Ângulo de fase como preditor de massa muscular em pacientes com doença inflamatória intestinal / Phase angle as a predictor of muscle mass in patients with inflammatory bowel disease

ABSTRACT Malnutrition/sarcopenia is frequent in patients with inflammatory bowel diseases (IBD), and results in muscle catabolism, impacting treatment response, postoperative complications, and quality of life. Objective: This study aims to assess whether the phase angle (PhA) is a parameter for predicting reduced muscle mass in patients with IBD. Methods: Adult patients with IBD were included in this cross-sectional study. For the estimation of muscle mass and the calculation of the PhA, we used bioelectrical impedance analysis (BIA). Crohn's disease (CD) and ulcerative colitis (UC) activity scores were defined using the Harvey-Bradshaw index and partial Mayo score, respectively. The area under the ROC curve was calculated to identify the PhA cut-off point for reduced muscle mass. Results: The sample consisted of 145 patients, with 39 (26.9%) with IBD in the active phase. There was a correlation of the PhA with skeletal muscle mass (SMM) (rs 0.35, P<0.001) and with the skeletal muscle mass index (SMI) (rs 0.427, P<0.001), and the associations remained in the most active form (moderate or severe) of IBD. The ROC curve analysis indicated that the cut-offs points of the PhA ≤5.042 for female and PhA ≤6.079 for male can be used to predict muscle mass reduction. Conclusion: The PhA can be considered a predictor of muscle mass reduction in IBD patients, and we can use it for screening and monitoring the evolution of malnutrition.

RESUMO A desnutrição/sarcopenia é frequente em pacientes com doenças inflamatórias intestinais (DII), resultando em catabolismo muscular, com impacto nas respostas aos tratamentos, complicações cirúrgicas e na qualidade de vida. Objetivo: Este estudo tem como objetivo, avaliar se o ângulo de fase (AF) é um parâmetro para a predição de redução de massa muscular em pacientes com DII. Métodos: Pacientes adultos com DII foram incluídos neste estudo transversal. A estimativa da massa muscular e o cálculo do AF foram realizados a partir do exame de bioimpedância elétrica (BIA). As atividades da doença de Crohn e retocolite ulcerativa foram definidas pelo índice Harvey-Bradshaw e escore parcial de Mayo, respectivamente. A área de curva ROC foi calculada para identificar o ponto de corte do AF para a massa muscular reduzida. Resultados: A amostra foi composta por 145 pacientes, sendo 39 (26.9%) com DII em fase ativa. Houve correlação do AF com massa muscular esquelética (MME) (rs 0.35, P<0.001) e com o índice de massa muscular esquelética (IMME) (rs 0.427, P<0.001), mantendo-se as associações na forma mais ativa (moderada ou grave) da DII. A análise da curva ROC indicou que os pontos de corte de AF ≤5.042 para mulheres e ≤6.079 para homens podem ser usados para prever a redução da massa muscular. Conclusão: O AF pode ser considerado um preditor de redução de massa muscular nos pacientes com DII e ser utilizado para triagem e acompanhamento da evolução da desnutrição.

Physical condition and perceived fatigue in post-covid patients: An observational descriptive study

ABSTRACT BACKGROUND: Patients with severe coronavirus disease 2019 (COVID-19) often require hospital admission and experience sequelae such as chronic fatigue or low muscle mass. OBJECTIVE: To analyze the functional capacity of a cohort of patients with severe acute respiratory syndrome coronavirus 2 who required hospitalization. DESIGN AND SETTING: An observational descriptive study was conducted on post-COVID-19 patients referred to the Rehabilitation Department of Gregorio Marañón Hospital (Madrid, SPAIN). METHODS: Cardiorespiratory fitness, muscle strength, body composition, and perception of fatigue and dyspnea were analyzed. Furthermore, the existing correlations between clinical variables and physical conditions were analyzed. RESULTS: Forty-two patients who required hospital admission (80 ± 22.45 days) or intensive care unit (ICU) admission (58 ± 10.52 days) were analyzed. They presented with decreased strength, respiratory capacity, and moderate-to-severe perceived fatigue. Additionally, an inverse correlation was found between right-handgrip strength and days in the ICU, as well as the 6-minute walk test for women. Similarly, strength and fitness were negatively associated with perceived fatigue. CONCLUSIONS: Post-COVID-19 patients showed low muscle function and low levels of physical fitness associated with high perceived fatigue.

Progress of chronic obstructive pulmonary disease patients with different muscle mass levels / 公共卫生与预防医学

Objective To investigate the difference of the disease progression in patients with chronic obstructive pulmonary disease (COPD) with different muscle mass levels and the influence of related factors on the disease progression. Methods A total of 308 newly diagnosed patients with COPD from February 2021 to February 2022 were selected for this study. All patients were below moderate COPD. The patients were divided into two groups according to their muscle mass levels: sarcopenia group (98 cases) and control group (210 cases). The diagnostic criteria for sarcopenia were based on sarcopenia diagnostic thresholds: RSMI 2 in men and 2 for women. All subjects were followed up for 4 months to observe the progress of the patient's condition. The correlation between the muscle mass level and pulmonary function level, as well as the results of 6-minute walking test and CAT score was evaluated, and the influence of muscle mass level on the patient's disease progress was analyzed. At the same time, the potential influence of related factors (body fat rate, vitamin D level, etc.) on the condition of patients with different muscle mass levels was discussed. SPSS 19.0 software was used to perform statistical analysis. Results Under the same treatment intervention, the baseline and follow-up lung function improvement levels of patients in the sarcopenia group were lower than those in the control group, and the difference was statistically significant (P<0.05). At the same time, the baseline and follow-up 6-minute walk test results of the patients in the sarcopenia group were also worse than those of the control group, and the difference was statistically significant (P<0.05). Further correlation analysis was carried out between the patient's muscle mass level and the post-treatment pulmonary function indicators and 6MWD test level. The results showed that the muscle mass level was positively correlated with several pulmonary function indicators (FEV1, FEV1% predict) and 6MWD (both P<0.05). Considering the possible influence of other factors on the control and progress of the patient's condition, the present study used follow-up CAT score results to distinguish the prognosis of the patient's condition improvement, and used improvement and non-improvement as dependent variables to analyze the influence of various potential influencing factors. The results of regression model analysis showed that lower baseline muscle mass, women, lower body fat percentage, and lower vitamin D level were the main risk factors. Conclusion Under the same treatment condition, COPD patients with different muscle mass levels improve more slowly when complicated with sarcopenia and have poor prognosis. Women, lower body fat percentage and lower vitamin D level are potential risk factors for poor prognosis.

Untangle the relationship of muscle mass and bone mineral content on handgrip strength: Results of ELSA-Brasil / Desvendando a relação entre massa muscular e conteúdo mineral ósseo na força de preensão palmar: Resultados do ELSA-Brasil

Abstract The study aims to investigate the independent association of muscle mass (MM) and bone mineral content (BMC) in the performance of the handgrip strength (HGS) test and whether there is effect modification by sex and age. In 12,491 participants from the ELSA-Brasil we estimated the associations between MM, BMC and HGS using linear regression models. All the analyses were performed for total population, also stratified for sex and age. For total population an interaction term was included between each explanatory variable of interest with sex and age to verify the presence of effect modification. We observed that the higher quintiles of MM and BMC were associated to an increasing in the mean of HGS compared to the first quintile, with greater magnitudes in men compared to women, also adults compared to elderly. When we estimated the independent effect of each exposure of interest, MM showed stronger effect in HGS in women, men and adults then BMC. In conclusion, we observed that higher amounts of MM and BMC are associated with higher HGS, regardless of sociodemographic characteristics, health conditions and lifestyle, with this effect being greater in men and adults.

Resumo O estudo tem como objetivo investigar a associação independente da massa muscular (MM) e conteúdo mineral ósseo (CMO) na realização do teste de força de preensão manual (FPM) e se há modificação do efeito por sexo e idade. Em 12.491 participantes do ELSA-Brasil estimamos as associações entre MM, CMO e FPM usando modelos de regressão linear. Todas as análises foram realizadas para a população total, também estratificada por sexo e idade. Para a população total foi incluído um termo de interação entre cada variável explicativa de interesse com sexo e idade para verificar a presença de modificação de efeito. Observamos que os maiores quintis de MM e BMC estiveram associados a um aumento na média da FPM em relação ao primeiro quintil, com maiores magnitudes em homens em relação a mulheres, também em adultos em relação a idosos. Quando estimamos o efeito independente de cada exposição de interesse, MM mostrou efeito mais forte na FPM em mulheres, homens e adultos do que BMC. Em conclusão, observamos que maiores quantidades de MM e BMC estão associadas a maior FPM, independentemente das características sociodemográficas, condições de saúde e estilo de vida, sendo esse efeito maior em homens e adultos.

COVID-19 related to sarcopenia: Current perspectives on etiology, clinical implications, and nutritional rehabilitation

Sarcopenia is a progressive skeletal muscle disorder characterized by reduced strength and quality. Pathophysiological mechanisms, clinical aspects, and nutritional points were related to sarcopenia in COVID-19 found in skeletal muscle during and after the disease course, which corroborated the development of adverse events. Declining physical activity, insufficient protein intake, and worsened proinflammatory response have been shown to have negative consequences on muscle protein synthesis, potentiating the risk of acute sarcopenia. Obesity sarcopenia has also been shown to worsen the prognosis of patients with SARS-CoV-2. Nutritional rehabilitation is used to prevent or minimize the development of acute sarcopenia. Dietary recommendations include increased energy supply and protein intake of 1.2 to 2.0 g/kg of body weight. Evidence suggests that aging with sedentary behaviors, pathophysiological changes, and inflammation alter body composition. In addition, nutritional deficiencies are predictors and aggravators of acute sarcopenia in COVID-19.

Sarcopenia é um distúrbio progressivo do músculo esquelético caracterizado pela redução da força e qualidade. Mecanismos fisiopatológicos, aspectos clínicos e nutricionais foram relacionados à sarcopenia no COVID-19 encontrada no músculo esquelético, durante e após o curso da doença, o que corroborou para o desenvolvimento de eventos adversos. O declínio da atividade física, a ingestão insuficiente de proteínas e piora da resposta pró-inflamatória demonstraram ter consequências negativas na síntese de proteínas musculares, potencializando risco de sarcopenia. A obesidade sarcopênica também demonstrou piorar o prognóstico de pacientes infectados com SARS-CoV-2. A reabilitação nutricional pode prevenir ou minimizar o desenvolvimento de sarcopenia. As recomendações dietéticas incluem maior oferta de energia e maior ingestão de proteínas de 1,2 a 2,0 g/kg de peso corporal. Evidências sugerem que o envelhecimento com comportamentos sedentários, alterações fisiopatológicas e inflamação, alterações na composição corporal, deficiências nutricionais são preditores e agravantes da sarcopenia aguda na COVID-19.

Analysis of Dietary Intake and Body Composition of Collegiate Runners / Análisis de la Ingesta Dietética y Composición Corporal de Corredores Universitarios

SUMMARY: The aim of this cross-sectional study was to compare dietary intake to published recommendations and to analyze the potential relationship between body composition and dietary intake in collegiate athletes. Eighteen healthy male middle- and long- distance runners (age 20.11 ± 2.72 y; height, 174.7 ± 6.1 cm; body mass, 64.0 ± 7.7 kg), were recruited from a Mexican university track and field team at the beginning of the general preparation phase for national competitions. Participants completed three 24-hour dietary recalls, which were used to estimate dietary intake. Body composition was measured by Dual-energy X-ray absorptiometry (DXA). Athletes displayed high body fat values. Protein intake was significantly higher than published recommendations. Iron, zinc, sodium, and vitamin C intake were significantly higher than recommended values, while potassium and calcium intake were below established recommendations. No significant correlations between body composition variables (i.e body fat, lean body mass, bone mineral content) and dietary intake (i.e energy, macronutrients and selected vitamins and minerals) could be found. These findings suggest that coaches and practitioners should pay close attention to dietary intake and body composition of endurance athletes starting general preparation for competition. Future studies on changes of dietary intake and body composition during off-season and competitive phase, which also track physical activity, are warranted.

El objetivo de este estudio transversal fue comparar la ingesta dietética con las recomendaciones publicadas y analizar la relación potencial entre la composición corporal y la ingesta dietética en corredores universitarios. Dieciocho atletas masculinos sanos de media y larga distancia (edad 20,11 ± 2,72 años; altura, 174,7 ± 6,1 cm; masa corporal, 64,0 ± 7,7 kg), fueron reclutados de un equipo de atletismo de una universidad mexicana al comienzo de la fase de preparación general de competiciones nacionales. Los participantes completaron tres recordatorios dietéticos de 24 horas, que se utilizaron para estimar la ingesta dietética. La composición corporal se midió mediante absorciometría de rayos X de energía dual (DXA). Los atletas mostraron altos valores de grasa corporal. La ingesta de proteínas fue significativamente mayor que las recomendaciones publicadas. La ingesta de hierro, zinc, sodio y vitamina C fue significativamente superior a los valores recomendados, mientras que la ingesta de potasio y calcio estuvo por debajo de las recomendaciones establecidas. No se encontraron correlaciones significativas entre las variables de composición corporal (es decir, grasa corporal, masa corporal magra, contenido mineral óseo) y la ingesta dietética (es decir, energía, macronutrientes y vitaminas y minerales seleccionados). Estos hallazgos sugieren que los entrenadores y los practicantes deberían prestar mucha atención a la ingesta dietética y la composición corporal de los atletas de resistencia que comienzan la preparación general para la competencia. Se justifican estudios futuros sobre los cambios en la ingesta dietética y la composición corporal durante la fase fuera de temporada y competitiva, como también un seguimiento de la actividad física.

A basic review of Sarcopenia Diagnosis

@#Associated with aging, sarcopenia is characterized by a decline in skeletal muscle mass, muscle strength and physical performance, eventually resulting in reduced physical capability, disability, poor quality of life, mortality in older people and high health care expenditure. The prevalence varies significantly by population characteristics, disease status, diagnostic criteria and measurement tools. It is essential to achieve an accurate diagnosis of sarcopenia for the management plan to be effective. This review briefly discusses the essential steps in diagnosing sarcopenia: Find – Assess – Confirm - Severity.

Association between appendicular skeletal muscle mass and ankle-brachial index in patients with type 2 diabetes / 中华健康管理学杂志

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.

Research progress on ultrasound assessment of sarcopenia / 中华临床营养杂志

Sarcopenia is an age-related syndrome with progressive, generalized loss of muscle mass, strength, and physiological function. Low muscle mass is an important diagnostic criterion for sarcopenia. Ultrasound is safe, convenient and cost-effective, with extensive availability. It's a promising diagnostic tool for muscle mass assessment and sarcopenia screening in the elderly population. This review focuses on the specific methods and latest research progress on ultrasound assessment of sarcopenia.

Association between sarcopenia and metabolic syndrome in middle-aged and elderly people in Urumqi， Xinjiang / 上海预防医学

ObjectiveTo obtain the prevalence of sarcopenia in middle-aged and elderly people in Urumqi based on the 2020 updated based on the 2020 updated Consensus Report 2019 of Asian Working Group for Sarcopenia （AWGS2019）， and to further explore the association between sarcopenia and metabolic syndrome （MS）. MethodsA total of 1 438 middle-aged and elderly people （aged≥50 years） in Urumqi from July 2018 to January 2019 were selected as the research subjects. Data were collected by questionnaire survey， physical examination and laboratory test. Skeletal muscle mass，grip strength and 4 m walking speed were used to represent muscle mass， muscle strength and body function， respectively. Bioelectrical impedance analysis （BIA） was used to measure human body components. Based on the diagnostic criteria of sarcopenia recommended by AWGS2019， the prevalence of sarcopenia in people over 50 years old was obtained. Multivariate logistic regression model was used to explore the correlation between sarcopenia and MS in middle-aged and elderly people of different genders. ResultsThere were 194 patients with sarcopenia， with a prevalence of 13.49%. The prevalence was 15.56% in males and 12.12% in females. There was no significant difference in the prevalence of MS between male sarcopenia group （40.45%） and non-sarcopenia group （38.92%）， while the prevalence of MS in female sarcopenia group （39.04%） was higher than that in non-sarcopenia group （27.56%）. Multivariate logistic regression analysis showed that sarcopenia was a related factor of MS. Compared with non-sarcopenia， the risk of MS in male sarcopenia group was higher （OR=2.11，95%CI： 1.15‒3.88 ）. ConclusionSarcopenia increases the risk of MS in middle-aged and elderly people， with a greater risk in men. Fully understanding of sarcopenia is helpful to early identify high-risk groups of MS and prevent the occurrence of MS.

Sarcopenia y su relevancia en la práctica clínica / Sarcopenia and its relevance in clinical practice

La sarcopenia se define como una combinación de baja fuerza y masa muscular con alteración funcional del músculo, que afecta a poblaciones de diferentes edades por diversos motivos. La prevalencia global en adultos mayores se ha estimado en 10% (IC 95%: 8-12%) en hombres y 10% (IC 95%: 8-13%) en mujeres. Recientemente ha cobrado importancia su detección en enfermedades reumáticas, particularmente las inflamatorias. En esta revisión narrativa hemos considerado: a) recomendaciones para el diagnóstico de la sarcopenia; b) herramientas útiles para la práctica clínica y la investigación; c) su relación con las enfermedades reumáticas. Según el último Consenso Europeo de Sarcopenia la búsqueda debe comenzar cuando el paciente reporta síntomas y/o signos (debilidad, lentitud al caminar, desgaste muscular, pérdida de masa muscular, etc.). Para los adultos mayores se recomienda el cuestionario SARC-F como herramienta de tamizaje. Varias pruebas establecen los puntos de corte que deben utilizarse para diagnosticar la baja fuerza muscular, la disminución en la masa muscular y la alteración en el rendimiento físico. La relevancia de diagnosticar precozmente la sarcopenia se basa en el impacto clínico, económico y social que tiene, incluyendo la funcionalidad y calidad de vida de las personas, muy importante en aquellas con enfermedades reumatológicas.

Sarcopenia is defined as a combination of low muscle strength and mass with muscle function impairment that affects the population at different age ranges for different reasons. The global prevalence at the elderly was estimated at 10% (95% CI: 8-12%) in men and 10% (95% CI: 8-13%) in women. In recent years, the detection of sarcopenia in rheumatic diseases has become relevant. The aim of this revision was to develop a review regarding: a) recommendations for the diagnosis of sarcopenia; b) most useful tools for detection in clinical practice and research; c) relationship with some rheumatic diseases. According to the latest European Sarcopenia Consensus, in clinical practice, the search must start when the patient reports symptoms and signs (weakness, slow walking, muscle wasting, disease that leads to muscle loss, etc.). For the elderly population the SARC-F test is recommended as a screening tool. Several tests have established cut-off points to be used to diagnose low muscle strength, decrease in muscle mass or physical performance impairment. The relevance of early diagnosis of sarcopenia is based on the clinical, economic, social impact and also on functionality and quality of life in people, particularly in those with rheumatic diseases.

Consumo de suplementos dietarios en niños escolares de Bucaramanga, Colombia. Un estudio piloto / Dietary supplements consumption in school children from Bucaramanga, Colombia. A pilot study

Resumen Introducción: La obesidad infantil es un problema global de salud pública. Una de las causas subyacentes de este evento complejo y multicausal se relaciona con la alta ingesta de energía. El uso inadecuado de suplementos dietarios podría superar los requerimientos de energía y nutrientes y generar una ganancia excesiva de peso corporal en los niños. Objetivo: Describir el tipo, cantidad y frecuencia de consumo de suplementos dietarios ingeridos por niños y niñas durante la edad preescolar, y evaluar la correlación entre este consumo y la composición corporal de los mismos en la edad escolar. Metodología: Estudio de corte transversal analítico. Estudio piloto realizado en niños en edad escolar de Bucaramanga, Colombia. Variables dependientes: porcentaje de grasa corporal y masa músculo esquelética. Principal variable independiente: consumo de suplementos dietarios. La correlación entre variables fue evaluada usando el coeficiente de correlación de Spearman (rho). Resultados: La prevalencia del consumo de suplementos dietarios en algún momento, antes de los cinco años, fue de 51,11% (IC 95%, 0,35 a 0,66). Las formas de presentación usadas con mayor frecuencia fueron en polvo, granulado y líquido. Los tipos de suplementos utilizados correspondieron a fórmulas poliméricas (40,91%), seguidos por aceite de hígado de bacalao (36,36%). A mayor consumo de suplementos dietarios, se observó mayor porcentaje de grasa corporal (rho = 0,346) y menores valores de masa muscular esquelética (rho = -0,286). Sin embargo, estas correlaciones no fueron estadísticamente significativas (p = 0,114 y p = 0,286, respectivamente). Conclusión: Este estudio encontró una correlación débil y positiva entre el consumo de suplementos dietarios en la primera infancia y el porcentaje de grasa corporal y una correlación débil y negativa con la masa músculo esquelética; sin embargo, no hubo significancia estadística. Es necesario continuar investigando acerca de potenciales efectos no deseados del consumo inadecuado de suplementos durante la primera infancia.

Abstract Introduction: Childhood obesity is a global public health problem. One of the underlying causes of this complex and multicausal event is related to high energy intake. Inappropriate use of dietary supplements could exceed energy and nutrient requirements resulting in excessive body weight gain in children. Objective: To describe the type, quantity and frequency of consumption of dietary supplements ingested by boys and girls during preschool age and to evaluate the correlation between this consumption and their body composition at school age. Methods: Analytical cross-sectional study. Pilot study, carried out in school children from Bucaramanga, Colombia. Dependent variables: body fat percentage and skeletal muscle mass. Main independent variable: consumption of dietary supplements. The correlation between variables was evaluated using Spearman's correlation coefficient (rho). Results: The prevalence of consumption of dietary supplements at some point before the age of five was 51.11% (95% CI, 0.35 to 0.66). The most frequently used forms of presentation were powder, granules and liquid. The types of supplements used corresponded to polymeric formulas (40.91%), followed by cod liver oil (36.36%). A higher consumption of dietary supplements showed a higher percentage of body fat (rho=0.346) and lower values of skeletal muscle mass (rho= -0.286). However, these correlations were not statistically significant (p=0.114 and p=0.286, respectively). Conclusion: This study found a weak positive correlation between dietary supplement use in early childhood and body fat percentage and a weak negative correlation with skeletal muscle mass; however, there was no statistical significance. Further research is needed on the potential undesirable effects of inappropriate supplement use in early childhood.

Investigation and analysis of muscle mass loss with obesity in 318 young and middle-aged weight loss patients / 中国医师杂志

Objective:To investigate the status of muscle mass loss with obesity among young and middle-aged weight loss patients in nutrition clinic, and to analyze the risk factors of muscle mass loss with obesity.Methods:318 cases of weight loss in the nutrition clinic of Changsha Central Hospital were investigated retrospectively. All subjects completed height and weight measurements, calculated body mass index (BMI), and measured skeletal muscle mass of limbs with Inbody 270 body composition analyzer. According to the muscle mass and body fat percentage, they can be divided into muscle mass loss combined with obesity group, simple obesity group, simple muscle mass loss group and normal group. The differences in body composition and the incidence of metabolic abnormalities between groups were compared, and the risk factors of muscle mass reduction combined with obesity were analyzed by logistic regression.Results:(1) The detection rate of muscle mass loss combined with obesity was 4.7%(15/318), including 5 males and 10 females. In addition, there were 269 cases of simple obesity, 34 cases of normal, no simple loss of muscle mass. (2) Compared with the muscle mass loss combined with obesity group, the simple obesity group had a higher proportion of family history of obesity, history of exercise and nonalcoholic fatty liver disease (NAFLD) (all P<0.05), and a lower proportion of sleep time ≥7 hours ( P<0.05). The proportion of patients with exercise history was higher in the normal group ( P<0.05). Compared with the simple obesity group, the normal group had a lower proportion of family history of obesity and NAFLD (all P<0.05), and a higher proportion of exercise history and sleep duration ≥7 hours (all P<0.05). (3) Compared with the muscle mass loss combined with obesity group, the body composition indexes of the simple obesity group were higher (all P<0.05); Compared with the muscle mass loss combined with obesity group, the height, body water, skeletal muscle mass, limb muscle mass and basal metabolism of the normal group were higher (all P<0.05), but the body fat, body fat percentage and visceral fat grade of the normal group were lower (all P<0.05). Compared with the simple obesity group, the normal group had lower body weight, body fat, body fat percentage, BMI and visceral fat grade (all P<0.05). (4) There were no significant difference in the incidence of abnormal blood pressure, blood glucose, blood lipid and uric acid levels among the three groups (all P>0.05). (5) Logistic regression analysis showed that exercise history was a protective factor for muscle mass loss ( OR=0.164, P=0.026). Conclusions:The prevalence of muscle mass loss with obesity was 4.7% in young and middle-aged overweight and obese people. These people tend to move less, sleep more. No higher incidence of metabolic abnormalities was found. Exercise was a protective factor against loss of muscle mass.

Establishment of a nomogram prognostic model for risk factors of comprehensive complication index after radical gastrectomy for gastric cancer / 中华临床营养杂志

Objective:To explore the independent risk factors of comprehensive complication index (CCI) ≥ 26.2 after radical gastrectomy for gastric cancer and to establish and verify a nomogram model.Methods:Clinical data of patients undergoing radical gastrectomy for gastric cancer in Jinling Hospital from September 2017 to March 2019 were retrospectively collected. CCI score of each patient was obtained using CCI calculator. Potential risk factors of CCI ≥ 26.2 were screened by multivariate logistic regression analysis and a nomogram model was established. Besides, the nomogram model was evaluated for differentiation, consistency and clinical usefulness using area under the curve, calibration curves and decision curve, respectively.Results:A total of 237 patients undergoing radical gastrectomy were included, of whom 38 (16.0%) had a CCI ≥ 26.2. Multivariate logistic regression analysis showed that the third lumbar skeletal muscle mass index ( OR = 3.98, P = 0.001), the third lumbar fat mass index ( OR = 3.38, P = 0.002) and age ≥ 65 years( OR = 2.50, P = 0.018) were independent risk factors for postoperative CCI ≥ 26.2. The established nomogram model showed good differentiation, prediction consistency and clinical benefit (AUC = 0.753). Conclusion:The nomogram model based on 3 independent risk factors has good predictive performance and clinical benefit for CCI ≥ 26.2 after radical gastrectomy, which can be applied and promoted in clinical practice to a certain extent.

Effects of body mass index, appendicular skeletal muscle mass index and serum lipid levels on the risk of tumor progression in patients with high-risk renal clear cell carcinoma / 中华临床营养杂志

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.

Effect of Acute Rehabilitation Treatment for Patients with Severe COVID-19 / The Japanese Journal of Rehabilitation Medicine

Patients with severe coronavirus disease 2019 (COVID-19) have poor prognosis, with many cases being difficult to treat and many reports of neurological complications in patients who have been in the intensive care unit for a long time. Rehabilitation of patients with severe COVID-19 is important；however, no rehabilitation program has shown effectiveness. Thus, this study aimed to investigate the effects of a rehabilitation program developed and used at our hospital for patients with severe COVID-19. We enrolled 28 patients with severe COVID-19 (age 61［23-88］years；female/male, 9/19, body mass index, 25.0［18.0-33.6］kg/m2). We assessed the medical research council scoring (MRC) of the patients at the time of entry and exit from the ordinary ward using Wilcoxon signed-rank tests. MRC was significantly improved after exiting the ordinary ward compared with that on entering the ordinary ward (43 vs. 50 points；P＜.001). Moreover, Barthel index improved significantly after exiting the ordinary (32.5 vs. 77.5 points, P＜.001). Therefore, our acute rehabilitation treatment for patients with severe COVID-19 may be effective in improving their muscle strength and daily living.

Nutrition assistance improves skeletal muscle function and performance in community-dwelling older women / Assistência nutricional melhora o desempenho muscular esquelético de mulheres idosas residentes na comunidade

To analyze the effects of nutritional assistance focusing on protein intake (in the individual's usual diet) in relation to muscle mass, and the muscle strength and functional performance of community-dwelling older women. Methods: This is a non-randomized controlled clinical trial. Forty-three community-dwelling older women, who were allocated to the Control Group (CG; n = 20) or the Nutrition Group (NG; n = 23). The NG received individualized nutrition assistance and participated in group activities that focused on dietary protein intake once a week for 12 weeks. Main outcome measures: protein and energy intake; handgrip strength (HGS); gait speed (GS); quadriceps cross-sectional area (CSA); and intramuscular non-contractile tissue (IMNCT). The Student's t-test for independent samples, the Mann-Whitney U test, and a mixed model ANOVA with two factors (group and time) were adopted, followed by a post hoc Bonferroni test. A Spearman's correlation test was performed on tests for HGS; GS; CSA; IMNCT; age; and protein intake adjusted for weight (g/kg) (p ≤ 0.050). Results: Participants in the NG showed higher CSA values than those in the CG (p < 0.001). NG participants also had higher HGS (p < 0.001) and GS (p = 0.037) when compared to pre-intervention. Correlations were observed between IMNCT and protein intake adjusted for weight (g/kg) (r = -0.517; p = 0.020); HGS, and CSA (r = 0.827; p = 0.000); and CSA and age (r = -0.520, p = 0.009).

Analisar os efeitos da assistência nutricional com foco na ingestão proteica (na dieta habitual do indivíduo) em relação a massa muscular, força muscular e desempenho funcional de idosas de uma comunidade. Métodos: Trata-se um ensaio clínico controlado não randomizado. Quarenta e três idosas da comunidade foram alocadas no Grupo Controle (GC; n = 20) ou no Grupo Nutrição (GN; n = 23). O GN recebeu atendimento nutricional individualizado e participou de atividades grupais com foco na ingestão proteica da dieta uma vez por semana, durante 12 semanas. Principais medidas de resultado: ingestão de proteína e energia; força de preensão palmar (FPP); teste de velocidade da marcha (TVM); área de secção transversa do quadríceps (ASTq); e tecido intramuscular não contrátil (TIMNC). Utilizou-se o teste t de Student para amostras independentes, o teste U de Mann-Whitney e um modelo misto de análise de variância (ANOVA) com dois fatores (grupo e tempo), seguido de teste post hoc de Bonferroni. Um teste de correlação de Spearman foi realizado para FPP; TVM; ASTq; TIMNC; idade; e ingestão proteica ajustada para peso (g/kg) (p ≤ 0,050). Resultados: Os participantes do GN apresentaram valores de ASTq superiores aos do GC (p < 0,001). Os participantes do GN também exibiram maior FPP (p < 0,001) e GS (p = 0,037) quando comparados à pré-intervenção. Foram observadas correlações entre TIMNC e ingestão proteica ajustada para peso (g/kg) (r = -0,517; p = 0,020); HGS e ASTq (r = 0,827; p = 0,000); e ASTq e idade (r = -0,520, p = 0,009).

Potencia muscular en relación a la composición corporal en jugadores de voleibol adolescentes según género / Muscle power in relation to body compositionin adolescent volleyball players according to gender

RESUMEN Objetivo: analizar si existe diferencia en la composición corporal por género y si esta influye sobre el rendimiento físico de jugadores de vóleibol adolecentes. Método: se agruparon veinticinco jugadores de vóleibol (Hombres n = 10, Mujeres n = 15). Se midió la composición corporal y potencia muscular mediante la prueba de salto en contra movimiento y remate de balón. Resultados: se observó que los hombres presentaban una mayor masa muscular junto a una menor grasa corporal relacionada a un mayor rendimiento en las pruebas de rendimiento físico. Conclusión: los hombres presentan una mayor masa muscular y menor grasa corporal junto a un mejor rendimiento en las pruebas de potencia muscular.

ABSTRACT Objective: analyze if there is a difference in body composition by gender and if this influences the physical performance of adolescent volleyball players. Method: twenty-five adolescent volleyball players (Men n = 10, Women n = 15) were grouped together. Body composition and muscle power were measured using the countermovement jump test and volleyball spike. Results: the observations were that men had greater muscle mass together with lower body fat related to higher performance in physical performance tests. Conclusion: men have greater muscle mass and lower body fat along with better performance in muscle power tests.

The correlation between blood glucose level and muscle mass, strength and function in an elderly population / 中华内科杂志

Objective:To explore the correlation between blood glucose levels and the three factors of sarcopenia (muscle mass, strength and function) in older Chinese community dwellers.Methods:This is a retrospective study conducted by collecting the data of patients in Jiangsu Huaqiao Road Community Health Service Center from 2018 to 2019. Two hundred and fifty people aged 60 years or elder were selected. Among them, 101 were men and 149 were women. According to the American Diabetes Association diagnostic criteria for diabetes mellitus in 2018, they were divided into normal glucose tolerance (NGT) group, pre-diabetes group and diabetes group. The patients were assessed for sarcopenia as well.Results:Compared with those in the NGT group, muscle mass and upper limb muscle strength did not change in the diabetic group, but lower limb muscle strength and body function [walking speed, balance, short physical performance battery (SPPB)] decreased significantly in the diabetic group. Pearson correlation analyses showed that fasting plasma glucose(FPG) was negatively correlated with walking speed ( r=-0.248, P=0.001), three-pose balance ( r=-0.166, P=0.013) and SSPB ( r=-0.213, P=0.001). Glycosylated hemoglobin A1c(HbA1c) was positively correlated with sitting and standing time ( r=0.205, P=0.002), and negatively correlated with three-pose balance ( r=-0.186, P=0.006) and SSPB ( r=-0.154, P=0.024). Multiple regression analyses showed that FPG was negatively associated with walking speed (β=-0.125, P=0.005) and SPPB (β=-0.034, P=0.012), and that HbA1c was positively associated with sitting and standing time (β= 0.218, P =0.006) and negatively associated with three-pose balance (β=-0.143, P=0.012), and SPPB (β=-0.117, P =0.036). Conclusions:There is no significant correlation between blood glucose levels and muscle mass in the elderly; however, FPG is closely correlated with gait speed, and HbA1c is closely correlated with muscle strength of lower limbs and balance ability in the elderly.

The role of the gut microbiota in the pathogenesis of sarcopenia / 中华老年医学杂志

Sarcopenia is a progressive syndrome associated with aging, generalized loss of skeletal muscle mass, muscle strength and function.It is closely related to the occurrence of adverse events such as ambulatorydysfunction, falls and fractures in the elderly, and seriously affects the quality of life of the elderly.The etiology of sarcopenia has not been fully elucidated.Various pathophysiological mechanisms such as reduced exercise, genetic factors, age-related hormone changes, malnutrition and insufficient protein intake, decreased neuromuscular function, pro-inflammatory cytokines, and myocyte apoptosis are possible factors.Recent studies have found that intestinal microecological changes may be implicated in the occurrence and development of sarcopenia.In this article, we reviewed intestinal microecological changes and their possible role in the mechanisms underlying sarcopenia.