Background:Previous studies have highlighted the frequent occurrence of sarcopenia in patients with pancreatic diseases,including chronic pancreatitis.We aimed to clarify the prevalence of skeletal muscle(SM)loss and ...Background:Previous studies have highlighted the frequent occurrence of sarcopenia in patients with pancreatic diseases,including chronic pancreatitis.We aimed to clarify the prevalence of skeletal muscle(SM)loss and sarcopenia,and their associations with clinical characteristics,bone mineral density,and pancreatic imaging findings in patients with autoimmune pancreatitis(AIP).Methods:This study included 114 patients with AIP treated at Tohoku University Hospital.The SM index was assessed using a bioelectrical impedance analysis device,grip strength was measured using a hand dynamometer,and bone mineral density was evaluated using dual-energy X-ray absorptiometry.Univari-ate and multivariate logistic regression analyses were used to analyze factors associated with SM loss and sarcopenia.Results:Among 114 patients,57(50.0%)had SM loss,31(27.2%)had reduced grip strength,and 27(23.7%)had both.Patients with SM loss were older and had a lower body mass index,weaker grip strength,higher Controlling Nutritional Status scores,and lower serum lipase and albumin levels compared to those without SM loss.Computed tomography scans revealed a higher prevalence of pancreatic parenchy-mal atrophy in patients with SM loss.Similar differences were observed between patients with sarcopenia and those without.Osteopathy was observed in 35.6%of patients with SM loss and 38.1%of those with sarcopenia,whereas only 4.1%of patients without SM loss had osteopathy.Low BMI(<21.0 kg/m^(2))was also found to be an independent risk factor for SM loss in multivariate analysis.Age>72 years,low BMI(<20.0 kg/m^(2)),and low serum lipase levels(<13 U/L)were independent risk factors for sarcopenia in multivariate analysis.Conclusions:SM loss and sarcopenia are prevalent in patients with AIP and are associated with aging,poor nutritional status,low serum lipase levels,and pancreatic parenchymal atrophy.In addition to the high risk of osteopathy,careful attention should be paid to maintain muscle health in AIP patients.展开更多
Irisin is a chief myokine released during physical activity and has garnered attention for its potential therapeutic effects on different metabolic and cardiovascular disorders.This review explores the intricate conne...Irisin is a chief myokine released during physical activity and has garnered attention for its potential therapeutic effects on different metabolic and cardiovascular disorders.This review explores the intricate connections between irisin,physical activity,sarcopenia,type 2 diabetes mellitus(T2DM),and cardiovascular complications.Experimental data suggests that through irisin release,physical activity positively influences muscle health,metabolic regulation,and cardiovascular function.In individuals with sarcopenia,characterized by progressive muscle mass and function loss,irisin plays a pivotal role in maintaining muscle integrity and function.Additionally,irisin’s beneficial effects on insulin sensitivity and glucose metabolism suggest its involvement in the pathophysiology of T2DM.The review will examine how irisin may modulate the development of cardiovascular complications,particularly in the context of diabetes and aging.Additionally,it will explore its potential as a therapeutic target for managing sarcopenia,T2DM,and cardiovascular complications,underscoring the importance of physical activity in mitigating these interconnected health challenges.Further research is needed to elucidate the precise mechanisms by which irisin mediates these effects and assess its clinical applicability in preventing and treating metabolic and cardiovascular disorders.展开更多
BACKGROUND The prevalence of sarcopenia progressively increases with as liver function deteriorates.Muscle wasting has been shown to independently predict adverse outcomes in liver cirrhosis patients.AIM To screen eff...BACKGROUND The prevalence of sarcopenia progressively increases with as liver function deteriorates.Muscle wasting has been shown to independently predict adverse outcomes in liver cirrhosis patients.AIM To screen effective biomarkers for sarcopenia in liver cirrhosis.METHODS Untargeted metabolomics were performed on serum from 62 liver cirrhosis patients,including 41 with sarcopenia and 21 without sarcopenia.Candidate metabolite biomarkers were screened based on three machine-learning algorithms.The diagnostic or predictive value of potential biomarkers was evaluated by drawing receiver operating characteristic curves.RESULTS A total of 60 differential metabolites between cirrhotic sarcopenia and the nonsarcopenia group were identied.Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis revealed differential metabolites primarily involved in glycerophospholipid metabolism,alpha-linolenic acid metabolism,retrograde endocannabinoid signaling,and choline metabolism in cancer.Finally,four potential biomarkers were screened through machine learning algorithms,namely N-Acetylcarnosine,2-Stearylcitrate,CerP(d18:1/12:0),and 3-Methyl-alpha-ionylacetate.Among these,N-Acetylcarnosine can provide better diagnostic accuracy.CONCLUSION This study unveiled different plasma metabolic profiles of liver cirrhosis patients with and without sarcopenia.These valuable biomarkers have the potential to improve the prognosis of liver patients with cirrhosis by early detection or prediction of sarcopenia.展开更多
Introduction:Diet intervention,especially supplementation with high-quality protein,is considered to be a critical strategy in sarcopenia.However,different sources and types of protein have different health impacts.Ob...Introduction:Diet intervention,especially supplementation with high-quality protein,is considered to be a critical strategy in sarcopenia.However,different sources and types of protein have different health impacts.Objectives:The aim of this study is to explore the differences in the ameliorative effects and mechanisms of different sources and types of proteins on sarcopenia,providing an optimal path for the prevention and treatment of sarcopenia.Methods:A sarcopenia model was established by intraperitoneal injection of dexamethasone(5 mg/kg).Sixty male C57BL/6 mice(8 months old)were randomly divided into the normal control,sarcopenia,goat whey protein,goat milk casein,bovine whey protein,and bovine milk casein groups.Animals were treated for 8 consecutive weeks.Organism-level and molecular phenotypes,16S rRNA gene sequencing,and untargeted metabolomics profiling based on GC-TOF/MS were employed to investigate the correlation between host metabolism,microbial metabolism,autophagy and inflammation and their influence on sarcopenia in C57BL/6 male mice.Results:All 4 proteins increased muscle mass,and goat whey protein improved muscle strength in sarcopenic mice.Goat and bovine milk proteins promoted muscle regeneration by increasing MyoD1 and MyoG expression,and the former had a more distinct effect in inducing autophagy and decreasing inflammation than the latter.In addition,goat whey protein and casein could modulate hostmicrobial arginine co-metabolism.Notably,goat milk proteins responded well to sarcopenia comorbidities,including sarcopenic obesity,osteosarcopenia,and osteoarthritis.Conclusion:The study confirmed that goat milk proteins were more effective than bovine milk proteins for the control of sarcopenia.Moreover,we found that whey protein and casein could modulate host-microbial arginine co-metabolism,which shows their potential as precision nutritional supplements for the management of sarcopenia.Our study provides theoretical support for the prevention and control of sarcopenia.展开更多
BACKGROUND The impact of psychiatric disorder,especially depression,on the prognosis of sarcopenic patients is gaining prominence.Yet,there have been very few studies focusing on this issue,let alone the related targe...BACKGROUND The impact of psychiatric disorder,especially depression,on the prognosis of sarcopenic patients is gaining prominence.Yet,there have been very few studies focusing on this issue,let alone the related targeted mental health prevention.This cohort-based nested case-control study is geared to compare risk of depression and the depression-related ambulatory care utilization for sarcopenia persons with and without receiving add-on Chinese herbal medicines(CHMs)treatment.AIM To compare risk of depression and the depression-related ambulatory care utili-zation for sarcopenia persons with and without receiving add-on CHMs treat-ment.METHODS In the beginning,we recruited those aged 20-70 years with newly diagnosed sarcopenia and free of depression between 2002 and 2010 from a nationwide insurance database.From them,we identified cases with depression onset occurring after sarcopenia until December 31,2013.To cautiously isolate the effect of CHMs,we established the matched sets of treated and untreated subjects with CHMs use by randomly frequency matching.A conditional logistic regression was executed to explore the association of CHMs to depression risk,and the frequency and costs of depression-related ambulatory care were compared using Mann-Whitney U test.RESULTS Addition of CHMs to routine care of sarcopenia notably correlated with a lower risk of depression.A remarkable effect of CHMs in reducing depression was detected when sarcopenia subjects received CHMs for more than three years,lowering depression risk by as much as 65%.As compared to CHMs users,the non-CHMs users indeed incurred higher frequency and costs of depression-related ambulatory care after depression attack(P<0.05).Notably,the costs for per depression-related ambulatory care profoundly increased with the years after depression attack.CONCLUSION Sarcopenic patients can greatly benefit from add-on CHMs treatment,underscoring the urgent need for interdisciplinary collaboration and proactive treatment planning.展开更多
With the aging global population,the decline in muscle mass and function among the elderly has emerged as a significant concern.This systemic progressive generalized loss of muscle function and mass is referred to as ...With the aging global population,the decline in muscle mass and function among the elderly has emerged as a significant concern.This systemic progressive generalized loss of muscle function and mass is referred to as sarcopenia(SP).In recent years,a growing number of studies have investigated SP,revealing that many tumor diseases,especially in the digestive system,promote its occurrence due to the influence of the disease itself,diet,and other factors.Moreover,SP patients tend to have poorer postoperative recovery.At present,many diagnostic methods have been developed for SP,but no unified standard has been established.Furthermore,the cutoff values of many diagnostic methods for different populations are still in the exploratory stage,and additional clinical studies are required to explore these issues.This article comprehensively and systematically summarizes the diagnostic methods and criteria mentioned in previous research,focusing on the impact of SP on post-surgical patients with various malignant tumors.展开更多
Skeletal muscles perform important metabolic functions.Muscle mass wasting in sarcopenia is an urgent problem of modern medicine,the interest in which is related to its prognostic significance.The liver has numerous d...Skeletal muscles perform important metabolic functions.Muscle mass wasting in sarcopenia is an urgent problem of modern medicine,the interest in which is related to its prognostic significance.The liver has numerous direct and indirect metabolic and immune connections with skeletal muscle and disruptions of these connections in liver disease are of clinical interest.A recent article by Liang et al emphasized potential biomarkers of sarcopenia in liver cirrhosis.Identification of biomarkers of sarcopenia in patients with cirrhosis has important diagnostic value.Common pathophysiologic mechanisms of sarcopenia and liver cirrhosis include disorders of protein and energy metabolism,disturbances in the structure of gut microbiota,inflammation and oxidative stress.展开更多
BACKGROUND Sarcopenia is a clinical syndrome presented with progressive and generalized skeletal muscle loss and function dysfunction.Usually,it is considered an agerelated process influenced by genetic,lifestyle fact...BACKGROUND Sarcopenia is a clinical syndrome presented with progressive and generalized skeletal muscle loss and function dysfunction.Usually,it is considered an agerelated process influenced by genetic,lifestyle factors,and diseases.Obstructive jaundice is one of the most common pathophysiological changes in patients needing hepatobiliary or pancreatic operations that can adversely affect the tissue and organ function throughout the human body.However,the effects of obstructive jaundice on the occurrence of sarcopenia remain unclear.AIM To investigate the incidence of sarcopenia in patients with surgical obstructive jaundice and the association of sarcopenia with postoperative outcome.METHODS This cross-sectional study was conducted from December 2019 to January 2024.Data retrieved included patient demographics,disease entities,sarcopenia-related parameters(including grip strength,6-m walking time,and limb skeletal muscle mass index),postoperative complications,and length of hospital stay.Sarcopenia was confirmed using Asian Working Group standards.Logistic regression was used to analyze the relationship between total bilirubin level and sarcopenia.The factors influencing sarcopenia in patients with surgical obstructive jaundice and association of sarcopenia with postoperative complications were also investigated.RESULTS Overall,1708 patients met the inclusion criteria,with a mean age of 60.09±13.52 years(sex:52.28%male).There were 383 patients(22.42%)with obstructive jaundice and 1325(77.58%)without jaundice.Sarcopenia,low walking speed,low grip strength,and low limb skeletal muscle index were more prevalent in patients with obstructive jaundice than nonobstructive jaundice.The odds ratio(OR)for sarcopenia in patients with obstructive jaundice was 1.689[95%confidence interval(CI):1.295-2.203,P<0.001],indicating that jaundice is a significant risk factor for sarcopenia.The occurrence of sarcopenia was higher in patients with severe obstructive jaundice than mild obstructive jaundice(39.3%vs 22.8%,P<0.05).Obstructive jaundice was positively correlated with reduced walking speed(OR=1.627,95%CI:1.185-2.234,P=0.003)and decreased grip strength(OR=1.669,95%CI:1.212-2.300,P=0.002).Age(OR=1.077,95%CI:1.040-1.114,P<0.001)and body mass index(OR=0.703,95%CI:0.630-0.784,P<0.001)were independent risk factors of sarcopenia in patients with obstructive jaundice.Patients with obstructive jaundice and sarcopenia had a higher rate of postoperative complications(46.3%vs 33.1%,P=0.032),longer postoperative hospital stays(11.33±6.75 days vs 9.19±7.32 days,P=0.016),and longer total hospital stays(17.10±7.69 days vs 15.98±8.55 days,P=0.032)than those without sarcopenia.CONCLUSION Sarcopenia is more prevalent in patients with obstructive jaundice and is positively correlated with the degree of jaundice.Sarcopenia prolongs hospital stays and is associate with postoperative complications.展开更多
The etiology,risk factors,and management of sarcopenia and metabolic dysfunction-associated steatotic liver disease(MASLD)are comparable,which prompted the investigators to search for a particular diagnostic or progno...The etiology,risk factors,and management of sarcopenia and metabolic dysfunction-associated steatotic liver disease(MASLD)are comparable,which prompted the investigators to search for a particular diagnostic or prognostic biomarker that was involved in both disorders.Peptides or proteins known as myokines,or exerkines,are produced and secreted by contracted muscles.Myokines work similarly to hormones in their actions.One common clinical hallmark of sarcopenia and MASLD is physical inactivity,which is associated with alterations in the levels of myokines.Irisin is a positive regulator of muscle size that is elevated in the biological fluids during exercise.Significantly low levels were observed in the pathological conditions associated with physical inactivity.The serum levels of irisin are significantly higher in MASLD patients,while their levels were lower in risk factors of MASLD,e.g.,diabetes mellitus,obesity,and insulin resistance.In sarcopenia with obesity(sarcopenic obesity)or with a normal build,serum irisin levels are significantly lower than in healthy subjects.Therefore,serial determination of irisin levels that showed a transition from higher to lower levels in MASLD indicated the development of sarcopenia in those patients.展开更多
BACKGROUND Sarcopenia is prevalent among patients with end-stage liver disease(ESLD)and is associated with adverse outcomes both before and after liver transplantation(LT).Accurate assessment of muscle mass is essenti...BACKGROUND Sarcopenia is prevalent among patients with end-stage liver disease(ESLD)and is associated with adverse outcomes both before and after liver transplantation(LT).Accurate assessment of muscle mass is essential for effective risk stratification and optimization of transplant outcomes.AIM To identify imaging modalities used to assess sarcopenia in ESLD patients awaiting LT,and evaluate the clinical utility of each technique in predicting waitlist mortality,length of hospital stay,and post-transplant survival.METHODS A systematic search was conducted in PubMed,MEDLINE,EMBASE,and Scopus for studies published between May 2015 and May 2025.Eligible studies included original research evaluating sarcopenia using imaging techniques in ESLD patients listed for LT.Due to heterogeneity in study design,diagnostic criteria,and outcomes,data were synthesized qualitatively.RESULTS A total of 17 studies met the inclusion criteria,encompassing modalities such as computed tomography(CT),magnetic resonance imaging,dual-energy X-ray absorptiometry,and ultrasound.CT at the third lumbar vertebra level was most frequently used,exhibiting consistent prognostic values for pre-and post-transplant outcomes.However,considerable variability in cutoff values and sarcopenia definitions was observed.Emerging evidence also supports the prognostic relevance of muscle quality indicators,including muscle attenuation and fat infiltration.CONCLUSION CT and magnetic resonance imaging are the most robust imaging methods for sarcopenia diagnosis in patients with ESLD.Standardized diagnostic criteria incorporating muscle quality metrics are essential for improving prognostic accuracy and guiding clinical decision making in LT candidates.Such integration would also support the development of unified frameworks for sarcopenia assessment in transplantation practice.展开更多
The skeletal muscle is the largest organ present in the body and is responsible for mechanical activities like maintaining posture,movement,respiratory function,and support for the health and functioning of other syst...The skeletal muscle is the largest organ present in the body and is responsible for mechanical activities like maintaining posture,movement,respiratory function,and support for the health and functioning of other systems of the body.Skeletal muscle atrophy is a condition characterized by a reduction in muscle size,strength,and activity,which leads to an increased dependency on others for movement,an increased risk of falls,and a reduced quality of life.Various conditions like osteoarthritis,osteoporosis,and fractures are directly associated with increased muscle atrophy.Additionally,numerous risk factors,like aging,malnutrition,physical inactivity,and certain disease conditions,through distinct pathways,negatively affect skeletal muscle health and lead to muscle atrophy.Among various determinants of overall muscle health,the rate of muscle protein synthesis and degradation is an important parameter that eventually alters the fate of overall muscle health.In conditions of excessive skeletal muscle atrophy,including sarcopenia,the rate of muscle protein degradation usually exceeds the rate of protein synthesis.The availability of amino acids in the systemic circulation is a crucial step in muscle protein synthesis.The current review aims to consolidate the existing evidence on amino acids,highlight their mechanisms of action,and assess their roles and effectiveness in enhancing skeletal muscle health.展开更多
OBJECTIVE:To explore the potential molecular mechanism of Qigu capsule(芪骨胶囊,QGC) in the treatment of sarcopenia through network pharmacology and to verify it experimentally.METHODS:The active compounds of QGC and ...OBJECTIVE:To explore the potential molecular mechanism of Qigu capsule(芪骨胶囊,QGC) in the treatment of sarcopenia through network pharmacology and to verify it experimentally.METHODS:The active compounds of QGC and common targets between QGC and sarcopenia were screened from databases.Then the herbs-compounds-targets network,and protein-protein interaction(PPI) network was constructed.Gene ontology(GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment analysis were performed by R software.Next,we used a dexamethasone-induced sarcopenia mouse model to evaluate the anti-sarcopenic mechanism of QGC.RESULTS:A total of 57 common targets of QGC and sarcopenia were obtained.Based on the enrichment analysis of GO and KEGG,we took the phosphatidylinositol 3-kinase(PI3K)/protein kinase B(Akt) signaling pathway as a key target to explore the mechanism of QGC on sarcopenia.Animal experiments showed that QGC could increase muscle strength and inhibit muscle fiber atrophy.In the model group,the expression of muscle ring finger-1 and Atrogin-1 were increased,while myosin heavy chain was decreased,QGC treatment reversed these changes.Moreover,compared with the model group,the expressions of pPI3K,p-Akt,p-mammalian target of rapamycin and pForkhead box O3 in the QGC group were all upregulated.CONCLUSION:QGC exerts an anti-sarcopenic effect by activating PI3K/Akt signaling pathway to regulate skeletal muscle protein metabolism.展开更多
Cirrhosis represents the end stage of chronic liver disease,significantly reducing life expectancy as it progresses from a compensated to a decompensated state,leading to serious complications.Recent improvements in m...Cirrhosis represents the end stage of chronic liver disease,significantly reducing life expectancy as it progresses from a compensated to a decompensated state,leading to serious complications.Recent improvements in medical treatment have created a shift in cirrhosis management.Various causes,including hepatitis viruses,alcohol consumption,and fatty liver disease,contribute to cirrhosis and are closely linked to liver cancer.The disease develops through hepatocyte necrosis and regeneration,resulting in fibrosis and sinusoidal capillarization,leading to portal hypertension and complications such as ascites,hepatic encephalopathy,and organ dysfunction.Cirrhosis also holds an increased risk of hepatocellular carcinoma.Diagnosing cirrhosis involves assessing fibrosis scores through blood tests and measuring liver stiffness through elastography.Liver transplantation is the definitive treatment for endstage liver disease and acute liver failure.展开更多
Rapid population aging has led to an increased focus on age-related conditions such as sarcopenia.causing loss of muscle mass and strength^([1,2]). Sarcopenia is associated with adverse outcomes,including falls, funct...Rapid population aging has led to an increased focus on age-related conditions such as sarcopenia.causing loss of muscle mass and strength^([1,2]). Sarcopenia is associated with adverse outcomes,including falls, functional decline, frailty, and mortality, which can lower the quality of life and shorten lifespan^([1,2]).展开更多
Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions r...Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions result from a complex interplay of systemic inflammation,immobilization,catabolic stress,mitochon-drial dysfunction,and immune dysregulation,often culminating in impaired recovery,prolonged hospitalization,and increased long-term mortality.First identified in survivors of sepsis and prolonged mechanical ventilation,these muscle abnormalities were initially described using computed tomography-based assessments of muscle area and density.Subsequent advances in imaging,biomarker discovery,and functional testing have enabled earlier detection and risk stratification across diverse ICU populations.While nutritional optimization and early mobilization form the cornerstone of current prevention and treatment strategies,the emergence of novel approaches,including automated artificial intelligence-based screening,neuromuscular electrical stimulation,and targeted pharmacologic therapies,has broadened the clinical scope of interventions.Despite their significant prognostic implications,ICU-acquired sarcopenia and myosteatosis remain under-recognized in routine critical care practice.This mini-review aims to synthesize current knowledge regarding their pathophysiology,available diagnostic modalities,prognostic relevance,and the evolving landscape of therapeutic strategies for long-term functional recovery in critically ill patients.展开更多
Background:Poor nutritional status is closely related to the development of sarcopenia and possible sarcopenia.Limited articles have evaluated the impact of undernutrition at different stages of life on the developmen...Background:Poor nutritional status is closely related to the development of sarcopenia and possible sarcopenia.Limited articles have evaluated the impact of undernutrition at different stages of life on the development of sarcopenia or possible sarcopenia in old age.The 1959–1962 Chinese famine provided the possibility for large-scale population studies on the effects of long-term undernutrition or inad-equate intake on various health problems.In this study,we aimed to investigate the effects of long-term reduction of food intake(expo-sure to the 1959–1962 Chinese famine)in early life on the development of sarcopenia and possible sarcopenia in later life.Methods:We used data from the China Health and Retirement Longitudinal Survey(CHARLS)2015 and obtained information on whether participants had experienced famine from the 2014 Life Course Survey of Chinese Residents.After data integration and cleaning,we divided the included participants into five age-exposure cohorts based on birthdate,including cohorts exposed to famine during preschool,midchildhood,young teenage years,teenage years,and adulthood to analyze the long-term effects of exposure to famine on the development of sarcopenia and possible sarcopenia.Results:Exposure to moderate or severe famine did not significantly increase the risk of possible sarcopenia(P>0.05).In a further stratified analysis,moderate famine exposure in adulthood significantly increased the risk of possible sarcopenia(1.475 times;95%CI:1.104–1.969,P=0.009).However,there was no significant association between famine exposure and possible sarcopenia in the preschool,midchildhood,young teenage,or teenage exposure cohorts(P>0.05).Conclusions:Exposure to famine in preadulthood did not increase the risk of possible sarcopenia in older adults.However,the risk of possible sarcopenia in later life was increased about 50%among participants who were exposed to moderate famine in adulthood.展开更多
Background:This study compared the validity of the creatinine-to-cystatin C ratio(CCR),sarcopenia index(SI),and relative skeletalmuscle index(RSMI)as predictors of sarcopenia in patients with colorectal cancer(CRC)and...Background:This study compared the validity of the creatinine-to-cystatin C ratio(CCR),sarcopenia index(SI),and relative skeletalmuscle index(RSMI)as predictors of sarcopenia in patients with colorectal cancer(CRC)and explored their impact on the patient prognosis.Methods:We retrospectively studied patients with CRC who underwent surgical intervention at the Department of Colorectal and Anal Surgery,situatedwithin the First Affiliated Hospital of GuangxiMedical University.The investigation spanned from January 2015 to December 2017,encompassing a cohort of patients subject to surgical management forCRC during this period.Pearson’s correlation analysis was employed to evaluate the relationships between the CCR,SI,RSMI,and skeletal muscle index(SMI)and the patient prognosis.Receiver operating characteristic(ROC)curves were generated to evaluate the predictive precision of these biomarkers and ascertain the optimal cutoff values.Multivariate logistic regression analysis was conducted to pinpoint the independent factors linked with sarcopenia.Survival analyses,contingent on different surrogate markers of muscle mass and sarcopenia,were performed utilizing the Kaplan-Meier method alongside the log-rank test.Results:Weenrolled 815 patientswithCRC(522 male and 293 female patients)whowere eligible for the analysis.In accordancewith the guidelines set forth by the International Consensus on Sarcopenia,sarcopenia was diagnosed in a collective total of 503 patients.A Pearson’s correlation coefficient(r)analysis demonstrated that the CCR,SI,and RSMI were positively correlated with the SMI.In both male and female patients,the RSMI(male:r=0.400,P<0.001;female:r=0.640,P<0.001)was more strongly correlated with the SMI than with the CCR(male:r=0.203,P<0.001;female:r=0.192,P<0.001)or SI(male:r=0.335,P<0.001;female:r=0.285,P<0.001).In male patients,the areas under the ROC curves(AUC)for the CCR,SI,and RSMI were 0.596[(95%confidence interval(CI)=0.545-0.647)],0.648(95%CI=0.599-0.698),and 0.681(95%CI=0.629-0.733),respectively.In female patients,the AUC for the CCR,SI,and RSMI were 0.615(95%CI=0.551-0.680),0.660(95%CI=0.598-0.722),and 0.772(95%CI=0.719-0.825),respectively.A multivariable logistic regression analysis demonstrated that the CCR remained an influential factor for sarcopenia after correcting for confounding[odds ratio(OR)=0.993,95%CI=0.986-1.000,P=0.038].The SI and RSMI also remained influential factors for sarcopenia after correcting for confounding factors(OR=0.983,95%CI=0.972-0.994,P=0.002;and OR=0.401,95%CI=0.320-0.502,P<0.001,respectively).The groups characterized by low CCR and SI demonstrated notably reduced overall survival compared with their counterparts with high CCR and SI(P=0.007 and P=0.001,respectively),whereas the RSMI and sarcopenia did not exhibit a significant correlation with survival(P=0.608 and P=0.062,respectively).Conclusions:The CCR,SI,and RSMI all have predictive value for sarcopenia in patients with CRC.TheRSMI was a better predictor of sarcopenia than either the CCR or SI in both male and female patientswith CRC.However,the RSMI did not have any significant value for predicting the prognosis of patients with CRC.Subsequent prospective investigations are warranted to elucidate a superiormarker or amalgamation thereof,capable of accurately prognosticating sarcopenia and the overall prognosis in individuals diagnosed with CRC.Such studies should aim to meticulously evaluate a comprehensive array of potential markers,considering their individual and collective predictive value in delineating the clinical trajectory of CRC patients.By conducting rigorous prospective analyses,researchers can strive to uncover novel insights into the complex interplay between sarcopenia and CRC outcomes,thereby facilitating the development of more precise prognostic models and tailored therapeutic approaches.展开更多
BACKGROUND The development and progression of gastric cancer(GC)are closely linked to the nutritional status of patients.Although immunotherapy has been demonstrated to be clinically effective,the relationships of sar...BACKGROUND The development and progression of gastric cancer(GC)are closely linked to the nutritional status of patients.Although immunotherapy has been demonstrated to be clinically effective,the relationships of sarcopenia and myosteatosis with the use of immune checkpoint inhibitors(ICIs)in patients with gastric cancer remain to be characterized.METHODS We performed a retrospective study of patients who were undergoing immuno-therapy for GC.For the evaluation of sarcopenia,the optimal cut-off value for the skeletal muscle index was established using receiver operating characteristic analysis of data obtained from pre-treatment computed tomography images at the L3 vertebral level.Myosteatosis was defined using the mean skeletal muscle density(SMD),with a threshold value of<41 Hounsfield units(HU)for patients with a body mass index(BMI)<25 kg/m^(2)and<33 HU for those with a BMI≥25 kg/m^(2).The log-rank test was used to compare progression-free survival(PFS)and overall survival(OS),and a Cox proportional hazard model was used to identify prognostic factors.Nomograms were developed to predict the PFS and OS of patients on the basis of the results of multivariate analyses.RESULTS We studied 115 patients who were undergoing ICI therapy for GC,of whom 27.4%had sarcopenia and 29.8%had myosteatosis.Patients with sarcopenia or myosteatosis had significantly shorter PFS and OS than those without these conditions.Furthermore,both sarcopenia and myosteatosis were found to be independent predictors of PFS and OS in patients with GC administering an ICI.The prediction models created for PFS and OS were associated with C-indexes of 0.758 and 0.781,respectively.CONCLUSION The presence of sarcopenia or myosteatosis is a reliable predictor of the clinical outcomes of patients with GC who are undergoing treatment with an ICI.展开更多
Cirrhosis is frequently associated with sarcopenia,with reported rates of over 80%in patients with decompensated alcohol-related liver disease.Sarcopenia nega-tively impacts the prognosis of cirrhotic patients and aff...Cirrhosis is frequently associated with sarcopenia,with reported rates of over 80%in patients with decompensated alcohol-related liver disease.Sarcopenia nega-tively impacts the prognosis of cirrhotic patients and affects the response to treatment of patients with hepatocellular carcinoma(HCC).For these reasons,identifying an easy-to-perform method to assess sarcopenia in is a key element in the optimization of care in this patient population.Assessment of muscle mass by computed tomography is considered the standard of care for the diagnosis of sarcopenia,but exposure to radiation and high costs limit its application in this setting,especially for repeated assessments.We believe that ultrasound,a cheap and harmless technique also used for HCC screening in cirrhotic patients,could have an expanding role in the diagnosis and follow-up of sarcopenia in these patients.展开更多
The prevalence of metabolic-associated fatty liver disease(MAFLD)has increased substantially in recent years because of the global obesity pandemic.MAFLD,now recognized as the number one cause of chronic liver disease...The prevalence of metabolic-associated fatty liver disease(MAFLD)has increased substantially in recent years because of the global obesity pandemic.MAFLD,now recognized as the number one cause of chronic liver disease in the world,not only increases liver-related morbidity and mortality among sufferers but also worsens the complications associated with other comorbid conditions such as cardiovascular disease,type 2 diabetes mellitus,obstructive sleep apnoea,lipid disorders and sarcopenia.Understanding the interplay between MAFLD and these comorbidities is important to design optimal therapeutic strategies.Sarcopenia can be either part of the disease process that results in MAFLD(e.g.,obesity or adiposity)or a consequence of MAFLD,especially in the advanced stages such as fibrosis and cirrhosis.Sarcopenia can also worsen MAFLD by reducing exercise capacity and by the production of various muscle-related chemical factors.Therefore,it is crucial to thoroughly understand how we deal with these diseases,especially when they coexist.We explore the pathobiological interlinks between MAFLD and sarcopenia in this comprehensive clinical update review article and propose evidence-based therapeutic strategies to enhance patient care.展开更多
基金supported in part by the Japan Pancreas Soci-ety and the MHLW Research Program on Rare and Intractable Dis-eases(Grant Number 23FC1015,Principal investigator:Mitsuhiro Kawano).
文摘Background:Previous studies have highlighted the frequent occurrence of sarcopenia in patients with pancreatic diseases,including chronic pancreatitis.We aimed to clarify the prevalence of skeletal muscle(SM)loss and sarcopenia,and their associations with clinical characteristics,bone mineral density,and pancreatic imaging findings in patients with autoimmune pancreatitis(AIP).Methods:This study included 114 patients with AIP treated at Tohoku University Hospital.The SM index was assessed using a bioelectrical impedance analysis device,grip strength was measured using a hand dynamometer,and bone mineral density was evaluated using dual-energy X-ray absorptiometry.Univari-ate and multivariate logistic regression analyses were used to analyze factors associated with SM loss and sarcopenia.Results:Among 114 patients,57(50.0%)had SM loss,31(27.2%)had reduced grip strength,and 27(23.7%)had both.Patients with SM loss were older and had a lower body mass index,weaker grip strength,higher Controlling Nutritional Status scores,and lower serum lipase and albumin levels compared to those without SM loss.Computed tomography scans revealed a higher prevalence of pancreatic parenchy-mal atrophy in patients with SM loss.Similar differences were observed between patients with sarcopenia and those without.Osteopathy was observed in 35.6%of patients with SM loss and 38.1%of those with sarcopenia,whereas only 4.1%of patients without SM loss had osteopathy.Low BMI(<21.0 kg/m^(2))was also found to be an independent risk factor for SM loss in multivariate analysis.Age>72 years,low BMI(<20.0 kg/m^(2)),and low serum lipase levels(<13 U/L)were independent risk factors for sarcopenia in multivariate analysis.Conclusions:SM loss and sarcopenia are prevalent in patients with AIP and are associated with aging,poor nutritional status,low serum lipase levels,and pancreatic parenchymal atrophy.In addition to the high risk of osteopathy,careful attention should be paid to maintain muscle health in AIP patients.
文摘Irisin is a chief myokine released during physical activity and has garnered attention for its potential therapeutic effects on different metabolic and cardiovascular disorders.This review explores the intricate connections between irisin,physical activity,sarcopenia,type 2 diabetes mellitus(T2DM),and cardiovascular complications.Experimental data suggests that through irisin release,physical activity positively influences muscle health,metabolic regulation,and cardiovascular function.In individuals with sarcopenia,characterized by progressive muscle mass and function loss,irisin plays a pivotal role in maintaining muscle integrity and function.Additionally,irisin’s beneficial effects on insulin sensitivity and glucose metabolism suggest its involvement in the pathophysiology of T2DM.The review will examine how irisin may modulate the development of cardiovascular complications,particularly in the context of diabetes and aging.Additionally,it will explore its potential as a therapeutic target for managing sarcopenia,T2DM,and cardiovascular complications,underscoring the importance of physical activity in mitigating these interconnected health challenges.Further research is needed to elucidate the precise mechanisms by which irisin mediates these effects and assess its clinical applicability in preventing and treating metabolic and cardiovascular disorders.
基金Supported by The Medical Key Science and Technology Project of Shanxi Province,No.2020xm23.
文摘BACKGROUND The prevalence of sarcopenia progressively increases with as liver function deteriorates.Muscle wasting has been shown to independently predict adverse outcomes in liver cirrhosis patients.AIM To screen effective biomarkers for sarcopenia in liver cirrhosis.METHODS Untargeted metabolomics were performed on serum from 62 liver cirrhosis patients,including 41 with sarcopenia and 21 without sarcopenia.Candidate metabolite biomarkers were screened based on three machine-learning algorithms.The diagnostic or predictive value of potential biomarkers was evaluated by drawing receiver operating characteristic curves.RESULTS A total of 60 differential metabolites between cirrhotic sarcopenia and the nonsarcopenia group were identied.Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis revealed differential metabolites primarily involved in glycerophospholipid metabolism,alpha-linolenic acid metabolism,retrograde endocannabinoid signaling,and choline metabolism in cancer.Finally,four potential biomarkers were screened through machine learning algorithms,namely N-Acetylcarnosine,2-Stearylcitrate,CerP(d18:1/12:0),and 3-Methyl-alpha-ionylacetate.Among these,N-Acetylcarnosine can provide better diagnostic accuracy.CONCLUSION This study unveiled different plasma metabolic profiles of liver cirrhosis patients with and without sarcopenia.These valuable biomarkers have the potential to improve the prognosis of liver patients with cirrhosis by early detection or prediction of sarcopenia.
基金supported by the Beijing Natural Science Foundation(7232236)the National Key R&D Program of China(2022YFF1100104)。
文摘Introduction:Diet intervention,especially supplementation with high-quality protein,is considered to be a critical strategy in sarcopenia.However,different sources and types of protein have different health impacts.Objectives:The aim of this study is to explore the differences in the ameliorative effects and mechanisms of different sources and types of proteins on sarcopenia,providing an optimal path for the prevention and treatment of sarcopenia.Methods:A sarcopenia model was established by intraperitoneal injection of dexamethasone(5 mg/kg).Sixty male C57BL/6 mice(8 months old)were randomly divided into the normal control,sarcopenia,goat whey protein,goat milk casein,bovine whey protein,and bovine milk casein groups.Animals were treated for 8 consecutive weeks.Organism-level and molecular phenotypes,16S rRNA gene sequencing,and untargeted metabolomics profiling based on GC-TOF/MS were employed to investigate the correlation between host metabolism,microbial metabolism,autophagy and inflammation and their influence on sarcopenia in C57BL/6 male mice.Results:All 4 proteins increased muscle mass,and goat whey protein improved muscle strength in sarcopenic mice.Goat and bovine milk proteins promoted muscle regeneration by increasing MyoD1 and MyoG expression,and the former had a more distinct effect in inducing autophagy and decreasing inflammation than the latter.In addition,goat whey protein and casein could modulate hostmicrobial arginine co-metabolism.Notably,goat milk proteins responded well to sarcopenia comorbidities,including sarcopenic obesity,osteosarcopenia,and osteoarthritis.Conclusion:The study confirmed that goat milk proteins were more effective than bovine milk proteins for the control of sarcopenia.Moreover,we found that whey protein and casein could modulate host-microbial arginine co-metabolism,which shows their potential as precision nutritional supplements for the management of sarcopenia.Our study provides theoretical support for the prevention and control of sarcopenia.
文摘BACKGROUND The impact of psychiatric disorder,especially depression,on the prognosis of sarcopenic patients is gaining prominence.Yet,there have been very few studies focusing on this issue,let alone the related targeted mental health prevention.This cohort-based nested case-control study is geared to compare risk of depression and the depression-related ambulatory care utilization for sarcopenia persons with and without receiving add-on Chinese herbal medicines(CHMs)treatment.AIM To compare risk of depression and the depression-related ambulatory care utili-zation for sarcopenia persons with and without receiving add-on CHMs treat-ment.METHODS In the beginning,we recruited those aged 20-70 years with newly diagnosed sarcopenia and free of depression between 2002 and 2010 from a nationwide insurance database.From them,we identified cases with depression onset occurring after sarcopenia until December 31,2013.To cautiously isolate the effect of CHMs,we established the matched sets of treated and untreated subjects with CHMs use by randomly frequency matching.A conditional logistic regression was executed to explore the association of CHMs to depression risk,and the frequency and costs of depression-related ambulatory care were compared using Mann-Whitney U test.RESULTS Addition of CHMs to routine care of sarcopenia notably correlated with a lower risk of depression.A remarkable effect of CHMs in reducing depression was detected when sarcopenia subjects received CHMs for more than three years,lowering depression risk by as much as 65%.As compared to CHMs users,the non-CHMs users indeed incurred higher frequency and costs of depression-related ambulatory care after depression attack(P<0.05).Notably,the costs for per depression-related ambulatory care profoundly increased with the years after depression attack.CONCLUSION Sarcopenic patients can greatly benefit from add-on CHMs treatment,underscoring the urgent need for interdisciplinary collaboration and proactive treatment planning.
文摘With the aging global population,the decline in muscle mass and function among the elderly has emerged as a significant concern.This systemic progressive generalized loss of muscle function and mass is referred to as sarcopenia(SP).In recent years,a growing number of studies have investigated SP,revealing that many tumor diseases,especially in the digestive system,promote its occurrence due to the influence of the disease itself,diet,and other factors.Moreover,SP patients tend to have poorer postoperative recovery.At present,many diagnostic methods have been developed for SP,but no unified standard has been established.Furthermore,the cutoff values of many diagnostic methods for different populations are still in the exploratory stage,and additional clinical studies are required to explore these issues.This article comprehensively and systematically summarizes the diagnostic methods and criteria mentioned in previous research,focusing on the impact of SP on post-surgical patients with various malignant tumors.
文摘Skeletal muscles perform important metabolic functions.Muscle mass wasting in sarcopenia is an urgent problem of modern medicine,the interest in which is related to its prognostic significance.The liver has numerous direct and indirect metabolic and immune connections with skeletal muscle and disruptions of these connections in liver disease are of clinical interest.A recent article by Liang et al emphasized potential biomarkers of sarcopenia in liver cirrhosis.Identification of biomarkers of sarcopenia in patients with cirrhosis has important diagnostic value.Common pathophysiologic mechanisms of sarcopenia and liver cirrhosis include disorders of protein and energy metabolism,disturbances in the structure of gut microbiota,inflammation and oxidative stress.
基金Supported by Shandong Province Biliary Pancreatic Cancer Clinical Quality Specialty Construction Fund,No.SLCZDZK-2401.
文摘BACKGROUND Sarcopenia is a clinical syndrome presented with progressive and generalized skeletal muscle loss and function dysfunction.Usually,it is considered an agerelated process influenced by genetic,lifestyle factors,and diseases.Obstructive jaundice is one of the most common pathophysiological changes in patients needing hepatobiliary or pancreatic operations that can adversely affect the tissue and organ function throughout the human body.However,the effects of obstructive jaundice on the occurrence of sarcopenia remain unclear.AIM To investigate the incidence of sarcopenia in patients with surgical obstructive jaundice and the association of sarcopenia with postoperative outcome.METHODS This cross-sectional study was conducted from December 2019 to January 2024.Data retrieved included patient demographics,disease entities,sarcopenia-related parameters(including grip strength,6-m walking time,and limb skeletal muscle mass index),postoperative complications,and length of hospital stay.Sarcopenia was confirmed using Asian Working Group standards.Logistic regression was used to analyze the relationship between total bilirubin level and sarcopenia.The factors influencing sarcopenia in patients with surgical obstructive jaundice and association of sarcopenia with postoperative complications were also investigated.RESULTS Overall,1708 patients met the inclusion criteria,with a mean age of 60.09±13.52 years(sex:52.28%male).There were 383 patients(22.42%)with obstructive jaundice and 1325(77.58%)without jaundice.Sarcopenia,low walking speed,low grip strength,and low limb skeletal muscle index were more prevalent in patients with obstructive jaundice than nonobstructive jaundice.The odds ratio(OR)for sarcopenia in patients with obstructive jaundice was 1.689[95%confidence interval(CI):1.295-2.203,P<0.001],indicating that jaundice is a significant risk factor for sarcopenia.The occurrence of sarcopenia was higher in patients with severe obstructive jaundice than mild obstructive jaundice(39.3%vs 22.8%,P<0.05).Obstructive jaundice was positively correlated with reduced walking speed(OR=1.627,95%CI:1.185-2.234,P=0.003)and decreased grip strength(OR=1.669,95%CI:1.212-2.300,P=0.002).Age(OR=1.077,95%CI:1.040-1.114,P<0.001)and body mass index(OR=0.703,95%CI:0.630-0.784,P<0.001)were independent risk factors of sarcopenia in patients with obstructive jaundice.Patients with obstructive jaundice and sarcopenia had a higher rate of postoperative complications(46.3%vs 33.1%,P=0.032),longer postoperative hospital stays(11.33±6.75 days vs 9.19±7.32 days,P=0.016),and longer total hospital stays(17.10±7.69 days vs 15.98±8.55 days,P=0.032)than those without sarcopenia.CONCLUSION Sarcopenia is more prevalent in patients with obstructive jaundice and is positively correlated with the degree of jaundice.Sarcopenia prolongs hospital stays and is associate with postoperative complications.
文摘The etiology,risk factors,and management of sarcopenia and metabolic dysfunction-associated steatotic liver disease(MASLD)are comparable,which prompted the investigators to search for a particular diagnostic or prognostic biomarker that was involved in both disorders.Peptides or proteins known as myokines,or exerkines,are produced and secreted by contracted muscles.Myokines work similarly to hormones in their actions.One common clinical hallmark of sarcopenia and MASLD is physical inactivity,which is associated with alterations in the levels of myokines.Irisin is a positive regulator of muscle size that is elevated in the biological fluids during exercise.Significantly low levels were observed in the pathological conditions associated with physical inactivity.The serum levels of irisin are significantly higher in MASLD patients,while their levels were lower in risk factors of MASLD,e.g.,diabetes mellitus,obesity,and insulin resistance.In sarcopenia with obesity(sarcopenic obesity)or with a normal build,serum irisin levels are significantly lower than in healthy subjects.Therefore,serial determination of irisin levels that showed a transition from higher to lower levels in MASLD indicated the development of sarcopenia in those patients.
文摘BACKGROUND Sarcopenia is prevalent among patients with end-stage liver disease(ESLD)and is associated with adverse outcomes both before and after liver transplantation(LT).Accurate assessment of muscle mass is essential for effective risk stratification and optimization of transplant outcomes.AIM To identify imaging modalities used to assess sarcopenia in ESLD patients awaiting LT,and evaluate the clinical utility of each technique in predicting waitlist mortality,length of hospital stay,and post-transplant survival.METHODS A systematic search was conducted in PubMed,MEDLINE,EMBASE,and Scopus for studies published between May 2015 and May 2025.Eligible studies included original research evaluating sarcopenia using imaging techniques in ESLD patients listed for LT.Due to heterogeneity in study design,diagnostic criteria,and outcomes,data were synthesized qualitatively.RESULTS A total of 17 studies met the inclusion criteria,encompassing modalities such as computed tomography(CT),magnetic resonance imaging,dual-energy X-ray absorptiometry,and ultrasound.CT at the third lumbar vertebra level was most frequently used,exhibiting consistent prognostic values for pre-and post-transplant outcomes.However,considerable variability in cutoff values and sarcopenia definitions was observed.Emerging evidence also supports the prognostic relevance of muscle quality indicators,including muscle attenuation and fat infiltration.CONCLUSION CT and magnetic resonance imaging are the most robust imaging methods for sarcopenia diagnosis in patients with ESLD.Standardized diagnostic criteria incorporating muscle quality metrics are essential for improving prognostic accuracy and guiding clinical decision making in LT candidates.Such integration would also support the development of unified frameworks for sarcopenia assessment in transplantation practice.
文摘The skeletal muscle is the largest organ present in the body and is responsible for mechanical activities like maintaining posture,movement,respiratory function,and support for the health and functioning of other systems of the body.Skeletal muscle atrophy is a condition characterized by a reduction in muscle size,strength,and activity,which leads to an increased dependency on others for movement,an increased risk of falls,and a reduced quality of life.Various conditions like osteoarthritis,osteoporosis,and fractures are directly associated with increased muscle atrophy.Additionally,numerous risk factors,like aging,malnutrition,physical inactivity,and certain disease conditions,through distinct pathways,negatively affect skeletal muscle health and lead to muscle atrophy.Among various determinants of overall muscle health,the rate of muscle protein synthesis and degradation is an important parameter that eventually alters the fate of overall muscle health.In conditions of excessive skeletal muscle atrophy,including sarcopenia,the rate of muscle protein degradation usually exceeds the rate of protein synthesis.The availability of amino acids in the systemic circulation is a crucial step in muscle protein synthesis.The current review aims to consolidate the existing evidence on amino acids,highlight their mechanisms of action,and assess their roles and effectiveness in enhancing skeletal muscle health.
基金Shanghai Clinical Research Center for Chronic Musculoskeletal Diseases (20MC1920600)Shanghai Key Clinical Specialty "Traditional Chinese Medicine Orthopaedic Traumatology"(shslczdzk03901)+3 种基金The Second Round of Construction Project of National TCM Academic School Inheritance Studio "Shi's Trauma Department"[Letter of the People's Education of Traditional Chinese Medicine (2019) No.62]Shanghai High-level Local Universities "Chronic Muscle and Bone Damage Research and Transformation" Innovation Team [No.3 of Shanghai Education Commission (2022)]Program for Shanghai High-Level Local University Innovation Team (SZY20220315)Shanghai Shenkang Hospital Development Center Clinical Three-year Action Plan (SHDC2020CR3090B)。
文摘OBJECTIVE:To explore the potential molecular mechanism of Qigu capsule(芪骨胶囊,QGC) in the treatment of sarcopenia through network pharmacology and to verify it experimentally.METHODS:The active compounds of QGC and common targets between QGC and sarcopenia were screened from databases.Then the herbs-compounds-targets network,and protein-protein interaction(PPI) network was constructed.Gene ontology(GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment analysis were performed by R software.Next,we used a dexamethasone-induced sarcopenia mouse model to evaluate the anti-sarcopenic mechanism of QGC.RESULTS:A total of 57 common targets of QGC and sarcopenia were obtained.Based on the enrichment analysis of GO and KEGG,we took the phosphatidylinositol 3-kinase(PI3K)/protein kinase B(Akt) signaling pathway as a key target to explore the mechanism of QGC on sarcopenia.Animal experiments showed that QGC could increase muscle strength and inhibit muscle fiber atrophy.In the model group,the expression of muscle ring finger-1 and Atrogin-1 were increased,while myosin heavy chain was decreased,QGC treatment reversed these changes.Moreover,compared with the model group,the expressions of pPI3K,p-Akt,p-mammalian target of rapamycin and pForkhead box O3 in the QGC group were all upregulated.CONCLUSION:QGC exerts an anti-sarcopenic effect by activating PI3K/Akt signaling pathway to regulate skeletal muscle protein metabolism.
文摘Cirrhosis represents the end stage of chronic liver disease,significantly reducing life expectancy as it progresses from a compensated to a decompensated state,leading to serious complications.Recent improvements in medical treatment have created a shift in cirrhosis management.Various causes,including hepatitis viruses,alcohol consumption,and fatty liver disease,contribute to cirrhosis and are closely linked to liver cancer.The disease develops through hepatocyte necrosis and regeneration,resulting in fibrosis and sinusoidal capillarization,leading to portal hypertension and complications such as ascites,hepatic encephalopathy,and organ dysfunction.Cirrhosis also holds an increased risk of hepatocellular carcinoma.Diagnosing cirrhosis involves assessing fibrosis scores through blood tests and measuring liver stiffness through elastography.Liver transplantation is the definitive treatment for endstage liver disease and acute liver failure.
基金supported by the Ministry of Education Chunhui Program Collaborative Scientific Research Projects(Grant No.:HZKY20220286)Henan Province Foreign Experts Introduction Program(Grant No.:HNGD2022021)+1 种基金Natural Science Foundation of Henan Province(Grant No.:23230042151)the Foundation of the National Key Program of Research and Development of China(Grant No.:2016YFC0900803)。
文摘Rapid population aging has led to an increased focus on age-related conditions such as sarcopenia.causing loss of muscle mass and strength^([1,2]). Sarcopenia is associated with adverse outcomes,including falls, functional decline, frailty, and mortality, which can lower the quality of life and shorten lifespan^([1,2]).
文摘Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions result from a complex interplay of systemic inflammation,immobilization,catabolic stress,mitochon-drial dysfunction,and immune dysregulation,often culminating in impaired recovery,prolonged hospitalization,and increased long-term mortality.First identified in survivors of sepsis and prolonged mechanical ventilation,these muscle abnormalities were initially described using computed tomography-based assessments of muscle area and density.Subsequent advances in imaging,biomarker discovery,and functional testing have enabled earlier detection and risk stratification across diverse ICU populations.While nutritional optimization and early mobilization form the cornerstone of current prevention and treatment strategies,the emergence of novel approaches,including automated artificial intelligence-based screening,neuromuscular electrical stimulation,and targeted pharmacologic therapies,has broadened the clinical scope of interventions.Despite their significant prognostic implications,ICU-acquired sarcopenia and myosteatosis remain under-recognized in routine critical care practice.This mini-review aims to synthesize current knowledge regarding their pathophysiology,available diagnostic modalities,prognostic relevance,and the evolving landscape of therapeutic strategies for long-term functional recovery in critically ill patients.
文摘Background:Poor nutritional status is closely related to the development of sarcopenia and possible sarcopenia.Limited articles have evaluated the impact of undernutrition at different stages of life on the development of sarcopenia or possible sarcopenia in old age.The 1959–1962 Chinese famine provided the possibility for large-scale population studies on the effects of long-term undernutrition or inad-equate intake on various health problems.In this study,we aimed to investigate the effects of long-term reduction of food intake(expo-sure to the 1959–1962 Chinese famine)in early life on the development of sarcopenia and possible sarcopenia in later life.Methods:We used data from the China Health and Retirement Longitudinal Survey(CHARLS)2015 and obtained information on whether participants had experienced famine from the 2014 Life Course Survey of Chinese Residents.After data integration and cleaning,we divided the included participants into five age-exposure cohorts based on birthdate,including cohorts exposed to famine during preschool,midchildhood,young teenage years,teenage years,and adulthood to analyze the long-term effects of exposure to famine on the development of sarcopenia and possible sarcopenia.Results:Exposure to moderate or severe famine did not significantly increase the risk of possible sarcopenia(P>0.05).In a further stratified analysis,moderate famine exposure in adulthood significantly increased the risk of possible sarcopenia(1.475 times;95%CI:1.104–1.969,P=0.009).However,there was no significant association between famine exposure and possible sarcopenia in the preschool,midchildhood,young teenage,or teenage exposure cohorts(P>0.05).Conclusions:Exposure to famine in preadulthood did not increase the risk of possible sarcopenia in older adults.However,the risk of possible sarcopenia in later life was increased about 50%among participants who were exposed to moderate famine in adulthood.
基金supported by the Guangxi Medical and Health Appropriate Technology Development and Application Project(No.S2021095)Undergraduate Enrollment Project of Guangxi Medical University(No.S202410598186).
文摘Background:This study compared the validity of the creatinine-to-cystatin C ratio(CCR),sarcopenia index(SI),and relative skeletalmuscle index(RSMI)as predictors of sarcopenia in patients with colorectal cancer(CRC)and explored their impact on the patient prognosis.Methods:We retrospectively studied patients with CRC who underwent surgical intervention at the Department of Colorectal and Anal Surgery,situatedwithin the First Affiliated Hospital of GuangxiMedical University.The investigation spanned from January 2015 to December 2017,encompassing a cohort of patients subject to surgical management forCRC during this period.Pearson’s correlation analysis was employed to evaluate the relationships between the CCR,SI,RSMI,and skeletal muscle index(SMI)and the patient prognosis.Receiver operating characteristic(ROC)curves were generated to evaluate the predictive precision of these biomarkers and ascertain the optimal cutoff values.Multivariate logistic regression analysis was conducted to pinpoint the independent factors linked with sarcopenia.Survival analyses,contingent on different surrogate markers of muscle mass and sarcopenia,were performed utilizing the Kaplan-Meier method alongside the log-rank test.Results:Weenrolled 815 patientswithCRC(522 male and 293 female patients)whowere eligible for the analysis.In accordancewith the guidelines set forth by the International Consensus on Sarcopenia,sarcopenia was diagnosed in a collective total of 503 patients.A Pearson’s correlation coefficient(r)analysis demonstrated that the CCR,SI,and RSMI were positively correlated with the SMI.In both male and female patients,the RSMI(male:r=0.400,P<0.001;female:r=0.640,P<0.001)was more strongly correlated with the SMI than with the CCR(male:r=0.203,P<0.001;female:r=0.192,P<0.001)or SI(male:r=0.335,P<0.001;female:r=0.285,P<0.001).In male patients,the areas under the ROC curves(AUC)for the CCR,SI,and RSMI were 0.596[(95%confidence interval(CI)=0.545-0.647)],0.648(95%CI=0.599-0.698),and 0.681(95%CI=0.629-0.733),respectively.In female patients,the AUC for the CCR,SI,and RSMI were 0.615(95%CI=0.551-0.680),0.660(95%CI=0.598-0.722),and 0.772(95%CI=0.719-0.825),respectively.A multivariable logistic regression analysis demonstrated that the CCR remained an influential factor for sarcopenia after correcting for confounding[odds ratio(OR)=0.993,95%CI=0.986-1.000,P=0.038].The SI and RSMI also remained influential factors for sarcopenia after correcting for confounding factors(OR=0.983,95%CI=0.972-0.994,P=0.002;and OR=0.401,95%CI=0.320-0.502,P<0.001,respectively).The groups characterized by low CCR and SI demonstrated notably reduced overall survival compared with their counterparts with high CCR and SI(P=0.007 and P=0.001,respectively),whereas the RSMI and sarcopenia did not exhibit a significant correlation with survival(P=0.608 and P=0.062,respectively).Conclusions:The CCR,SI,and RSMI all have predictive value for sarcopenia in patients with CRC.TheRSMI was a better predictor of sarcopenia than either the CCR or SI in both male and female patientswith CRC.However,the RSMI did not have any significant value for predicting the prognosis of patients with CRC.Subsequent prospective investigations are warranted to elucidate a superiormarker or amalgamation thereof,capable of accurately prognosticating sarcopenia and the overall prognosis in individuals diagnosed with CRC.Such studies should aim to meticulously evaluate a comprehensive array of potential markers,considering their individual and collective predictive value in delineating the clinical trajectory of CRC patients.By conducting rigorous prospective analyses,researchers can strive to uncover novel insights into the complex interplay between sarcopenia and CRC outcomes,thereby facilitating the development of more precise prognostic models and tailored therapeutic approaches.
基金This study was approved by the Ethics Committee of Harbin Medical University Cancer Hospital.
文摘BACKGROUND The development and progression of gastric cancer(GC)are closely linked to the nutritional status of patients.Although immunotherapy has been demonstrated to be clinically effective,the relationships of sarcopenia and myosteatosis with the use of immune checkpoint inhibitors(ICIs)in patients with gastric cancer remain to be characterized.METHODS We performed a retrospective study of patients who were undergoing immuno-therapy for GC.For the evaluation of sarcopenia,the optimal cut-off value for the skeletal muscle index was established using receiver operating characteristic analysis of data obtained from pre-treatment computed tomography images at the L3 vertebral level.Myosteatosis was defined using the mean skeletal muscle density(SMD),with a threshold value of<41 Hounsfield units(HU)for patients with a body mass index(BMI)<25 kg/m^(2)and<33 HU for those with a BMI≥25 kg/m^(2).The log-rank test was used to compare progression-free survival(PFS)and overall survival(OS),and a Cox proportional hazard model was used to identify prognostic factors.Nomograms were developed to predict the PFS and OS of patients on the basis of the results of multivariate analyses.RESULTS We studied 115 patients who were undergoing ICI therapy for GC,of whom 27.4%had sarcopenia and 29.8%had myosteatosis.Patients with sarcopenia or myosteatosis had significantly shorter PFS and OS than those without these conditions.Furthermore,both sarcopenia and myosteatosis were found to be independent predictors of PFS and OS in patients with GC administering an ICI.The prediction models created for PFS and OS were associated with C-indexes of 0.758 and 0.781,respectively.CONCLUSION The presence of sarcopenia or myosteatosis is a reliable predictor of the clinical outcomes of patients with GC who are undergoing treatment with an ICI.
文摘Cirrhosis is frequently associated with sarcopenia,with reported rates of over 80%in patients with decompensated alcohol-related liver disease.Sarcopenia nega-tively impacts the prognosis of cirrhotic patients and affects the response to treatment of patients with hepatocellular carcinoma(HCC).For these reasons,identifying an easy-to-perform method to assess sarcopenia in is a key element in the optimization of care in this patient population.Assessment of muscle mass by computed tomography is considered the standard of care for the diagnosis of sarcopenia,but exposure to radiation and high costs limit its application in this setting,especially for repeated assessments.We believe that ultrasound,a cheap and harmless technique also used for HCC screening in cirrhotic patients,could have an expanding role in the diagnosis and follow-up of sarcopenia in these patients.
文摘The prevalence of metabolic-associated fatty liver disease(MAFLD)has increased substantially in recent years because of the global obesity pandemic.MAFLD,now recognized as the number one cause of chronic liver disease in the world,not only increases liver-related morbidity and mortality among sufferers but also worsens the complications associated with other comorbid conditions such as cardiovascular disease,type 2 diabetes mellitus,obstructive sleep apnoea,lipid disorders and sarcopenia.Understanding the interplay between MAFLD and these comorbidities is important to design optimal therapeutic strategies.Sarcopenia can be either part of the disease process that results in MAFLD(e.g.,obesity or adiposity)or a consequence of MAFLD,especially in the advanced stages such as fibrosis and cirrhosis.Sarcopenia can also worsen MAFLD by reducing exercise capacity and by the production of various muscle-related chemical factors.Therefore,it is crucial to thoroughly understand how we deal with these diseases,especially when they coexist.We explore the pathobiological interlinks between MAFLD and sarcopenia in this comprehensive clinical update review article and propose evidence-based therapeutic strategies to enhance patient care.
