Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

Comparison of Three Screening Methods for Sarcopenia in Community-Dwelling Older Persons

Hospital readmissions (HRs) are common, potentially preventable, and a marker of poor quality in health services. This study aimed to identify risk factors for HR in clinical patients, with an emphasis on nutrition aspects, especially calf circumference (CC), as a marker of muscle mass. A prospective cohort study of patients admitted to the internal medicine ward was conducted. The short form of the Patient-Generated Subjective Global Assessment was performed in the first 24 hours of hospitalization. In addition, single-frequency bioelectrical impedance analysis was used to estimate the phase angle, CC as a surrogate of muscle mass, and handgrip strength as a marker of strength. The Charlson Comorbidity Index (CCI) was used to assess the severity of the comorbidities. Reassessments were performed every 7 days during hospitalization. HR was evaluated 30 days after discharge by phone contact. A sample of 161 patients was assessed; 54.6% were male, with a mean age of 59.2 ± 17.8 years. The median CCI was 2.76 (interquartile range: 1-4), and nutrition risk and low CC were present in 77.6% and 46% of the patients, respectively. The readmission rate was 16.8% after 30 days. After controlling for sex and age, a CCI > 2 (odds ratio [OR]: 3.29; 95% confidence interval [CI]: 1.21-8.97), the presence of cancer (OR: 4.52; 95% CI: 1.11-18.42), nutrition risk (OR: 9.53; 95% CI: 1.16-77.9), and a low CC (OR: 3.89; 95% CI: 1.34-11.31) were significantly associated with 30 day HR. In conclusion, muscle mass loss, identified by CC, can be a good predictor of 30-day HR, even after controlling for other well-known risk factors.

Calf Circumference: A Marker of Muscle Mass as a Predictor of Hospital Readmission.

The aim of this systematic review and meta-analyses was to calculate the pooled prevalence of sarcopenia based on the Asia Working Group for Sarcopenia (AWGS) criteria among Japanese community-dwelling older adults. Data from 8 studies were used to determine the prevalence of sarcopenia in the overall population and in men; data from 9 studies were used to determine that of women. The pooled prevalence rates of sarcopenia using random-effects models were 9.9% (95% confidence interval [CI], 6.2%-15.4%) overall; 9.8% (95% CI, 6.2%-15.2%) among men; and 10.1% (95% CI, 6.4%-15.5%) among women. These findings would be useful to inform community-based strategies and advanced research addressing sarcopenia prevention.

Prevalence of sarcopenia defined using the Asia Working Group for Sarcopenia criteria in Japanese community-dwelling older adults: A systematic review and meta-analysis.

General muscle health declines with age, and in particular, sarcopenia—defined as progressive loss of muscle mass and strength/physical performance—is a growing issue in Asia with a rising population of community‐dwelling older adults. Several guidelines have addressed early identification of sarcopenia and management, and although nutrition is central to treatment of sarcopenia, there are currently few guidelines that have examined this specifically in the Asian population. Therefore, the Asian Working Group for Sarcopenia established a special interest group (SIG) comprising seven experts across Asia and one from Australia, to develop an evidence‐based expert consensus. A systematic literature search was conducted using MEDLINE on the topic of muscle health, from 2016 (inclusive) to July 2021, in Asia or with relevance to healthy, Asian community‐dwelling older adults (≥60 years old). Several key topics were identified: (1) nutritional status: malnutrition and screening; (2) diet and dietary factors; (3) nutritional supplementation; (4) lifestyle interventions plus nutrition; and (5) outcomes and assessment. Clinical questions were developed around these topics, leading to 14 consensus statements. Consensus was achieved using the modified Delphi method with two rounds of voting. Moreover, the consensus addressed the impacts of COVID‐19 on nutrition, muscle health, and sarcopenia in Asia. These statements encompass clinical expertise and knowledge across Asia and are aligned with findings in the current literature, to provide a practical framework for addressing muscle health in the community, with the overall aim to encourage and facilitate broader access to equitable care for this target population.

Roles of nutrition in muscle health of community‐dwelling older adults: evidence‐based expert consensus from Asian Working Group for Sarcopenia

[Purpose] The purpose of this study is to evaluate the applicability of the calf circumference as a tool for screening sarcopenia. [Subjects and Methods] One hundred sixteen community-dwelling elderly females were enrolled. Calf circumference of the dominant leg was measured using a plastic measuring tape. Subjects were divided into 3 groups based on body mass index (BMI); subjects with the values for BMI <18.5 kg/m2; those with BMI 18.5 to 25.0; those with BMI ≥25.0 kg/m2. Positive predictive value and negative predictive value of sarcopenia were calculated based on the obtained cut off values of calf circumference and the diagnosis of sarcopenia in each group. [Results] Prevalence rate of sarcopenia was 9.4% (n=10). Cut off value of the calf circumference was 32.8 cm (sensitivity: 73.0%, specificity: 80.0%, AUC: 0.792). Each BMI group showed high negative predictive value of sarcopenia based on the calf circumference cut off value of 32.8 cm. [Conclusion] These results suggested that to identify non-sarcopenia by larger calf circumference is more reasonable and useful than to identify sarcopenia due to the smaller calf circumference regardless of BMI.

Large calf circumference indicates non-sarcopenia despite body mass

Slow walking speed as one indicator of physical frailty has been found to be associated with deterioration of the health status. Although many reports have shown that exercise training improves motor function, it is unclear whether a group-based and short-term health promotion intervention will improve motor function in older adults. This study aimed to examine the effectiveness of a short-term health promotion intervention on motor function in community-dwelling older adults. A 6-month middle-term and moderate-intensity programme (MTMIP) and a 6-week short-term high-intensity programme (STHIP) were conducted. There were 28 and 29 subjects selected for the MTMIP and STHIP, respectively. The difference in motor function test outcomes was compared by assessment of comfortable walking speed, maximal walking speed, a sit-to-stand test (STS), and a timed up-and-go test (TUG). Comfortable walking speed, maximum walking speed, STS and TUG were significantly improved at end of the programme in the STHIP group (p = 0.02, p = 0.03, p < 0.001 and p = 0.002). Multiple regression analysis revealed that implementation of STHIP had a significant effect on end-of-programme comfortable walking speed (β = 0.19, p = 0.006, 95% CI 0.06 to 0.32). It was assumed that the training content of the STHIP, with its emphasis on high intensity and physical performance, was the main factor in improved walking speed. Our results demonstrated the effectiveness of STHIP on motor function. These findings could help support development of more effective intervention methods in community-dwelling older adults.

The effect of short-term health promotion intervention on motor function in community-dwelling older adults.

[Purpose] This study examined characteristics of dynamic standing balance, with an without an insole, in patients with spastic diplegia cerebral palsy (CP). [Participants and Methods] This cross-sectional study used a crossover design. Eleven patients with spastic diplegia CP and gross motor levels between I and III with spastic diplegia CP (according to the Gross Motor Function Classiﬁcation System expanded and revised version) were randomly allocated to either the barefoot or insole groups. The Index of postural stability (IPS) was evaluated while each patient was barefoot and while wearing insoles. The Pediatric Evaluation of Disability Inventory (PEDI) was used to measure functional self-care and mobility domains. [Results] While wearing the insoles, the center movement distance between right and left positions was significantly higher. While barefoot, IPS and area of postural sway correlated with the PEDI subscales for mobility and self-care. [Conclusion] Insoles promote standing balance and dynamic balance to move the center of pressure within the base of support. Such improvements may enhance activities of daily living in patients with spastic diplegia CP.

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Characteristics of dynamic standing balance with and without an insole in patients with spastic diplegia cerebral palsy.

[Purpose] This study aimed to develop a tablet app that emulates paper questionnaires used in clinical care, and to verify the difference between the utility of tablet survey methods and paper questionnaire methods with elderly people. [Subjects and Methods] A tablet app was developed in the Java language. A questionnaire was provided to 30 community-dwelling elderly people. The subjects were randomly allocated to the group responding on the tablet (tablet group) or that responding to a paper-based questionnaire (questionnaire group). Assessed items included response time to questions, whether or not they had queries regarding the survey, and data input time. For the tablet group, a questionnaire was conducted regarding the operability of the tablet. [Results] There was no difference in response time between the two groups. Significantly more people in the tablet group had queries regarding the survey. Data input time was 426 seconds for the tablet group and 1268 seconds for the questionnaire group. In the survey regarding tablet operability, there were no negative opinions about the visibility of the screen. [Conclusion] Tablets can be used with elderly people to shorten the data input time. The present findings suggested that tablet surveys could be effective for a large-scale investigation.

Difference between tablet methods and paper questionnaire methods of conducting a survey with community-dwelling elderly.

Salazosulfapyridine is a generally safe drug often used to treat rheumatoid arthritis and ulcerative colitis. However, agranulocytosis is a rare but serious adverse effect of this drug. To date, there have been no reports describing the clinical course of salazosulfapyridine-induced agranulocytosis in a chronic hemodialysis patient. The patient was a 64-year-old man with IgA nephropathy who had been on chronic hemodialysis for about 3 years. For 1 month, he had general fatigue, mild fever, and pain in multiple joints of the upper extremities. He was hospitalized and underwent detailed examinations in our department. Laboratory investigations revealed an erythrocyte sedimentation rate of 67 mm/h and a C-reactive protein level of 7.73 mg/dL. Rheumatoid factor and anti-cyclic citrullinated peptide antibody were negative. Musculoskeletal ultrasonography showed inflammation of the tendon sheath in both wrists and the right shoulder joint. Computed tomography scans revealed osteosclerosis and narrowing of the sacroiliac joint. The diagnosis was seronegative spondyloarthropathy. He was started on salazosulfapyridine. Four weeks later, he had a high fever and low granulocyte count. Treatment with granulocyte colony-stimulating factor was started. The agranulocytosis could not be ascribed to any other cause and was considered an adverse effect of salazosulfapyridine, which was then stopped. Nine days later, the granulocyte count had recovered and the fever had resolved. Currently, there are no guidelines on the use of salazosulfapyridine in chronic hemodialysis patients. The starting dosage should be smaller for these patients than for patients without renal impairment. Also, the laboratory monitoring interval for complete blood count should be shorter than usual.

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Masaru Umeda

Papers

Large calf circumference indicates non-sarcopenia despite body mass

The effect of short-term health promotion intervention on motor function in community-dwelling older adults.

Characteristics of dynamic standing balance with and without an insole in patients with spastic diplegia cerebral palsy.

Difference between tablet methods and paper questionnaire methods of conducting a survey with community-dwelling elderly.

Salazosulfapyridine-induced agranulocytosis in a patient on chronic hemodialysis with seronegative spondyloarthropathy: a case report