Associations of ADL Disability With Trunk Muscle Mass and Muscle Quality Indicators Measured by Opportunistic Chest Computed Tomography Imaging Among Older Inpatients

Objectives: Sarcopenia is an important predictor of dependence in activities of daily living (ADL disability); however, the association between muscle quality and ADL disability has not been established. We aimed (1) to assess the feasibility of measuring trunk muscle mass and muscle quality by chest CT images; and (2) to explore the possible associations of ADL disability with these muscle mass and muscle quality indicators among older inpatients.Methods: We included older patients in an acute care ward. ADL disability was defined as the Barthel Index (BI) score ≤ 60 points. Unenhanced chest CT images at the 12th thorax (T12) vertebral level were used to segment skeletal muscle area (SMA) and intermuscular adipose tissue (IMAT) and to measure the mean skeletal muscle radiodensity (SMD). Skeletal muscle index (SMI), the muscle mass indicator, was calculated by SMA (cm2)/body height squared (m2). The percentage of IMAT (IMAT%) was calculated using the equation: IMAT% = IMAT/(SMA+ IMAT) ×100%. Skeletal muscle radiodensity, IMAT, and IMAT% were the muscle quality indicators. Kendall's tau rank correlation coefficients (τ) were calculated to explore the correlations. Univariate and multivariate logistic regression models were performed to calculate odds ratios (OR) and 95% confidence interval (CI).Results: We included 212 participants. Skeletal muscle index and SMD were positively and significantly associated with the BI score (τ = 0.14 and 0.31, respectively, both P < 0.001); whereas IMAT and IMAT% were negatively and significantly associated with the BI score (τ = −0.21, P < 0.001; τ = −0.21, P < 0.012). After adjusting for confounders, SMI (adjusted OR 1.03, 95% CI 0.97–1.09) was not independently associated with ADL disability; however, SMD (adjusted OR 0.94, 95% CI 0.88–0.99), IMAT (adjusted OR 1.11, 95% CI 1.03–1.20), and IMAT% (adjusted OR 1.09, 95% CI 1.02–1.16) were independently associated with ADL disability. Subgroup analysis found similar results in men; however, none of these indicators were independently associated with ADL disability in women.Conclusion: Trunk muscle quality indicators (SMD, IMAT, and IMAT%) measured by chest CT images, but not SMI, are independently associated with ADL disability in a single-center study population of older inpatients, especially in men. Further research is necessary to validate our findings.

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Diagnosing sarcopenia and myosteatosis based on chest computed tomography images in healthy Chinese adults

Insights into Imaging ◽

10.1186/s13244-021-01106-2 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Lingling Tan ◽

Guiyi Ji ◽

Ting Bao ◽

Hongbo Fu ◽

Ling Yang ◽

...

Keyword(s):

Computed Tomography ◽

Skeletal Muscle ◽

Muscle Mass ◽

Ct Images ◽

Chest Ct ◽

Muscle Quality ◽

Whole Body ◽

Chinese Adults ◽

Chest Computed Tomography ◽

Healthy Chinese

Abstract Background Measuring muscle mass and muscle quality based on chest Computed Tomography (CT) images would facilitate sarcopenia and myosteatosis research. We aimed (1) to measure muscle mass and myosteatosis based on chest CT images at the 12th thoracic vertebra level and compare the relevant indicators with whole-body skeletal muscle mass (BSM) and whole-body fat mass (BFM) measured by bioelectrical impedance analysis; and (2) to determine the cut-off points of these indicators for diagnosing sarcopenia or myosteatosis in healthy Chinese adults. Methods Chest CT images were analyzed using a segmentation software. Skeletal muscle area (SMA), skeletal muscle radiodensity (SMD), and intermuscular adiposity tissue (IMAT) were measured. Skeletal muscle indices (SMIs) and IMAT/SMA ratio were calculated. Results We included 569 participants. SMA, SMA/height2, and SMA/BMI were strongly and positively correlated with BSM (r = 0.90, 0.72, and 0.69, respectively, all p < 0.001); whereas SMA/weight was moderately and positively correlated with BSM (r = 0.38, p < 0.001). IMAT and IMAT/SMA were strongly and positively correlated with BFM (r = 0.67 and 0.58, respectively, both p < 0.001). SMD was moderately and negatively correlated with BFM (r = − 0.40, p < 0.001). We suggest SMA/height2 (< 25.75 cm2/m2 in men and < 20.16 cm2/m2 in women) for diagnosing sarcopenia and SMD (< 37.42 HU in men and < 33.17 HU in women) or IMAT (> 8.72 cm2 in men and > 4.58 cm2 in women) for diagnosing myosteatosis. Conclusions Muscle mass indicators (SMA and SMIs) and muscle quality indicators (SMD, IMAT, and IMAT/SMA) measured by chest CT images are valuable for diagnosing sarcopenia and myosteatosis, respectively.

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Characterizing Muscle Phenotype and Prognosis in Patients with Multiple Myeloma

Proceedings of IMPRS ◽

10.18060/24807 ◽

2020 ◽

Vol 3 ◽

Author(s):

Shannon Zhou ◽

Libbie Silverman ◽

Andrew Young ◽

David Roodman ◽

Attaya Suvannasankha ◽

...

Keyword(s):

Skeletal Muscle ◽

Multiple Myeloma ◽

Muscle Mass ◽

Lumbar Vertebrae ◽

University Hospital ◽

Muscle Quality ◽

Rank Test ◽

Muscle Area ◽

Skeletal Muscle Index ◽

Skeletal Muscle Area

Background/Objective: Low muscle mass (myopenia), poor muscle quality, myosteatosis, and muscle loss are associated with mortality in solid tumors. However, their impact in hematological malignancies remains unclear. We sought to determine how muscle phenotype relates to survival in patients with multiple myeloma. Methods: We performed a retrospective review of patients with multiple myeloma treated at Indiana University Hospital from 2012-2016. Total skeletal muscle area (SMA) (cm2) and radiodensity were measured on baseline (closest to diagnosis) and last CT scans at the third lumbar vertebrae area. SMA was normalized to height (SMA cm2/m2) to define skeletal muscle index (SKMI). Myopenia was defined as (SKMI) <52.4 cm2/m2 (men) and <38.5 cm2/m2 (women). Myosteatosis and obesity were defined per published BMI-specific cutoffs. Difference in survival between groups was estimated using log rank test. Results: Of 455 patients with multiple myeloma, 137 had more than one CT scan; 42 of these have been assessed to date. Half (21/42) were myopenic. Myopenia was equally prevalent across BMI categories and showed no association with survival. More than half of patients displayed myostetatosis; however, this was not associated with survival. Obesity and myopenic obesity were likewise not correlated with survival. Below-median baseline SKMI correlated with mortality, HR 2.721 (95% CI, 1.160-5.564: P=0.0129). As well, below-median final SMA correlated with mortality, HR 2.381 (95% CI, 1.094-5.181, P=0.0213). On average patients lost .7129% of SMA (95% CI; -6.072%-4.646%). Females had higher mortality, HR 2.355 (95% CI 0.9895-5.604, P=0.0215). Conclusion and Potential Impact: Although this study represents a fraction of treated patients to date, myopenia was prevalent among patients at diagnosis of multiple myeloma. Low muscle mass and sex appear to be important prognostic factors for survival. Additional measurements as well as univariate and multivariate analyses are necessary to verify these findings and identify additional factors that contribute to survival in multiple myeloma.

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Relationships between insulin sensitivity, skeletal muscle mass and muscle quality in obese adolescent boys

European Journal of Clinical Nutrition ◽

10.1038/ejcn.2012.142 ◽

2012 ◽

Vol 66 (12) ◽

pp. 1366-1368 ◽

Cited By ~ 19

Author(s):

S Lee ◽

Y Kim ◽

D A White ◽

J L Kuk ◽

S Arslanian

Keyword(s):

Skeletal Muscle ◽

Insulin Sensitivity ◽

Muscle Mass ◽

Skeletal Muscle Mass ◽

Muscle Quality ◽

Adolescent Boys ◽

Obese Adolescent

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Change in skeletal muscle index and its prognostic significance in conversion therapy for initially unresectable colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.3_suppl.56 ◽

2021 ◽

Vol 39 (3_suppl) ◽

pp. 56-56

Author(s):

Hiroaki Nozawa ◽

Shigenobu Emoto ◽

Koji Murono ◽

Yasutaka Shuno ◽

Soichiro Ishihara

Keyword(s):

Colorectal Cancer ◽

Skeletal Muscle ◽

Muscle Mass ◽

Skeletal Muscles ◽

Systemic Chemotherapy ◽

Stage Iv ◽

The Body ◽

Pharmacological Intervention ◽

Conversion Therapy ◽

Skeletal Muscle Index

56 Background: Systemic chemotherapy can cause loss of skeletal muscle mass in colorectal cancer (CRC) patients in the neoadjuvant and palliative settings. However, it is largely unknown how the body composition is changed by chemotherapy rendering unresectable CRC to resectable disease or how it affects the prognosis. This study aimed at elucidating the effects of systemic chemotherapy on skeletal muscles and survival in stage IV CRC patients who underwent conversion therapy. Methods: We reviewed 98 stage IV CRC patients who received systemic chemotherapy in our hospital. According to the treatment setting, patients were divided into the ‘Conversion’, ‘Neoadjuvant chemotherapy (NAC)’, and ‘Palliation’ groups. The cross-sectional area of skeletal muscles at the third lumbar level and changes in the skeletal muscle index (SMI), defined as the area divided by height squared, during chemotherapy were compared among patient groups. The effects of these parameters on prognosis were analyzed in the Conversion group. Results: The mean SMI increased by 8.0% during chemotherapy in the Conversion group (n = 38), whereas it decreased by 6.2% in the NAC group (n = 18) and 3.7% in the Palliation group (n = 42, p < 0.0001). Moreover, patients with increased SMI during chemotherapy had a better overall survival (OS) than those whose SMI decreased in the Conversion group (p = 0.021). The increase in SMI was an independent predictor of favorable OS on multivariate analysis (hazard ratio: 0.26). Conclusions: Stage IV CRC patients who underwent conversion to resection often had an increased SMI. As such an increase in SMI further conveys a survival benefit in conversion therapy, it may be important to make efforts to preserve muscle mass by meticulous approaches, such as nutritional support, muscle exercise programs, and pharmacological intervention even during chemotherapy in patients with metastatic CRC.

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Skeletal muscle index and its association with mobility among community‐dwelling older women

Baltic Journal of Health and Physical Activity ◽

10.29359/bjhpa.13.1.05 ◽

2021 ◽

Vol 13 (1) ◽

pp. 37-44

Author(s):

ZBIGNIEW M. OSSOWSKI

Keyword(s):

Skeletal Muscle ◽

Older People ◽

Older Women ◽

Muscle Mass ◽

Skeletal Muscle Mass ◽

Lower Extremities ◽

Community Dwelling ◽

Functional Mobility ◽

Skeletal Muscle Index ◽

Chair Stand

Background: The loss of muscle function and reduced mobility levels are the main reasons for the limitations of independence and disability in older people. The main aim of this study was to determine the relationship between the skeletal muscle index and mobility in older women. Material and methods: ‪The study involved 166 older women. Skeletal muscle mass and other body components were determined by bioimpedance using an InBody 720 device. Functional mobility was evaluated with the timed up-and-go test. 30-second chair stand was also used to measure the level of functional strength in lower extremities. Results: ‪The skeletal muscle index was positively correlated with functional mobility (r=-0.22; p=0.00) and 30-second chair stand (r=-0.47; p=0.00). However, the strength of lower extremities was a significantly better parameter in predicting mobility in older women than the skeletal muscle index and skeletal muscle mass. Conclusions: The functional strength of lower extremity muscles and the skeletal muscle index can have a positive effect on functional mobility in older people. The results may be helpful in clinical practice when diagnosing mobility limitations and in the process of programming physical activity of older women aimed at the prevention of sarcopenia.

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Reference Values for Skeletal Muscle Mass – Current Concepts and Methodological Considerations

Nutrients ◽

10.3390/nu12030755 ◽

2020 ◽

Vol 12 (3) ◽

pp. 755 ◽

Cited By ~ 6

Author(s):

Carina O. Walowski ◽

Wiebke Braun ◽

Michael J. Maisch ◽

Björn Jensen ◽

Sven Peine ◽

...

Keyword(s):

Skeletal Muscle ◽

Muscle Mass ◽

Reference Values ◽

Skeletal Muscle Mass ◽

Bioelectrical Impedance ◽

Reference Population ◽

Muscle Quality ◽

Whole Body ◽

Whole Body Imaging ◽

Cross Sectional

Assessment of a low skeletal muscle mass (SM) is important for diagnosis of ageing and disease-associated sarcopenia and is hindered by heterogeneous methods and terminologies that lead to differences in diagnostic criteria among studies and even among consensus definitions. The aim of this review was to analyze and summarize previously published cut-offs for SM applied in clinical and research settings and to facilitate comparison of results between studies. Multiple published reference values for discrepant parameters of SM were identified from 64 studies and the underlying methodological assumptions and limitations are compared including different concepts for normalization of SM for body size and fat mass (FM). Single computed tomography or magnetic resonance imaging images and appendicular lean soft tissue by dual X-ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA) are taken as a valid substitute of total SM because they show a high correlation with results from whole body imaging in cross-sectional and longitudinal analyses. However, the random error of these methods limits the applicability of these substitutes in the assessment of individual cases and together with the systematic error limits the accurate detection of changes in SM. Adverse effects of obesity on muscle quality and function may lead to an underestimation of sarcopenia in obesity and may justify normalization of SM for FM. In conclusion, results for SM can only be compared with reference values using the same method, BIA- or DXA-device and an appropriate reference population. Limitations of proxies for total SM as well as normalization of SM for FM are important content-related issues that need to be considered in longitudinal studies, populations with obesity or older subjects.

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Simplified morphological evaluation of skeletal muscle mass and maximum muscle strength in healthy young women: Comparison between thigh and calf

Women s Health ◽

10.1177/1745506520962009 ◽

2020 ◽

Vol 16 ◽

pp. 174550652096200

Author(s):

Tomohiro Yasuda

Keyword(s):

Skeletal Muscle ◽

Regression Analysis ◽

Muscle Mass ◽

Young Women ◽

Skeletal Muscle Mass ◽

Handgrip Strength ◽

Muscle Thickness ◽

Skeletal Muscle Index ◽

Stand Test ◽

Sit To Stand

Objectives: The purpose of this study was to examine the prediction of skeletal muscle mass and maximum muscle strength using simplified morphology evaluation in young Japanese women from the thigh and calf perspective. Methods: A total of 249 Japanese young women (aged 18–25 years) were used for data analyses in this study. Thigh and calf girths were measured using a tape measure at 50% of thigh length and at 30% proximal of calf length, respectively. Muscle thickness was measured using B-mode ultrasound at the anterior and posterior thigh (at 50% of thigh length) and at the posterior lower leg (at 30% proximal of calf length), respectively. The measurements were carried out on the right side of the body while the participants stood with their elbows extended and relaxed. A stepwise multiple regression analysis (method of increasing and decreasing the variables; criterion set at p < 0.05) was performed for skeletal muscle index (defined by appendicular skeletal muscle mass/height2), handgrip strength, or sit-to-stand test and five variable factors (girth (thigh and calf) and muscle thickness (anterior and posterior thigh and posterior calf)). Results: Unlike the sit-to-stand test, skeletal muscle index or handgrip strength was correlated ( p < 0.001) with the girth or muscle thickness for both thigh and calf. Unlike the sit-to-stand test, the prediction equations for skeletal muscle index and handgrip strength estimation showed significant correlations with multiple regression analysis of data obtained from the calf girth and muscle thickness. In both skeletal muscle index and handgrip strength, calf girth was adopted as a Step 1, respectively. Conclusion: Our results indicated that skeletal muscle index and handgrip strength could be evaluated by the simplified morphology methods, especially that for the calf girth measurement, which may be a good indicator of screening/preventing for sarcopenia in healthy Japanese young women.

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Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with Chemoradiation

Cancers ◽

10.3390/cancers11050709 ◽

2019 ◽

Vol 11 (5) ◽

pp. 709 ◽

Cited By ~ 10

Author(s):

Patrick Naumann ◽

Jonathan Eberlein ◽

Benjamin Farnia ◽

Thilo Hackert ◽

Jürgen Debus ◽

...

Keyword(s):

Skeletal Muscle ◽

Pancreatic Cancer ◽

Weight Loss ◽

Muscle Mass ◽

Muscle Wasting ◽

Statistical Tests ◽

Locally Advanced ◽

Advanced Pancreatic Cancer ◽

Skeletal Muscle Index ◽

Poor Outcomes

Background: Surgical resection offers the best chance of survival in patients with pancreatic cancer, but those with locally advanced disease (LAPC) are usually not surgical candidates. This cohort often receives either neoadjuvant chemotherapy or chemoradiation (CRT), but unintended weight loss coupled with muscle wasting (sarcopenia) can often be observed. Here, we report on the predictive value of changes in weight and muscle mass in 147 consecutive patients with LAPC treated with neoadjuvant CRT. Methods: Clinicopathologic data were obtained via a retrospective chart review. The abdominal skeletal muscle area (SMA) at the third lumbar vertebral body was determined via computer tomographic (CT) scans as a surrogate for the muscle mass and skeletal muscle index (SMI) calculated. Uni- and multi-variable statistical tests were performed to assess for impact on survival. Results: Weight loss (14.5 vs. 20.3 months; p = 0.04) and loss of muscle mass (15.1 vs. 22.2 months; p = 0.007) were associated with poor outcomes. The highest survival was observed in patients who had neither cachectic weight loss nor sarcopenia (27 months), with improved survival seen in those who ultimately received a resection (23 vs. 10 months; p < 0.001). Cox regression revealed that either continued weight loss or continued muscle wasting (SMA reduction) was predictive of poor outcomes, whereas a sarcopenic SMI was not. Conclusions: Loss of weight and lean muscle in patients with LAPC is prognostic when persistent. Therefore, both should be assessed longitudinally and considered before surgery.

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Impact of Skeletal Muscle Mass, Muscle Quality, and Visceral Adiposity on Outcomes Following Resection of Intrahepatic Cholangiocarcinoma

Annals of Surgical Oncology ◽

10.1245/s10434-016-5668-3 ◽

2016 ◽

Vol 24 (4) ◽

pp. 1037-1045 ◽

Cited By ~ 31

Author(s):

Shinya Okumura ◽

Toshimi Kaido ◽

Yuhei Hamaguchi ◽

Atsushi Kobayashi ◽

Hisaya Shirai ◽

...

Keyword(s):

Skeletal Muscle ◽

Muscle Mass ◽

Intrahepatic Cholangiocarcinoma ◽

Skeletal Muscle Mass ◽

Visceral Adiposity ◽

Muscle Quality

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Prevalence of older adults with low muscle mass living in a residential continuing care retirement community in Florida

Clinical Nursing Studies ◽

10.5430/cns.v7n1p83 ◽

2018 ◽

Vol 7 (1) ◽

pp. 83 ◽

Cited By ~ 1

Author(s):

Dennis Hunt ◽

Sareen S. Gropper ◽

Kelly A. Miller ◽

Barbara Tymczyszyn ◽

Deborah Chapa

Keyword(s):

Older Adults ◽

Skeletal Muscle ◽

Muscle Mass ◽

Nurse Practitioners ◽

Oldest Old ◽

Bioelectrical Impedance ◽

Retirement Community ◽

Continuing Care ◽

Skeletal Muscle Index ◽

Continuing Care Retirement Community

Muscle mass, strength, and function have been shown to decline with aging, and if of sufficient magnitude can result in sarcopenia. This study’s objective was to determine the prevalence of low muscle mass in a group of adults living in a “premier” Florida residential continuing care retirement community. The sample consisted of 80 older adults, ranging from young old (65-74 years) to the oldest old (85+ years) with the oldest participant being 94 years. Skeletal muscle mass was assessed via bioelectrical impedance analysis. Skeletal muscle index values were calculated and compared with established cut-off values to classify each individual’s muscle mass as normal or low (sarcopenic). The prevalence of sarcopenia among the males was 66% and among females was 73%. When examined by age, 56% of those in their 70s, 73% of those in their 80s, and 79% of adults in their 90s had low muscle mass indicative of sarcopenia. This study found a higher prevalence for sarcopenia in females and males, especially among the oldest groups, than previously reported in a nationally representative sample of adults. This study’s findings also suggest the need for further studies examining whether the prevalence of low muscle mass among adults in either classification varies with socioeconomic status and ethnicity. Continuing care retirement communities may provide excellent environments for the screening, diagnosis, and implementation of exercise and nutritional programs for residents to help prevent or attenuate sarcopenia’s deleterious effects. Nurse practitioners must incorporate screening for sarcopenia in their wellness package for their patients. Screening, nutritional education and support and exercise prescriptions are vital to prevent associated decline from sarcopenia.

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