Association between lean body mass and muscle thickness with frailty in community dwelling dutch older adults

Rationale: Lean body mass, including muscle, is known to decrease with age, which may contribute to loss of physical function, an indicator of frailty. Moreover, low muscle thickness is considered an indicator of frailty in critically ill patients. However, little is known about the relationship between muscle thickness and frailty in community dwelling adults. Therefore, we studied the association between frailty and whole body lean body mass index (LBMi) and muscle thickness of the rectus femoris (RF) in community dwelling older adults. Methods: In older adults aged ≥55y, who participated in the Hanze Health and Ageing Study, frailty status was assessed with a multidimensional instrument, measuring frailty on a cognitive, psychosocial en physical level, i.e., the Groningen Frailty Indicator (GFI), using ≥4 as cut-off score for frailty. LBMi (kg/m2) was estimated with BIA (Quadscan 4000©, Bodystat), using the build-in equation. Muscle thickness (mm) of the RF was measured with ultrasound, using the Bodymetrix© (Intelametrix). Univariate and multivariate binary logistic regression analyses were performed for LBMi and for RF thickness. Multivariate analysis corrected for age, sex, body mass index (kg/m2), and handgrip strength (handgrip dynamometer; kg). A p-level of <0.05 was considered significant and Odds Ratios (OR; [95% CI]) were presented. Results: 93 participants (age 65.2±7.7 years; male 46 %; LBMi 17.2±2.6 kg/m2; RF 14.6±4.4 mm; median GFI =1 (interquartile range=0-3; frail: n=18) were included in the analysis. In both the univariate and multivariate analysis, LBMi (p=0.082, OR=0.82 [0.66-1.03]; p=0.077, OR=0.55 [0.28-1.07] respectively) and muscle thickness of RF (p=0.436, OR=0.95 [0.84-1.08]; p=0.796, OR= 1.02 [0.88-1.18] respectively) were not significantly associated with frailty. None of the co-variables were significantly associated with frailty either. Conclusion: In this sample of older adults aged ≥55 years, LBMi and RF thickness are not associated with frailty. However, frail participants scored at cut-off or just above, and measurements in a population with higher scores for frailty may provide further insight in the association between lean body mass and muscle thickness and frailty

Patient-generated subjective global assessment:innovation from paper to digital app

Purpose: The Patient-Generated Subjective Global Assessment (PG-SGA), including the PG-SGA Short Form (SF, aka ‘abridged’), was originally developed in the mid 1990’s as a scored, patient self-report, paperbased instrument and has been widely validated. The PG-SGA (SF) has been used for screening, assessment and monitoring, triageing for multimodal intervention and for evaluation of clinical and health economic outcomes. There have been ad hoc translations, often with permission of the originator (FDO) but broad international use requires consistent, medically accurate, and certified translations. Although the PG-SGA (or SF) is known to be quick and easy, current advances in technology could further improve and facilitate quick and easy use of global patient screening and assessment, standardized scoring algorithms, limiting inter-observer variability, and global collaboration and communication. We aimed to develop a user friendly, cross-culturally validated, multilingual digital app and resources to support the clinical and research applications of the PG-SGA (SF) and Pt-Global app in the context of a global centralized database and research consortium. Methods: After completion of a Dutch PG-SGA cross-cultural adaptation project, a digital app based on the English and Dutch PG-SGA was developed. Steps included: 1) development and testing of standardized scoring and decision-making algorithms based on the validated PG-SGA scoring system; 2) compatibility with iOS, Android and WindowsPhone platforms; 3) development and pilot testing of prototype by an international test panel (n=35; professionals testing the app on patients as part of routine care process, researchers, and lay persons) from Australia, Belgium, Canada, Norway, Sweden, The Netherlands and USA, evaluating the app on lay-out, user friendliness, relevance and time of completion; 4) improvement based on input; 5) launch of app and supportive website at www.pt-global.org on 12 Jun 2014, including complimentary introductory use; 5) international education activities; 6) digital presence through Twitter, Facebook, LinkedIn and YouTube; 7) launch of web-based version on 15 September 2014. Results: 15 professionals (Pros; 11 dietitians, 1 doctor, 1 physiotherapist) and 2 lay persons participated in the pilot testing. Included settings were: 9 hospitals, 4 cancer centers, 2 nursing homes, 3 research. 8/15 had experience with the PG-SGA, 7/15 PG-SGA were naïve. 5 Pros tested on 1-5 patients, and 9 on 6-10 patients. 88% rated layout (very) good with feedback: calm, professional, clear, intuitive, easy; 88% rated good for user friendliness. 75% rated flow/user interface (very) good. In 88% Patient screens were completed by Pros. Reported time to complete Patient screens was: 65% in 0-5 minutes, 29% in 5-10 min; 6% (n=1) >10 minutes. Interestingly, patients started completing the app spontaneously. Some issues with concerns about touch screen were expressed. 87% completed the professional section in

Agreement between rectus femoris muscle thickness by ultrasound and skeletal muscle mass by bio-electrical impedance analysis: a pilot study

Rationale: Sarcopenia is a major problem and is common in community-dwelling elderly. In daily practice, there is need for low cost and easily assessable measurement tools to assess depletion of skeletal muscle (SM) mass, for example as one of the indicators of sarcopenia. Bio-electrical impedance analysis (BIA) is often used to estimate body composition, whereas ultrasound measurement is an upcoming and promising tool, as it is quick, easy to use and inexpensive in comparison with other tools that assess SM mass. Ultrasound could assess site-specific loss of SM mass and determine myoesteatosis. Therefore, in this pilot study we aimed to assess agreement between muscle thickness of rectus femoris (RF) by ultrasound and SM mass by BIA in an older population. Methods: Twenty-six older adults (mean± standard deviation (SD) age 64 ±5.0 y, 62% women) from the Hanze Health and Ageing Study were included. SM mass by BIA was estimated using the Janssen equation. Muscle thickness of RF was assessed by analyzing ultrasound images from the right leg. Two non-parametric tests were used for analysis. Correlation between ultrasound and BIA was assessed with Spearman Rho. Agreement was determined with Kendall’s coefficient of concordance (Kendall’s W). In both tests a score ≥ 0.7 was considered a strong correlation. Results: Mean (±SD) RF thickness was 18.9 (±3.8) mm. Median SM mass (Interquartile range) was 23.5 (20.8-34.7) kg. Correlation between RF thickness and SM mass was moderately positive (Spearman r=0.611; P = 0.001), whereas Kendall’s W showed a strong agreement (W= 0.835; P=0.002). Conclusion: Ultrasound measurement of RF showed an acceptable agreement with skeletal muscle mass assessed by BIA in our sample of older adults. Therefore, ultrasound could be a promising portable tool to estimate muscle size

Association between muscle thickness, fat-free mass and malnutrition in patients with copd: an exploratory study

Rationale: Malnutrition is a common problem in patients with Chronic Obstructive Pulmonary Disease (COPD). Whereas estimation of fat-free muscle mass index (FFMi) with bio-electrical impedance is often used, less is known about muscle thickness measured with ultrasound (US) as a parameter for malnutrition. Moreover, it has been suggested that in this population, loss of muscle mass is characterized by loss of the lower body muscles rather than of the upper body muscles.1 Therefore, we explored the association between FFMi, muscle thickness of the biceps brachii (BB) and the rectus femoris (RF), and malnutrition in patients with COPD. Methods: Patients were assessed at the start of a pulmonary rehabilitation program. Malnutrition was assessed with the Scored Patient-Generated Subjective Global Assessment (PG-SGA). Malnutrition was defined as PG-SGA Stage B or C. FFMi (kg/m²) was estimated with bio-electrical impedance analysis BIA 101® (Akern), using the Rutten equation. Muscle thickness (mm) of the BB and the RF was measured with the handheld BodyMetrix® device (Intelametrix). Univariate and multivariate logistic regression analyses were performed to analyse associations between FFMi and muscle thickness for BB and RF, and malnutrition. Multivariate analysis corrected for sex, age, and GOLD-stage. Odds ratios (OR) and 95% confidence intervals (CI) were presented. A p-level of <0.05 was considered significant. Results: In total, 27 COPD patients (age 64±8.1 years; female 60%, GOLD-stage 3, interquartile range=3-4, BMI 27±6.6 kg/m2) were included in the analyses. In the univariate analysis, FFMi (p=0.014; OR=0.70, 95%CI: -0.12—0.15), RF thickness (p=0.021; OR=0.79, 95%CI: -0.09—0.01), and BB thickness (p=0.006; OR=0.83, 95%CI: -0.06—0.01) were all significantly associated with malnutrition. In the multivariate analysis, FFMi (p=0.031; OR=0.59, 95%CI: -0.18—0.01) and BB thickness (p=0.017; OR=0.73, 95%CI:-0.09—0.01) were significantly associated with malnutrition. None of the co-variables were significantly associated with malnutrition. Conclusion: In this relatively small sample of patients with severe COPD, low FFMi and low BB muscle thickness were both robustly associated with increased odds of being malnourished. BB muscle thickness measured with US may provide added value to the toolbox for nutritional assessment. The results of this exploratory study suggest that upper body muscles may reflect nutritional status more closely than lower body muscles. Reference: 1 Shrikrishna D, Patel M, Tanner RJ, Seymour JM, Connolly BA, Puthucheary ZA, et al. Quadriceps wasting and physical inactivity in patients with COPD. Eur Respir J. 2012;40(5):1115–22.

Understanding behavioral mechanisms for physical activity in head and neck cancer patients: a qualitative study

Rationale: Head and neck cancer (HNC) patients often have adverse changes in body composition. Loss of muscle mass and strength frequently occur, even when dietary intake is adequate. Nascent evidence suggests that a healthy lifestyle, including adequate physical activity (PA) and diet, may prevent muscle wasting. HNC patients often show suboptimal health behavior pre-diagnosis, and additional barriers to PA can arise from cancer treatment. Better understanding of the behavioral mechanisms of PA in this mostly sedentary group is needed to design effective individualized PA-supporting interventions. This qualitative study explored the perspective of HNC patients on PA. Methods: We conducted 9 semi-structured interviews in HNC patients, 6-8 weeks after treatment (surgery +/-(chemo)radiation). The interviews were guided by the Theory of Planned Behavior (TPB) key concepts, including: attitude; social norm (with emphasis on role of healthcare professionals); self-efficacy; intention; barriers/facilitators, knowledge/skills; and current PA behaviour. Interviews were analysed by directed content analysis. Results: Important themes identified for PA were: physical barriers, health as stimulus, role of habits, and lack of interest. While all themes could be fitted within the key concepts of TBP, there was little interaction between intention and other concepts. In fact, PA intention was not an explicit consideration for most patients. Conclusion: HNC patients perceived physical barriers, health, habits, and lack of interest as important themes with regard to PA. Our tentative results suggest that the TPB may not be the most appropriate model for explaining PA in HNC patients. For future research aiming to understand PA in HNC patients, theories less focused on rational reasoning and more on autonomy, such as Self Determination Theory, may be better suited

Oral Health and Frailty in Community-Dwelling Older Adults in the Northern Netherlands:A Cross-Sectional Study

The aim of this study was to explore the association between oral health and frailty in community-dwelling Dutch adults aged 55 years and older. Included were 170 participants (n = 95 female [56%]; median age 64 years [IQR: 59-69 years]). Frailty was assessed by the Groningen Frailty Indicator. Oral health was assessed by the Oral Health Impact Profile-14-NL (OHIP-NL14). OHIP-NL14 item scores were analyzed for differences between frail and non-frail participants. Univariate and multivariate logistic regression analyses were performed to assess the association between oral health and presence of frailty. The multivariate analysis included age, gender, and depressive symptoms as co-variables. After adjustment, 1 point increase on the OHIP-NL14 scale was associated with 21% higher odds of being frail (p = 0.000). In addition, significantly more frail participants reported presence of problems on each OHIP-NL14 item, compared to non-frail participants (p &lt; 0.003). Contrast in prevalence of different oral health problems between frail and non-frail was most prominent in 'younger' older adults aged 55-64 years. In conclusion: decreased oral health was associated with frailty in older adults aged &gt;= 55 years. Since oral health problems are not included in most frailty assessments, tackling oral health problems may not be sufficiently emphasized in frailty policies.</p