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Sarcopenia has recently emerged as a new condition that, independently from malnutrition, may adversely affect the prognosis of cancer patients. Purpose of this narrative review is to define the prevalence of sarcopenia in differe...
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Sarcopenia has recently emerged as a new condition that, independently from malnutrition, may adversely affect the prognosis of cancer patients. Purpose of this narrative review is to define the prevalence of sarcopenia in different primaries, its role in leading to chemotherapy toxicity and decreased compliance with the oncological therapy and the effect of some drugs on the onset of sarcopenia. Finally, the review aims to describe the current approaches to restore the muscle mass through nutrition, exercise and anti-inflammatory agents or multimodal programmes with a special emphasis on the results of randomized controlled trials. The examination of the computed tomography scan at the level of the third lumbar vertebra-a common procedure for staging many tumours-has allowed the oncologist to evaluate the muscle mass and to collect many retrospective data on the prevalence of sarcopenia and its clinical consequences. Sarcopenia is a condition affecting a high percentage of patients with a range depending on type of primary tumour and stage of disease. It is noteworthy that patients may be sarcopenic even if their nutritional status is apparently maintained or they are obese. Sarcopenic patients exhibited higher chemotherapy toxicity and poorer compliance with oncological treatments. Furthermore, several antineoplastic drugs appeared to worsen the sarcopenic status. Therapeutic approaches are several and this review will focus on those validated by randomized controlled trials. They include the use of omega-3-enriched oral nutritional supplements and orexigenic agents, the administration of adequate high-protein regimens delivered enterally or parenterally, and programmes of physical exercise. Better results are expected combining different procedures in a multimodal approach. In conclusion, there are several premises to prevent/treat sarcopenia. The oncologist should coordinate this multimodal approach by selecting priorities and sequences of treatments and then involving a nutrition health care professional or a physical therapist depending on the condition of the single patient.
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? 2023Background: This study aimed to validate the proposed Korean Working Group on Sarcopenia (KWGS) guideline, which introduces the concept of functional sarcopenia, in older Korean adults. Methods: Data from the Aging Study of ...
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? 2023Background: This study aimed to validate the proposed Korean Working Group on Sarcopenia (KWGS) guideline, which introduces the concept of functional sarcopenia, in older Korean adults. Methods: Data from the Aging Study of Pyeongchang Rural Area, a longitudinal cohort of community-dwelling older adults, were utilized to compare frailty status and institutionalization-free survival among participants according to sarcopenia status. Based on the KWGS guideline, severe sarcopenia was defined as low muscle mass and strength with slow gait speed; sarcopenia (not severe) was defined as low muscle mass with low muscle strength or slow gait speed; and functional sarcopenia was defined as low muscle strength and slow gait speed without low muscle mass. Results: Among the 1302 participants, 329 (25.3 %) had severe sarcopenia, 147 (11.3 %) had sarcopenia (not severe), and 277 (21.3 %) had functional sarcopenia. Frailty was significantly greater in participants with any phenotype of sarcopenia than in those without sarcopenia. Additionally, participants with functional sarcopenia were frailer than those with sarcopenia (not severe). Furthermore, the rates of institutionalization and mortality were higher in participants with any phenotype of sarcopenia than in those without sarcopenia. There was no statistical difference between the rates of sarcopenia (not severe) and those with functional sarcopenia. These findings remained consistent after adjusting for age and sex. Conclusions: Each phenotype according to the KWGS guideline was associated with significantly greater frailty and increased risk of institutionalization and mortality. Functional sarcopenia was associated with greater frailty and had comparable prognosis with sarcopenia (not severe).
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Opinion statement Sarcopenia is being consistently recognized as a condition not only associated with the presence of a malignancy but also induced by the oncologic therapies. Due to its negative impact on tolerance to chemotherap...
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Opinion statement Sarcopenia is being consistently recognized as a condition not only associated with the presence of a malignancy but also induced by the oncologic therapies. Due to its negative impact on tolerance to chemotherapy and final outcome in both medical and surgical cancer patients, sarcopenia should be always considered and prevented, and, if recognized, should be appropriately treated. A CT scan at the level of the third lumbar vertebra, using an appropriate software, is the more common and easily available way to diagnose sarcopenia. It is now acknowledged that mechanisms involved in iatrogenic sarcopenia are several and depending on the type of molecule included in the regimen of chemotherapy, different pharmacologic antidotes will be required in the future. However, progression of the disease and the associated malnutrition per se are able to progressively erode the muscle mass and since sarcopenia is the hallmark of cachexia, the therapeutic approach to chemotherapy-induced sarcopenia parallels that of cachexia. This approach mainly relies on those strategies which are able to increase the lean body mass and include the use of anabolic/anti-inflammatory agents, nutritional interventions, physical exercise and, even better, a combination of different therapies. There are some phase II studies and some small controlled randomized trials which have validated these treatments using single agents or combined multimodal approaches. While these approaches may require the cooperation of some specialists (nutritionists with a specific knowledge on pathophysiology of catabolic states, accredited exercise physiologists and physiotherapists), the oncologist too should directly enter these issues to coordinate the choice and priority of the treatments. Who better than the oncologist knows the natural history of the disease, its evolution, and the probability of tolerance and response to the oncologic therapy? Only the oncologist knows when it is essential to potentiate any effort to better achieve a control of the disease, using all the available armamentarium, and when the condition is too advanced and hence requires a more palliative than supporting care. The oncologist also knows when to expect a gastrointestinal toxicity (mucositis, nausea, vomiting, and diarrhea) and hence it is more convenient using a parenteral than an enteral nutritional intervention or, on the contrary, when patient is suitable for discharge from hospital and oral supplements should be promptly tested for compliance and then prescribed. When patients are at high risk for malnutrition or if, regardless of their nutritional status, they are candidate to aggressive and potentially toxic treatments, they should undergo a jointed evaluation by the oncologist and the nutritionist and physical therapist to assess together a combined approach. In conclusion, the treatment of both cancer- or chemotherapy-related sarcopenia represents a challenge for the modern oncologist who must be able to coordinate a new panel of specialists with the same skill necessary to decide the priority of different oncologic treatments within a complex multidisciplinary context.
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Abstract Object The SARC-F questionnaire is a sarcopenia screening tool. However, the validity of the SARC-F score ≥4 (SARC-F≥4) for the evaluation of sarcopenia in the hospital setting has not been investigated. This study inve...
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Abstract Object The SARC-F questionnaire is a sarcopenia screening tool. However, the validity of the SARC-F score ≥4 (SARC-F≥4) for the evaluation of sarcopenia in the hospital setting has not been investigated. This study investigated the validity of SARC-F≥4 as a screening tool for sarcopenia among hospitalized older adults.Design Cross-sectional retrospective study.Setting A university hospital.Participants This study included older adult patients (age ≥65 years) who were hospitalized at, and subsequently discharged from, the hospital between April and September 2019 and underwent a nutritional assessment by the nutrition support team during their hospitalization.Measurements SARC-F was recorded at the time of admission, and the criteria specified by the Asia Working Group for Sarcopenia in 2019 (AWGS 2019) were applied to diagnose sarcopenia and possible sarcopenia. Appendicular muscle mass was estimated through validated equations, and three different models were developed for sarcopenia diagnosis. The sensitivity, specificity, and positive/negative likelihood ratios were calculated to analyze the accuracy of the SARC-F≥4 for sarcopenia and possible sarcopenia. Receiver-operating characteristic analyses were conducted to calculate the area under the curve (AUC).Results In total, 1,689 patients (mean age: 77.2±13 years; male: 54.4%) were analyzed, and 636 patients (37.7%) had SARC-F≥4. Patients with SARC-F≥4 had a statistically significant higher prevalence of AWGS 2019-defined sarcopenia than patients with SARC-F <4 in the models (65.4–78.9% vs 40.9–15.2%, p<0.001). The sensitivity, specificity, and positive/negative likelihood ratios of SARC-F≥4 for sarcopenia and possible sarcopenia were 49.1–51.3%, 73.9–81.2%, and 1.88–2.72/0.60–0.69 and 48.0%, 84.5%, and 3.11/0.62, respectively. The AUC for sarcopenia and possible sarcopenia were 0.644–0.695 and 0.708, respectively. The AUC of SARC-F for possible sarcopenia was equivalent to or larger than that for sarcopenia (DeLong test p=0.438, 0.088, and <0.001 vs the three models).Conclusions SARC-F≥4 is suitable as a screening tool for sarcopenia in hospitalized older adults. SARC-F assessment could facilitate the detection and exclusion of sarcopenia at hospitalization and may lead to early adoption of a therapeutic and preventive approach.
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Background:?Sarcopenia is a muscle disease with significant morbidity and mortality. Vitiligo is a common autoimmune inflammatory disease which results from absence, deficiency, or dysfunction of melanocytes. Links between sarcope...
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Background:?Sarcopenia is a muscle disease with significant morbidity and mortality. Vitiligo is a common autoimmune inflammatory disease which results from absence, deficiency, or dysfunction of melanocytes. Links between sarcopenia and autoimmune inflammatory processes were reported. However, no previous reports on association between sarcopenia and vitiligo were identified.?Objective:?To assess presarcopenia in patients with vitiligo and to evaluate the effect of sociodemographic and clinical characteristics of vitiligo patients of sarcopenia if present.?Subject and methods:?This case control study included 63 patients with Vitiligoand 63 apparently healthy control group matched in age and gender.Sarcopenia was diagnosed by measuring the Appendicular Lean Mass Index. Cut off point required for sarcopenia is Results:?Mean age of vitiligo patients was 38.7 ?±? 14.0 years (range: 20-69 years) and for controls 39.9 ?±? 11.6 years (range: 20-70 years) (p=0.604). Female were 34 (54.0%) and 29 (46.0%) males, while in the controls 30 (47.6%) were females and 33 (52.4%) males (p=0.604). Presarcopenia was significantly higher in Vitiligo compared to controls. Vitiligo increases the risk of having presarcopenia by about five-fold (OR [95%CI]=4.706[1.26-17.61], p=0.013).Only BMI was significantly negatively correlated with presarcopenia. BMI decreases the risk of having presarcopenia by odds ratio of 0.837 (0.032). other baseline characteristics had no significant impact of presarcopenia in vitiligo (P model<0.01, R2?=0.46 Accuracy= 0.57 AUC=0.92).?Conclusions:?Vitiligo was significantly positively correlated with presarcopenia and increased the risk of presarcopenia by about five-fold.
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Age-related loss of muscle and bone (sarcopenia and osteoporosis), increases the risk of falls and fractures and consequently leads to a substantial economic burden for the society. The combined condition, osteosarcopenia, may ide...
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Age-related loss of muscle and bone (sarcopenia and osteoporosis), increases the risk of falls and fractures and consequently leads to a substantial economic burden for the society. The combined condition, osteosarcopenia, may identify patients at a higher risk of those outcomes and could be relevant for assessment and treatment in clinical practice.
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Muscle weakness is a key component of age-related conditions such as sarcopenia and frailty. Resistance training is highly effective at preventing and treating muscle weakness; however, few adults meet recommended levels. Retireme...
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Muscle weakness is a key component of age-related conditions such as sarcopenia and frailty. Resistance training is highly effective at preventing and treating muscle weakness; however, few adults meet recommended levels. Retirement may be a key life-stage to promote resistance training. We carried out a virtual focus group study to explore motivators and barriers to resistance training around the time of retirement, with the aim of determining strategies and messages to increase its uptake. The five focus groups (n = 30) were recorded, transcribed and thematically analysed. We found that resistance training was positively viewed when associated with immediate and long-term health and wellbeing benefits and had a social dimension; but there was a lack of understanding as to what constitutes resistance training, the required intensity level for effects; the role of pain; and the consequences of muscle weakness.
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Background Studies in mice have suggested that sarcopenic animals may have atrophic diaphragmatic muscles; however, to date, no clinical studies are available. Aims To investigate whether the diaphragmatic thickness is affected in...
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Background Studies in mice have suggested that sarcopenic animals may have atrophic diaphragmatic muscles; however, to date, no clinical studies are available. Aims To investigate whether the diaphragmatic thickness is affected in older patients with sarcopenia and if this is associated with impaired respiratory functions. Methods Thirty sarcopenic and 30 non-sarcopenic elderly patients aged over 65 were included. All patients underwent comprehensive geriatric assessment. The diagnosis of sarcopenia was made according to the criteria of the European Working Group on Sarcopenia in Older People. Ultrasonographic evaluations of the patients were carried out by an experienced radiologist. Diaphragmatic thickness was measured in three positions: end of deep inspiration, quiet breathing, end of forced expiration. Peak expiratory flow (PEF) rate was evaluated by a peak flow meter.
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In this commentary, we describe the sarcopenia spectrum that results in frailty and consider the impact of several components of the frailty definition on its global prevalence. We review proposed operational definitions of sarcop...
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In this commentary, we describe the sarcopenia spectrum that results in frailty and consider the impact of several components of the frailty definition on its global prevalence. We review proposed operational definitions of sarcopenia and the extent to which they have been shown to predict hard clinical outcomes, such as hip fracture, falls, and mortality. A head-to-head comparison of nine proposed operational definitions of sarcopenia as predictors of falls revealed that the definition involving appendicular lean mass (ALM)/ht(2) alone was a significant predictor; the prevalence of sarcopenia by this definition was 11 %. We consider the strengths and limitations of definitions that include functional measurements, such as gait speed and grip strength, along with measures of lean tissue mass. The functional assessments are harder to standardize than the more objective ALM measurements. The prevalence of sarcopenia by definitions that include functional and lean mass measurements tends to be lower than the prevalence by definitions that include lean mass alone. A low prevalence limits opportunity for early identification and application of prevention strategies. For these and other reasons, it seems advantageous to base the operational definition of sarcopenia on ALM/ht(2) alone. This commentary addresses the importance of a globally applicable operational definition of sarcopenia and both desirable and undesirable features of such a definition.
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