Prevention and Treatment of Sarcopenia: Multidisciplinary Approaches in Clinical Practice.

Sarcopenia is a common clinical problem in older people and often leads to severe adverse outcomes [...].

Health maintenance through home-based interventions for community-dwelling older people with sarcopenia during and after the COVID-19 pandemic: A systematic review and meta-analysis.

BACKGROUND: The COVID-19 pandemic has greatly impacted people's lifestyles and changed the delivery of health interventions, especially interventions for community-dwelling older people with sarcopenia. OBJECTIVE: To summarize the components and explore the effectiveness of home-based interventions for improving sarcopenia and other health-related outcomes among community-dwelling older people with sarcopenia. DESIGN: Systematic review and meta-analysis. METHODS: The Cochrane Library, Scopus, EMBASE, Web of Science, CINAHL, Medline (via PubMed), and PsycINFO were searched for relevant papers published from January 1, 2010 to March 29, 2022. Only papers written in English were included. The modified version of Cochrane's risk-of-bias tool was used to assess the risks of bias in the included studies. The template for intervention description and replication checklist was used to summarize the intervention components. The mean difference (MD) or standard mean difference with a 95 % confidence interval (CI) was used to determine the effect size of studies using the same or different measuring methods. Random-effects models were in meta-analyses to pool the effects of home-based interventions on the included outcomes. RESULTS: After detailed screening and exclusion, 11 randomized controlled trials including 1136 older people with sarcopenia were included in our analyses. Three categories of home-based interventions were identified: exercise interventions, nutritional interventions, and combined exercise and nutritional interventions. The overall analysis of the outcomes (e.g., appendicular skeletal muscle mass index, lean mass, body fat mass, handgrip strength, and gait speed), showed that the effects of home-based exercise interventions were inconclusive. Compared with passive controls, home-based exercise interventions significantly improved knee extension strength (MD = 0.56 kg, 95 % CI: 0.09, 1.03, p = 0.020) and reduced the time required to complete the Timed Up and Go Test (MD = -1.41 s, 95 % CI: -2.28, -0.54, p = 0.001). Home-based nutritional interventions were effective in improving appendicular skeletal muscle mass (MD = 0.25 kg, 95 % CI: 0.02, 0.49, p = 0.030), gait speed (MD = 0.06 m/s, 95 % CI: 0.03, 0.09, p = 0.0001), and quality of life in terms of both the physical component summary (MD = 13.54, 95 % CI: 0.73, 26.34, p = 0.040) and mental component summary scores (MD = 8.69, 95 % CI: 2.98, 14.41, p = 0.003). CONCLUSION: Home-based exercise interventions have the potential to improve muscle strength and physical function, while home-based nutritional interventions are effective in increasing muscle mass, physical function, and quality of life. Both of these can be applied at home during and after the COVID-19 pandemic to alleviate sarcopenia and improve health-related outcomes in community-dwelling older people.

Recent advances in cell-based and cell-free therapeutic approaches for sarcopenia.

Sarcopenia is a progressive loss of muscle mass and function that is connected with increased hospital expenditures, falls, fractures, and mortality. Although muscle loss has been related to aging, injury, hormonal imbalances, and diseases such as malignancies, chronic obstructive pulmonary disease, heart failure, and kidney failure, the underlying pathogenic mechanisms of sarcopenia are unclear. Exercise-based interventions and multimodal strategies are currently being considered as potential therapeutic approaches to prevent or treat these diseases. Although drug therapy research is ongoing, no drug has yet been proven to have a substantial safety and clinical value to be the first drug therapy to be licensed for sarcopenia. To better understand the molecular alterations underlying sarcopenia and effective treatments, we review leading research and available findings from the systemic change to the muscle-specific microenvironment. Furthermore, we explore possible mechanisms of sarcopenia and provide new knowledge for the development of novel cell-free and cell-based therapeutics. This review will assist researchers in developing better therapies to improve muscle health in the elderly.

Respiratory sarcopenia: A position paper by four professional organizations.

We defined respiratory sarcopenia as a coexistence of respiratory muscle weakness and decreased respiratory muscle mass. Although respiratory muscle function is indispensable for life support, its evaluation has not been included in the regular assessment of respiratory function or adequately evaluated in clinical practice. Considering this situation, we prepared a position paper outlining basic knowledge, diagnostic and assessment methods, mechanisms, involvement in respiratory diseases, intervention and treatment methods, and future perspectives on respiratory sarcopenia, and summarized the current consensus on respiratory sarcopenia. Respiratory sarcopenia is diagnosed when respiratory muscle weakness and decreased respiratory muscle mass are observed. If respiratory muscle mass is difficult to measure, we can use appendicular skeletal muscle mass as a surrogate. Probable respiratory sarcopenia is defined when respiratory muscle weakness and decreased appendicular skeletal muscle mass are observed. If only respiratory muscle strength is decreased without a decrease in respiratory function, the patient is diagnosed with possible respiratory sarcopenia. Respiratory muscle strength is assessed using maximum inspiratory pressure and maximum expiratory pressure. Ultrasonography and computed tomography are commonly used to assess respiratory muscle mass; however, there are insufficient data to propose the cutoff values for defining decreased respiratory muscle mass. It was jointly prepared by the representative authors and authorized by the Japanese Society for Respiratory Care and Rehabilitation, Japanese Association on Sarcopenia and Frailty, Japanese Society of Respiratory Physical Therapy and Japanese Association of Rehabilitation Nutrition. Geriatr Gerontol Int 2023; 23: 5-15.

The Contribution of Diet Therapy and Probiotics in the Treatment of Sarcopenia Induced by Prolonged Immobilization Caused by the COVID-19 Pandemic.

The prolonged immobilization associated with COVID-19 infection and the restrictions imposed by the pandemic have determined major changes in physical activity and eating habits, with a negative impact on physical performance. This study monitored non-pharmacological interventions (diet therapy and probiotics) in managing sarcopenia for patients with recent SARS-CoV-2 history (14 days). A prospective study was performed on 200 patients (between December 2020-December 2021), with SPPB score < 9, randomly divided into: Group K-DP (93 patients) with dietary therapy (protein 1.2-1.5 g/kg) and probiotics for two months; and Group K-non-DP (107 patients) without diet therapy and probiotics. All patients were included in a specific physical training program (40 min), three sessions per week. Skeletal muscle index (SMI), serum albumin, and hemoglobin were determined. The SMI was initially low for both groups without significant statistical differences (6.5 ± 0.52 kg/m2 for Group K-non-DP vs. 6.7 ± 0.57 Kg/m2 for Group K-DP, p = 0.135). After two months, significant difference between initial and final SMI values was determined for Group K-DP (6.92 ± 0.50 kg/m2 vs. 6.77 ± 0.56 kg/m2, p = 0.048). In Group K-DP, at end of study, were more patients with normal SMI (n = 32 → N = 70) values (p < 0.001) and fewer sarcopenia patients (p < 0.001). The initial serum albumin means values in the two groups (Group K-non-DP, 4.17 ± 1.04 g/dL, and Group K-DP, 3.95 ± 0.98 g/dL) were not statistically significantly different (p = 0.122). The hemoglobin level improved significantly following a hyper protein diet enriched with pro-biotics (p = 0.003). Diet therapy, consisting of increased protein intake and specific probiotics and specific physical therapy, demonstrated superiority in improving the functional status of patients with recent COVID-19 infection.

Roles of nutrition in muscle health of community-dwelling older adults: evidence-based expert consensus from Asian Working Group for Sarcopenia.

General muscle health declines with age, and in particular, sarcopenia-defined as progressive loss of muscle mass and strength/physical performance-is a growing issue in Asia with a rising population of community-dwelling older adults. Several guidelines have addressed early identification of sarcopenia and management, and although nutrition is central to treatment of sarcopenia, there are currently few guidelines that have examined this specifically in the Asian population. Therefore, the Asian Working Group for Sarcopenia established a special interest group (SIG) comprising seven experts across Asia and one from Australia, to develop an evidence-based expert consensus. A systematic literature search was conducted using MEDLINE on the topic of muscle health, from 2016 (inclusive) to July 2021, in Asia or with relevance to healthy, Asian community-dwelling older adults (≥60 years old). Several key topics were identified: (1) nutritional status: malnutrition and screening; (2) diet and dietary factors; (3) nutritional supplementation; (4) lifestyle interventions plus nutrition; and (5) outcomes and assessment. Clinical questions were developed around these topics, leading to 14 consensus statements. Consensus was achieved using the modified Delphi method with two rounds of voting. Moreover, the consensus addressed the impacts of COVID-19 on nutrition, muscle health, and sarcopenia in Asia. These statements encompass clinical expertise and knowledge across Asia and are aligned with findings in the current literature, to provide a practical framework for addressing muscle health in the community, with the overall aim to encourage and facilitate broader access to equitable care for this target population.

Post-COVID-19 acute sarcopenia: physiopathology and management.

In this review, we discuss the pathophysiologic and management aspects of acute sarcopenia in relation to SARS-CoV-2 infection. COVID-19 is as a multi-organ infectious disease characterized by a severe inflammatory and highly catabolic status, influencing the deep changes in the body build, especially the amount, structure, and function of skeletal muscles which would amount to acutely developed sarcopenia. Acute sarcopenia may largely impact patients' in-hospital prognosis as well as the vulnerability to the post-COVID-19 functional and physical deterioration. The individual outcome of the COVID-19 and the degree of muscle mass and functional loss may be influenced by multiple factors, including the patient's general pre-infection medical and functional condition, especially in older adults. This paper gathers the information about how the SARS-CoV-2 hyper-inflammatory involvement exacerbates the immunosenescence process, enhances the endothelial damage, and due to mitochondrial dysfunction and autophagy, induces myofibrillar breakdown and muscle degradation. The aftermath of these acute and complex immunological SARS-CoV-2-related phenomena, augmented by anosmia, ageusia and altered microbiota may lead to decreased food intake and exacerbated catabolism. Moreover, the imposed physical inactivity, lock-down, quarantine or acute hospitalization with bedrest would intensify the acute sarcopenia process. All these deleterious mechanisms must be swiftly put to a check by a multidisciplinary approach including nutritional support, early physical as well cardio-pulmonary rehabilitation, and psychological support and cognitive training. The proposed holistic and early management of COVID-19 patients appears essential to minimize the disastrous functional outcomes of this disease and allow avoiding the long COVID-19 syndrome.

Post COVID-19 Syndrome ("Long COVID") and Diabetes: Challenges in Diagnosis and Management.

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

Sarcopenia: An underlying treatment target during the COVID-19 pandemic.

The role of skeletal muscle mass in modulating immune response and supporting metabolic stress has been increasingly confirmed. Patients with sarcopenia, characterized by reduced muscle mass and muscle strength, were reported to have poor immune response and metabolic stress when facing acute infection, major surgeries, and other attacks. Based on empirical data, patients with sarcopenia are speculated to have increased infection rates and dismal prognoses amid the current 2019 novel coronavirus disease (COVID-19) epidemic. COVID-19 infection also aggravates sarcopenia because of the increased muscle wasting caused by systematic inflammation and the reduced physical activity and inadequate nutrient intake caused by social isolation. Notably, the interventions targeting skeletal muscle are anticipated to break the vicious circle and benefit the treatment of both conditions. We recommend sarcopenia assessment for populations with advanced age, inactivity, chronic disease, cancers, and nutritional deficiency. Patients with sarcopenia and COVID-19 infection need intensive care and aggressive treatments. The provision of at-home physical activities together with protein supplementation is anticipated to reverse sarcopenia and promote the prevention and treatment of COVID-19. The recommended protocols on nutritional support and physical activities are provided in detail.