Role of muscle ultrasound in frailty assessment in older adults with type 2 diabetes mellitus.

BACKGROUND: Frailty is a geriatric syndrome that is characterized by increased vulnerability to intrinsic and extrinsic stressors due to decreased biologic reserves. Muscle ultrasound (US) is a valid and reliable method for assessing muscle quantity in older adults. The study aims to examine the relationship between frailty definitions and US-derived muscle parameters. METHODS: We conducted a cross-sectional study with type 2 diabetes mellitus outpatients in a tertiary hospital, and all participants underwent a comprehensive geriatric assessment. For frailty assessment, the Fried Frailty Phenotype (FFP), the Clinical Frailty Scale (CFS), and the Edmonton Frailty Scale (EFS) were performed. Muscle US measurements included Gastrocnemius Medialis (GM) muscle thickness, GM fascicle length, GM pennation angle, Rectus Femoris (RF) muscle thickness, Rectus Femoris cross-sectional area (RFCSA), Rectus Abdominis (RA) muscle thickness, External Oblique (EO) muscle thickness, Internal Oblique (IO) muscle thickness, and Transverse Abdominis (TA) muscle thickness. RESULTS: In all, 373 participants were included in the study. The median age of participants was 72.7 ± 5.9 years, and 64.6% of them were female. According to the FFP, 18.2% of the participants were living with frailty, 56% of them were pre-frail; 57.4% of them were living with frailty according to the CFS; 25.2% of them were living with frailty, and 20.6% of them were pre-frail according to the EFS. The FFP, CFS, and EFS scores were related to muscle thickness of GM, RF, and RA, fascicle length of GM, and pennation angle of GM and RFCSA. Particularly, GM pennation angle, RF muscle thickness, and RFCSA were associated with an increased risk of frailty. Besides muscle thickness of GM, RF, and RA, fascicle length of GM, pennation angle of GM, and RFCSA were significant for predicting the presence of frailty. CONCLUSIONS: US-derived regional muscle measurements are associated with frailty definitions (in both physical, cumulative deficit, and multidimensional models) in a diabetic geriatric population.

The role of thiol-disulfide homeostasis and ischemia-modified albumin in osteosarcopenia.

BACKGROUND: Oxidative stress results from an imbalance between the induction of reactive oxygen species and the ability of cells to metabolize them. Numerous markers can be used to assess the level of oxidative stress. Thiol-disulfide homeostasis (TDH) and ischemia-modified albumin (IMA) are some of them. The aim of this study is to investigate the role of TDH and IMA, which are indicators of oxidative stress, in older patients with osteosarcopenia (OS). METHODS: The study was conducted cross-sectionally in a geriatrics outpatient clinic. Patients who applied to the outpatient clinic for three months were included in the study. Patients with acute infection, delirium, malignancy, severe liver, heart or kidney dysfunction and who did not give their consent for the study were excluded from the study. The study was conducted with 136 patients. Sarcopenia was diagnosed according to muscle ultrasonography (USG) and handgrip strength (HGS) results. Osteopenia/osteoporosis was diagnosed according to bone mineral densitometry (BMD) results. The combination of osteopenia/osteoporosis and sarcopenia was accepted as OS. RESULTS: Native thiol, total thiol value and nativethiol /totalthiol*100 values were significantly lower in the group with OS (respectively; value = 265 ± 53.8 standard deviation (SD) µmol/L, p = ≤ 0.001; value = 295.33 ± 55.77 SD µmol/L, p = 0.001; value = 90.06 (2.8) interquartile ranges (IQR), p = 0.033). Disulfide/native thiol*100 and disulfide/total thiol*100 values were significantly higher in the group with OS (respectively; value = 5.5 (1.7) IQR, p = 0.033; value = 4.97 (1.4) IQR, p = 0.034). CONCLUSION: In our study, the role of oxidative stress in OS was demonstrated by using TDH as an oxidative stress parameter.

Assessment of phase angle as a novel indicator for sarcopenic obesity according to the ESPEN/EASO criteria in older adults with diabetes mellitus.

BACKGROUND: Sarcopenic obesity (SO) is a clinical condition in which sarcopenia and obesity occur together, and is associated with more poor clinical outcomes, increased mortality, and morbidity than sarcopenia. Phase angle (PhA), a parameter derived from bioimpedance analysis (BIA), provides data on cellular health, membrane integrity, and cellular function. This study aimed to evaluate the relationship between SO and PhA among older adults with type 2 diabetes mellitus (DM). METHODS: We performed a cross-sectional study in a tertiary hospital, and all participants underwent a comprehensive geriatric assessment, the hand-grip strength test (HGST), the chair stand test (CST) for muscle strength evaluation, the 4-meter walking test, and the timed up-and-go (TUG) test for physical performance assessment. The diagnosis of SO was made according to the ESPEN/EASO criteria. The PhA was determined automatically by the BIA using resistance and reactance at 50 kHz for each participant. RESULTS: A total of 322 participants were included in the study. The mean age of the participants was 72.5 ±5.8, and 203 (63%) of them were female; 63 (19.6%) of them were sarcopenic obese. In multivariable logistic regression analyses, a significant relationship was found when the model was adjusted for age, female gender, MNA-sf scores, HbA1c level, and CCI scores (OR: 0.53, 95%CI: 0.29-0.98, P = 0.04). In ROC analyses, for PhA in predicting SO diagnosis, the AUC was 0.586 (95%CI: 0.505-0.678, P = 0.033). At the cut-off score 4.4, sensitivity was 57.1% and specificity was 61.4%; positive predictive value (PPV) was 26.5%; negative predictive value (NPV) was 85.5%. CONCLUSIONS: The study identified a significant relationship between SO and PhA among older adults with type 2 DM. However, larger prospective studies are needed to confirm the potential utility of PhA as a biomarker for SO.

Physical frailty is related to oxidative stress through thiol/disulfide homeostasis parameters.

AIM: To evaluate relationship between frailty and oxidative stress through thiol/disulfide homeostasis parameters [Native thiol (NT), total thiol (TT), and disulfide levels (D), disulfide-native thiol (D/NT), disulfide-total thiol (D/TT), native thiol-total thiol (NT/TT) ratios, and ischemia-modified albumin levels (IMA)]. MATERIALS AND METHODS: In total, 139 community-dwelling older adults were included. The frailty status, defined by the FRIED frailty index (FFI) and Clinical Frailty Scale (CFS), and comprehensive geriatric assessment results compared with thiol/disulfide homeostasis parameters and ischemia-modified albumin levels. RESULTS: NT and TT levels were significantly lower in the frail group (respectively; p = 0.014, p = 0.020). The FFI scores were correlated with the levels of NT, TT, D/NT, D/TT, and NT/TT (respectively; r = - 0.25, r = - 0.24, r = 0.17, r = 0.17, r = - 0.17). The significant correlation could not be retained with the CFS scores. In ROC analysis, the AUC for NT was calculated as 0.639 in diagnosing frailty according to the FFI (95% CI 0.542-0.737), AUC was 0.638 for TT (95% CI 0.540-0.735), and AUC was 0.610 for NT/TT (95% CI 0.511-0.780). The AUC was calculated as 0.610 for both D/NT and D/TT in diagnosing physical frailty (95% CI 0.511-0.708). CONCLUSION: Thiol/disulfide homeostasis parameters can be a potential biomarker in diagnosing physical frailty. However, further studies are needed for diagnosing frailty defined with cumulative deficit models.

A pilot study for a practical screening tool for dementia: validation of 5-minute cognitive test in a geriatric population.

BACKGROUND: The aim of this study is to validate the Turkish version of the 5-minute cognitive test (FCT) in a geriatric population. MATERIALS AND METHOD: In total, 61 participants aged ≥65 years with normal cognitive functions, mild cognitive impairment (MCI), and early stage dementia were included. The FCT was compared to the standardised Mini Mental State Examination (MMSE) and the Qmci-TR (quick mild cognitive impairment) test. RESULTS: Test reliability for the FCT was strong (Cronbach's α = 0.747). We demonstrated a strong correlation of FCT scores with MMSE and Qmci-TR scores (respectively, r = 0.730, P < 0.001, r = 0.723, P < 0.001). The fact that the scores obtained in the dementia group were significantly lower also showed that the test can be used reliably in the differentiation of MCI and early dementia (P < 0.001). CONCLUSIONS: The FCT is a brief, reliable, and valid cognitive screening test for screening dementia at early stages in a Turkish geriatric population.

The relationship between urinary incontinence and abdominal muscle thickness in community-dwelling older women undergoing comprehensive geriatric assessment.

PURPOSE: Urinary incontinence (UI) is one of the most common geriatric syndromes in older adults, especially in women. The aim of this study is to show the relationship between urinary incontinence and abdominal muscle thickness measured by muscle ultrasonography (US) in community-dwelling older women adults. METHODS: Eighty-seven community-dwelling older women participated in our study. The presence and the type of UI were recorded. Clinical and demographic characteristics were collected, and a comprehensive geriatric assessment was performed on all participants. Abdominal muscle layer thicknesses were evaluated with muscle US. RESULTS: The prevalence of UI was 55.2% (n = 48) of the study population. The median [IQR] age of the patients in the UI group was 73.0 [69.0-77.5] years and it was 69.0 [67.0-73.0] years in patients without UI (p = 0.007). Abdominal muscle thicknesses were measured smaller in patients with UI than those without UI except for internal oblique muscle thickness. The median [IQR] rectus abdominis muscle thickness was lower in patients with UI than in patients without UI, and the difference was statistically significant (p < 0.003). RA muscle was associated with UI regardless of age, polypharmacy, malnutrition, and frailty (OR: 0.58; 95% CI 0.38-0.89; p = 0.01). CONCLUSIONS: We have shown that UI was independently related to the rectus abdominis muscle thickness, which may reflect the function and mass of the pelvic floor muscles.