Sarcopenia (muscle wasting) is common in people with hepatocellular carcinoma (HCC). Sarcopenia is associated with poor clinical outcomes in HCC patients, such as shorter survival and side effects of treatment. There is no specific drug for sarcopenia, but multimodal therapy and interdisciplinary…
Sarcopenia is characterised by age-related reductions in skeletal muscle strength, mass, and functional ability. Importantly, sarcopenia is a multifactorial condition associated with metabolic alterations, including poor glucose disposal, insulin resistance, decreased metabolic rate and, thus, type 2 diabetes (T2D). Developing non-pharmaceutical guidelines for the prevention and treatment of both diseases when they coexist is essential to optimise patient health and reduce premature mortality within this patient population. This review aimed to examine 1) the pathophysiological link between sarcopenia and T2D, and 2) lifestyle interventions with the potential to mitigate both sarcopenia and T2D.
It is known that one in five adults with pre-frailty progresses to frailty over a 3-year period. Low protein and energy intake, increased prevalence of multimorbidity, and a sedentary lifestyle are well-characterised drivers of sarcopenia. Consequently, they act as catalysts of older adults’ transition to frailty. In this vein, stimulating increased muscle protein synthesis through regular physical exercise and protein-enriched diet consumption is pivotal for pre-frail older adults. Current U.S. Food and Nutrition Board guidelines recommend a dietary allowance of 0.8 g/kg of protein per day for older adults. However, this amount may be insufficient for those with pre-frailty due to their low-grade inflammation, multimorbidity, and increased susceptibility to anabolic resistance. This study aimed to examine the impact of leucine-enriched protein supplementation with or without exercise on 1) physical function, 2) body composition, and 3) systemic inflammation in pre-frail older adults with a daily protein consumption of ≤1 g/kg.
The normal ageing process is accompanied by progressive declines in muscle mass and strength. Abnormal and excessive losses of skeletal muscle mass and quality emerge as a consequence of age-related musculoskeletal disorders, e.g. sarcopenia. The latter confers affected patients with increased risks of adverse outcomes, including falls, fractures, and mortality. Moreover, sarcopenic patients often exhibit higher levels of dependency and disability, both of which impact their health-related quality of life (HRQoL). HRQoL measures are well-characterised predictors of hard clinical outcomes, including hospitalisation and mortality. Accordingly, the use of sarcopenia-specific HRQoL tools in clinical practice and interventional trials is recommended by recent European Working Group on Sarcopenia in Older People (EWGSOP2) guidelines. This meta-analysis aimed to characterise the relationship between sarcopenia and patient-reported HRQoL.
Ageing is often associated with appetite reduction and ensuing weight loss. Although it is known that physical activity (PA) can prevent these ageing-related processes, the exact molecular mechanisms underpinning this ability remain unknown. Recent research has highlighted the role of exerkines, i.e. proteins released during and after PA, in controlling energy metabolism. Growth differentiation factor 15 (GDF-15), a stress-signalling cytokine secreted during PA and involved in ageing, exercise, and appetite control, has emerged as a potential mediator of late-life, ageing-related weight loss. This study aimed to explore the associations between PA, GDF-15, and body weight changes in older adults enrolled in the Multidomain Alzheimer Preventive Trial over a 3-year period.
This study investigates the connection between sarcopenia and age-related spinal deformities, focusing on lumbar paravertebral muscles (PVM) quality and volume. Results show that sarcopenic patients have higher ectopic fat infiltration in PVM, contributing to spinal deformities, highlighting the importance of understanding and addressing sarcopenia in relation to spinal health.
Appetite Loss, Malnutrition, and Mortality: a Significant Association in Need of Urgent Recognition?
This systematic literature review highlights the underrecognition of appetite loss in older adults and its association with malnutrition and mortality. The study underscores the urgent need for standardized screening and comprehensive guidelines to improve the assessment and management of appetite loss in this population.
This study reveals the prognostic value of sarcopenia measurements in patients with advanced metastatic gastroesophageal cancer, showing its association with poor overall and progression-free survival. The findings highlight the importance of considering sarcopenia status alongside clinical variables for better prognostication.
This article provides an overview of the current state of research on anorexia of ageing, its metabolic implications, and potential biomarkers, highlighting the need for further investigation into appetite regulation in older adults to improve health outcomes and personalized nutritional care.
Muscle strength has recently been defined as sarcopenia’s main component by the revised European Working Group in Sarcopenia for Older People (EWGSOP2). This shift from muscle mass to strength has had transformative implications within clinical practice and has greatly facilitated sarcopenia’s diagnostic process. Despite this trailblazing consensus, sarcopenia remains an issue of growing concern throughout high-income countries (HICs). Although low- and middle-income countries (LMICs) are disproportionately affected by the threat of sarcopenia, their care providers and healthcare systems seem to be the least prepared to tackle it. The aim of this article is to expose the state of sarcopenia awareness and management in LMICs. It further proposes solutions to prepare the developing world for this growing concern.
Nocturnal hypoxia commonly occurs in patients with chronic obstructive pulmonary disease (COPD), and in this context may be referred to as prolonged intermittent hypoxia (PIH). It is estimated that 1 in 5 COPD patients also suffer from sarcopenia, which may affect both respiratory and non-respiratory skeletal muscles and be causally linked to PIH. The presentation of sarcopenia alongside COPD is known to reduce quality of life and increase both hospitalisation and mortality rates in affected patients. Despite this, the adaptive cellular responses to PIH in skeletal muscle have not yet been adequately investigated. The aim of this article was to discuss findings from a 2022 paper by Attaway and colleagues, which itself aimed to explore adaptive cellular responses to PIH.
All types of ovarian cancers hold a high risk of morbidity and mortality for the patients. Currently, there are many efforts to assess ovarian cancer progression, to allow for the development of accurate treatment and management plans for preventing mortality in the long-term. A physical indicator of increased vulnerability is frailty. Frailty can lead to falls, hospitalisation and increased risk of death. Generally, frailty is closely associated with poor prognosis and shorter progression-free survival in many conditions, including ovarian cancer. However, diagnosing frailty is complex, due to a lack of a set definition and due to comorbidities appearing in older patients. Although this study draws useful conclusions, its limitation holds that some confounding factors could not be adjusted for, meaning further research is needed to understand the interplay between ovarian cancer and frailty. This review by Can E et al. aimed to understand the prognostic value of frailty to predict complications and mortality in patients with ovarian cancer.
Currently, medical treatment for cancer is personalised by looking at genetic and molecular factors of cancer cells. However, for characterising patients, factors such as age, weight, BMI, comorbidities, etc are used. Hence, there is no set, universal variable(s) to be used in managing cancer. It is possible that this is the reason that many anticancer drugs perform poorly clinically, due to this variability between patients. One of the factors that can be used is chronological age, which defines the patient’s accumulated damage to their system. Age is an accurate predictor of various outcomes, including the outcomes of anticancer drug therapies. For example, patients between the ages of 65-69 are often less likely to respond well to chemotherapy. A way to index age is sarcopenia, but due to the complex, varying body compositions associated with tumour growth, it is difficult to use sarcopenia consistently as an index for age in cancer management. This review by Laviano A aimed to explore variables, such as sarcopenia and ageing, in their effects on cancer and anticancer drug successes.
Exercise, nutrition, or combined interventions: which is the most effective treatment for sarcopenia?
No pharmacologic intervention has yet been approved for the treatment of sarcopenia. Only exercise and nutritional support via increased protein intake have been shown to significantly improve this condition. As such, lifestyle interventions aiming to increase physical exercise and/or protein intake are recommended for the prevention, management, and treatment of sarcopenia. The aim of this systematic review was to assess the intervention (exercise or nutrition alone, against a combination of both) best able to improve sarcopenia. This improvement was measured in older adults using the skeletal muscle index (SMI), handgrip, and gait speed.
Three new definitions of sarcopenia have emerged in the past four years, proposed by the Sarcopenia Definition and Outcome Consortium (2020, SDOC), the European Working Group on Sarcopenia in Older People (2019, EWGSOP2) and the Asian Working Group on Sarcopenia (2019, AWGS2). No consensus on a unique definition of sarcopenia has yet been achieved, as the three new definitions proposed exhibit significant differences from each other. EWGSOP2’s definition of sarcopenia, for instance, characterises it as low muscle strength and mass, while the one developed by SDOC focuses on low muscle strength and gait speed instead. The aim of this scoping review was to investigate all three recent sarcopenia definitions’ predictive validity for clinical outcomes.
The Journal of Cachexia, Sarcopenia and Muscle mainly publishes research on cachexia, sarcopenia and muscle wasting disorders, but also includes papers on cancer, heart failure, ageing and many other conditions. Before November 2022, there were seen to be 775,000 downloads of the articles within the journal, with the top three countries downloading articles being China, the US and Japan. The most downloaded and cited article is entitled, Cachexia as a major underestimated and unmet medical need: facts and numbers. This review by Frohlich A et al. aimed to review the successes of the Journal of Cachexia, Sarcopenia and Muscle in 2022.