United Kingdom

Background: • Hip fracture is the most common reason for older people to require emergency surgery. • Sarcopenia, a condition of decreasing muscle mass, strength and physical performance with age, is common in older people. • Sarcopenia is associated with poor postoperative outcomes following hip fracture surgery; however, sarcopenia is not screened for on admission with hip fracture. • A simple, cheap and effective screening tool for sarcopenia is grip strength testing. Aims: 1. Design a protocol for grip strength testing in patients admitted with hip fracture. 2. Deliver a training programme in grip strength testing to physiotherapy staff. 3. Assess the feasibility of implementation through quantitative, qualitative and economic analysis. 4. Assess for association between grip strength and other risk scores in hip fracture. Conclusions: • Grip strength testing was simple, cheap and effective in screening for low muscle strength in hip fracture. • A protocol suited to the specific capabilities of hip fracture patients was produced. • A team of staff were trained over a relatively short number of sessions. • Testing was acceptable to both patients and staff and was conducted with fidelity to the protocol. • Testing was rapidly adopted into admission assessment for a high proportion of patients. • Many patients with low grip strength were identified who are at high risk of adverse postoperative outcomes following hip fracture.

ISTRC 2021 - International Sarcopenia Translational Research Conference

Implementing grip strength assessment in hip fracture patients: a feasibility project

hip fracture

feasibility

grip strength

sarcopenia

implementation

Welcome to the inaugural International Sarcopenia Translational Research Conference.  “Where Worlds Meet” – the event brings together a broad range of researchers and practitioners in a truly interdisciplinary forum, covering discovery science through to clinical practice.

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Access to this event requires a registration. Please email Eleanor Lockhart at sarcconf@ncl.ac.uk if you have any questions regarding your registration. 

poster

Background: Sarcopenia is a prevalent condition with aging, and it is related to clinical and functional decline. Previously care setting has shown to play an important role in sarcopenia prevalence, plus in Spain aged population has a high percentage of women. Objective: to analyse the clinical and functional characteristics of community-dwelling and institutionalised older women with or without sarcopenia. Methods: Study design: A multicentre cross-sectional study. Setting: Valencia (Spain), Jan 2019-Feb 2020. Sample: older women (n=197), living in community (48.2%) and in residential facilities (51.8%). Clinical variables: number of medications, visits to doctor, number of hospitalisation stays, falls, Abbreviated Charlson’s Comorbidity Index. Results: Sarcopenic older women living in community took more medication (p=0.021) and presented significant functional decline for Barthel Index and biceps strength (both p= 0.0001) compared to non-sarcopenic women. Institutionalised sarcopenic older women showed higher number of falls (p=0.001), a decline of Barthel Index and biceps strength (both p= 0.0001), and also a significant decline in quadriceps strength (p=0.001) and calf circumference (p=0.004) compared to nonsarcopenic women. Conclusion: Number of medication and number of falls are characteristic of sarcopenic women living in community and institutionalised, respectively. The main functional variables that characterise sarcopenic women, whether they live in the community or institutionalised are Barthel Index and biceps strength. Clinicians may take these findings into consideration in order to identify sarcopenic women depending on their living setting.

Clinical and functional characteristics of sarcopenic vs non sarcopenic older women living in different settings

Background: 1) Cow’s milk is a source of several nutrients and non-nutrients that synergistically may be beneficial for skeletal muscle . 2) Muscle strength (grip strength, GS), a key component of sarcopenia , declines with advancing age , and has been proposed as a biological marker of ageing. 3) Evidence that links milk intake to decline in muscle strength from midlife to old age is lacking. Methods: 1) Analytic sample: 2723 (50.8% women) participants who had data for at least one exposure (milk, g/day) and one outcome (GS, kg). 2) Milk intake assessment: 5-day food diaries (ages 36, 43, 53 and 60-64 years) 6 . 3) Exposure: grand mean of total, reduced-fat and full-fat milk consumption were each categorised in thirds (T1 (lowest) to T3 (highest)). 4) Outcomes: maximum GS at ages 53, 60-64, and 69 years, and probable sarcopenia at age 69 defined by sex-specific cut-offs (<16 kg in women; <27 kg in men) 2 . 5) Statistical analyses: logistic regression to examine the risk of probable sarcopenia, and multilevel models to investigate decline in GS in relation to milk intake thirds. Conclusion: The data suggests that a higher milk consumption across adulthood is associated with better muscle strength in midlife and may reduce the risk of sarcopenia in later life.

Association between milk intake and decline in muscle strength from mid- to late life: the MRC National Survey of Health and Development

Introduction: 1) Low-income countries are expected to see the largest increase in over 60-year-olds over the next 30 years.1 This will lead to an increase in age related conditions such as sarcopenia and frailty. Assessing the prevalence and relationship of these syndromes is important in understanding how many older adults may be affected. 2) Sarcopenia has rarely been studied in rural communities in lowincome countries, yet may be an important contributor to poor health and impaired functioning. Bioimpedance analysis (BIA) and physical function tests used in the diagnosis of sarcopenia have also been associated with frailty. Methods: 1) Data were analysed from a randomly selected frailty-weighted sample of 235 adults aged ≥60 years from 5 randomly selected villages in Hai district, Kilimanjaro region of northern Tanzania. 2) This cohort was created from 1207 older adults who were screened using the Brief Frailty Instrument for Tanzania (B-FIT) to generate a sample with an artificially inflated number of frail and pre-frail individuals. 3) A diagnosis of sarcopenia was derived using the European Working Group on Sarcopenia in Older People’s definition; using estimated appendicular skeletal muscle mass by BIA, and grip strength. Those who also had poor physical performance by a low “timed up and go” (TUG) score were categorised as having severe sarcopenia. 4) Frailty was identified through a comprehensive geriatric assessment. Results: 1) A strong association was observed between frailty and sarcopenia: Chi2 test X= 35.475 (p <0.001), suggesting a relationship between the two syndromes. 2) Of the 235 individuals, 194 had complete data for grip strength, anthropometric and BIA measurements, allowing a diagnosis of sarcopenia to be derived. 47 (24.2%) participants had sarcopenia, of whom 19 had severe sarcopenia. Adjusting for frailty-weighting, the estimated prevalence of sarcopenia and severe sarcopenia in the screened population was 19.5% and 5.4% respectively. 3) 41 of the 235 individuals investigated did not have sufficient data recorded to diagnose sarcopenia, this included grip strength and measurements needed for bioimpedance analysis. 4) Phase angle (by BIA), grip strength and TUG all predicted frailty independently in multivariate regression analyses. 5) All of the physical factors investigated were significantly poorer in the frail group compared to the non-frail group (p<0.001). Conclusion: 1) The estimated prevalence of sarcopenia in rural northern Tanzania was 19.5%, this prevalence is higher than global estimates of sarcopenia in ≥60 year olds. 2) Phase angle and physical function tests were effective at predicting frailty in this population. 3) Bioimpedance may be an effective method for assessing sarcopenia in Northern Tanzania, and other low resource environments. 

Investigating the Prevalence of Sarcopenia, and its Association with Frailty in Northern Tanzania

Introduction: The prevalence of PD and sarcopenia both increase with age. They share features of pathogenesis including IL6 driven neuroinflammation and mitochondrial dysfunction. However the degree to which they co-occur and if the presence of sarcopenia is influenced by Parkinson’s disease stage is unknown. Methods: Predefined literature search strategies were used on MEDLINE, EMBASE, Scopus and Web of Science. Studies conducted in people with PD or aPS reporting on the prevalence of sarcopenia or those providing sufficient data to compute this using validated sarcopenia definitions were included. Mean prevalence was calculated across studies. A pooled odds ratio was calculated across studies reporting on prevalence of sarcopenia in controls. Risk of bias was assessed using the AXIS tool. Results: 1683 studies (199 duplicates) were identified through the search; 67 assessed in full; 14 met inclusion criteria. Average study quality score was 14.5/20. The mean prevalence of sarcopenia in parkinsonian patients was 17.9% (range 2- 31.4%). The mean prevalence of probable sarcopenia (i.e. low muscle strength) was 49.1% (range 17.5-76.7%). In all studies with non-parkinsonian controls, sarcopenia was more prevalent in those with parkinsonian disorders. The combined odds ratio was 2.49 (p <0.0001) see fig. 1. UPDRS III score positively correlated with prevalence of sarcopenia but this was not consistently shown in individual studies, see fig 2. Only 3 studies commented on the prevalence of sarcopenia in aPS and there was little agreement as to whether sarcopenia is more prevalent in PD or aPS. Conclusions: Sarcopenia is a prevalent and important issue in parkinsonian disorders. Probable sarcopenia is especially common. Recognition of this should prompt clinical testing and provision of appropriate interventions to minimise negative clinical outcomes associated with movement disorders being compounded by muscle weakness.

The Prevalence of Sarcopenia in Parkinson’s Disease and Related Disorders A systematic review

Adiposity and grip strength: a Mendelian Randomisation study

Background: Sarcopenia is associated with a low intake of energy and nutrients (e.g., protein and specific micronutrients as calcium, selenium, magnesium and vitamin D), which appears to influence muscle mass (muscle quantity and quality) and function (strength and walking speed). Material and methods: This research was part of a cross-sectional study called the Nutriage project (Ref. 0359_NUTRIAGE_1_E-5), which included a sample of permanent residents in fifteen nursing homes for older adults in Galicia (Northwest Spain). Food intake data were collected by the precise weighing method. Results were compared with Dietary Reference Intakes for >70-year-olds, alongside recommendations of the European Society for Clinical Nutrition and Metabolism and PROT-AGE group. The variables analyzed were energy, protein, selenium, calcium, magnesium and vitamin D in both sexes. Means for nutrient intake, were calculated, and differences by sex and age categories were tested using t-test or ANOVA. P values < 0.05 were considered statistically significant. Results: The sample selected for this study was 162 residents, where 65.4% were women and 34.6% were men. The average age of the participants was 85.6 years. Conclusions: The dietary intake of the institutionalized elderly in this study did not meet the recommended nutritional requirements in terms of calcium, magnesium and vitamin D. 5% of the residents did not meet their caloric needs and 22% of them were below the protein recommendations of ESPEN and PROT-AGE group. Despite finding no significant differences, in our sampl e we have seen that energy, protein and micronutrient consumption is higher in women than in men. Based on these findings, the nutritional intake of nursing homes is inadequate in terms of micronutrients, especially considering the published scientific evidence on the contribution of proteins and specific nutrients for the prevention of sarcopenia.

Protein and micronutrients intake in elderly living in nursing homes in northeast Spain: Are enough to prevent sarcopenia?

Background: • Dietary protein provides essential amino acids required for healthy aging. • Understanding how dietary protein sources vary for different population subgroups will allow for more targeted nutrition interventions. Methods: • Analysis of cross-sectional data from NHANES 2011–2016 • Adults (18+ years) with one 24-hour dietary recall (n = 15,697) • Population proportions were calculated based on protein intake (g/day) for food categories.  Discussion: • The top ten sources of protein accounted for over 40% of dietary protein for all groups. • Chicken (whole pieces) was the top-ranked source for all groups. • Only two plant-based proteins appeared in the top ten sources: beans, peas and legumes for Hispanics, and nuts and seeds for Other. • Public health strategies that encourage diversity in protein sources and incorporate legumes nuts, and poultry have the potential to shift the overall population protein intake distribution toward improving overall diet quality.

Age and Racial/Ethnicity Differences in Dietary Sources of Protein, NHANES, 2011-2016

Background: Beginning as early as the 4th decade of life, evidence suggests that skeletal muscle mass and skeletal muscle strength decline in a linear fashion, with up to 50% of mass being lost by the 8th decade of life[1] . Given that muscle mass accounts for up to 60% of body mass, pathological changes to this important metabolically active tissue can have profound consequences on the older adult. The consequences of sarcopenia are often severe in older adults, as the strength and functional declines associated with sarcopenia can in turn contribute to a number of adverse health outcomes, including loss of function, disability, and frailty. A greater understanding of sarcopenia and frailty among healthcare professionals could have a dramatic impact on outcome and quality of life of the elderly. Material and methods: This longitudinal study included NHS healthcare professionals (n=50) who were asked to complete a questionnaire regarding awareness of sarcopenia, risks involved, diagnostic strategies and it’s management. Conclusion: Although concept of sarcopenia and frailty is familiar to most NHS healthcare professional’s practical application is limited due to lack of awareness regarding the diagnostic methodology, risks as well as time constrains.

Awareness regarding Frailty and Sarcopenia among healthcare professionals at a District General Hospital in South East United Kingdom

Background: The beneficial effect of resistance training (RT) for skeletal muscle health and physical functioning in older adults is well recognised. It may be further enhanced by ensuring adequate protein intake, preferably from sources with high biological value protein that are inexpensive, easy to prepare, and well tolerate. However, few intervention studies have used a whole food approach with RT, and there are challenges associated with older adults taking part in such interventions. Thirty community-dwelling older adults (18 men and 12 women) performed 6-weeks of RT, twice weekly, and were randomised into three intervention groups: "whole milk (3.6% fat) + RT” (Group 1), “skimmed milk (0.3% fat) + RT” (Group 2), and “control drink + RT” (Group 3). Control drink (cranberry juice) was supplemented with maltodextrin to match the caloric value of whole milk. Approximately 1 week following completion of the 6-week intervention delivered twice-weekly in a local gym, a homebased post intervention interview was conducted to understand participants’ experiences of taking part as well as the motivators and barriers to continuing the intervention after the study completion. Participants were asked a combination of structured multiple-response and standardised open-ended questions. Participants’ responses to 11 open-ended questions were recorded verbatim pertaining to (a) overall experience in the study (probing for what they liked/enjoyed or disliked/found difficult), three questions; (b) attitudes and barriers to consuming 2 X 500 mL milk/control drink intake postexercise (e.g. volume or liquid, taste), two questions; (c) changes in appetite and habitual diet because of milk/control drink intake, two questions; (d) opinions about the feasibility/acceptability of the intervention (milk+RT) for muscle health in older adults one question; (e) intentions to continue the intervention on their own after the study completion (probing for motivators and barriers), two questions and (f) any additional comments or thoughts about the study.  Conclusions: Overall participants responded positively to a nutritional and RT intervention. Opportunities for peer encouragement, social bonds and their retention, and affordability of exercising in a gym setting should be provided to older adults to promote and maintain positive health behaviours.

MIlk Intervention Muscle AgeiNg (MIlkMAN) pilot study: a content analysis of motivators and barriers to engagement

Background: Sarcopenia (muscle loss) is associated with chronic disease and lower quality of life in older adults. Increased protein intake is suggested as a strategy to slow or reverse this loss of muscle mass and strength. However, diverse study designs result in inconsistent findings on protein’s effects. Design: Meta-analysis used a random effects model (weighted mean difference (WMD)) and generic inverse variance methods to synthesize quantitative data, followed by a leave-one-out method for sensitivity analysis. Conclusions: In healthy older adults undergoing resistance exercise, increased protein intake leads to greater lean body mass, appendicular lean mass and knee extension strength, although no superior effect is seen with the use of additional protein alone.

Protein interventions augment the effect of resistance exercise on lean mass and strength in older adults: systematic review and meta-analysis of randomized controlled trials

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