle mass and intramuscular adipose tissue of the quadriceps were evaluated with muscle thickness and echo intensity, respectively. Multiple regression analysis was performed to confirm whether changes in echo intensity of the quadriceps on the paretic and non-paretic sides were related to changes in muscle thickness of those. The age, sex, days from onset stroke, change in the subcutaneous fat thickness, and paretic lower extremity function were set as an independent variable. RESULTS: Change in echo intensity of the quadriceps on the paretic side (ß = - 0.55, p = 0.018) was independently and significantly associated with changes in muscle thickness of the quadriceps on the paretic side. Similarly, change in echo intensity of the quadriceps on the non-paretic side (ß = -0.55, p = 0.013) was independently and significantly associated with change in muscle thickness of the quadriceps on the non-paretic side. CONCLUSIONS: Our findings indicate that muscle mass and intramuscular adipose tissue of the quadriceps are strongly and negatively correlated and an increase in muscle mass of the quadriceps is related to a decrease in intramuscular adipose tissue on the paretic and non-paretic sides in convalescent stroke patients. Furthermore, we must recognize that convalescent stroke patients with a decrease in muscle mass have an increase in intramuscular adipose tissue.

Higher malnutrition risk in older inpatients who are referred to the department of rehabilitation is related to increase of intramuscular adipose tissue: A prospective study.

BACKGROUND & AIMS: A recent cross-sectional study reported that a higher intramuscular adipose tissue of the quadriceps is related to higher malnutrition risk in older inpatients. However, a longitudinal relationship between them in older inpatients remains unclear. This study aimed to examine the relationship between the malnutrition risk at hospital admission and change in quadriceps intramuscular adipose tissue induced during the hospital stay in older inpatients. METHODS: The inclusion criteria in this longitudinal study were older patients (aged ≥65 years) who were referred to the department of rehabilitation. Patients who died during a hospital stay, who underwent thigh amputation, and who had a hospital stay of <3 days or a lack of data were excluded from the study. Malnutrition risk at post-acute hospital admission was assessed using Geriatric Nutritional Risk Index (GNRI). Intramuscular adipose tissue and muscle mass of the quadriceps were assessed at hospital admission and discharge using echo intensity and muscle thickness on ultrasound images. The changes in quadriceps echo intensity and thickness were calculated by subtracting these baseline values from these values at discharge. Multiple regression analysis was performed to examine whether GNRI at admission is independently and significantly related to the quadriceps echo intensity and thickness at discharge and changes in quadriceps echo intensity and thickness. The independent variables were GNRI, age, sex, days from onset disease, disease, quadriceps echo intensity or thickness at admission, and change in quadriceps thickness. RESULTS: This study included 200 inpatients (median [interquartile range] age: 83.0 [77.0-88.0], 57.0% female). GNRI at admission was significantly and independently related to quadriceps echo intensity at discharge (ß = -0.136, p = 0.008) and change in quadriceps echo intensity (ß = -0.177, p = 0.008). In contrast, GNRI was not significantly and independently related to quadriceps thickness at discharge (ß = 0.087, p = 0.158) and change in quadriceps thickness (ß = 0.133, p = 0.158). CONCLUSIONS: Our results suggest that a higher malnutrition risk at post-acute hospital admission in older inpatients is related to an increase of intramuscular adipose tissue of the quadriceps during the hospital stay. Malnutrition risk at hospital admission in older inpatients is considered to be a predictor for an increase of intramuscular adipose tissue of the quadriceps during a hospital stay.

Extracellular water-to-total body water ratio is an essential confounding factor in bioelectrical impedance analysis for sarcopenia diagnosis in women.

PURPOSE: The extracellular water-to-total body water ratio (ECW/TBW) is used in bioelectrical impedance analysis (BIA) for measuring muscle mass; however, ECW/TBW may be affected by several factors common in older individuals. Here, we assessed the relationships of ECW/TBW with handgrip strength, gait speed, and skeletal muscle mass index (SMI) in older women. METHODS: In this cross-sectional study, 73 community-dwelling women aged ≥ 65 years who could independently perform activities of daily living were included. ECW/TBW was measured using direct segmental multifrequency BIA. The participants were divided into ECW/TBW < 0.40 (n = 54) and ECW/TBW ≥ 0.40 (n = 19) groups, with the latter indicating overhydration. SMI was calculated as appendicular skeletal muscle mass/(height)2 (kg/m2). The relationships of SMI with handgrip strength and gait speed were assessed using partial correlation coefficients. Age, number of medications, pain, and medical history were treated as control variables. RESULTS: The average age of participants was 77.6 ± 6.0 years. The SMI was significantly related to handgrip strength (partial correlation coefficient = 0.293, P = 0.016) but not to gait speed (partial correlation coefficient = - 0.183, P = 0.138). Similarly, the SMI of the ECW/TBW < 0.40 group was significantly related to handgrip strength (partial correlation coefficient = 0.372, P = 0.009) but not gait speed (partial correlation coefficient = - 0.267, P = 0.066); however, the SMI of the ECW/TBW ≥ 0.40 group was not related to either variable. CONCLUSION: ECW/TBW represents a confounding factor, which should be considered when using BIA for sarcopenia diagnosis.

Nutritional and swallowing statuses but not intramuscular adipose tissue and muscle mass are related to activities of daily living in older inpatients who are judged as severely low body mass index in the Global Leadership Initiative on Malnutrition criteria.

BACKGROUND & AIMS: Which factors are related to activities of daily living (ADL) in older inpatients who are judged as the severely low body mass index (BMI) in the Global Leadership Initiative on Malnutrition (GLIM) criteria is unclear. This study aimed to examine the related factors to ADL in older inpatients who are judged as severely low BMI in the GLIM criteria. METHODS: This cross-sectional study included 377 inpatients aged ≥70 years. We divided the participants into the following three groups: the severely low BMI group (<17.8 kg/m2) (n = 106), moderately low BMI group (≥17.8 to < 20.0 kg/m2) (n = 87), and normal BMI group (≥20.0 kg/m2) (n = 184). ADL were assessed using the motor-Functional Independence Measure (FIM). Multiple regression analyses were used to identify the factors independently associated with the motor-FIM score in each group. RESULTS: The Food Intake Level Scale (FILS) and Geriatric Nutritional Risk Index (GNRI) were significantly related to the motor-FIM score of the severely low BMI group. The FILS, GNRI, updated Charlson comorbidity index (UCCI), and quadriceps echo intensity were significantly related to the motor-FIM score of the moderately low BMI group. The FILS, GNRI, UCCI, quadriceps thickness, and subcutaneous fat thickness of the thigh were significantly related to the motor-FIM score of the normal BMI group. CONCLUSIONS: Our findings indicate that nutritional and swallowing statuses but not intramuscular adipose tissue and muscle mass are related to ADL in older inpatients who are judged as severely low BMI in the GLIM criteria. Intervention for nutritional and swallowing statuses may be prioritized over an exercise intervention to improve ADL of older inpatients who are judged as severely low BMI.

Relationship between muscle mass and fraction of intramuscular adipose tissue of the quadriceps in older inpatients.

BACKGROUND: In 2021, the International Society of Physical and Rehabilitation Medicine (ISPRM) special interest group on sarcopenia included the quadriceps thickness assessed with ultrasound image as an indicator of muscle mass in the diagnosis criteria of sarcopenia. If quadriceps echo intensity of older inpatients is to be a strong predictor of quadriceps thickness, muscle quality of the quadriceps may be estimated by the muscle mass when diagnosing sarcopenia using the criteria of ISPRM. OBJECTIVE: This study aimed to examine the association between muscle mass and fraction of intramuscular adipose tissue of the quadriceps in older inpatients. METHODS: This cross-sectional study included 399 inpatients aged ≥ 65 years. Primary outcomes were muscle mass and fraction of intramuscular adipose tissue of the quadriceps. Images were acquired using a B-mode ultrasound. Muscle mass and fraction of intramuscular adipose tissue of the quadriceps were assessed based on the muscle thickness and echo intensity, respectively. A multiple regression analysis (forced entry method) was performed to confirm whether quadriceps echo intensity was related to quadriceps thickness even after adjusting for other factors. RESULTS: In the multiple regression analyses for both male and female models, quadriceps echo intensity (male: ß = - 0.537, p < 0.001; female: ß = - 0.438, p < 0.001), Geriatric Nutritional Risk Index (male: ß = 0.236, p < 0.001; female: ß = 0.213, p < 0.001), and subcutaneous fat thickness of the thigh (male: ß = 0.197, p < 0.001; female: ß = 0.248, p < 0.001) were independently and significantly associated with quadriceps thickness. CONCLUSIONS: Our results show that there is a negative and significant association between muscle mass and fraction of intramuscular adipose tissue in older inpatients. Muscle quality of the quadriceps in older inpatients may be estimated to some extent by the muscle mass.

Longitudinal relationship between intramuscular adipose tissue of the quadriceps and activities of daily living in older inpatients.

BACKGROUND: The longitudinal relationship between intramuscular adipose tissue of the quadriceps and activities of daily living (ADL) in older inpatients remains unclear. This study aimed to examine whether decrease of intramuscular adipose tissue of the quadriceps in older inpatients is related to the recovery of ADL than increase of muscle mass. METHODS: This longitudinal study included 202 inpatients aged ≥65 years [median age: 83.0 (77.0-88.0), 56.4% female]. Recovery of ADL during hospital stay was assessed using the change in Barthel index (BI) score (i.e. BI score at discharge minus BI score at admission) and BI score at discharge. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed using echo intensity and muscle thickness on ultrasound images, respectively. Higher echo intensity indicates greater intramuscular adipose tissue. Multiple regression analysis was performed to identify the factors independently associated with the change in BI score and BI score at discharge. Changes in quadriceps echo intensity and thickness and subcutaneous fat thickness of the thigh, quadriceps echo intensity and thickness, and subcutaneous fat thickness of the thigh at admission, age, sex, days from onset disease, BI score at admission, and disease were set as independent variables. RESULTS: The means of the change in quadriceps echo intensity and thickness were -2.3 ± 15.7 and 0.1 ± 0.4 cm, respectively. The median of the change in BI score was 15.0 (0.0-30.0). The quadriceps echo intensity at discharge was significantly lower than at admission (P = 0.043). The quadriceps thickness (P = 0.004) and BI score at discharge (P < 0.001) were significantly higher than those at admission. Change in quadriceps echo intensity was independently and significantly associated with the change in BI score (ß = -0.25, P = 0.006) and BI score at discharge (ß = -0.18, P = 0.006). In contrast, change in quadriceps thickness was not independently and significantly associated with the change in BI score (ß = 0.09, P = 0.244) and BI score at discharge (ß = 0.06, P = 0.244). CONCLUSIONS: Our study indicates that a decrease of intramuscular adipose tissue of the quadriceps is related to the recovery of ADL than an increase of muscle mass in older inpatients. Intramuscular adipose tissue of the quadriceps in older inpatients is considered to be a predictor for the recovery of ADL, and intervening for intramuscular adipose tissue may be important for improving ADL in older inpatients.

Intramuscular adipose tissue of the quadriceps is more strongly related to recovery of swallowing ability than is muscle mass in older inpatients: A prospective study.

OBJECTIVES: This study aimed to examine whether intramuscular adipose tissue of the quadriceps at admission is related to the recovery of swallowing ability during a hospital stay in older inpatients. METHODS: This prospective study included 344 inpatients ages ≥ 65 y. Those who had stroke that was the obvious cause of dysphagia were excluded. Recovery of swallowing ability was assessed using Food Intake Level Scale (FILS) score at discharge and FILS change. Ultrasound images were acquired at admission. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed based on echo intensity and muscle thickness, respectively. Multiple regression analysis was performed to examine whether quadriceps echo intensity is independently associated with FILS score at discharge and FILS change. The independent variables were quadriceps echo intensity and thickness, subcutaneous fat thickness of the thigh, Barthel Index score at admission, age, sex, number of medications, C-reactive protein, updated Charlson Comorbidity Index, FILS score at admission, Geriatric Nutritional Risk Index, days from disease onset, length of hospital stay, and units of rehabilitation therapy. RESULTS: Quadriceps echo intensity was independently and significantly associated with FILS score at discharge (ß = -0.15, P < 0.01) and FILS change (ß = -0.19, P < 0.01). Quadriceps thickness was not independently and significantly associated with FILS score at discharge or FILS change. CONCLUSIONS: The present study revealed that intramuscular adipose tissue of the quadriceps in older inpatients is more strongly related to recovery of swallowing ability than is muscle mass.