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      Protocol for understanding acute sarcopenia: a cohort study to characterise changes in muscle quantity and physical function in older adults following hospitalisation

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          Abstract

          Background

          Older adults are vulnerable to the effects of acute sarcopenia (acute muscle insufficiency) following hospitalisation. However, this condition remains poorly characterised to date. It is hypothesised that acute sarcopenia arises due to a combination of bed rest and inflammatory surge. This study aims to characterise changes in muscle quantity and function, determining which factors (clinical and biological) are most predictive, and how these relate to change in physical function at 13 weeks.

          Methods

          This study will include three groups of patients aged 70 years and older; patients undergoing elective colorectal surgery, patients admitted for emergency abdominal surgery, and patients admitted under general medicine with acute bacterial infections. Changes in muscle quantity (Bilateral Anterior Thigh Thickness with ultrasound and bioelectrical impedance analysis) and muscle function (muscle strength, physical performance) within 1 week of hospitalisation or surgery will be characterised, with follow-up of patients at 13 weeks. Physical function will be measured using the Patient Reported Outcome Measures Information System, and the Short Physical Performance Battery (or gait speed alone within 1 week of surgery).

          Discussion

          This study will fully characterise changes in muscle quantity and function in hospitalised older adults and enable risk stratification towards targeted interventions in clinical practice. The results of this study will inform further research involving interventions to ameliorate changes.

          Trial registration

          ClinicalTrials.gov Identifier: NCT03858192; Prospectively registered 28th February 2019.

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          Most cited references29

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          Estimation of skeletal muscle mass by bioelectrical impedance analysis.

          The purpose of this study was to develop and cross-validate predictive equations for estimating skeletal muscle (SM) mass using bioelectrical impedance analysis (BIA). Whole body SM mass, determined by magnetic resonance imaging, was compared with BIA measurements in a multiethnic sample of 388 men and women, aged 18-86 yr, at two different laboratories. Within each laboratory, equations for predicting SM mass from BIA measurements were derived using the data of the Caucasian subjects. These equations were then applied to the Caucasian subjects from the other laboratory to cross-validate the BIA method. Because the equations cross-validated (i.e., were not different), the data from both laboratories were pooled to generate the final regression equation SM mass (kg) = [(Ht 2 / R x 0.401) + (gender x 3.825) + (age x -0. 071)] + 5.102 where Ht is height in centimeters; R is BIA resistance in ohms; for gender, men = 1 and women = 0; and age is in years. The r(2) and SE of estimate of the regression equation were 0.86 and 2.7 kg (9%), respectively. The Caucasian-derived equation was applicable to Hispanics and African-Americans, but it underestimated SM mass in Asians. These results suggest that the BIA equation provides valid estimates of SM mass in healthy adults varying in age and adiposity.
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            The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients.

            The Mini Nutritional Assessment (MNA) has recently been designed and validated to provide a single, rapid assessment of nutritional status in elderly patients in outpatient clinics, hospitals, and nursing homes. It has been translated into several languages and validated in many clinics around the world. The MNA test is composed of simple measurements and brief questions that can be completed in about 10 min. Discriminant analysis was used to compare the findings of the MNA with the nutritional status determined by physicians, using the standard extensive nutritional assessment including complete anthropometric, clinical biochemistry, and dietary parameters. The sum of the MNA score distinguishes between elderly patients with: 1) adequate nutritional status, MNA > or = 24; 2) protein-calorie malnutrition, MNA < 17; 3) at risk of malnutrition, MNA between 17 and 23.5. With this scoring, sensitivity was found to be 96%, specificity 98%, and predictive value 97%. The MNA scale was also found to be predictive of mortality and hospital cost. Most important it is possible to identify people at risk for malnutrition, scores between 17 and 23.5, before severe changes in weight or albumin levels occur. These individuals are more likely to have a decrease in caloric intake that can be easily corrected by nutritional intervention.
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              • Article: not found

              Association between ultrasound measurements of muscle thickness, pennation angle, echogenicity and skeletal muscle strength in the elderly.

              The increase of elderly in our society requires simple tools for quantification of sarcopenia in inpatient and outpatient settings. The aim of this study was to compare parameters determined with musculoskeletal ultrasound (M-US) with muscle strength in young and elderly patients. In this prospective, randomised and observer blind study, 26 young (24.2 ± 3.7 years) and 26 old (age 67.8 ± 4.8 years) patients were included. Muscle thickness, pennation angle and echogenicity of all muscles of musculus quadriceps were measured by M-US and correlated with isometric maximum voluntary contraction force (MVC) of musculus quadriceps. Reproducibility of M-US measurements as well as simple and multiple regression models were calculated. Of all measured M-US variables the highest reproducibility was found for measurements of thickness (intraclass correlation coefficients, 85-97%). Simple regression analysis showed a highly significant correlation of thickness measurements of all muscles of musculus quadriceps with MVC in the elderly and in the young. Multiple regression analysis revealed that thickness of musculus vastus medialis had the best correlation with MVC in the elderly. This study showed that measurement of muscle thickness, especially of musculus vastus medialis, by M-US is a reliable, bedside method for monitoring the extent of sarcopenia.
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                Author and article information

                Contributors
                c.welch@bham.ac.uk
                c.a.greig@bham.ac.uk
                tahir.masud@nuh.nhs.uk
                t.pinkney@bham.ac.uk
                t.jackson@bham.ac.uk
                Journal
                BMC Geriatr
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                1471-2318
                10 July 2020
                10 July 2020
                2020
                : 20
                : 239
                Affiliations
                [1 ]Medical Research Council and Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham and Nottingham, UK
                [2 ]GRID grid.6572.6, ISNI 0000 0004 1936 7486, Institute of Inflammation and Ageing, , University of Birmingham, ; Birmingham, UK
                [3 ]GRID grid.412563.7, ISNI 0000 0004 0376 6589, University Hospitals Birmingham NHS Foundation Trust, ; Birmingham, UK
                [4 ]GRID grid.415490.d, ISNI 0000 0001 2177 007X, University of Birmingham Research Laboratories, , Queen Elizabeth Hospital Birmingham, ; Mindelsohn Way, Edgbaston, Birmingham, B152GW UK
                [5 ]GRID grid.412563.7, ISNI 0000 0004 0376 6589, Birmingham Biomedical Research Centre, , University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, ; Birmingham, UK
                [6 ]GRID grid.6572.6, ISNI 0000 0004 1936 7486, School of Sport and Exercise Sciences, , University of Birmingham, ; Birmingham, UK
                [7 ]GRID grid.6572.6, ISNI 0000 0004 1936 7486, School of Sport, Exercise and Rehabilitation Sciences, , University of Birmingham, ; Edgbaston, Birmingham, B15 2TT UK
                [8 ]GRID grid.4563.4, ISNI 0000 0004 1936 8868, University of Nottingham, ; Nottingham, UK
                [9 ]GRID grid.240404.6, ISNI 0000 0001 0440 1889, Nottingham University Hospitals NHS Trust, ; Nottingham, UK
                [10 ]Clinical Gerontology Research Unit (CGRU), First Floor, South Corridor, City Hospital, Nottingham, NG5 1PB UK
                [11 ]GRID grid.6572.6, ISNI 0000 0004 1936 7486, Academic Department of Surgery, , University of Birmingham, ; Room 29, 4th Floor, Heritage Building, Edgbaston, Birmingham, B15 2TH UK
                [12 ]GRID grid.415490.d, ISNI 0000 0001 2177 007X, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, ; Mindelsohn Way, Edgbaston, Birmingham, B152GW UK
                Author information
                http://orcid.org/0000-0003-3894-355X
                Article
                1626
                10.1186/s12877-020-01626-4
                7350619
                32650734
                852dc4c8-607f-4728-a10a-5a7e1a041a10
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 4 August 2019
                : 22 June 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000832, Dowager Countess Eleanor Peel Trust;
                Award ID: 253
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100000265, Medical Research Council;
                Funded by: FundRef http://dx.doi.org/10.13039/501100000341, Arthritis Research UK;
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2020

                Geriatric medicine
                acute sarcopenia,physical function,older adults,hospitalisation
                Geriatric medicine
                acute sarcopenia, physical function, older adults, hospitalisation

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