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Sarcopenia, a condition characterized by loss of skeletal muscle mass and function, has important clinical ramifications. We aimed to map the existing literature about prevalence, risk factors, associated adverse outcomes, and treatment of sarcopenia in individuals with chronic kidney disease (CKD). A scoping review of the literature was conducted to identify relevant articles published from databases’ inception to September 2019. Individuals with CKD, regardless of their disease stage and their comorbidities, were included. Only studies with sarcopenia diagnosed using both muscle mass and function, based on published consensus definitions, were included. For studies on treatment, only randomized controlled trials with at least one sarcopenia parameter as an outcome were included. Our search yielded 1318 articles, of which 60 from were eligible for this review. The prevalence of sarcopenia ranged from 4 to 42% according to the definition used, population studied, and the disease stage. Several risk factors for sarcopenia were identified including age, male gender, low BMI, malnutrition, and high inflammatory status. Sarcopenia was found to be associated with several adverse outcomes, including disabilities, hospitalizations, and mortality. In CKD subjects, several therapeutic interventions have been assessed in randomized controlled trial with a muscle mass, strength, or function endpoint, however, studies focusing on sarcopenic CKD individuals are lacking. The key interventions in the prevention and treatment of sarcopenia in CKD seem to be aerobic and resistance exercises along with nutritional interventions. Whether these interventions are effective to treat sarcopenia and prevent clinical consequences in this population remains to be fully determined.

Objective Sarcopenia has been recognized as a third category of complications in people with diabetes. However, few studies focus on the reduction of skeletal muscle mass in young people with diabetes. The aim of this study was to investigate risk factors of pre-sarcopenia in young patients with diabetes and establish a practical tool to diagnose pre-sarcopenia in those people. Methods Patients ( n  = 1246) enrolled from the National Health and Nutrition Examination Survey (NHANES) cycle year of 2011 to 2018 were randomly divided into the training set and validation set. The all-subsets regression analysis was used to select the risk factors of pre-sarcopenia. A nomogram model for the prediction of pre-sarcopenia in the diabetic population was established based on the risk factors. The model was evaluated by the area under the receiver operating characteristic curve for discrimination, calibration curves for calibration, and decision curve analysis curves for clinical utility. Results In this study, gender, height, and waist circumference were elected as predictive factors for pre-sarcopenia. The nomogram model presented excellent discrimination in training and validation sets with areas under the curve of 0.907 and 0.912, respectively. The calibration curve illustrated excellent calibration, and the decision curve analysis showed a wide range of good clinical utility. Conclusions This study develops a novel nomogram that integrates gender, height, and waist circumference and can be used to easily predict pre-sarcopenia in diabetics. The novel screen tool is accurate, specific, and low-cost, highlighting its potential value in clinical application.

Background Sarcopenia and osteopenia/osteoporosis show a high prevalence in old age and incur a high risk for falls, fractures, and further functional decline. Physical performance and bone metabolism in patients suffering from the so-called osteosarcopenia—the combination of sarcopenia and osteopenia—are currently still unknown. Aims This study investigates physical performance and bone metabolism in osteosarcopenic, prefrail, community-dwelling older adults. Methods 68 prefrail adults between 65 and 94 years were assigned to four groups according to mean DXA results: osteosarcopenic [low T -score and low appendicular lean mass (aLM)], sarcopenic (low aLM), osteopenic (low T -score), and controls. Multiple linear regression analysis, adjusted for age, gender, physical activity, and 25-OH-vitamin D3 serum level, was used to identify the influence of being osteosarcopenic, sarcopenic, or osteopenic on physical performance (hand grip, chair rise test, sit-to-stand power, gait speed, SPPB) and serum markers for increased bone turnover [osteocalcin, β-crosslaps and procollagen type 1 amino-terminal propeptide (P1NP)]. Results Only osteosarcopenic participants showed significantly reduced hand grip strength, increased chair rising time, and STS power time as well as significantly increased bone turnover markers. Discussion Due to low physical performance and high bone turnover, older adults with osteosarcopenia have to be regarded as the most at-risk population for fractures and further functional decline. Conclusions Up-to-date osteoporosis and post-fracture management of older persons should aim at both, bone and muscle.

Background Sarcopenia is a progressive age‐related skeletal muscle disorder associated with increased likelihood of adverse outcomes. Muscle wasting is often accompanied by an increase in body fat, leading to ‘sarcopenic obesity’. The aim of the present study was to analyse the association of lifestyle variables such as diet, dietary components, physical activity (PA), body composition, and inflammatory markers, with the risk of sarcopenic obesity. Methods A cross‐sectional analysis based on baseline data from the PREDIMED‐Plus study was performed. A total of 1535 participants (48% women) with overweight/obesity (body mass index: 32.5 ± 3.3 kg/m2; age: 65.2 ± 4.9 years old) and metabolic syndrome were categorized according to sex‐specific tertiles (T) of the sarcopenic index (SI) as assessed by dual‐energy X‐ray absorptiometry scanning. Anthropometrical measurements, biochemical markers, dietary intake, and PA information were collected. Linear regression analyses were carried out to evaluate the association between variables. Results Subjects in the first SI tertile were older, less physically active, showed higher frequency of abdominal obesity and diabetes, and consumed higher saturated fat and less vitamin C than subjects from the other two tertiles (all P < 0.05). Multiple adjusted linear regression models evidenced significant positive associations across tertiles of SI with adherence to the Mediterranean dietary score (P‐trend < 0.05), PA (P‐trend < 0.0001), and the 30 s chair stand test (P‐trend < 0.0001), whereas significant negative associations were found with an inadequate vitamin C consumption (P‐trend < 0.05), visceral fat and leucocyte count (all P‐trend < 0.0001), and some white cell subtypes (neutrophils and monocytes), neutrophil‐to‐lymphocyte ratio, and platelet count (all P‐trend < 0.05). When models were additionally adjusted by potential mediators (inflammatory markers, diabetes, and waist circumference), no relevant changes were observed, only dietary variables lost significance. Conclusions Diet and PA are important regulatory mediators of systemic inflammation, which is directly involved in the sarcopenic process. A healthy dietary pattern combined with exercise is a promising strategy to limit age‐related sarcopenia.

Polypharmacy in older adults is associated with multiple negative consequences that may affect muscular function, independently from the presence of medical conditions. The aim of this systematic review and meta‐analysis was to investigate the association of sarcopenia with polypharmacy and higher number of medications. A systematic literature search of observational studies using PubMed, Web of Science, Scopus and Cochrane Library databases was conducted from inception until June 2022. To determine if sarcopenia is associated with a higher risk of polypharmacy and increased number of medications, a meta‐analysis using a random‐effects model was used to calculate the pooled effects (CRD42022337539). Twenty‐nine studies were included in the systematic review and meta‐analysis. Sarcopenia was associated with a higher prevalence of polypharmacy (odds ratio [OR]: 1.65, 95% confidence interval [CI] [1.23, 2.20], I2 = 84%, P < 0.01) and higher number of medications (mean difference: 1.39, 95% CI [0.59, 2.19], I2 = 95%, P < 0.01) compared with individuals without sarcopenia. Using meta‐regression, a high variance was observed due to different populations (i.e., community‐dwelling, nursing home residents, inpatients, outpatients) for both outcomes of polypharmacy (r = −0.338, SE = 0.1669, 95% CI [−0.67, −0.01], z = −2.03, P = 0.04) and number of medications (r = 0.589, SE = 0.2615, 95% CI [0.08, 1.10], z = 2.25, P = 0.02). This systematic review and meta‐analysis reported a significantly increased risk of polypharmacy and higher number of medications in people with sarcopenia compared with individuals without this condition. Future research should clarify whether the specificity and number of medications is a direct contributor in accelerating the progression of muscle wasting and dysfunction contributing to sarcopenia in older adults.

Background Aging is associated with a progressive change of body composition characterized by muscle mass decline and accumulation of adipose tissue that can lead to sarcopenia and obesity, respectively. The prevalence of sarcopenia is poorly known given the different parameters and thresholds in proposed definitions. The combination of obesity (defined as a percentage of body fat mass of > 25% in men and > 35% in women) and sarcopenia (SO) adds complexity to the characterization of this pathology. SARA-OBS aimed to better characterize sarcopenia (including SO) and its consequences on physical function over time, in community-dwelling older adults at risk of mobility disability, and to support the design of further interventional clinical trials. Methods This was an international, multicenter, 6-month observational study of men and women aged ≥ 65 years suffering from sarcopenia according to the Foundation for the National Institute of Health (FNIH) cut-offs for Sarcopenia a nd with a Short Physical Performance Battery (SPPB) ≤ 8. The primary endpoint was the change in Gait Speed (GS) in the 400-meter walking test (400MWT), reported at baseline and at Month 6/ end of the study (EOS). Secondary endpoints included changes in handgrip strength (HGS), physical performance (6-Minute Walking Distance [6MWD], SPPB), the Physical Function Domain (PF-10) sub-score and total score of the SF-36 survey and the Sarcopenia and Quality of Life (SarQoL) questionnaire. Results Overall, the mean (± SD) change from baseline to Month 6/EOS in 400MWT GS was − 0.027 ± 0.171 m/sec ( p  = 0.064). Both GS and 6MWD decreased significantly in subgroup with GS ≥ 0.8 m/sec at baseline (-0.047 ± 0.185 m/sec; p  = 0.017 and − 24.01 ± 68.24 m; p  = 0.001, respectively). In subgroup with SPPB = 8 at baseline, 6MWD also decreased (-36.80 ± 67.60 m; p  < 0.001). We observed a significant change from baseline for 6MWD in the SO subgroup (-18.30 ± 81.95 m; p  = 0.013). Neither HGS nor SarQoL changed significantly from baseline to Month 6/EOS. Conclusions SARA-OBS results contribute to defining subgroups of older adults at risk of functional decline over 6 months, specifically subjects with SPPB = 8, affecting GS and the 6MWD. Additionally, the SO subpopulation exhibited a relevant deterioration in physical function as evaluated by the 6MWD. Trial registration NCT03021798 (ClinicalTrials.gov). Date of registration 16/01/2017.

Background Endothelial damage induces myofibrillar breakdown and muscle degradation in COVID‐19 infection. There is a relationship between increased endothelin‐1 synthesis and sarcopenia. We evaluated the preventive effect of early bosentan therapy as an endothelin receptor blocker in sarcopenia in high‐risk outpatients with COVID‐19 infection. Methods From 15 December 2021 to 15 August 2023, patients within 3 days of the onset of signs and symptoms were randomly assigned to receive bosentan, 62.5 mg, or placebo, twice daily from enrollment for 30 days. The primary outcome was disease progression (death or hospitalization within 15 days after randomization), and the data for this outcome have been previously published. Sarcopenia as a secondary outcome was assessed prospectively at 3, 6, 9 and 12 months after randomization using the criteria of the Asian Working Group for Sarcopenia (AWGS) 2019 (IRCT.ir, IRCT20211203053263N1). Results A total of 313 patients (156 bosentan group, 157 controls) were included in the analyses, which were performed under the intent‐to‐treat principle. Overall, the incidence of sarcopenia was 8.6% (n = 27). Nineteen (73%) had severe sarcopenia. At the 3‐month follow‐up, the incidence of sarcopenia was 8.3% in the total population, with the significant risk difference (RD) of −10.17% in the bosentan group versus the control group. The incidence in the total population and RD in the bosentan group versus the control group at months 6, 9 and 12 were 8.6% (RD: −10.81%, p < 0.001), 8.3% (RD: −10.17%, p = 0.001) and 5.4% (RD: −6.99%, p = 0.003), respectively. During the study, 29 people developed severe COVID‐19 and were hospitalized. At follow‐up, sarcopenia occurred in four inpatients and 23 outpatients (p = 0.23). Mortality occurred in 5.1% (n = 16) of the total population, including 4 (1.3%) of the patients in the bosentan group and 12 (3.8%) of the patients in the placebo group (p = 0.069). None of the patients who died had sarcopenia. Bosentan did not cause any severe adverse events and was well tolerated. Conclusion Early administration of bosentan may prevent sarcopenia in high‐risk outpatients with COVID‐19.

Background Sarcopenic Obesity (SO) is characterized by low lean and high fat mass; i.e. from a functional aspect a disproportion between engine (muscle) and mass to be moved (fat). At present, most research focuses on the engine, but the close “cross talk” between age-associated adipose and skeletal muscle tissue inflammation calls for comprehensive interventions that affect both components alike. Protein and exercise are likely candidates, however with respect to the latter, the enthusiasm for intense and frequent exercise is rather low, especially in functionally limited older people. The aim of this study was therefore to evaluate the effect of whole-body electromyostimulation (WB-EMS), a time-efficient, joint-friendly and highly customizable exercise technology, on obesity parameters and cardiometabolic risk in men with SO. Methods One-hundred community-dwelling (cdw) Bavarian men ≥70 years with SO were randomly assigned to either (a) whey protein supplementation (WPS), (b) WB-EMS and protein supplementation (WB-EMS&P) or (c) non-intervention control (CG). Protein supplementation contributed to an intake of 1.7–1.8 g/kg/body mass/d, WB-EMS consisted of 1.5 × 20 min/week (85 Hz, 350 μs, 4 s of strain–4 s of rest) with moderate-high intensity. Using an intention to treat approach with multiple imputation, the primary study endpoint was total body fat mass (TBF), secondary endpoints were trunk fat mass (TF), waist circumference (WC) and total-cholesterol/HDL-cholesterol ratio (TC/HDL-C). Results After 16 weeks of intervention, TBF was reduced significantly in the WPS (− 3.6 ± 7.2%; p  = 0.005) and WB-EMS&P (− 6.7 ± 6.2%; p  < 0.001), but not in the CG (+ 1.6 ± 7.1%; p  = 0.191). Changes in the WB-EMS&P (p < 0.001) and the WPS group ( p  = 0.011) differ significantly from the CG. TF decreased in the WB-EMS&P ( p < 0.001) and WPS ( p  = .117) and increased in the CG ( p  = .159); WC decreased significantly in the treatment groups and was maintained in the CG. Lastly, the TC/HDL-C ratio improved significantly in the WB-EMS&P and WPS group and was maintained in the CG. Significant differences between WB-EMS&P and WPS were determined for waist circumference only ( p  = 0.015; TBF: p  = 0.073; TF: p  = 0.087; TC/HDL-C: p  = .773). Conclusion Moderate-high dosed whey protein supplementation, especially when combined with WB-EMS, may be a feasible choice to address obesity and cardiometabolic risk in older cdw men with SO unable or unmotivated to exercise conventionally. Trial registration number ClinicalTrials.gov NCT02857660 ; registration date: 05/01/2017.

To present the preliminarily findings regarding the effects of a herbal medicine, Ninjin'yoeito, on comorbid frailty and sarcopenia in patients with chronic obstructive pulmonary disease (COPD). Patients with COPD (GOLD II or higher) and fatigue were randomly assigned to Group A (n = 28; no medication for 12 weeks, followed by 12-week administration) or B (n= 25; 24-week continuous administration). Visual analog scale (VAS) symptoms of fatigue, the COPD assessment test (CAT), and the modified Medical Research Council (mMRC) Dyspnea Scale were examined. Physical indices such asknee extension leg strength and walking speed, skeletal muscle mass index (SMI), and respiratory function test were also measured. VAS fatigue scales in Group B significantly improved after 4, 8, and 12 weeks compared to those in Group A (each p<0.001, respectively). Right and left knee extension leg strength in Group B significantly improved after 12 weeks compared to that in Group A (p=0.042 and p=0.037, respectively). The 1-s walking speed for continued to increase significantly over 24 weeks in Group B (p=0.016, p<0.001, p<0.001, p=0.004, p<0.001, and p<0.001 after 4, 8, 12, 16, 20, and 24 weeks, respectively); it also significantly increased after the administration of Ninjin'yoeito in Group A. In Group B, the SMI significantly increased at 12 weeks in patients with sarcopenia (p=0.025). The CAT scores in Group B significantly improved after 12 weeks compared to those in Group A (p=0.006). The mMRC scores in Group B also significantly improved after 8 and 12 weeks compared to those in Group A (p= 0.045 and p <0.001, respectively). The changes in %FEV1.0 in Group B were significantly improved at 12 and 24 weeks (p=0.039 and p=0.036, respectively). Overall, Ninjin'yoeito significantly improved patients' quality of life, physical activity, muscle mass, and possibly lung function, suggesting that Ninjin'yoeito may improve frailty and sarcopenia in patients with COPD.

Background Osteosarcopenia is geriatric syndrome defined as the concomitant occurrence of osteopenia/osteoporosis, and sarcopenia. Osteosarcopenia is a relatively new concept in geriatric medicine; however, it may increase the risk of fragility fractures, several morbidities and mortalities, and socioeconomic costs. Although resistance exercises and nutritional support—including protein, calcium, and vitamin D—are potential non-pharmacological management procedures, evidence is still lacking. The objective of this study was therefore to evaluate the effect of combined resistance exercise and nutritional support on the quality and quantity of bone and muscle in postmenopausal females with osteosarcopenia. Methods This research proposal presents the protocol for a prospective, single-center, single-blinded, two-armed randomized controlled trial. Thirty-four participants with osteosarcopenia will be recruited and randomly divided into intervention and control groups; both groups will receive nutritional supplements (protein, 40 g; vitamin D, 1600 IU; calcium, 600 mg) daily. The intervention group will undergo 24 weeks of resistance exercise of increasing intensity, achieved through a three-phase step-up process. The primary outcomes will be the changes in skeletal muscle index and bone marrow density of the lumbar spine and femoral neck between the baseline and end of intervention (24 weeks). The secondary outcomes will be the body composition, whole body phase angle, physical function assessment, quality of life, psychological assessment, and bone turnover markers of participants, surveyed at multiple time points. Discussion This randomized controlled trial may reveal the effect of resistance exercise and nutritional support on older postmenopausal women with osteosarcopenia. The results will provide evidence for developing proper non-pharmacological management guidelines for postmenopausal women. Trial registration Clinical Research Information Service of Republic of Korea, KCT0008291, Registered on 16 March 2023, https://cris.nih.go.kr/cris/search/detailSearch.do/25262 .