Updated systematic review and meta-analysis on diagnostic issues and the prognostic impact of myosteatosis: A new paradigm beyond sarcopenia

Ahn, Hyemin; Kim, Dong Wook; Ko, Yousun; Ha, Jiyeon; Shin, Young Bin; Lee, Jiwoo; Sung, Yu Sub; Kim, Kyung Won

doi:10.1016/j.arr.2021.101398

Cited by 110 publications

(112 citation statements)

References 69 publications

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“…As the population of ageing people is increasing worldwide, diseases associated with ageing, such as sarcopenia, are becoming increasingly important 1,2 . A decline in the quantity and quality of skeletal muscles is one of the major physical changes associated with ageing, 3 and it is an important factor for patients with diseases 4–6 . Furthermore, low skeletal muscle quality combined with low physical function leads to poor prognosis 7 .…”

Section: Introductionmentioning

confidence: 99%

Features of trunk muscle wasting during acute care and physical function recovery with aortic disease

Kamiya

Matsunaga

Kitamura

et al. 2022

J cachexia sarcopenia muscle

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Background Low skeletal muscle area or density, such as myosteatosis, identified on computed tomography (CT) is associated with poor prognosis in patients with cardiovascular diseases. However, there is a lack of evidence regarding the clinical process of skeletal muscle decline as a short‐term change during acute care settings. This study focused on the use of routine CT imaging for aortic disease management and investigated the changes in skeletal muscle before and after acute care. Methods This prospective study included 123 patients who underwent abdominal CT before and after acute care. The all‐abdominal and each abdominal muscle areas were divided into eight parts (e.g. rectus abdominis, psoas, and erector spine), and their areas and densities were measured at the third lumbar vertebra level after the patients were discharged and de‐identified with blinding to avoid measurement bias. Short physical performance battery (SPPB) was measured at the start and end of in‐hospital cardiac rehabilitation. A generalized linear model with patients as random effects was made to investigate skeletal muscle loss during acute care. Multivariate linear regression analysis was also used to assess the relationship between the change in skeletal muscle during acute care and SPPB during in‐hospital cardiac rehabilitation. Results The median age of the patients was 70 (interquartile: 58–77) years, and 69.9% (86/123) were men. The median day between acute care from the day of surgery or hospital admission and follow‐up CT was 7 (interquartile: 3–8) days. Overall muscle density declined after acute care (estimate value: −3.640, 95% confidence interval [CI]: −4.538 to −2.741), and each abdominal muscle density consistently declined (interaction: F value = 0.099, P = 0.998). In contrast, there was no significant change in the overall muscle area (estimate value: −0.863, 95% CI: −2.925 to 1.200). Changes in the muscle area were different for each skeletal muscle (interaction: F value = 2.142, P = 0.037), and only the erector spine muscle significantly declined (estimate value: −1.836, 95% CI: −2.507 to −1.165). After adjusting for confounding factors, a greater decline in muscle density was associated with lower recovery score on SPPB (β = 0.296, 95% CI: 0.066 to 0.400). Conclusions Muscle density consistently declined after acute care, especially the erector spine muscles, which also significantly decreased in size. A higher decline in muscle density was associated with a slower recovery of physical function during in‐hospital cardiac rehabilitation in patients with aortic diseases.

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Section: Introductionmentioning

confidence: 99%

Features of trunk muscle wasting during acute care and physical function recovery with aortic disease

Kamiya

Matsunaga

Kitamura

et al. 2022

J cachexia sarcopenia muscle

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“…The mechanism linking myosteatosis to mortality is not fully understood, but it is known that myosteatosis induces metabolic and mechanical dysfunction of skeletal muscles 39 . These conditions have been linked to systemic inflammation and oxidative stress, which could impair protein synthesis, muscle protein turnover, and function of internal organs, and may ultimately increase the risk of death 18,40 …”

Section: Discussionmentioning

confidence: 99%

Chest computed tomography‐derived muscle mass and quality indicators, in‐hospital outcomes, and costs in older inpatients

Shen

Luo

et al. 2022

J cachexia sarcopenia muscle

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Background Muscle mass and muscle quality assessed by computed tomography (CT) have been associated with poor prognosis in oncology and surgery patients, but the relevant evidence was limited in older patients. We hypothesized that muscle mass and muscle quality indicators derived from opportunistic chest CT images at the 12th thorax vertebra level (T12) could predict in‐hospital death, length of hospital stay (hospital LOS), and hospital costs among older patients in acute care wards. Methods We conducted a prospective cohort study. Older patients admitted to the acute geriatric wards of a teaching hospital were continuously recruited. Chest CT images were analysed using SliceOmatic software. The skeletal muscle area, skeletal muscle radiodensity, and intermuscular adipose tissue (IMAT) at the T12 level were measured. Skeletal muscle index (SMI) was calculated using skeletal muscle area divided by body height squared. Results We included 1135 older patients with a median age of 80 years (interquartile range, 73 to 85 years), 498 (44%) were women, 148 (13%) patients died during hospitalization. The SMI and SMD were negatively correlated to age (ρ = −0.11, P < 0.001, ρ = −0.30, P < 0.001, respectively), whereas the IMAT was positively correlated to age (ρ = 0.27, P < 0.001). Compared with survivors, dead patients had significantly lower SMI in men (P < 0.001) but not in women (P = 0.760). After adjusting for sex and other potential confounders, the SMI [increased per 1 cm2/m2, odds ratio (OR) 0.96, 95% confidence interval (CI) 0.93 to 0.99] and SMD (increased per 1 Hounsfield unit, OR 0.93, 95% CI 0.90 to 0.96) were negatively and independently associated with in‐hospital death, whereas the IMAT (increased per 1 cm2, OR 1.09, 95% CI 1.05 to 1.14) was independently and positively associated with in‐hospital death. None of the SMI, SMD, or IMAT was significantly related to long hospital LOS or increased hospital costs. Conclusions Chest CT‐derived muscle mass indicator (T12 SMI) and muscle quality indicators (T12 SMD and T12 IMAT) may serve as prognostic factors for predicting in‐hospital death among older inpatients. Opportunistic chest CT images might be an overlooked resource for measuring muscle mass and muscle quality and for predicting short‐term prognosis in older inpatients.

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“…Our study implies the potential value of opportunistic usage of chest CT images to assess loss of muscle mass (a key component of sarcopenia) and myosteatosis among older adults in both clinical practice and research. A recent systematic review demonstrated that most of the previous studies (66 out of 70) used abdominal CT to assess myosteatosis and only one study used chest CT (37). Nevertheless, chest CT is far more frequently used than abdominal CT in clinical practice and has been routinely used in health screening (13).…”

Section: Discussionmentioning

confidence: 99%

Associations of ADL Disability With Trunk Muscle Mass and Muscle Quality Indicators Measured by Opportunistic Chest Computed Tomography Imaging Among Older Inpatients

Jing

et al. 2021

Front. Med.

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Objectives: Sarcopenia is an important predictor of dependence in activities of daily living (ADL disability); however, the association between muscle quality and ADL disability has not been established. We aimed (1) to assess the feasibility of measuring trunk muscle mass and muscle quality by chest CT images; and (2) to explore the possible associations of ADL disability with these muscle mass and muscle quality indicators among older inpatients.Methods: We included older patients in an acute care ward. ADL disability was defined as the Barthel Index (BI) score ≤ 60 points. Unenhanced chest CT images at the 12th thorax (T12) vertebral level were used to segment skeletal muscle area (SMA) and intermuscular adipose tissue (IMAT) and to measure the mean skeletal muscle radiodensity (SMD). Skeletal muscle index (SMI), the muscle mass indicator, was calculated by SMA (cm2)/body height squared (m2). The percentage of IMAT (IMAT%) was calculated using the equation: IMAT% = IMAT/(SMA+ IMAT) ×100%. Skeletal muscle radiodensity, IMAT, and IMAT% were the muscle quality indicators. Kendall's tau rank correlation coefficients (τ) were calculated to explore the correlations. Univariate and multivariate logistic regression models were performed to calculate odds ratios (OR) and 95% confidence interval (CI).Results: We included 212 participants. Skeletal muscle index and SMD were positively and significantly associated with the BI score (τ = 0.14 and 0.31, respectively, both P < 0.001); whereas IMAT and IMAT% were negatively and significantly associated with the BI score (τ = −0.21, P < 0.001; τ = −0.21, P < 0.012). After adjusting for confounders, SMI (adjusted OR 1.03, 95% CI 0.97–1.09) was not independently associated with ADL disability; however, SMD (adjusted OR 0.94, 95% CI 0.88–0.99), IMAT (adjusted OR 1.11, 95% CI 1.03–1.20), and IMAT% (adjusted OR 1.09, 95% CI 1.02–1.16) were independently associated with ADL disability. Subgroup analysis found similar results in men; however, none of these indicators were independently associated with ADL disability in women.Conclusion: Trunk muscle quality indicators (SMD, IMAT, and IMAT%) measured by chest CT images, but not SMI, are independently associated with ADL disability in a single-center study population of older inpatients, especially in men. Further research is necessary to validate our findings.

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Updated systematic review and meta-analysis on diagnostic issues and the prognostic impact of myosteatosis: A new paradigm beyond sarcopenia

Cited by 110 publications

References 69 publications

Features of trunk muscle wasting during acute care and physical function recovery with aortic disease

Features of trunk muscle wasting during acute care and physical function recovery with aortic disease

Chest computed tomography‐derived muscle mass and quality indicators, in‐hospital outcomes, and costs in older inpatients

Associations of ADL Disability With Trunk Muscle Mass and Muscle Quality Indicators Measured by Opportunistic Chest Computed Tomography Imaging Among Older Inpatients

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