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Sarcopenia

Decoding Sarcopenia: Advances in Research and Management: Dive into the evolving landscape of sarcopenia research. From cutting-edge studies on its impact on cancer patients to innovative management strategies, gain insights into combating this muscle-wasting condition.

Sarcopenia, unpreparedness, and the developing world: an urgent concern?

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.
Read MoreSarcopenia, unpreparedness, and the developing world: an urgent concern?

PIH and sarcopenia in COPD: a causal relationship?

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.
Read MorePIH and sarcopenia in COPD: a causal relationship?

Sarcopenia, perioperative mortality and advanced ovarian cancer: a review

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.
Read MoreSarcopenia, perioperative mortality and advanced ovarian cancer: a review

Sarcopenia and age in cancer patients: a review

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.
Read MoreSarcopenia and age in cancer patients: a review

Current sarcopenia definitions and clinical outcomes: a need for homogeneity?

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.
Read MoreCurrent sarcopenia definitions and clinical outcomes: a need for homogeneity?

2022: A year of research in JCSM

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.
Read More2022: A year of research in JCSM

Explaining and combatting the knowledge gaps surrounding sarcopenia

Sarcopenia is characterised by an age-related decline in muscle mass and strength combined with impairments in physical function. The risk of falls, fractures, and death is doubled in individuals with sarcopenia compared to those without. This patient population also frequently possesses comorbid diseases, including diabetes, cardiovascular disease, dementia, and chronic obstructive pulmonary disease. This may significantly increase their risk of suffering adverse outcomes post-surgery. The aim of this editorial was to expose the serious nature of sarcopenia and underscore associated knowledge gaps in clinical practice.
Read MoreExplaining and combatting the knowledge gaps surrounding sarcopenia

Sarcopenia and frailty assessments’ predictive value in elderly patients with COVID-19

Dynapenia is characterised by an age-related loss of muscle strength. When coupled with low muscle mass, it is instead diagnosed as sarcopenia according to the European Working Group on Sarcopenia in Older People revised guidelines (EWGSOP2). The SARS-CoV-2 infection is accompanied by severe inflammation and increased catabolism, which may significantly impact infected patients’ skeletal muscle structure and function. These impacts may be detrimental to elderly patients, who are disproportionately affected and already highly burdened by the disease. Recent studies have suggested that sarcopenia at the time of hospital admission may shape older patients’ length of stay and increase mortality in those with moderate to severe COVID-19. The aim of this study was to examine the association between simple clinical biomarkers, including those for the assessment of muscle function and frailty, and the risk of poor survival as well as increased length of hospital stay in older patients with COVID-19. Sarcopenia was screened using SARC-F, while frailty was assessed in accordance with the Rockwood Clinical Frailty Scale.
Read MoreSarcopenia and frailty assessments’ predictive value in elderly patients with COVID-19

Sarcopenia and its metabolic basis in CKD: the key to treating physical frailty?

Patients with chronic kidney disease (CKD) possess an increased risk of developing physical or phenotypic frailty. The skeletal muscle dysfunction underpinning physical frailty has been associated with increased mortality. CKD-related phenotypic frailty shares features with ageing-related frailty, and CKD has thus been touted as a clinically relevant model of premature ageing. The aim of this review was to examine the metabolic basis and pathogenesis of the skeletal muscle dysfunction responsible for phenotypic frailty in patients with CKD.
Read MoreSarcopenia and its metabolic basis in CKD: the key to treating physical frailty?

Sarcopenic obesity: prevalence and related outcomes

Ageing is associated with increased fat accumulation and weight gain due to altered energy metabolism. Sarcopenia, defined as a loss of muscle mass and function associated with increased mortality risk, is also linked to ageing. Sarcopenia obesity (SO) refers to the combination of age-related sarcopenia and obesity, and stems from the negative correlation between intermuscular adipose tissue accumulation and muscle performance. While elderly patients with obesity possess lower death rates than those with lower body mass indexes, patients with SO have higher mortality rates than these same peers. This, as well as obesity’s protective role against sarcopenia in the elderly, is the basis of the commonly known ‘obesity paradox’. The aim of this review was to assess the current clinical evidence relating to SO.
Read MoreSarcopenic obesity: prevalence and related outcomes

Sarcopenia and cachexia prevalence in older patients with colorectal cancer

Colorectal cancer (CRC) incidence has been shown to increase with age, an association which is clinically significant in the context of global ageing populations. Frailty, defined as increased vulnerability to stressors like surgery, is a marker associated with poor outcomes in patients with CRC. Sarcopenia, characterised by an age- and disease-related loss in muscle function and mass, has been identified as a major contributor to frailty. Patients with cancer also commonly experience cancer cachexia, i.e., loss of fat and muscle mass. This syndrome has also been associated with poorer survival rates for cancer patients. As such, both sarcopenia and cachexia constitute potentially modifiable risk factors of negative surgical outcomes. This study aimed to examine the prevalence of preoperative sarcopenia and cachexia in a group of older (≥65 years) vulnerable patients undergoing resection for localized CRC.
Read MoreSarcopenia and cachexia prevalence in older patients with colorectal cancer

Sarcopenia in kidney transplant recipients: prevalence, predictors, and prognosis

Patients with end-stage kidney disease (ESKD) are recommended to consider kidney transplantation (KT), a procedure known for improving survival and quality of life a smaller cost than dialysis. Current studies in kidney transplant recipients (KTRs) note heterogenous prevalence rates for sarcopenia, which ranges from 3.7% to 72.1%. This heterogeneity could be attributed to differences in diagnostic criteria and/or sample sizes. Ultimately, however, it contributes to the uncertainty surrounding sarcopenia’s clinical predictors and its impact on outcomes in KTRs. The aim of this study was to investigate the literature on KTRs to determine the most common reported diagnostic criteria of sarcopenia, its prevalence, clinical predictors, and its impact on KTRs’ outcomes.
Read MoreSarcopenia in kidney transplant recipients: prevalence, predictors, and prognosis

Perioperative nutrition and sarcopenic cancer: a review

Perioperative care in cancer patients is being reconsidered with our understanding of the association of sarcopenia and post-operative complications risks. Generally, there exists very little literature regarding the perioperative care of sarcopenic cancer patients. It has, however, been found that sarcopenic patients had significantly higher complication rates than that of non-sarcopenic patients. Future research needs to continue to understand the reasons behind this. Perioperative cancer also needs to be understood within various degrees of sarcopenia, through stratifying the population by muscle depletion and reduced function levels. Although nutritional support alone cannot counteract these issues that sarcopenic patients face, this approach can aid in decreasing progressive muscle mass loss, potentially lowering the risk of post-operative complications. This review by Bozzetti F aimed to understand the relationship between sarcopenia, muscle mass loss, and nutritional interventions.
Read MorePerioperative nutrition and sarcopenic cancer: a review

Frailty status, inflammatory, and muscle catabolism biomarker patterns: a strong association?

Fraily development is largely determined by low levels of nutrients, increased expression of inflammatory biomarkers, and age-related oxidative stress (OS). These frailty-related dysfunctions may lead to impairments in muscle structure and function, causing the onset of a muscle-catabolic state. As such, they may contribute to the development of sarcopenia, which is both a cause and a consequence of frailty. Measuring biomarker patterns such as dietary, OS, inflammatory, and muscle-related biomarkers (e.g., 3-methylhistidine (3MH)) has been touted as a means to understand the complex mechanisms behind frailty. Despite this, data on multi-biomarker patterns remains scarce. The aim of this study was to measure a variety of circulating biomarkers in an attempt to characterise their patterns. The existence of an association between these patterns and frailty status in non-frail and frail in-hospital patients was then assessed.
Read MoreFrailty status, inflammatory, and muscle catabolism biomarker patterns: a strong association?

The role of sarcopenia-associated mitochondrial dysfunction in recovery post-arthroplasty

Total knee arthroplasty (TKA) is the main procedure used to treat end-stage osteoarthritis. Although it is a highly successful treatment associated with 10-year survival in over 90% of cases, approximately 25% of patients experience unsatisfactory functional outcomes. Poor recovery rates after TKA have been linked to sarcopenia, a condition up to 44% of patients undergoing TKA suffer from. Mitochondrial dysfunction is one of sarcopenia’s major drivers. Despite this, mitochondrial function’s role in recovery post-TKA remains unknown. The aim of this study was to investigate the link between mitochondrial function at baseline and recovery after TKA. To do so, activity after TKA was monitored using a wrist mounted tracker. From this data, the relationship between activity and traditional outcome measures (e.g. grip strength) associated with recovery was clarified.
Read MoreThe role of sarcopenia-associated mitochondrial dysfunction in recovery post-arthroplasty

SARCOPENIA DEFINITION

Sarcopenia is a condition which focuses on muscle loss. Loss of muscle mass and function, especially muscle strength and gait speed, associated with aging occurs in sarcopenia. Sarcopenia, cachexia, and malnutrition are considered as the main causes of muscle wasting and affect millions of elderly people and patients. Moreover, muscle atrophy can develop independently from diseases and age through disuse of the muscles. For a better classification and common language in medical science for ‘muscle wasting disease’ there is a proposal to combine the concepts of muscle wasting, sarcopenia, frailty, and cachexia by disease aetiology and disease progression. Patients with muscle atrophy show decreased muscle strength and therefore reduced quality of life, which is caused by a lower activity and increased exercise intolerance.

Despite a large number of studies, the understanding of the development of muscle wasting and the involved pathways remains very limited and more research is needed. Although many researchers and pharmaceutical companies have tried to find therapies for muscle atrophy, including cachexia and sarcopenia, no solution has been established until now.

REFERENCES

Rosenberg IH. Sarcopenia: origins and clinical relevance. Clin Geriatr Med 2011;27:337–339.

Anker SD, Coats AJ, Morley JE, Rosano G, Bernabei R, von Haehling S, Kalantar-Zadeh K. Muscle wasting disease: a proposal for a new disease classification. J Cachexia Sarcopenia Muscle 2014;5:1–3

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