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.
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.
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.
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.
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.
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.
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.
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.
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.
Resilience is characterised by the ability to bounce back after exposure to a stressor or a form of adversity. It is frequently separated into physical and psychological components, with the former being defined as the ability to recover following age-related losses or disease. A decline in resilience is both a marker and a risk factor for accelerated ageing and frailty, respectively.
The aim of this editorial was to showcase the importance of resilience in the recovery of frail patients. It also exposes the mechanisms behind resilience, as well as the gaps in its clinical assessment.
The Hospital Frailty Risk Score (HFRS) was developed to detect frail individuals based on data extracted from hospital databases. An association between the HFRS, 30-day mortality, 30-day emergency hospital readmission, and long length of stay (LOS) was originally validated in populations of elderly patients admitted to hospital via the emergency department. Data regarding the HFRS’ predictive ability in the context of direct admissions and post-discharge outcomes is thus lacking.
The aim of this study was to investigate the associations between the HFRS and 30-day mortality, 30-day hospital readmission, and long LOS by analysing in- and out-patient healthcare in France.
For hepatocellular carcinoma, the most common type of liver cancer, liver transplantations are considered the best treatment, as they present with a 60-80% survival rate for 5 years. Suitability for a transplant is assessed by factors such as the patient’s tumour presentation and their responses to treatments, with the Milan Criteria representing the total criteria with all additional prognostic factors. Yet, general health is rarely included into this judgement. General health, especially low muscle pass (e.g, sarcopenia) may affect survival rates for liver transplantations; this has, however, rarely been addressed. This study discovered that a higher pre-operative muscle mass contributed to an increased rate of long-term survival post-liver transplantation.
This review by Beumer B et al. aimed to determine whether adding in the consideration of muscle mass, and working beyond the Milan Criteria, may benefit our understanding of the outcomes of liver transplantations.
Frailty is characterised by increased vulnerability to acute stressors. As it is common in adults with heart failure (HF), frailty has been used as a predictor of mortality and morbidity for HF patients.
Frailty Phenotype, the most commonly used frailty instrument in HF, is used for the physical examination of frailty. While physical frailty instruments are commonly used in clinical practice, a proportion of studies have expressed issues with such tools. As HF may have detrimental effects on physical function, the use of physical instruments may lead to an under- or over-estimation of frailty.
This study aims to compare the predictive ability of three physical frailty instruments (the Frailty Phenotype, the St Vincent’s Frailty instrument and the SHARE-FI); and three multi-domain instruments (the FRAIL scale, the Deficit Accumulation Index, and St Vincent’s Frailty plus cognition 7 and mood) in adults with HF.
While it was initially characterised by a loss of muscle mass, sarcopenia has been defined by several international panels as a decline in muscle function, with a focus on muscle strength and physical performance. Despite the existence of algorithms and research into screening tools for its diagnosis, sarcopenia has not yet been appropriately recognised by the World Health Organisation’s latest version of the ICD (ICD-11), which is used by most countries. Definitions of sarcopenia are growing more precise, yet this does not translate into improved patient care and outcomes.
This article aims to summarise the knowledge gaps surrounding sarcopenia’s definition, diagnosis, and treatment in current clinical practice. It also highlights the next steps in achieving worldwide sarcopenia recognition.
Sarcopenia is characterised by progressive and generalised skeletal muscle loss, both in terms of mass and function. Its main risk factors include ageing, gender, sedentary lifestyles and malnutrition. The latter is also frequently diagnosed alongside head- and- neck squamous cell carcinomas (HNSCC), with up to 46%-49% of patients being malnourished upon diagnosis.
Although sarcopenia has been identified as a prognostic factor for HNSCC, only a small number of studies investigate the association between sarcopenia and survival in HNSCC.
This study aimed to assess the association between pre-therapeutic sarcopenia and survival, as well as its impact on tolerance of chemoradiotherapy for the treatment of HNSCC. The outcomes measured in this study were overall survival (OS), disease-free survival (DFS), and treatment tolerance.
Frailty is a state of vulnerability, recognised clinically, where patients experience an ageing-associated decline in their physical and cognitive abilities. There are two main scales for measuring frailty. The Clinical Frailty Scale (CFS) is often used for intensive care unit patients. The Diseases-10 Modified Frailty Index (mFI) is also used; it is derived from the understanding of 11 comorbidities. However, it was unknown how the two compare. In this study of 7,001 patients, it was found that a greater proportion of patients were categorised as frail using the CFS, and this scale also predicted better those who would survive past the 6-month mark versus those who would die. This indicates that the two scales are not equivalent, and the mFI should not be used for frailty.
This review by A. Subramaniam et al. aimed to highlight the differences between the two scales, the Clinical Frailty Scale and the Diseases-10 Modified Frailty Index, to determine which is a better predictor of frailty.
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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