Low skeletal muscle mass and high visceral adiposity are associated with recurrence of acute cholecystitis after conservative management:A propensity score-matched cohort study

Background:Recurrent acute cholecystitis(RAC)can occur after non-surgical treatment for acute cholecystitis(AC),and can be more severe in comparison to the first episode of AC.Low skeletal muscle mass or adiposity have various effects in several diseases.We aimed to clarify the relationship between RAC and body parameters.Methods:Patients with AC who were treated at our hospital between January 2011 and March 2022 were enrolled.The psoas muscle mass and adipose tissue area at the third lumbar level were measured using computed tomography at the first episode of AC.The areas were divided by height to obtain the psoas muscle mass index(PMI)and subcutaneous/visceral adipose tissue index(SATI/VATI).According to median VATI,SATI and PMI values by sex,patients were divided into the high and low PMI groups.We performed propensity score matching to eliminate the baseline differences between the high PMI and low PMI groups and analyzed the cumulative incidence and predictors of RAC.Results:The entire cohort was divided into the high PMI(n=81)and low PMI(n=80)groups.In the propensity score-matched cohort there were 57 patients in each group.In Kaplan-Meier analysis,the low PMI group and the high VATI group had a significantly higher cumulative incidence of RAC than their counterparts(log-rank P=0.001 and 0.015,respectively).In a multivariate Cox regression analysis,the hazard ratios of low PMI and low VATI for RAC were 5.250(95%confidence interval 1.083-25.450,P=0.039)and 0.158(95%confidence interval:0.026-0.937,P=0.042),respectively.Conclusions:Low skeletal muscle mass and high visceral adiposity were independent risk factors for RAC.

Age-dependent Changes in Skeletal Muscle Mass and Visceral Fat Area in a Chinese Population

Objective:The present study was conducted to demonstrate the age-dependent changes in skeletal muscle mass and visceral fat area in a population of Chinese adults aged 30-92 years old.Methods:A total of 6669 healthy Chinese men and 4494 healthy Chinese women aged 30-92 years old were assessed for their skeletal muscle mass and visceral fat area.Results:The results showed age-dependent decreases in the total skeletal muscle mass indexes in both men and women aged 40-92 years old as well as age-dependent increases in the visceral fat area in men aged 30-92 years old and in women aged 30-80 years old.Multivariate regression models showed that the total skeletal muscle mass index was positively associated with the body mass index and negatively associated with the age and visceral fat area in both sexes.Conclusion:The loss of skeletal muscle mass becomes obvious at approximately 50 years of age,and the visceral fat area commences to increase at approximately 40 years of age in this Chinese population.

Prognostic value of computed tomography derived skeletal muscle mass index in lung cancer:A meta-analysis

BACKGROUND The prognostic role of the skeletal muscle mass index(SMI)derived from computed tomography(CT)imaging been well verified in several types of cancers.However,whether the SMI could serve as a reliable and valuable predictor of long-term survival in lung cancer patients remains unclear.AIM To identify the prognostic value of the CT-derived SMI in lung cancer patients.METHODS The PubMed,Web of Science,and Embase electronic databases were searched up to November 5,2021 for relevant studies.The Reference Citation Analysis databases were used during the literature searching and selection.Hazard ratios(HRs)and 95%confidence intervals(CIs)were calculated to assess the association of the SMI with the overall survival(OS)of lung cancer patients.All statistical analyses were performed with STATA 12.0 software.RESULTS A total of 12 studies involving 3002 patients were included.The pooled results demonstrated that a lower SMI was significantly related to poorer OS(HR=1.23,95%CI:1.11-1.37,P<0.001).In addition,the subgroup analyses stratified by treatment(nonsurgery vs surgery),tumor stage(advanced stage vs early stage),and tumor type(non-small cell lung cancer vs lung cancer)showed similar results.CONCLUSION The CT-derived SMI is a novel and valuable prognostic indicator in lung cancer and might contribute to the clinical management and treatment of lung cancer patients.

Loss of skeletal muscle mass is not specific to type 2 diabetes

Skeletal muscle is a massive insulin-sensitive tissue in the body.Loss of muscle mass is associated with mitochondrial dysfunction,and is often a result of diabetes.Insulin deficiency or insulin resistance can only be seen as reduced skeletal muscle mass.Diabetes is caused by insulin deficiency or insulin resistance;however,insulin resistance is not unique to diabetics.Insulin resistance also exists in many diseases.

Comparison of the Two Algorithms of Skeletal Muscle Mass Index: An Observational Study in a Large Cohort of Chinese Adults

Objective: To compare the two skeletal muscle mass index (SMI) algorithms. One is SMM [SMM(%) = total skeletal muscle mass (kg)/body weight mass (kg) × 100%];and the other is SMH [SMH (kg/m2) = total skeletal muscle mass (kg)/height (m)2]. Methods: Body composition, body mass index (BMI) and body fat percentage (BFP) were estimated using a bioelectrical impedance analyzer. SMI was calculated by the two algorithms described above, and measurement parameters were stratified by age, BMI and levels of physical activity. Results: Levels of BMI, BFP, SMM and SMH differed significantly between the sexes. BMI and BFP were positively associated with age, while SMM was negatively associated with age (β = −0.2294, P < 0.001). Furthermore, SMM was determined to have a negative association with BMI (β = −0.5340, P < 0.001), while a positive association between SMH and BMI (β = 0.7930, P β = −0.9849, P β = −0.0642, P < 0.001) were negatively associated with BFP. In both men and women, SMM maintained the analogous correlation with other indicators. In the general population, SMM showed a gradual downward trend from low body weight to grade III obesity (F = 9528.32, P < 0.001), but SMH (F = 34395.46, P F = 9706.20, P < 0.001) had a reciprocal association. BMI, BFP and SMM differences were observed based on levels of physical activity (P < 0.001). However, there was no significant difference in SMH based on exercise (P > 0.05). Conclusions: SMM may be a more ideal and accurate clinical algorithm for SMI because it is more tightly associated with other body composition indices, as compared with SMH.

Possibilities of Assessing Respiratory Muscle Strength and Trunk Muscle Mass in the Prevention of Sarcopenia in Older People Living in the Community

Objective: The purpose of this study was to clarify the relationship between respiratory muscle strength and skeletal muscle mass (trunk, upper limbs, and lower limbs) in older people who were certified as requiring nursing or supportive care. Methods: Thirty-five older people (65 years or older) who were certified as requiring nursing care or support were included in the study. The subjects were divided into a non-sarcopenic group (n = 12) and a sarcopenic group (n = 23) according to the sarcopenia diagnostic criteria proposed by the Asian Working Group for Sarcopenia. Maximum inspiratory pressure, maximum expiratory pressure, skeletal muscle mass (trunk, upper and lower limbs), and hand grip strength were measured. Pearson’s correlation coefficient and multiple regression analysis were used for statistical processing. Results: In the non-sarcopenic group, both expiratory muscle strength and hand grip strength were correlated with skeletal muscle mass. In the sarcopenia group, expiratory muscle strength was not correlated with skeletal muscle mass, and only hand grip strength was correlated with upper limb muscle mass. Multiple regression analysis revealed that, in the non-sarcopenic group, trunk muscle mass was the primary factor in expiratory muscle strength and upper limb muscle mass was the primary factor in hand grip strength. In the sarcopenia group, upper limb muscle mass was found to be the main factor in hand grip strength. Conclusion: Our results highlight the importance of assessing expiratory muscle strength and trunk muscle mass before sarcopenia develops in older people who require support and nursing care.

Skeletal muscle loss is associated with diabetes in middle-aged and older Chinese men without non-alcoholic fatty liver disease

BACKGROUND Skeletal muscle,a key insulin target organ,has been reported to be associated with diabetes mellitus(DM).Compared to non-diabetic patients,diabetic patients have decreased muscle mass and a higher prevalence of sarcopenia,and patients with sarcopenia may be at increased risk of developing diabetes.In individuals with nonalcoholic fatty liver disease(NAFLD),sarcopenia is associated with the severity of fibrosis and steatosis.Previous studies have demonstrated that NAFLD is strongly associated with DM and sarcopenia.AIM To determine the relationship between skeletal muscle mass and DM in Chinese middle-aged and elderly men,and whether the association is affected by NAFLD.METHODS Skeletal muscle mass was calculated as appendicular skeletal muscle mass(ASM)in kg/body weight×100%.Liver fat content(LFC)was measured using a quantitative ultrasound method.RESULTS As the ASM decreased,fasting blood glucose(FBG),2-h postprandial blood glucose(2hBG),and LFC increased in both genders,as did the prevalence of DM and NAFLD.Spearman analysis showed that the ASM was negatively correlated with the FBG,2hBG,and LFC.Stepwise logistic regression analysis showed that after adjustments,the ASM quartile was negatively associated with the presence of DM in males,but not in females.Subgroup analysis showed that the ASM quartiles remained negatively correlated with the presence of DM in the non-NAFLD population(including males and females),but no correlation was found between ASM quartiles and the presence of DM in the NAFLD population.When stratified by LFC quartiles,ASM was negatively correlated with the presence of DM in the first and second LFC quartiles in males.CONCLUSION Skeletal muscle mass loss was shown to be associated with the presence of DM in males,but not in females;NAFLD weakens this association.The results suggested that the stratified management of diabetes mellitus should be considered according to skeletal muscle mass and NAFLD.

Associations between Geriatric Nutrition Risk Index,bone mineral density and body composition in type 2 diabetes patients

BACKGROUND Type 2 diabetes mellitus(T2DM),a fast-growing issue in public health,is one of the most common chronic metabolic disorders in older individuals.Osteoporosis and sarcopenia are highly prevalent in T2DM patients and may result in fractures and disabilities.In people with T2DM,the association between nutrition,sarcopenia,and osteoporosis has rarely been explored.AIM To evaluate the connections among nutrition,bone mineral density(BMD)and body composition in patients with T2DM.METHODS We enrolled 689 patients with T2DM for this cross-sectional study.All patients underwent dual energy X-ray absorptiometry(DXA)examination and were categorized according to baseline Geriatric Nutritional Risk Index(GNRI)values calculated from serum albumin levels and body weight.The GNRI was used to evaluate nutritional status,and DXA was used to investigate BMD and body composition.Multivariate forward linear regression analysis was used to identify the factors associated with BMD and skeletal muscle mass index.RESULTS Of the total patients,394 were men and 295 were women.Compared with patients in tertile 1,those in tertile 3 who had a high GNRI tended to be younger and had lower HbA1c,higher BMD at all bone sites,and higher appendicular skeletal muscle index(ASMI).These important trends persisted even when the patients were divided into younger and older subgroups.The GNRI was positively related to ASMI(men:r=0.644,P<0.001;women:r=0.649,P<0.001),total body fat(men:r=0.453,P<0.001;women:r=0.557,P<0.001),BMD at all bone sites,lumbar spine(L1-L4)BMD(men:r=0.110,P=0.029;women:r=0.256,P<0.001),FN-BMD(men:r=0.293,P<0.001;women:r=0.273,P<0.001),and hip BMD(men:r=0.358,P<0.001;women:r=0.377,P<0.001).After adjustment for other clinical parameters,the GNRI was still significantly associated with BMD at the lumbar spine and femoral neck.Additionally,a low lean mass index and higherβ-collagen special sequence were associated with low BMD at all bone sites.Age was negatively correlated with ASMI,whereas weight was positively correlated with ASMI.CONCLUSION Poor nutrition,as indicated by a low GNRI,was associated with low levels of ASMI and BMD at all bone sites in T2DM patients.Using the GNRI to evaluate nutritional status and using DXA to investigate body composition in patients with T2DM is of value in assessing bone health and physical performance.

Correlation between TG/HDL-C Ratio and Sarcopenia in Middle-Aged and Elderly People in Southwest China

Objective: To study the correlation between TG/HDL-C ratio and sarcopenia in middle-aged and elderly people in southwest China. Methods: Body mass index (BMI) and serum of middle-aged and elderly people aged 50 - 70 years in Southwest China were collected, grip strength was measured by grip strength meter, muscle mass and fat mass of upper, lower limbs and trunk were measured by body composition analyzer based on bioelectrical impedance method, and TG and HDL-C in serum were determined by enzymatic method. Results: Pearson correlation analysis showed that TG/HDL-C ratio (r = 0.246, p p p > 0.05). Conclusion: TG/HDL-C ratio is a predictor of skeletal muscle mass, and TG/HDL-C ratio is a protective factor for sarcopenia in middle-aged and elderly people in southwest China, and it can be used as a potential evaluation indicator for sarcopenia.

Prognostic role of sarcopenia in metastatic colorectal cancer patients during first-line chemotherapy:A retrospective study

BACKGROUND Sarcopenia is a condition characterized by decreased skeletal muscle mass due to physiological ageing or to a concomitant disease such as neoplasia.In cancer patients,a low lean body mass is suggested to be a negative prognostic factor for survival and for the development of dose-limiting chemotherapy toxicities irrespective of disease stage.AIM To evaluate the prognostic role of sarcopenia in patients with metastatic colorectal cancer(mCRC)undergoing first-line chemotherapy.METHODS Our retrospective analysis included 56 mCRC patients who received first-line chemotherapy from 2014 to 2017 at the Medical Oncology Unit of our hospital.Computerized scans were performed before starting chemotherapy and at the first disease reassessment.Sarcopenia was assessed using the skeletal mass index=muscle area in cm^(2)/(height in m^(2))calculated at the L3 vertebra.Overall survival and objective response rate were evaluated.Toxicities were analyzed during the first four cycles of therapy and graded according to Common Terminology Criteria for Adverse Events version 4.0.A loss of skeletal muscle mass≥5%was considered indicative of deterioration in muscle condition.RESULTS Median age was 67 years and 35.7%of patients were≥70 years old.Fourteen patients(25%)were sarcopenic at baseline computed tomography(CT)scan(7/33 men;7/23 women);5/14 sarcopenic patients were≥70 years old.Median followup was 26.8 mo(3.8-66.8 mo)and median overall survival was 27.2 mo(95%CI:23.3-37.3).Sarcopenia was not correlated to overall survival(P=0.362),to higher toxicities reported during the first 4 cycles of chemotherapy(P=1.0)or to response to treatment(P=0.221).At the first disease reassessment,a skeletal muscle loss(SML)≥5%was found in 17 patients(30.3%)3 of whom were already sarcopenic at baseline CT scan,while 7 patients became sarcopenic.SML was not correlated to overall survival(P=0.961).No statistically significant correlation was found between baseline sarcopenia and age(P=1.0),body mass index(P=0.728),stage at diagnosis(P=0.355)or neutrophil/lymphocyte ratio(P=0.751).CONCLUSION Neither baseline sarcopenia nor SML affected survival.In addition,baseline sarcopenia was not related to worse treatment toxicity.However,these results must be interpreted with caution due to the limited sample size.

SARS-CoV-2-the Unforeseen Peril of David Winning Against Goliath:the Immune Giant Collapsing Under Its Own Rampaging Cytokine Storm

We examined SARS-CoV-2(Covid-19)available treatments and prophylactic methods that included interventions associated with inhibiting the“type II transmembrane serine protease”(TMPRSS2)to limit the fusion between the Covid-19 Spike proteins and ACE2 receptors,or newly developed therapeutics like Remdesivir that interferes with the viral RNA replication.We explored the dilemma of ACE2 receptors that have a protective function against high blood pressure associated disorders,yet,they serve as the viral points of entry,elevating the probability of infection.Human tissues’analysis reveals a higher ACE2 expression in adipose tissue,placing obesity-related conditions in the eye of the pandemic storm.It primarily exposes males due to the surge of ACE2 receptors in the testes along with other tissues.Males manifest a relatively higher positive ACE2 correlations with certain immune cells in the lungs,thyroid,adrenals,liver and colon,while females evidence higher ACE2 correlations with immune cells in the heart.The remaining tissues’ACE2/immunity expressions are equivalent in both sexes,indicating that despite its preference for males,the threat of Covid-19 can easily target females.Recent reports indicate that Covid-19 is empowered by hindering the critical process of viral recognition during the adaptive immune response leading to the“cytokine storm”,the aggravated immune response that indiscriminately perseveres,rampaging the host’s vital organs.Sedentary lifestyle,age-related hormonal imbalance,and adiposity induced inflammation predispose the body to the immune collapse following Covid-19 invasion,spotlighting the detrimental aftermath of metabolic dysfunction,and excess food consumption provoked by elevated cortisol and dysregulated appetite hormones.ACE 2 expression is suppressed in the skeletal muscle,rendering fitness and weight management an effective Covid-19 preventive intervention,along with social distancing,hygiene,and facial coverings.Physical activity,or exercise alternative methods have recently demonstrated statistically significant reductions of the inflammatory marker C-Reactive Protein(CRP),triglycerides,visceral fat,cortisol and the orexigenic hormone ghrelin,juxtaposed by optimal increases of IGF-1,skeletal muscle mass,Free T3,HDL,and the anorexic hormone leptin.