Sarcopenia Risk Evaluation in a Sample of Hospitalized Elderly Men and Women: Combined Use of the Mini Sarcopenia Risk Assessment (MSRA) and the SARC-F.

BACKGROUND: SARC-F and Mini Sarcopenia Risk Assessment (MSRA) questionnaires have been proposed as screening tools to identify patients at risk of sarcopenia. The aim of this study is to test the use of SARC-F and MSRA, alone and combined, as a pre-screening tool for sarcopenia in geriatric inpatients. METHODS: 152 subjects, 94 men and 58 women, aged 70 to 94, underwent muscle mass evaluation by dual energy X-ray absorptiometry (DXA), muscle strength evaluation by handgrip, and completed the MSRA, SARC-F and Activity of daily living (ADL) questionnaires. RESULTS: 66 subjects (43.4%) were classified as sarcopenic according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. The 7-item SARC-F and MRSA and 5-item MSRA showed an area under the curve (AUC) of 0.666 (95% confidence interval (CI): 0.542-0.789), 0.730 (95% CI: 0.617-0.842) and 0.710 (95% CI: 0.593-0.827), respectively. The optimal cut-off points for sarcopenia detection were determined for each questionnaire using the Youden index method. The newly calculated cut-off points were ≤25 and ≤40 for MSRA 7- and 5-items, respectively. The ideal cut-off for the SARC-F was a score ≥3. Applying this new cut-off in our study population, sensitivity and specificity of the 7-item MSRA were 0.757 and 0.651, and 0.688 and 0.679 for the 5-item MSRA, respectively. Sensitivity and specificity of SARC-F were 0.524 and 0.765, respectively. The combined use of the 7-item SARC-F and MSRA improved the accuracy in sarcopenia diagnosis, with a specificity and sensitivity of 1.00 and 0.636. CONCLUSION: 7-item SARC-F and MSRA may be co-administered in hospital wards as an easy, feasible, first-line tool to identify sarcopenic subjects.

Weight Cycling as a Risk Factor for Low Muscle Mass and Strength in a Population of Males and Females with Obesity.

OBJECTIVE: This study aimed to determine whether multiple weight cycles in adulthood are an independent predictor of lower muscle mass and reduced strength, with potential implication for sarcopenia in adults with obesity. METHODS: A total of 60 males and 147 females with obesity were included, with a mean BMI of 37.9 ± 6.0 kg/m2 and a mean age of 52.6 ± 12.4 years. Muscle strength was evaluated with handgrip and appendicular skeletal muscle mass was measured with dual-energy x-ray absorptiometry. RESULTS: Participants were categorized into the following three groups: non-weight cyclers, mild weight cyclers, and severe weight cyclers. From a binary logistic regression that considered muscle mass categories as a dependent variable and weight cycling categories, age, and sex as independent variables, severe weight cyclers showed a 3.8-times increased risk of low muscle mass (95% CI: 1.42-10.01). Considering handgrip strength categories as a dependent variable and weight cycling categories, age, sex, and BMI as independent variables, severe weight cycling was associated with an increased risk of low muscle mass (about 6.3 times, 95% CI: 1.96-20.59). Severe weight cyclers showed a 5.2-times greater risk of developing sarcopenia. CONCLUSIONS: In adults with obesity, weight cycling is associated with lower muscle mass and strength and a greater likelihood of developing sarcopenic obesity.

The Potential of ß-Hydroxy-ß-Methylbutyrate as a New Strategy for the Management of Sarcopenia and Sarcopenic Obesity.

Sarcopenia is defined as an age-related loss of skeletal muscle mass and function and is recognized as a major clinical problem for older people. Essential amino acid supplementation, particularly ß-hydroxy-ß-methylbutyrate (HMB), a metabolite of leucine that is produced in skeletal muscle, has been evaluated in several studies as a nutritional approach to enhancing muscle protein synthesis in healthy or frail elderly subjects. Studies performed in in vitro conditions show that HMB may be effective in the treatment of muscle wasting, increasing myogenesis, reducing muscle apoptosis, and having a positive effect on muscle protein turnover; however, studies of the effects of HMB conducted in old animals have reported conflicting results. Clinical trials performed in older adults confirm that HMB can attenuate the progression of sarcopenia in elderly subjects. HMB supplementation results in an increase in skeletal muscle mass and strength in the elderly and its effect is even greater when combined with physical exercise. The role of HMB in sarcopenic obesity management is still under debate and a general lack of intervention studies in this population must be recognized. In conclusion, HMB appears to be effective for enhancing muscle mass and strength in the elderly. Less certain is the role of HMB supplementation in reducing fat mass and, thus, in the treatment of sarcopenic obesity.

Dynapenic abdominal obesity as predictor of mortality and disability worsening in older adults: A 10-year prospective study.

UNLABELLED: There are relatively few prospective studies evaluating the combined effect of abdominal obesity and low muscle strength on worsening disability and on mortality. The study aimed at evaluating prospectively the prognostic value of dynapenic abdominal obesity definition on disability worsening in a 5.5-year follow-up and mortality in a 10-year follow-up. METHODS: In 93 men and 169 women aged between 66 and 78 years, leg isometric strength, waist circumference (WC), BMI, glycemia, HOMA, lipid profile, vitamin D3, albumin, fibrinogen, physical activity level, income, smoking status and comorbidities were evaluated at the baseline. Reported disabilities were measured at baseline, 1-y, 2-y, 3-y and 5.5-y follow-up and mortality rate was evaluated during a 10-y follow-up. The study population was categorized in dynapenic abdominal obese (D/AO), nondynapenic abdominal obese (ND/AO), dynapenic nonabdominal obese (D/NAO), nondynapenic nonabdominal obese (ND/NAO) according to muscle strength/WC tertiles. RESULTS: D/NAO subjects presented a disability worsening risk of 1.69 times (95%CI:1.11-2.57), ND/AO subjects showed a 2-fold increase in risk (95%CI:1.34-2.98), while being D/AO more than trebled the risk, even after considering confounding variables (HR:3.39,95%CI:1.91-6.02). Mortality risk after adjustment for other confounding variables was 1.57 (95%CI:1.16-2.13) for ND/AO and 2.46 (95%CI:1.34-4.52) for D/AO. CONCLUSIONS: Dynapenic abdominal obese subjects are at higher risk of worsening disability and mortality than subjects with dynapenia or central fat distribution only.