The recent publication of the revised Consensus on definition and diagnosis of sarcopenia (EWGSOP2) and the Global Leadership Initiative on Malnutrition (GLIM) criteria changed the approach to ...research on sarcopenia and malnutrition. Whilst sarcopenia is a nutrition-related disease, malnutrition and cachexia are nutritional disorders sharing the common feature of low fat-free mass. However, they have differential characteristics and etiologies, as well as specific therapeutic approaches. Applying the current definitions in clinical practice is still a challenge for health professionals and the potential for misdiagnosis is high. This is of special concern in the subgroup of older people with cancer, in which sarcopenia, malnutrition, and cancer cachexia are highly prevalent and can overlap or occur separately. The purpose of this review is to provide an updated overview of the latest research and consensus definitions of sarcopenia, malnutrition, and cachexia and to discuss their implications for clinical practice in older patients with cancer. The overall aim is to improve the quality of nutritional care in light of the latest findings.
RobHortic is a remote-controlled field robot that has been developed for inspecting the presence of pests and diseases in horticultural crops using proximal sensing. The robot is equipped with ...colour, multispectral, and hyperspectral (400–1000 nm) cameras, located looking at the ground (towards the plants). To prevent the negative influence of direct sunlight, the scene was illuminated by four halogen lamps and protected from natural light using a tarp. A GNSS (Global Navigation Satellite System) was used to geolocate the images of the field. All sensors were connected to an on-board industrial computer. The software developed specifically for this application captured the signal from an encoder, which was connected to the motor, to synchronise the acquisition of the images with the advance of the robot. Upon receiving the signal, the cameras are triggered, and the captured images are stored along with the GNSS data. The robot has been developed and tested over three campaigns in carrot fields for the detection of plants infected with ‘Candidatus Liberibacter solanacearum’. The first two years were spent creating and tuning the robot and sensors, and data capture and geolocation were tested. In the third year, tests were carried out to detect asymptomatic infected plants. As a reference, plants were analysed by molecular analysis using a specific real-time Polymerase Chain Reaction (PCR), to determine the presence of the target bacterium and compare the results with the data obtained by the robot. Both laboratory and field tests were done. The highest match was obtained using Partial Least Squares-Discriminant Analysis PLS-DA, with a 66.4% detection rate for images obtained in the laboratory and 59.8% for images obtained in the field.
Phase angle (PhA), a marker of nutritional status obtained by bioelectrical impedance analysis (BIA), is associated with the integrity of cell membranes. Damage to muscle fiber membranes can impact ...muscle strength, which is related to adverse outcomes in adults with advanced chronic kidney disease (CKD). The main objective of this study was to determine the usefulness of the PhA in identifying muscle weakness in candidates for kidney transplants (KTs). Secondly, it aimed to examine the associations of PhA with other parameters of body composition, exercise performance, and muscle structure. Sensitivity, specificity, and area under the receiver operating characteristics curve were used to evaluate the PhA (index test) as a biomarker of muscle weakness. Muscle strength was estimated with maximal voluntary isometric contraction of the quadriceps (MVCI-Q) of the dominant side. Muscle weakness was defined as MVIC-Q < 40% of body weight. A total of 119 patients were evaluated (mean age 63.7 years, 75.6% men). A phase angle cut-off of 5.1° was identified to classify men with a higher likelihood of having low muscle strength in upper limbs (MVIC-Q 40% of their body weight). Male KT candidates with PhA < 5.1° had poorer exercise capacity, lower muscle strength, less muscle mass, and smaller muscle size. A PhA < 5.1° was significantly associated with an eight-fold higher muscle weakness risk (OR = 8.2, 95%CI 2.3–29.2) in a binary regression model adjusted by age, frailty, and hydration status. Remarkably, PhA is an easily obtainable objective parameter in CKD patients, requiring no volitional effort from the individual. The associations of PhA with aerobic capacity, physical activity, muscle mass, and muscle size underscore its clinical relevance and potential utility in the comprehensive evaluation of these patients.
The Global Leadership Initiative on Malnutrition (GLIM) criteria were introduced in 2018 for the diagnosis of malnutrition in adults. This review was aimed at gathering the evidence about the ...association between malnutrition according to the GLIM criteria and mortality in older people, an emerging and clinically meaningful topic in the implementation of the GLIM criteria in geriatric healthcare settings. This scoping review considered meta-analyses, systematic reviews, cohort studies, and cross-sectional studies published in PubMed, Scopus, and the Cochrane Database for Systematic Reviews from the development of the GLIM criteria in 2018 to January 2023. Seventeen articles (15 cohort and 2 cross-sectional studies) were included. The association between GLIM criteria and mortality had been assessed in hospitalized (11 over the 17 articles) and community-dwelling older populations, and those in nursing homes. The review found a strong association between malnutrition according to GLIM criteria and mortality in hospitalized (1.2-fold to 7-fold higher mortality) and community-dwelling older people (1.6-fold to 4-fold higher mortality). These findings highlight the prognostic value of the GLIM criteria and support strategies towards the implementation of malnutrition evaluation according to the GLIM, in order to optimize comprehensive geriatric assessment and provide older people with the highest quality of nutritional care. Studies in nursing home populations were very scarce and may be urgently required.
In 2018, the SARCUS working group published a first article on the standardization of the use of ultrasound to assess muscle. Recommendations were made for patient positioning, system settings and ...components to be measured. Also, shortcomings in knowledge were mentioned. An important issue that still required standardization was the definition of anatomical landmarks for many muscles.
A systematic search was performed in Medline, SCOPUS and Web of Sciences looking for all articles describing the use of ultrasound in the assessment of muscle not described in the first recommendations, published from 01/01/2018 until 31/01/2020. All relevant terms used for older people, ultrasound and muscles were used.
For 39 muscles, different approaches for ultrasound assessment were found that likely impact the values measured. Standardized anatomical landmarks and measuring points were proposed for all muscles/muscle groups. Besides the five already known muscle parameters (muscle thickness, cross-section area, pennation angle, fascicle length and echo-intensity), four new parameters are discussed (muscle volume, stiffness, contraction potential and microcirculation). The former SARCUS article recommendations are updated with this new information that includes new muscle groups.
The emerging field of ultrasound assessment of muscle mass only highlights the need for a standardization of measurement technique. In this article, guidelines are updated and broadened to provide standardization instructions for a large number of muscles.
Objective:
To evaluate the effectiveness of inspiratory/expiratory muscle training (IEMT) and neuromuscular electrical stimulation (NMES) to improve dysphagia in stroke.
Design:
Prospective, ...single-blind, randomized-controlled trial.
Setting:
Tertiary public hospital.
Subjects:
Sixty-two patients with dysphagia were randomly assigned to standard swallow therapy (SST) (Group I, controls, n=21), SST+ IEMT (Group II, n=21) or SST+ sham IEMT+ NMES (Group III, n=20).
Interventions:
All patients followed a 3-week standard multidisciplinary rehabilitation program of SST and speech therapy. The SST+IEMT group’s muscle training consisted of 5 sets/10 repetitions, twice-daily, 5 days/week. Group III’s sham IEMT required no effort; NMES consisted of 40-minute sessions, 5 days/week, at 80Hz.
Main outcomes:
Dysphagia severity, assessed by Penetration-Aspiration Scale, and respiratory muscle strength (maximal inspiratory and expiratory pressures) at the end of intervention and 3-month follow-up.
Results:
Maximal respiratory pressures were most improved in Group II: treatment effect was 12.9 (95% confidence interval 4.5-21.2) and 19.3 (95% confidence interval 8.5-30.3) for maximal inspiratory and expiratory pressures, respectively. Swallowing security signs were improved in Groups II and III at the end of intervention. No differences in Penetration-Aspiration Scale or respiratory complications were detected between the 3 groups at 3-month follow-up.
Conclusion:
Adding IEMT to SST was an effective, feasible, and safe approach that improved respiratory muscle strength. Both IEMT and NMES were associated with improvement in pharyngeal swallowing security signs at the end of the intervention, but the effect did not persist at 3-month follow-up and no differences in respiratory complications were detected between treatment groups and controls.
Given the potential benefits of introducing ultrasound in the clinical assessment of muscle disorders, this study aimed to assess the feasibility and reliability of measuring forearm muscle thickness ...by ultrasound in a geriatric clinical setting.
Cross-sectional pilot study in 25 participants (12 patients aged ≥ 70 years in an acute geriatric ward and 13 healthy volunteers aged 25-50 years), assessed by three raters. Muscle thickness measurement was estimated as the distance between the subcutaneous adipose tissue-muscle interface and muscle-bone interface of the radius at 30% proximal of the distance between the styloid process and distal insertion of the biceps brachii muscle of the dominant forearm. Examinations were repeated three times by each rater and intra- and inter-rater reliability was calculated. Feasibility analysis included consideration of technological, economic, legal, operational, and scheduling (TELOS) components.
Mean muscle-thickness measurement difference between groups was 4.4 mm (95% confidence interval CI 2.4 mm to 6.3 mm, p < 0.001). Intra-rater reliability of muscle-thickness assessment was excellent, with intraclass correlation coefficient (ICC) of 0.947 (95%CI 0.902 to 0.974), 0.969 (95%CI 0.942 to 0.985), and 0.950 (95%CI 0.907 to 0.975) for observer A, B, and C, respectively. Inter-rater comparison showed good agreement (ICC of 0.873 95%CI 0.73 to 0.94). Four of the 17 TELOS components considered led to specific recommendations to improve the procedure's feasibility in clinical practice.
Our findings suggest that US is a feasible tool to assess the thickness of the forearm muscles with good inter-rater and excellent intra-rater reliability in a sample of hospitalized geriatric patients, making it a promising option for use in clinical practice.
Summary Backgrounds & aims The European Society of Clinical Nutrition and Metabolism (ESPEN) consensus definition of malnutrition has been applied in hospitalized older diabetics and middle-aged ...patients, geriatric outpatients, and healthy elderly and young individuals. In a post-acute care setting, our aim was to assess malnutrition (ESPEN definition) and determine its relationship with sarcopenia in older in-patients deconditioned due to an acute process. Methods Eighty-eight in-patients aged ≥70 years with body mass index (BMI) <30 kg/m2 were included (84.1 years old; 62% women) and screened for malnutrition risk using biochemical markers and Mini-Nutritional Assessment-Short Form (MNA-SF). The ESPEN definition was applied: 1) BMI <18.5 kg/m2 or 2) unintentional weight loss plus a) low BMI or b) low fat-free mass index (FFMI). European Working Group on Sarcopenia in Older People (EWGSOP) criteria were also applied. Results Unintentional weight loss occurred in 27 (30.7%) of 88 in-patients considered “at risk” by MNA-SF. Malnutrition prevalence was 4.5%, 7.9%, and 17% using ESPEN definitions 1, 2a, and 2b, respectively; 19.3% were malnourished. Prevalence of sarcopenia was 37.5%, of which 90.9% fulfilled ESPEN malnutrition criteria, a significant association (p = 0.02). No differences in biochemical markers were observed between patients with or without malnutrition or sarcopenia. Conclusions ESPEN criteria constitute an appropriate tool to establish a malnutrition diagnosis in post-acute care. Sarcopenia, as defined by EWGSOP, was present in 37.5% of patients, of which 90.9% fulfilled ESPEN criteria; therefore, malnutrition was significantly related to sarcopenia. Additional work is needed to determine further implications of the ESPEN consensus definition.
Malnutrition has a negative impact on patients with chronic diseases and its early identification is a priority. The primary objective of this diagnostic accuracy study was to assess the performance ...of the phase angle (PhA), a bioimpedance analysis (BIA)-derived parameter, for malnutrition screening using the Global Leadership Initiative for Malnutrition (GLIM) criteria as the reference standard in patients with advanced chronic kidney disease (CKD) waiting for kidney transplantation (KT); criteria associated with low PhA in this population were also analyzed. Sensitivity, specificity, accuracy, positive and negative likelihood ratios, predictive values, and area under the receiver operating characteristic curve were calculated for PhA (index test) and compared with GLIM criteria (reference standard). Of 63 patients (62.9 years old; 76.2% men), 22 (34.9%) had malnutrition. The PhA threshold with the highest accuracy was ≤4.85° (sensitivity 72.7%, specificity 65.9%, and positive and negative likelihood ratios 2.13 and 0.41, respectively). A PhA ≤ 4.85° was associated with a 3.5-fold higher malnutrition risk (OR = 3.53 (CI95% 1.0-12.1)). Considering the GLIM criteria as the reference standard, a PhA ≤ 4.85° showed only fair validity for detecting malnutrition, and thus cannot be recommended as a stand-alone screening tool in this population.
Abstract
Introduction
Hospitalization is associated with acute changes in sarcopenia status in older people, but the influencing factors are not fully understood. Pre-admission care dependency level ...as a risk factor has not yet been investigated.
Objective
Evaluate if pre-admission care dependency level is an independent predictor of sarcopenia changes following hospitalization.
Setting and subjects
Data came from the Sarcopenia 9+ EAMA Project, a European prospective multi-centre study. For this study, 227 hospitalised older people were included from four different hospitals in Belgium, Spain and Poland, between 18 February 2019 and 5 September 2020.
Methods
Sarcopenia status at admission and discharge were calculated using a combined score (desirability value) based on muscle mass (calf circumference), strength (grip) and function (walking speed). Ratio of admission to discharge status was the outcome (desirability ratio; 1.00 meaning no difference). Predictor variable was the pre-admission care dependency level, classified into three groups: independent older people living at home, dependent older people living at home and older people living in a care home. Linear regression models were applied, considering potential confounders.
Results
Mean desirability ratio for dependent older people living at home (‘middle dependent group’) was lower (0.89) compared to independent older people (0.98; regression coefficient −0.09 95% CI −0.16, −0.02) and care home patients (1.05; −0.16 95% CI −0.01, −0.31). Adjusting for potential confounders or using another statistical approach did not affect the main results.
Conclusion
Dependent older people living at home were at higher risk of deterioration in sarcopenia status following hospitalization. In-depth studies investigating causes and potential interventions of these findings are needed.
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