Cystatin C is Better than Creatinine for Predicting Prognosis in Cirrhotic Patients with Sarcopenia

( Han Ah Lee ),( Seung Woon Park ),( Sang Jung Park ),( Tae Hyung Kim ),( Sang Jun Suh ),( Young Kul Jung ),( Ji Hoon Kim ),( Hyung Joon Yim ),( Jong Eun Yeon ),( Kwan Soo Byun ),( Soon Ho Um ),( Yeon 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Recent studies suggested that serum cystatin C (CysC) is a better prognostic marker than serum creatinine (Cr) for predicting prognosis in patients with liver cirrhosis. Overestimation of renal function by serum Cr in these patients is associated with decreased muscle mass, which is represented by sarcopenia. This study was performed to evaluate the effect of sarcopenia on the prognostic efficacy of serum Cr and CysC levels in patients with liver cirrhosis. Methods: Cirrhotic patients who performed abdominal CT and serum Cr and CysC levels were enrolled. Patients with hepatocellular carcinoma and parenchymal renal disease were excluded. At evaluation, transverse psoas muscle thickness (TMPT) was measured on a CT image at the level of the umbilicus. Sarcopenia was defined as TPMT/height <16.8 mm/m. Results: A total of 245 patients were enrolled. Age was 55.0±10.2 years and 159 patients (64.9%) were men. Child-Pugh grade was A, B, and C in 121 (49.4%), 68 (27.8%), and 56 (22.9%) patients, respectively. Sarcopenia was noted in 110 patients (44.9%): 33.9%, 55.9%, and 55.4% in patients with Child-Pugh grade A, B, and C, respectively (P=0.003). Cr level were significantly lower in patients with sarcopenia compared to those without sarcopenia (0.7±0.2 vs 0.8±0.2 mg/dL, P<0.001), while CysC level did not (1.0±0.2 vs 1.0±0.3 mg/L, P=0.970). During 23.3±26.1 months of follow-up, 32 patients (13.1%) died. CysC level was significantly associated with survival of both patients with sarcopenia (P<0.001) and those without sarcopenia (P<0.001), while Cr level was not significantly associated with survival of patients with sarcopenia (P=0.760). Conclusions: Serum Cr level was not useful for predicting prognosis in cirrhotic patients with sarcopenia, while CysC level was significantly associated with mortality regardless of the presence of sarcopenia. Serum CysC level is a better option for predicting prognosis in patients with cirrhosis, especially in those with sarcopenia.

Korean Working Group on Sarcopenia Guideline: Expert Consensus on Sarcopenia Screening and Diagnosis by the Korean Society of Sarcopenia, the Korean Society for Bone and Mineral Research, and the Korean Geriatrics Society

백지연,정희원,김경민,Miji Kim,Clara Yongjoo Park,Kwang-Pyo Lee,Sang Yoon Lee,Il-Young Jang,전옥희,Jae-Young Lim 대한노인병학회 2023 Annals of geriatric medicine and research Vol.27 No.1

Despite the introduction of a diagnostic code and acceptance of a diagnostic process for sarcopenia as a new health technology in Korea, many practitioners remain unfamiliar with the evaluation of sarcopenia. Thus, the Korean Working Group on Sarcopenia (KWGS) developed clinical practice guidelines for the diagnosis of sarcopenia in older Korean adults. A two-phase Delphi interview comprising 19 questions was conducted with 40 expert panelists, 22 of whom participated in the first round between June and August 2022. The second round of the Delphi interview included the remaining 11 questions that were not agreed upon in the first round. The screening process for sarcopenia includes various questionnaires and examinations used in different research and clinical settings. The diagnostic process for sarcopenia was simplified by combining the steps of case finding and assessment. The Short Physical Performance Battery test was given particular emphasis owing to its multifaceted nature. Regardless of muscle mass, having low muscle strength with low physical performance is considered clinically relevant and newly defined as “functional sarcopenia.” Comprehensive geriatric assessment is important for diagnosing sarcopenia. The KWGS’s clinical guideline aims to facilitate the early detection of sarcopenia by allowing various screening tools to be used in a unified process and reducing confusion about which tools to use for diagnosis. This recommendation expands the conceptual definition of sarcopenia as a complex pathophysiological state in line with the concept of frailty and aims to stimulate further research on the diagnosis and management of sarcopenia in clinical settings.

Sarcopenia is common in ulcerative colitis and correlates with disease activity

( Pardhu B Neelam ),( Rimesh Pal ),( Pankaj Gupta ),( Anupam K Singh ),( Jimil Shah ),( Harshal S Mandavdhare ),( Harjeet Singh ),( Aravind Sekar ),( Sanjay K Bhadada ),( Usha Dutta ),( Vishal Sharma 대한장연구학회 2024 Intestinal Research Vol.22 No.2

Background/Aims: Association of sarcopenia with disease severity in ulcerative colitis (UC) is not clearly defined. We planned to estimate the prevalence of sarcopenia in patients with UC as per the revised definition and its relation with the disease severity. Methods: A cross-sectional assessment of sarcopenia in patients with UC was performed. Disease activity was graded according to complete Mayo score. Hand grip strength was assessed with Jamar hand dynamometer, muscle mass using a dual energy X-ray absorptiometry scan, and physical performance with 4-m walk test. Sarcopenia was defined as a reduction of both muscle mass and strength. Severe sarcopenia was defined as reduced gait speed in presence of sarcopenia. Results: Of 114 patients (62 males, mean age: 36.49 ± 12.41 years), 32 (28%) were in remission, 46 (40.4%) had mild-moderate activity, and 36 (31.6%) had severe UC. Forty-three patients (37.7%) had probable sarcopenia, 25 (21.9%) had sarcopenia, and 14 (12.2%) had severe sarcopenia. Prevalence of sarcopenia was higher in active disease (2 in remission, 6 in active, and 17 in severe, P< 0.001). Of 14 with severe sarcopenia, 13 had severe UC while 1 had moderate UC. On multivariate analysis, lower body mass index and higher Mayo score were associated with sarcopenia. Of 37 patients with acute severe colitis, 16 had sarcopenia. Requirement of second-line therapy was similar between patients with and without sarcopenia. On follow-up (median: 18 months), there was a non-significant higher rate of major adverse events in those with sarcopenia (47.4% vs. 33.8%, P= 0.273). Conclusions: Sarcopenia and severe sarcopenia in UC correlate with the disease activity. (Intest Res 2024;22:162-171)

Prevalence and associated risk of advanced colorectal neoplasia in adults with sarcopenia

( Min Cheol Kim ),( Kyeong Ok Kim ),( Min Kyu Kang ) 대한내과학회 2022 The Korean Journal of Internal Medicine Vol.37 No.2

Background/Aims: Although several studies have shown that sarcopenia is associated with poor outcomes in colorectal cancer patients, the impact of sarcopenia on the development of colorectal neoplasia remains unclear. We aimed to evaluate the prevalence and association of colorectal neoplasia, especially advanced colorectal neoplasia, in adults with sarcopenia. Methods: We retrospectively analyzed the data for 10,676 adults who underwent first-time colonoscopy and bioelectrical impedance analysis (BIA) on the same day in a health screening program at a single center. Sarcopenia was diagnosed using established BIA-based criteria as adjusted appendicular skeletal muscle mass (ASM) divided by body mass index (BMI) (ASM/ BMI), height (ASM/height²), or weight (ASM/weight). Prevalence of overall and advanced colorectal neoplasia and their association with sarcopenia, as established by the aforementioned diagnostic criteria, were evaluated. Results: Among 10,676 subjects, 583 were diagnosed with sarcopenia using ASM/BMI. Subjects with sarcopenia had a higher prevalence of colorectal neoplasia than those without. In the multivariate analysis after adjusting for confounding factors, sarcopenia was an independent risk factor for any colorectal neoplasia (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.09 to 1.56) and advanced colorectal neoplasia (OR, 1.97; 95% CI, 1.27 to 3.06). The association between sarcopenia and advanced colorectal neoplasia remained significant for all sarcopenia measures including ASM/height² (OR, 2.19; 95% CI, 1.24 to 3.85) and ASM/weight (OR, 2.41; 95% CI, 1.54 to 3.77). Conclusions: Prevalence of overall and advanced colorectal neoplasia was higher in subjects with sarcopenia than in those without. Sarcopenia was a significant risk factor for colorectal neoplasia, especially for advanced colorectal neoplasia.

Association of Characteristics between Acute Stroke Patients and Sarcopenia: A Cross-Sectional Study

김소영,김병근,박세주 한국운동생리학회 2024 운동과학 Vol.33 No.2

PURPOSE: This study aimed to identify the prevalence of sarcopenia among acute stroke patients, differences in characteristics based on the presence of sarcopenia, the association between functional and sarcopenia factors, and the association between characteristics and the presence of sarcopenia. METHODS: This study was conducted using a cross-sectional design. Sixty-two stroke patients volunteered to participate and were assigned to the sarcopenia group (n=32) and the non-sarcopenia group (n=30). All data collection, including assessment of general characteristics, sarcopenia factors and functional factors, was completed within one day. RESULTS: A sarcopenia prevalence rate of 51% was observed. As skeletal muscle mass index (SMI) and grip strength increased, the berg balance scale (BBS) also increased. Additionally, as grip strength increased, the modified Barthel index (MBI) increased. Significant differences between groups were observed in the characteristics of age, weight, mini-mental state examination, SMI, grip strength, manual muscle testing, BBS, functional ambulation category, and MBI. Furthermore, with each increase of 1 in SMI, the probability of belonging to the sarcopenia group decreased by 0.204 times. CONCLUSIONS: A high prevalence of sarcopenia was observed in acute stroke patients, with differences in characteristics between stroke patients without sarcopenia and those with sarcopenia. As sarcopenia factors increased, BBS and MBI also increased. Increasing SMI in acute stroke patients can reduce the risk of sarcopenia diagnosis; therefore, exercise interventions aimed at increasing SMI should be considered.

Association of Dietary Variety Status and Sarcopenia in Korean Elderly

Hee-Sook Lim 대한골대사학회 2020 대한골대사학회지 Vol.27 No.2

Background: Sarcopenia is associated with a variety of factors including age, diseases, exercise, and heredity. In particular, diet is known to affect changes in muscle mass loss. Methods: The purpose of this study was to analyze the diversity of food intake according to the presence of sarcopenia in elderly people over 65 years old using the 2008 to 2011 Korea National Health and Nutrition Examination Survey. The differences in subjects’ general characteristics, lifestyle, and intake of 15 food groups were compared, and the risk odds ratio (OR) for sarcopenia was calculated for each food intake by gender. Results: The proportion of sarcopenia was 27.7% for males and 24.3% for females. The sarcopenia group had significantly lower intakes of nuts and seeds, meats, and milks than the non-sarcopenia group in males. The females had significantly lower intake of fruits, milks, and beverages in non-sarcopenia group. The dietary diversity score was significantly lower in females with sarcopenia than non-sarcopenia group. Regression analysis of the risk OR for sarcopenia according to food group intake showed that the subjects in the lowest tertile (<31.1 g) had a 1.83 times (95% confidence interval [CI], 1.13-2.42) risk for sarcopenia in males. In case of milks intake of females, the risk for sarcopenia increased 1.39 times (95% CI, 1.11-1.86) in subjects with the lowest tertile (<30.1 g). Conclusions: Dietary diversity status was the most vulnerable to female with sarcopenia. Sarcopenia was associated with meat intake in male and milk intake in female.

Sarcopenia Is Associated with Advanced Liver Fibrosis in Patients with Non-Alcoholic Fatty Liver Disease

( Min Kyu Kang ),( Jung Gil Park ),( Min Cheol Kim ),( Heon Ju Lee ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Sarcopenia has been known to increase risk of non-alcoholic fatty liver diseases (NAFLD). However, there are limited studies in relationship between sarcopenia and advanced fibrosis in large population. We aimed to investigate association between sarcopenia and advanced liver fibrosis in patients with NAFLD. Methods: A total of 53704 subjects were enrolled the study to be analyzed in single healthcare center. Fatty liver and appendicular skeletal muscle mass (ASM) was diagnosed by ultrasound and bio-impedance analysis, respectively. Sarcopenia was defined as two criteria using an ASM/body weight (sarcopenia-Wt, %) and ASM/body mass index (BMI) (sarcopenia-BMI), respectively. The stage of liver fibrosis is assessed by non-invasive scoring model including NAFLD fibrosis score (NFS) and Fibrosis-4 (FIB-4) index, which was determined as the both low and high cut-off value (COV). Results: Of 10711 patients with NAFLD, 1389 (13.0%) were diagnosed with sarcopenia. The scarcopenic patients were older (47.7 vs. 49.1 years, P=0.001), had lower BMI (24.4 vs. 20.4 kg/m2, P=0.000) and waist circumference (82.1 vs. 72.6 cm, P=0.000) compared to non-sarcopenic patients. Regardless of the classified sarcopenia based on body weight or BMI, presence of sarcopenia was independent risk factor for advanced liver fibrosis, which is assessed by low cut-off value for FIB-4 index (Adjusted for metabolic and lipid profiles and sex, ORs = 1.27 to 2.01, all Ps < 0.05). In addition, regardless of the classified sarcopenia based on body weight or BMI, presence of sarcopenia was also independent risk factor for advanced liver fibrosis, which is assessed by both COVs of NFS (Adjusted for obesity and hypertension, lipid profile, and sex, ORs = 1.65 to 2.68, P<0.01 in low COV group, ORs = 2.03 to 3.12, P=0.002 in high-COV group, respectively). Conclusions: Sarcopenia is an independent risk factor for advanced liver fibrosis in patients with NAFLD.

Sarcopenia in Korea: Prevalence and Clinical Aspects

김경민,임수,최경묵,김정희,유성훈,김태년,송욱,임재영,원장원,유형준,장학철 대한노인병학회 2015 Annals of geriatric medicine and research Vol.19 No.1

Sarcopenia has been defined as the considerable loss of skeletal muscle mass and strength that results in frailty in the elderly. Because muscle tissue plays diverse important roles in human, sarcopenia presents many negative health-related consequences including impaired energy homeostasis, falls and cardiovascular disease, and subsequently higher mortality. It is becoming evident that sarcopenia has a negative impact on the healthy life of the elderly. The European Working Group on Sarcopenia, the International Working Group on Sarcopenia and the Asian Working Group on Sarcopenia have released position statement regarding sarcopenia, and more recently the Foundation for the National Institutes of Health Sarcopenia Project has provided a new guideline for assessment of sarcopenia. At this time, there have been several data delineating the status of sarcopenia in Korea. This review focuses on largescale cohorts that assessed sarcopenia and highlights the controversies surrounding the clinical definition and prevalence of sarcopenia in Korea.

Association between Sarcopenia, Bone Density, and Health-Related Quality of Life in Korean Men

고선원,차영화,이정아,박혜순 대한가정의학회 2013 Korean Journal of Family Medicine Vol.34 No.4

Background: Sarcopenia is the loss of muscle mass leading to decreased muscle strength, physical disability, and increased mortality. The genesis of both sarcopenia and osteoporosis is multifactorial, and several factors that play a role in osteoporosis are thought to contribute to sarcopenia. This study evaluated the association between sarcopenia and bone density and health-related quality of life in Korean men. Methods: We used the data of 1,397 men over 50 years of age from the 2009 Korean National Health and Nutrition Examination Survey. Sarcopenia was defined as the appendicular skeletal muscle mass divided by height2 (kg/m2) < 2standard deviations below the sex-specific mean for young adults. Health-related quality of life was measured by the EuroQol-5 dimension (EQ-5D) instrument. Logistic regression analysis was performed to evaluate the relationship between sarcopenia, bone density, and health-related quality of life. Results: The T-score of the lumbar spine, total femur, and femur neck in bone mineral density in subjects with sarcopenia were lower than those in subjects without sarcopenia. The score of the EQ-5D index was significantly lower and the rate of having problems with individual components of health-related quality of life was higher in the sarcopenic group. After adjustment for age and body mass index, the odds ratios (ORs) (95% confidence interval [CI]) for sarcopenia were 2.06(1.07–3.96) in osteopenic subjects and 3.49 (1.52–8.02) in osteoporotic subjects, respectively. After adjustment, the total score of the EQ-5D index was significantly lower in the sarcopenic subjects. The ORs (95% CI) for having problems of mobility and usual activity of the EQ-5D descriptive system were 1.70 (1.02–2.84) and 1.90 (1.09–3.31), respectively. Conclusion: Sarcopenia was associated with decreased bone mineral density in Korean men. In addition, sarcopenia was related to poor quality of life, especially with regard to mobility and usual activity. Greater attention to and evaluation for sarcopenia are needed in subjects showing low bone mineral density to prevent and manage poor quality of life.

Diabetic Peripheral Neuropathy as a Risk Factor for Sarcopenia

Tae Jung Oh,Yoojung Song,Jae Hoon Moon,Sung Hee Choi,Hak Chul Jang 대한노인병학회 2019 Annals of geriatric medicine and research Vol.23 No.4

Background: Diabetic peripheral neuropathy (DPN) is prevalent in patients with type 2 diabetes, and its prevalence increases with age. A previous study demonstrated the association between DPN and muscle dysfunction; however, there are limited data on the association between DPN and sarcopenia. Methods: We enrolled participants with type 2 diabetes and measured hand grip strength (HGS), lean body mass using a bio-impedance analysis, and gait speed using a 4-m walking test. Sarcopenia was diagnosed according to the criteria from the Asian Working Group for Sarcopenia. We also performed various examinations of neuropathy, including both small- and large-fiber neuropathy. Results: Among 170 participants (mean age, 61.5±6.6 years), 24 (14.1%) were diagnosed with sarcopenia. The Michigan Neuropathy Screening Instrument Questionnaire (MNSI-Q) scores were higher in subjects with sarcopenia than in those without sarcopenia (2.7±1.3 vs. 2.4±1.3; p=0.008). However, other neuropathy examination results were not significantly associated with sarcopenia. The MNSI-Q score was negatively associated with HGS, with an odds ratio (OR) of 1.367 (95% confidence interval [CI], 1.122–1.667) in predicting the presence of sarcopenia. After adjusting for sex, body mass index, and diabetes duration, the MNSI-Q score was associated with the presence of sarcopenia (adjusted OR=1.310; 95% CI, 1.041–1.647). Conclusion: In this population with type 2 diabetes, patients with sarcopenia had higher neuropathy questionnaire scores than those without sarcopenia. Therefore, active screening for sarcopenia should be performed in subjects with DPN.