Evaluation of an alternative skeletal muscle index for skeletal muscle mass assessment in a group of Australian women.

BACKGROUND: Sarcopenia is assessed by several methods, including dual energy X-ray absorptiometry (DEXA), which provide a height-adjusted skeletal muscle index (H-SMI). A SMI 2 standard deviation below the young adult reference [1] combined with low muscle strength or performance is used to identify sarcopenia. As height declines with age, H-SMI may underestimate low skeletal muscle mass in the older population. Our study aims to evaluate an alternative SMI and to examine its relationship to grip strength in a group of Australian women. METHODS: Women from two cohorts were analysed. 2041 women had body composition data (112 had calf circumference, 137 had leg length measurements) without grip strength, and 49 women had grip strength measured (40 had body composition data).The relationship between leg length-adjusted SMI (LL-SMI) to grip strength and anthropometric variables to skeletal muscle mass by DEXA were examined by linear regression analysis. RESULTS: Cohort 1: Older women were compared to younger women. Older women were shorter but leg length did not differ between different age groups. H-SMI was not different between groups (P = 0.528). LL-SMI was lower in older women (P = 0.002). Cohort 2: LL-SMI was significantly associated with grip strength (P = 0.048) after adjustment for age. CONCLUSION: Older women were shorter, while leg length did not differ from the younger group. H-SMI may obscure and may underestimate low muscle mass in older individuals. LL-SMI may be a better measure of skeletal muscle mass in older individuals. These alternate SMI would benefit from further exploration in older individuals.

Prolapsing mucosal fold: largest reported, presenting with major haemorrhage.

Prolapsing mucosal folds are uncommon benign colonic lesions that when inflamed may macroscopically resemble, and be confused with, an adenomatous or hyperplastic polyp. They are usually small and rarely cause symptoms. We report the case of a 55-year-old female admitted to hospital following six episodes of significant rectal bleeding. A colonoscopy revealed a 45 × 12 × 5 mm3 pedunculated polyp in the sigmoid colon. There was no evidence of haemorrhoids, colitis or diverticulosis. The polyp was resected by electrosurgical snare at 40 cm and a resolution clip was used to prevent postoperative bleeding. Histology of the polyp demonstrated a polypoid prolapsed mucosal fold with a core of fibrovascular submucosal tissue and normal overlying mucosa. In an extensive review of available literature, no polyp of this size has been reported.