Attenuation of skeletal muscle and strength in the elderly: The Health ABC Study

2001 ◽  
Vol 90 (6) ◽  
pp. 2157-2165 ◽  
Author(s):  
Bret H. Goodpaster ◽  
Catherine L. Carlson ◽  
Marjolein Visser ◽  
David E. Kelley ◽  
Ann Scherzinger ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Skeletal Muscle ◽  
Muscle Strength ◽  
Attenuation Coefficient ◽  
Specific Force ◽  
Hounsfield Units ◽  
Cross Sectional ◽  
Men And Women ◽  
Muscle Attenuation ◽  
Attenuation Values

Although loss of muscle mass is considered a cause of diminished muscle strength with aging, little is known regarding whether composition of aging muscle affects strength. The skeletal muscle attenuation coefficient, as determined by computed tomography, is a noninvasive measure of muscle density, and lower values reflect increased muscle lipid content. This investigation examined the hypothesis that lower values for muscle attenuation are associated with lower voluntary isokinetic knee extensor strength at 60°/s in 2,627 men and women aged 70–79 yr participating in baseline studies of the Health ABC Study, a longitudinal study of health, aging, and body composition. Strength was higher in men than in women (132.3 ± 34.5 vs. 81.4 ± 22.0 N · m, P < 0.01). Men had greater muscle attenuation values (37.3 ± 6.5 vs. 34.7 ± 7.0 Hounsfield units) and muscle cross-sectional area (CSA) at the midthigh than women (132.7 ± 22.4 vs. 93.3 ± 17.5 cm2, P < 0.01 for both). The strength per muscle CSA (specific force) was also higher in men (1.00 ± 0.21 vs. 0.88 ± 0.21 N · m · cm−2). The attenuation coefficient was significantly lower for hamstrings than for quadriceps (28.7 ± 8.7 vs. 41.1 ± 6.9 Hounsfield units, P < 0.01). Midthigh muscle attenuation values were lowest ( P < 0.01) in the eldest men and women and were negatively associated with total body fat ( r = −0.53, P < 0.01). Higher muscle attenuation values were also associated with greater specific force production ( r = 0.26, P < 0.01). Multivariate regression analysis revealed that the attenuation coefficient of muscle was independently associated with muscle strength after adjustment for muscle CSA and midthigh adipose tissue in men and women. These results demonstrate that the attenuation values of muscle on computed tomography in older persons can account for differences in muscle strength not attributed to muscle quantity.

scholarly journals Skeletal muscle adiposity is associated with physical activity, exercise capacity and fibre shift in COPD

2014 ◽  
Vol 44 (5) ◽  
pp. 1188-1198 ◽  
Author(s):  
Matthew Maddocks ◽  
Dinesh Shrikrishna ◽  
Simone Vitoriano ◽  
Samantha A. Natanek ◽  
Rebecca J. Tanner ◽  
...  
Keyword(s):  
Physical Activity ◽  
Computed Tomography ◽  
Skeletal Muscle ◽  
Exercise Capacity ◽  
Intramuscular Fat ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Muscle Attenuation ◽  
Muscle Adiposity

Quadriceps muscle phenotype varies widely between patients with chronic obstructive pulmonary disease (COPD) and cannot be determined without muscle biopsy. We hypothesised that measures of skeletal muscle adiposity could provide noninvasive biomarkers of muscle quality in this population.In 101 patients and 10 age-matched healthy controls, mid-thigh cross-sectional area, percentage intramuscular fat and skeletal muscle attenuation were calculated using computed tomography images and standard tissue attenuation ranges: fat -190– -30 HU; skeletal muscle -29–150 HU.Mean±sdpercentage intramuscular fat was higher in the patient group (6.7±3.5%versus4.3±1.2%, p = 0.03). Both percentage intramuscular fat and skeletal muscle attenuation were associated with physical activity level, exercise capacity and type I fibre proportion, independent of age, mid-thigh cross-sectional area and quadriceps strength. Combined with transfer factor of the lung for carbon monoxide, these variables could identify >80% of patients with fibre type shift with >65% specificity (area under the curve 0.83, 95% CI 0.72–0.95).Skeletal muscle adiposity assessed by computed tomography reflects multiple aspects of COPD related muscle dysfunction and may help to identify patients for trials of interventions targeted at specific muscle phenotypes.

scholarly journals Evaluation of muscle quality and quantity for the assessment of sarcopenia using mid-thigh computed tomography: a cohort study

2021 ◽  
Author(s):  
Hiroki Oba ◽  
Yasumoto Matsui ◽  
Hidenori Arai ◽  
Tsuyoshi Watanabe ◽  
Hiroki Iida ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Muscle Strength ◽  
Muscle Mass ◽  
Physical Performance ◽  
Motor Function ◽  
Mass Measurement ◽  
Muscle Quality ◽  
Cross Sectional ◽  
Men And Women ◽  
Ct Attenuation Value

Abstract BackgroundPreviously, sarcopenia was diagnosed based on walking speed, grip strength and muscle mass. However, recent consensus has proposed a concern regarding the use of muscle mass measurement for sarcopenia diagnosis due to lack of accuracy; therefore, new assessment methods in clinical practice are required. We investigated the correlation between computed tomography (CT) and various motor function tests to assess the utility of CT as a potential diagnostic method for sarcopenia.MethodsIn total, 214 patients who were examined at our center during the study period (2016–2017) were included in the study. Single-slice CT scan of the mid-thigh region was performed, from which cross-sectional area (CSA) and CT attenuation value (CTV) of quadriceps femoris were evaluated for each subject. Other assessments included skeletal muscle mass index, muscle strength and physical performance. Furthermore, subjects were classified into four groups as per the Asia Working Group of Sarcopenia (AWGS) 2019 criteria as those with: normal, poor muscle function/strength (poor function), sarcopenia and severe sarcopenia.ResultsCSA and muscle strength exhibited the strongest correlation. Some physical performance tests showed the strongest correlation with CTV. The CSA was significantly lower in women with sarcopenia group and in both men and women with severe sarcopenia (all p < 0.01); furthermore, the CTV was significantly lower in women with poor-function and in both men and women with severe sarcopenia group (all p < 0.01).ConclusionsCSA mostly correlated with muscle strength, whereas CTV mostly correlated with physical performance. CT with measurements of CSA and CTV enables the evaluation of muscle mass and quality simultaneously. CT is believed to be useful in inferring evaluation of motor function and assessment of sarcopenia.

AGE, OBESITY, SARCOPENIA, AND PROXIMITY TO DEATH EXPLAIN REDUCED MEAN MUSCLE ATTENUATION IN PATIENTS WITH ADVANCED CANCER

2014 ◽  
pp. 1-6
Author(s):  
N. ESFANDIARI ◽  
S. GHOSH ◽  
C.M.M. PRADO ◽  
L. MARTIN ◽  
V. MAZURAK ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Skeletal Muscle ◽  
Adipose Tissue ◽  
Cancer Patients ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Time To Death ◽  
Computed Tomography Images ◽  
Muscle Attenuation

Background:Cancer cachexia is characterized by skeletal muscle loss. A feature of muscle wasting,reduction in the mean muscle attenuation from computed tomography images is believed to reflect pathologicalinfiltration of fat into muscle. It is a reported prognostic indicator in cancer patients. Objectives:To develop anexplanatory multivariate model of muscle attenuation of cancer patients incorporating age, sex, diseasecharacteristics, body composition. Time to death ≤92 days was included in the model as the demarcation of end-stage disease. Design:Multivariate general linear model regression analysis of total mean muscle attenuation andchange in muscle attenuation. Setting:Regional cancer center (Alberta, Canada). Participants: Patients withgastrointestinal and respiratory tract cancers (mean age 64±11 years, 44% female). Measurements: Total adiposetissue and skeletal muscle cross sectional area, and mean muscle attenuation at the 3rd lumbar vertebra wereassessed from baseline computed tomography (n=1719), and a subset with repeated measures (n=246 patientswith a total of 871 images). Results:At baseline, muscle attenuation associated with total skeletal muscle (β 0.09;95% CI 0.07 to 0.11; p<0.001) and adipose tissue (β -0.032; 95% CI -0.035 to -0.029; p<0.001) cross sectionalareas, age (β -0.28; 95% CI -0.32 to -0.24; p<0.001), time to death ≤92 days (β -1.9; 95% CI -3.1 to -0.7;p=0.003) and male sex (β -2.3; 95% CI –3.5 to -1.1; p<0.001). Change in muscle attenuation over time associatedwith total adipose tissue cross sectional area (β -0.008; 95% CI -0.012 to -0.004; p<0.001) and time to death ≤92days (β -1.6; 95% CI -3.0 to -0.2; p=0.03). Conclusions:The radiation attenuation of skeletal muscle is lowest inindividuals who are older, less muscular, have a higher fat mass and are within 92 days of death. Men had lowermuscle attenuation than women when controlled for other variables.

scholarly journals Establishment and validation of pre-therapy cervical vertebrae muscle quantification as a prognostic marker of sarcopenia in head and neck patients receiving definitive cancer surgery

2021 ◽  
Author(s):  
Brennan Olson ◽  
Jared Edwards ◽  
Catherine Degnin ◽  
Nicole Santucci ◽  
Michelle Buncke ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Overall Survival ◽  
Head And Neck ◽  
Cervical Vertebrae ◽  
Ct Imaging ◽  
Primary Study ◽  
Muscle Area ◽  
Cross Sectional ◽  
Men And Women ◽  
Muscle Cross Sectional Area

Importance: Sarcopenia, or diminished skeletal muscle mass, is prognostic for survival in patients with head and neck cancer (HNC). However, identification of this high-risk feature remains challenging for patients without computed tomography (CT) images that capture the abdomen or lower thorax. Objectives: To (1) define sarcopenia thresholds at the C3 vertebral level using previously established thresholds derived from abdominal CT imaging and (2) determine if C3-defined sarcopenia is associated with survival in patients with HNC. Design, setting, and participants: This retrospective cohort study was conducted in consecutive patients with a squamous cell carcinoma of the head and neck with cross-sectional abdominal or neck imaging within 60 days prior to treatment and treated between January 2005 and December 2017. Data analysis was completed from December 2018 to April 2021. Exposures: Measurement of the cross-sectional muscle area at the third lumbar and cervical vertebral levels using CT imaging. Main outcomes and measures: Primary study outcome was overall survival. Results: In a cohort of 253 HNC patients with CT imaging that captures both L3 and C3 vertebral levels, skeletal muscle cross-sectional area at C3 was strongly correlated with the L3 level in both men (n = 188; r = 0.77; p < 0.001) and women (n = 65; r = 0.80; p < 0.001), and C3-defined sarcopenia thresholds of 14.0 cm2/m2 (men) and 11.1 cm2/m2 (women) were best predictive of previously established L3-defined sarcopenia thresholds. Applying these defined C3 sarcopenia thresholds in a cohort of 536 HNC patients with neck imaging alone revealed that C3-defined sarcopenia was independently associated with reduced overall survival in men (HR = 2.63; 95% CI, 1.79, 3.85) but not women (HR = 1.18, 95% CI, 0.76, 1.85) with HNC. Conclusions and relevance: This study identifies sarcopenia thresholds at the C3 level that best predict L3-defined sarcopenia in both men and women. In HNC, C3-defined sarcopenia is associated with poor survival outcomes in men, but not women, suggesting sarcopenia may differentially affect men and women with HNC.

scholarly journals Muscle Characteristics Obtained Using Computed Tomography as Prognosticators in Patients with Castration-Resistant Prostate Cancer

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1864
Author(s):  
Jongsoo Lee ◽  
Jee Soo Park ◽  
Ji Eun Heo ◽  
Hyun Kyu Ahn ◽  
Won Sik Jang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Computed Tomography ◽  
Skeletal Muscle ◽  
Body Composition ◽  
Survival Rates ◽  
Castration Resistant Prostate Cancer ◽  
Vertebral Level ◽  
Skeletal Muscle Index ◽  
Castration Resistant ◽  
Muscle Attenuation

Limited studies have investigated the correlation between body composition and prostate cancer outcomes. We analyzed the effect of muscle mass and quality on castration-resistant prostate cancer (CRPC) outcomes. Skeletal muscle index (SMI) and skeletal muscle attenuation (SMA) were measured for 411 patients at the L3 vertebral level using computed tomography at CRPC diagnosis and were dived to low and high groups at the value of median. Analysis of the skeletal phenotypes and age (<70 and >70 years) was performed to evaluate the effect of SMI and SMA. The median survival rates for patients with low and high SMI were 19 and 24 months (p = 0.015), and those with low and high SMAs were 15 and 26 months (p < 0.001), respectively. In the subgroup analysis by age, SMA was a significant prognosticator in both groups, while SMI was a significant prognosticator only in patients aged >70 years. Patients with low SMA + low SMI had the worst prognosis. Muscle characteristics seems to be a prognosticator in survival of CRPC patients and may be considered in treatment planning.

scholarly journals Application of Computed Tomography (CT) Attenuation Values in Diagnosis of Transudate and Exudate in Patients with Pleural Effusion

2018 ◽  
Vol 11 (02) ◽  
pp. 19-25
Author(s):  
Keshab Sharma ◽  
PS Lamichhane ◽  
BK Sharma
Keyword(s):  
Computed Tomography ◽  
Pleural Effusion ◽  
Ct Scan ◽  
Pleural Fluid ◽  
Pleural Effusions ◽  
Hounsfield Units ◽  
Fluid Analysis ◽  
Ct Attenuation ◽  
The Mean ◽  
Attenuation Values

Background: Pleural effusion is the pathologic accumulation of fluid in the pleural space. The fluid analysis yields important diagnostic information, and in certain cases, fluid analysis alone is enough for diagnosis. Analysis of pleural fluid by thoracentesis with imaging guidance helps to determine the cause of pleural effusion. The purpose of this study was to assess the accuracy of computed tomography (CT) in characterizing pleural fluid based on attenuation values and CT appearance. Materials and Methods: This prospective study included 100 patients admitted to Gandaki Medical College and Teaching Hospital, Pokhara, Nepal between January 1, 2017 and February 28, 2018. Patients who were diagnosed with pleural effusion and had a chest CT followed by diagnostic thoracentesis within 48 hours were included in the study. Effusions were classified as exudates or transudates using laboratory biochemistry markers on the basis of Light’s criteria. The mean attenuation values of the pleural effusions were measured in Hounsfield units in all patients using a region of interest with the greatest quantity of fluid. Each CT scan was also reviewed for the presence of additional pleural features. Results: According to Light’s criteria, 26 of 100 patients with pleural effusions had transudates, and the remaining patients had exudates. The mean attenuation of the exudates (16.5 ±1.7 HU; 95% CI, range, -33.4 – 44 HU) was significantly higher than the mean attenuation of the transudates (11.6 ±0.57 HU; 95% CI, range, 5 - 16 HU), (P = 0.0001). None of the additional CT features accurately differentiated exudates from transudates (P = 0.70). Fluid loculation was found in 35.13% of exudates and in 19.23% of transudates. Pleural thickening was found in 29.7% of exudates and in 15.3% of transudates. Pleural nodule was found in 10.8% of exudates which all were related to the malignancy. Conclusion: CT attenuation values may be useful in differentiating exudates from transudates. Exudates had significantly higher Hounsfield units in CT scan. Additional signs, such as fluid loculation, pleural thickness, and pleural nodules were more commonly found in patients with exudative effusions and could be considered and may provide further information for the differentiation.

scholarly journals Do PTK2 gene polymorphisms contribute to the interindividual variability in muscle strength and the response to resistance training? A preliminary report

2012 ◽  
Vol 112 (8) ◽  
pp. 1329-1334 ◽  
Author(s):  
Robert M. Erskine ◽  
Alun G. Williams ◽  
David A. Jones ◽  
Claire E. Stewart ◽  
Hans Degens
Keyword(s):  
Skeletal Muscle ◽  
Resistance Training ◽  
Muscle Strength ◽  
Human Skeletal Muscle ◽  
Interindividual Variability ◽  
Knee Extension ◽  
Joint Torque ◽  
Specific Force ◽  
Tyrosine Kinase 2 ◽  
The Impact

The protein tyrosine kinase-2 (PTK2) gene encodes focal adhesion kinase, a structural protein involved in lateral transmission of muscle fiber force. We investigated whether single-nucleotide polymorphisms (SNPs) of the PTK2 gene were associated with various indexes of human skeletal muscle strength and the interindividual variability in the strength responses to resistance training. We determined unilateral knee extension single repetition maximum (1-RM), maximum isometric voluntary contraction (MVC) knee joint torque, and quadriceps femoris muscle specific force (maximum force per unit physiological cross-sectional area) before and after 9 wk of knee extension resistance training in 51 untrained young men. All participants were genotyped for the PTK2 intronic rs7843014 A/C and 3′-untranslated region (UTR) rs7460 A/T SNPs. There were no genotype associations with baseline measures or posttraining changes in 1-RM or MVC. Although the training-induced increase in specific force was similar for all PTK2 genotypes, baseline specific force was higher in PTK2 rs7843014 AA and rs7460 TT homozygotes than in the respective rs7843014 C- ( P = 0.016) and rs7460 A-allele ( P = 0.009) carriers. These associations between muscle specific force and PTK2 SNPs suggest that interindividual differences exist in the way force is transmitted from the muscle fibers to the tendon. Therefore, our results demonstrate for the first time the impact of genetic variation on the intrinsic strength of human skeletal muscle.

A cross-sectional study of muscle strength and mass in 45- to 78-yr-old men and women

1991 ◽  
Vol 71 (2) ◽  
pp. 644-650 ◽  
Author(s):  
W. R. Frontera ◽  
V. A. Hughes ◽  
K. J. Lutz ◽  
W. J. Evans
Keyword(s):  
Muscle Strength ◽  
Peak Torque ◽  
Cross Sectional Study ◽  
Fat Free Mass ◽  
Knee Extensors ◽  
Cross Sectional ◽  
Men And Women ◽  
Age Related ◽  
Muscle Groups ◽  
Old Men

The isokinetic strength of the elbow and knee extensors and flexors was measured in 200 healthy 45- to 78-yr-old men and women to examine the relationship between muscle strength, age, and body composition. Peak torque was measured at 60 and 240 degrees/s in the knee and at 60 and 180 degrees/s in the elbow by use of a Cybex II isokinetic dynamometer. Fat-free mass (FFM) was estimated by hydrostatic weighing in all subjects, and muscle mass (MM) was determined in 141 subjects from urinary creatinine excretion. FFM and MM were significantly lower (P less than 0.001) in the oldest group. Strength of all muscle groups at both testing speeds was significantly (P less than 0.006) lower (range 15.5–26.7%) in the 65- to 78- than in the 45- to 54-yr-old men and women. When strength was adjusted for FFM or MM, the age-related differences were not significant in all muscle groups except the knee extensors tested at 240 degrees/s. Absolute strength of the women ranged from 42.2 to 62.8% that of men. When strength was expressed per kilogram of MM, these gender differences were smaller and/or not present. These data suggest that MM is a major determinant of the age- and gender-related differences in skeletal muscle strength. Furthermore, this finding is, to a large extent, independent of muscle location (upper vs. lower extremities) and function (extension vs. flexion).

scholarly journals Assessment of Muscle Quality and Quantity for the Diagnosis of Sarcopenia Using Mid-Thigh Computed Tomography : A Cohort Study

2020 ◽  
Author(s):  
Hiroki Oba ◽  
Yasumoto Matsui ◽  
Hidenori Arai ◽  
Tsuyoshi Watanabe ◽  
Hiroki Iida ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Muscle Strength ◽  
Muscle Mass ◽  
Physical Performance ◽  
Motor Function ◽  
Mass Measurement ◽  
Muscle Quality ◽  
Cross Sectional ◽  
Skeletal Mass ◽  
Low Mass

Abstract BackgroundPreviously, sarcopenia was diagnosed based on walking speed, grip strength, and muscle mass. However, recent consensus has proposed a concern regarding the use of muscle mass measurement for sarcopenia diagnosis due to lack of accuracy; therefore, new assessment methods in clinical practice are required. We compared computed tomography (CT) with various motor function tests to determine the validity of CT as a potential diagnostic method for sarcopenia.MethodsIn total, 214 patients who were examined at our center during the study period (2016–2017) were included in the study. Single-slice CT scan of the mid-thigh region was performed, from which cross-sectional area (CSA) and CT attenuation value (CTV) of quadriceps femoris were evaluated for each subject. Other assessments included skeletal mass index, muscle strength and physical performance. Furthermore, subjects were classified into four groups: normal, low muscle mass (low mass), poor muscle function/strength (poor function), and sarcopenia.ResultsCSA and muscle strength exhibited the strongest correlation. Some physical performance tests showed the strongest correlation with CTV. CSA was significantly reduced both in men and women with low mass and sarcopenia group (p < 0.01), whereas CTV was significantly lower in men with sarcopenia group and in women with poor function and sarcopenia group (p < 0.01).ConclusionsCSA mostly reflects muscle strength, whereas CTV mostly reflects physical performance. CT with measurements of CSA and CTV enables the evaluation of muscle mass and quality simultaneously. Thus, CT is thought to be useful for the assessment of motor function and diagnosis of sarcopenia.

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