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Objective:To assess the relationship between appendicular skeletal muscle mass (ASM) and ankle brachial index (ABI) among patients with type 2 diabetes.Methods:In this cross-sectional study, from July 2018 to March 2019, a total of 278 patients with type 2 diabetes treated in Zhongda Hospital were enrolled in this study, and there were 158 males and 120 females. General information and clinical biochemical parameters and ABI in the patients were collected. The appendicular muscle mass was quantitatively measured with body composition analyzer to achieve ASM. And the appendicular skeletal muscle mass index (ASMI), skeletal muscle index (SMI), and appendicular skeletal muscle mass/body mass index (ASM/BMI) were calculated respectively. Correlation analysis and multiple linear regression analyses with different adjustment models were conducted to analyze the correlation between ABI and above-mentioned indexes.Results:The Pearson correlation analysis showed that ABI had significant positive correlation with ASM, ASMI and ASM/BMI ( r=0.14, 0.13, 0.13, all P<0.05), but a marginal relation with SMI ( r=0.116, P=0.053). Multiple linear regression analysis suggested that ASMI ( β=0.053, 95% CI: 0.006-0.101, P=0.027) and AMI/ABI ( β=0.347, 95% CI: 0.040-0.654, P=0.027) were significantly related to ABI. Conclusion:ASM is positively associated with ABI in patients with type 2 diabetes.
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Objective:To assess the association of appendicular skeletal muscle mass(ASM) to fat mass(FM) ratio in early pregnancy with the risk of gestational diabetes mellitus (GDM).Methods:A total of 468 pregnant women who visited the Nutritional Department of Peking Union Medical College Hospital or Shunyi Maternal and Child Care Service Center in 2018 and 2019 were recruited. Detailed information and clinical data were collected. The body components were measured using the bioelectrical impedance analysis (BIA) method during early pregnancy (< 14 weeks) and the ASM to FM ratio was calculated. The patients were divided into the GDM group and normal glucose tolerance (NGT) group according to the results of the oral glucose tolerance test (OGTT) performed during 24-28 weeks. Binary logistics regression was used to explore the correlation between the ASM/FM ratio and the risk of GDM. The receiver operator characteristic (ROC) curve of subjects was used to evaluate the predictive value of ASM/FM ratio for GDM and the cut-off value was reported.Results:Compared to the NGT group, the ASM and FM in early pregnancy in the GDM group were significantly higher, while the ASM/FM ratio was significantly lower. A lower ASM/FM ratio in early pregnancy was one of the risk factors of developing GDM. The cut-off value of the ASM/FM ratio was 0.809. The area under the ROC curve for predicting GDM increased from 68.1% to 72.3% when ASM/FM ratio was incorporated, with a significant difference by Delong test ( P = 0.006). Conclusion:Inadequate muscle mass would increase the risk of GDM and the ASM/FM ratio could serve as a predictor of GDM.
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Objective:To evaluate the potential effects of serum lipid levels, appendicular skeletal muscle mass index (ASMI) and body mass index (BMI), together with its dynamic changes, on tumor progression in renal clear cell carcinoma patients, so as to inform body weight management.Methods:This prospective cohort study included a total of 100 patients with high-risk clear cell renal cell carcinoma. Serum lipid levels were detected, ASMI and BMI were measured using bioelectrical impedance analysis and the dynamic changes of BMI were tracked. The effects of BMI, ASMI and serum lipid levels on tumor progression within 2 years were explored.Results:Patients with normal BMI and low ASMI had 5.248 (95% CI: 1.946 to 14.153, P = 0.001) times higher risk of tumor progression than those who were overweight or obese. For every 0.1-unit increase in pre-operative HDL-C, the risk of tumor progression decreased by 0.771 (95% CI: 0.631 to 0.942, P = 0.011) times. Patients who experienced more than 5% decrease in BMI compared with baseline had 5.165 (95% CI: 1.735 to 15.370, P = 0.003) times the progression risk of patients whose BMI changed within ±5% from baseline. Conclusions:The advantage of obese clear cell carcinoma patients over normal-weight patients in tumor progression-free survival may be influenced by ASMI, pre-onset involuntary weight loss and lipid levels. Therefore, patient weight management should not merely focus on absolute BMI but tailor to individual characteristics, including cancer stage, body composition and metabolic status.
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Objective@#To study the occurrence of sarcopenia in patients with liver cirrhosis, and to explore their risk factors and impact on clinical outcomes.@*Methods@#199 hospitalized cases with liver cirrhosis were collected for nutritional risk screening, anthropometric measurement and blood biochemical examination. The body composition analysis was measured based on the skeletal muscle content of the four limbs to calculate the appendicular skeletal muscle mass index (ASMI). Patients were divided into sarcopenia and non-sarcopenia group and the relevant indexes of both groups were compared to screen for factors affecting the occurrence of sarcopenia. During the follow-up of 48 months, the survival and complications of the both groups were compared. Statistical analysis was performed using t-test, χ2 test and logistic regression analysis in terms of different data.@*Results@#The incidence of sarcopenia in cirrhosis was 36.7%, with the highest prevalence in patients with recurrent hepatic encephalopathy (62.5%), followed by patients with abdominal ascites / pleural effusion (37.6%). The incidence of sarcopenia was significantly higher in those with nutritional risk than in those without nutritional risk (P < 0.05). However, even among those without nutritional risk, 14.8% had combined sarcopenia. The body mass index (BMI), upper arm muscle circumference (AMC), and body cell mass (BCM) of the sarcopenia group were lower than those of the non-sarcopenia group (P < 0.05), and the edema index (ECW/TBW) was higher than the latter (P < 0.05). Multivariate analysis showed that age, gender, BMI, and complications of hepatic encephalopathy were the main influencing factors of cirrhosis combined with sarcopenia (P < 0.05). During the follow-up period, the sarcopenia group had a higher mortality rate than non-sarcopenia goup (P < 0.05), and the incidence of recurrent abdominal ascites/pleural effusion, hepatic encephalopathy, and infection was also significantly elevated (P < 0.05).@*Conclusion@#Sarcopenia is one of the manifestations of malnutrition in patients with liver cirrhosis, which increases the risk of mortality and other complications, and has adverse impact on the clinical outcome. Additionally, older age, male sex, low BMI and recurrent hepatic encephalopathy has higher risk for developing sarcopenia.
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Background & objectives: Attempts have been made to estimate appendicular skeletal muscle mass (ASMM) using anthropometric indices and most of these are country specific. This study was designed to develop and cross-validate simple predictive models to estimate the ASMM based on anthropometry in a group of healthy middle-aged women in Sri Lanka. Methods: The study was conducted on a randomly selected group of community-dwelling women aged 30-60 years. ASMM (kg) quantified with dual-energy X-ray absorptiometry (DXA) (ASMMDXA) was used as the reference standard. Anthropometric measurements such as body weight (kg), height (m), limb circumferences (cm) and skinfold thickness (mm) which showed significant correlations with ASMMDXA, were used to develop the models. The models were developed using a group of 165 women (aged 30-60 yr) and were cross-validated using a separate sample of women (n=167) (mean age: 48.9±8.56 yr), selected randomly. Results: Nine anthropometry-based models were developed using weight, height, skinfold thicknesses, circumferences, body mass index, menopausal status (MS) and age as independent variables. Four models which were based on height, weight, triceps skinfold thickness (TSFT), age and MS met all the validation criteria with high correlations (ranged 0.89-0.92) and high predictive values explaining high variance (80-84%) with low standard error of estimate (1.10-1.24 kg). Interpretation & conclusions: The four models (ASMM 1-ASMM 4) developed based on height, weight, TSFT, age and MS showed a high accuracy in estimating the ASMM in middle-aged women.
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Objective@#To investigate the associations between the appendicular skeletal muscle mass index and main anthropometric parameters, and to provide clues for preventing the reduction of skeletal muscle mass among overweight and obese adults in China.@*Methods@#1 488 volunteered participants who resided in Beijing longer than one year, between 22 and 55 years old, with self-report BMI ≥24 kg/m2 were recruited from April to May 2014. 171 participants whose BMI ≤24 kg/m2 or with organic diseases at the first physical examination were excluded, finally 1 317 overweight/obese participants (male and female were 507, and 810, respectively) were enrolled into the present study. After measuring the anthropometric parameters and body composition by the DXA, Pearson correlation analysis and multiple linear regression models were used to analyze the associations between the appendicular skeletal muscle mass index and main anthropometric parameters.@*Results@#The average age of males and females was (35.6±8.4) and (38.2±9.4) years old, respectively. The females' mean levels of body fat percentage, BMI, waist circumference, hip circumference, and bone mineral density were (41.59±4.14)%, (29.00±3.75) kg/m2, (92.56±9.00) cm, (101.74±6.75) cm, and (1.20±0.10) g/cm2, respectively; and the males' mean levels were (34.22±4.61)%, (30.07±4.12) kg/m2, (99.63±9.49) cm, (102.93±7.28) cm, and (1.28±0.11) g/cm2, respectively. The mean level of appendicular skeletal muscle mass and skeletal muscle mass index in males were (26.98±3.88), and (8.96±1.02) kg, respectively, which were significantly higher than it in females ((18.57±2.61), and (7.26±0.83) kg, respectively) (P<0.001). For male, the correlation coefficients of skeletal muscle mass index with BMI, waist circumference, hip circumference, body fat percentage and bone mineral density were 0.814, 0.601, 0.637, 0.558, and 0.434, respectively; for female, the correlation coefficients of skeletal muscle mass index with BMI, waist circumference, hip circumference, body fat rate and bone mineral density were 0.761, 0.534, 0.585, 0.610, and 0.304, respectively. The correlations were statistically significant (P<0.001). Multiple linear regression analysis showed that the skeletal muscle mass index of male decreased with the increase of age (β=-0.01, 95%CI:-0.01-0.00) and body fat percentage (β=-0.13, 95%CI:-0.15--0.12) (P<0.05), while increased with the increase of BMI (β=0.31, 95%CI: 0.29-0.32) and bone mineral density (β=0.54, 95%CI: 0.10-1.01) (P<0.05). The skeletal muscle mass index of female decreased with the increase of age (β=-0.01, 95%CI:-0.01-0.00) and body fat percentage (β=-0.12, 95%CI:-0.14--0.12) (P<0.05), while increased with the increase of BMI (β=0.26, 95%CI: 0.25-0.28) and hip circumference (β=0.01, 95%CI: 0.00-0.02) (P<0.05).@*Conclusion@#The skeletal muscle mass index of male was higher than it of female. For male, the skeletal muscle mass index might be associated with age, BMI, body fat percentage and bone mineral density. While for female, the skeletal muscle mass index might be associated with age, BMI, body fat percentage and hip circumference.
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Aging processes are inevitably accompanied by structural and functional changes in vital organs. Skeletal muscle, which accounts for 40% of total body weight, deteriorates quantitatively and qualitatively with aging. Skeletal muscle is known to play diverse crucial physical and metabolic roles in humans. Sarcopenia is a condition characterized by significant loss of muscle mass and strength. It is related to subsequent frailty and instability in the elderly population. Because muscle tissue is involved in multiple functions, sarcopenia is closely related to various adverse health outcomes. Along with increasing recognition of the clinical importance of sarcopenia, several international study groups have recently released their consensus on the definition and diagnosis of sarcopenia. In practical terms, various skeletal muscle mass indices have been suggested for assessing sarcopenia: appendicular skeletal muscle mass adjusted for height squared, weight, or body mass index. A different prevalence and different clinical implications of sarcopenia are highlighted by each definition. The discordances among these indices have emerged as an issue in defining sarcopenia, and a unifying definition for sarcopenia has not yet been attained. This review aims to compare these three operational definitions and to introduce an optimal skeletal muscle mass index that reflects the clinical implications of sarcopenia from a metabolic perspective.
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Aged , Humans , Aging , Body Mass Index , Body Weight , Consensus , Diagnosis , Muscle, Skeletal , Prevalence , SarcopeniaABSTRACT
BACKGROUND: Protein is the most important nutrient for the muscle synthesis and maintenance of muscle mass. However, there have been no studies comparing muscle mass indexes according to protein intake in obese patients. Thus, the present study investigated the hypothesis that high protein intake positively affected muscle mass indexes in obese patients. METHODS: Male (n=50) and female (n=30) obese patients were recruited. Each sex was divided into 2 groups according to their protein intake. Dietary intake, fat-free mass, appendicular skeletal muscle mass, appendicular skeletal muscle mass/height², skeletal muscle index, total bone area, bone mineral count, bone mineral density, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, interleukin-6, tumor necrosis factor α, smoking, alcohol, and exercise were assessed. RESULTS: Fat-free mass, appendicular skeletal muscle mass, and appendicular skeletal muscle mass/height² were significantly higher in obese men in the higher protein intake group, while serum triglyceride was significantly lower in the same group. However, bone indexes and inflammatory cytokines according to protein intake were not significantly different in obese men. Fat-free mass, bone indexes, muscle indexes, blood lipid profiles, and inflammatory cytokines were not significantly different according to protein intake in obese women. CONCLUSION: In this population, increasing protein intake may positively affect fat-free mass, appendicular skeletal muscle mass, appendicular skeletal muscle mass/height², and serum triglyceride in obese men. Therefore, additional studies may be necessary to identify the appropriate level of protein intake required to prevent a decrease in muscle mass, and increase muscle mass in obese patients.
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Female , Humans , Male , Bone Density , Cholesterol , Cholesterol, HDL , Cholesterol, LDL , Cytokines , Interleukin-6 , Miners , Muscle, Skeletal , Smoke , Smoking , Triglycerides , Tumor Necrosis Factor-alphaABSTRACT
Objective To explore the changes of appendicular skeletal muscle (ASM) in peritoneal dialysis (PD) patients, and to analyze the relationship between ASM changes and dietary intake.Methods One hundred and fourteen PD patients were enrolled in Department of Nephrology, Peking University Third Hospital using convenience sampling.At baseline, and 6 and 12 months after PD, bioelectrical impedance analysis was used to assess the body weight, total muscle mass, and ASM of these patients, and three-day food record was used to assess the dietary intake.Demographics and clinical data were also collected at baseline.Results Compared with baseline, the patients' ASM at 12 months after PD decreased significantly [(19.27 ± 5.59) kg vs.(25.65 ±6.09) kg, P =0.000], the dietary protein intake and energy intake decreased significantly [(0.85 ± 0.21) g/(kg · d) vs.(0.90 ± 0.27) g/(kg · d), P =0.038;(128.37 ± 26.67) kJ/(kg· d)vs.(137.27 ±29.23) kJ/(kg· d), P=0.001].The patients were divided into three groups based on ASM loss, the mean dietary protein intake of the top-loss 1/3 group was statistically lower than that of the bottom-loss 1/3 group [(0.82 ± 0.18) g/(kg · d) vs.(0.91 ± 0.20) g/(kg · d), P =0.021].Conclusions With the continuation of PD, ASM of patients may decrease, which is likely to be mainly related to deficiency in protein and energy intakes.Dietary management should be strengthened in PD patients to alleviate the loss of ASM.