Evaluation of sarcopenia in long-lived elderly patients: comparison between the Muscle Mass Index and the Calf Circumference

The increase in life expectancy, observed in several countries, including Brazil, is due to improvements in living and health conditions and the epidemiological transition from the causes of morbidity and mortality, from infectious and parasitic diseases to chronic diseases. Furthermore, an increase in longevity, in addition to advances in science, with the improvement of diagnoses and the search for new treatments contributed to the increase in years lived1,2. However, the aging process is associated with a decrease in organic functions over the years. Sarcopenia is considered a complex geriatric syndrome and is defined as an age-related decline in skeletal muscle mass and function2. It is a major public health concern because it can result in functional decline, disability, falls, increased hospitalization costs, poor quality of life, and even deaths3. Although Dual-energy X-ray Absorptiometry (DXA) is the most used method to estimate the loss of muscle mass4 the high cost and low viability hinder its use in Primary Health Care (PHC). Methods such as Muscle Mass Index (MMI) and Calf Circumference (CC) can be used replacing DXA due to ease of access and application as well as low cost5. The Academic League of Geriatrics and Gerontology, Três Lagoas Campus, Federal Univeristy of Mato Grosso do Sul designed and executed a research intending to evaluate several aspects in elderly people with extreme longevity. One of the variables analyzed was sarcopenia, which was evaluated and compared using MMI and CC. For this purpose, a cross-sectional and quantitative study was performed in 2019/2020, with n = 69 individuals aged ≥ 90 years, of both genders, users of the Unified Health System in the town of Três Lagoas – MS. A sociodemographic questionnaire containing gender, age, and years of schooling was applied. Anthropometric data (CC and MMI) were collected in triplicate. The skeletal muscle mass was determined using the formula of Lee and collaborators which considers age, body mass, gender, ethnicity and height5. The values of MMI ​​of Janssen and collaborators were used as a reference to classify whether the nonagenarian or centenarians were sarcopenic or not6. For CC, a cutoff score ≤ 31 centimeters was adopted as a sign of sarcopenia7. The interviewed elderly had an average age of 93.5 years old, 1.3 years of schooling and 52.2% of the participants were women. The average CC was 31.2 centimeters, with 46.1% being considered sarcopenic patients according to this parameter. The average MMI was 5.1 kg/m2, with 100% of the elderly patients being considered sarcopenic through this method. There was no relationship between CC and MMI (p = 0.213). The high rates of sarcopenia found, especially using MMI and the absence of a relationship between the CC and MMI highlights the need to use more reliable methods to evaluate sarcopenia in long-lived elderly people, since the identification from CC, despite being easy and fast, may not be sensitive in this age group. These findings also lead to considering the use of more specific methods or those associated with other variables, such as Timed up and Go (TUG), for the evaluation of sarcopenia in the elderly aged 90 years or over. Future investigations should  consider the importance of validating specific instruments for elderly people in extreme longevity, as they constitute a group that has unique characteristics. The screening, monitoring, and health promotion carried out by PHC teams can promote the improvement in the quality of life of elderly people in extreme longevity

The SIB Swiss Institute of Bioinformatics' resources: focus on curated databases

The SIB Swiss Institute of Bioinformatics (www.isb-sib.ch) provides world-class bioinformatics databases, software tools, services and training to the international life science community in academia and industry. These solutions allow life scientists to turn the exponentially growing amount of data into knowledge. Here, we provide an overview of SIB's resources and competence areas, with a strong focus on curated databases and SIB's most popular and widely used resources. In particular, SIB's Bioinformatics resource portal ExPASy features over 150 resources, including UniProtKB/Swiss-Prot, ENZYME, PROSITE, neXtProt, STRING, UniCarbKB, SugarBindDB, SwissRegulon, EPD, arrayMap, Bgee, SWISS-MODEL Repository, OMA, OrthoDB and other databases, which are briefly described in this article

Evaluation of sarcopenia in long-lived elderly patients: comparison between the muscle mass index and the calf circumference

Introduction: With population aging, many elderly citizens have been achieving extreme longevity (≥ 90 years). Sarcopenia is related to several adverse outcomes, such as disability, falls, hospitalization and death; hence, its early identification is important. Several methods can be used for its evaluation, with dual-energy x-ray absorptiometry (DXA) being the most accurate. Nevertheless, due to low availability and high cost, other methods are routinely adopted for screening in Primary Health Care (PHC), such as the evaluation of the Muscle Mass Index (MMI) and the Calf Circumference (CC).Objective: To evaluate sarcopenia in elderly people with extreme longevity, and then compare it by means of MMI and CC.Methodology: Cross-sectional and quantitative study, performed in 2019/2020, with n = 69 individuals aged ≥ 90 years, of both genders, users of the Unified Health System in the town of Três Lagoas – MS. We collected sociodemographic and anthropometric data in triplicate. For CC, we used a cutoff score ≤ 31 centimeters as a sign of sarcopenia. We determined MMI based on the calculation of skeletal muscle mass, using the formula of Lee and collaborators, which considers height, body mass, gender, age and ethnicity. The classification of sarcopenia adopted was that of Janssen and collaborators (women: ≤ 5.75 kg/m2 = severe sarcopenia; 5.76 – 6.75 kg/m2 = moderate sarcopenia; and ≥ 6.76 kg/m2 = normal muscle mass. Men: ≤ 8.50 kg/m2 = severe sarcopenia; 8.51 – 10.75 kg/m2 = moderate sarcopenia; and ≥ 10.76 kg/ m2 = normal muscle mass). In order to relate the variables, we applied the Spearman’s correlation test. Results: A total of 52.2% of the participants were women, with an average age of 93.5 years old and 1.3 years of schooling. The average CC was 31.2 centimeters, with 46.1% being considered sarcopenic patients according to this parameter. The average MMI was 5.1 kg/m2, with 100% of the elderly patients being considered sarcopenic through this method. There was no relationship between CC and MMI (p = 0.213).Discussion: We found a high prevalence of sarcopenia in the long-lived elderly patients, mainly using MMI. This data is worrying, since these elderly people may have several limitations due to sarcopenia. The absence of a relationship between the CC and MMI variables highlights the need to use more reliable methods to evaluate sarcopenia in long-lived elderly people, since the identification from CC, despite being easy and fast, may not be sensitive in this age group. Conclusion: We should highlight the need for personalization of public policies and evaluation recommendations for elderly people with extreme longevity in PHC, as they constitute a group that has unique characteristics

Use of WhatsApp by older adults screened for depression in socioeconomically deprived areas of Guarulhos, São Paulo State, Brazil: challenges and possibilities for telehealth

This study aimed to investigate the relationship between sociodemographic characteristics, depressive symptomatology, mobile phone ownership, and different uses of WhatsApp among older adults enrolled in primary care clinics in Guarulhos, São Paulo State, Brazil. This is a secondary data analysis, using data collected in the screening of participants to be included in the PROACTIVE cluster randomized trial. Individuals aged ≥ 60 years, registered in primary care clinics in Guarulhos, were assessed for sociodemographic characteristics, depressive symptoms according to the PHQ-9, mobile phone ownership, and use of WhatsApp. We performed multiple logistic regression models to investigate characteristics of the potential users of digital interventions. Of 3,356 older adults screened for depression, 45.7% said they use WhatsApp to receive/send messages. In the subsample that presented depressive symptomatology (n = 1,020), 41.9% stated using WhatsApp. Younger older adults and those with better socioeconomic status used more WhatsApp and were more likely to own a mobile phone. Participants with higher levels of symptoms of depression were less likely to use WhatsApp. Gender, age, schooling level, income, and depressive symptomatology are variables associated with the possession of a cell phone and with the use of WhatsApp by the older adults of the sample. These findings can help to implement digital health programs better suited to disadvantaged populations in Brazil and other low- and middle-income countries through mental telehealth interventions using WhatsApp and mobile health services to the older people

Dll1AG does not activate Notch signaling.

<p>U2OS cells, stably expressing HA-tagged Notch1, were transiently-transfected with a CSL-luciferase construct and pRL-TK-renilla luciferase, as described in Materials and Methods. (A) Twenty-four hours after transfection, 7x10⁴ OP9 cells stably expressing either VSV-Dll1 (dark gray bars, Dll1-OP9), VSV-Dll1AG (black bars, Dll1AG-OP9) or control cells (light gray bars, parental OP9) were added. Luciferase activity was measured after 20 hours of coculture. The relative luciferase activity in the presence of Dll1-OP9 was defined as 100%. Bottom panel shows the expression levels of full-length Dll1 and Dll1AG in the cell lines used for coculture. (B) Increasing amounts of Dll1-OP9 and Dll1AG-OP9 cells were cocultured with Notch1 expressing cells and the Notch reporter activity was measured. Error bars represent the standard variation of triplicate experiments.</p

Internalization of Dll1AG.

<p>Hela cells were transiently-transfected with VSV-Dll1 or VSV-Dll1AG. Cy3-coupled anti-VSV antibody uptake (for 0 or 30 minutes), and secondary labeling with Alexa 488-coupled anti-IgG (to label Dll1 present at the cell surface) were performed as described in the legend to Figure 3. The presented image is typical of the results obtained in multiple experiments. The graph at the bottom of the figure presents the quantitation of the abovementioned experiment, in which the proportion of wt or mutant ligand remaining at the cell surface is plotted against time. For each condition, 20 images were quantified. Values on the graph are indicated +/- standard deviation. The p-value was calculated using MATLAB. Scale bar, 10 µm.</p

Dll1AG does not recycle and exhibits a shorter half-life than wild type Dll1.

<p>(A) Surface proteins of Dll1- and Dll1AG-expressing OP9 cells were labeled with biotin and a recycling assay was performed as described in Materials and Methods. NDB: not debiotinylated; Mesna2: second Mesna treatment. (B) Western blot analysis of cells expressing Dll1 or Dll1AG. Approximate equal loading of the full-length form was used in order to facilitate estimation of the extent of metalloprotease cleavage. (C) HeLa cells were transiently-transfected with plasmids encoding Dll1-Apa or Dll1-Apa-AG together with GFP. Following cycloheximide treatment the levels of ligands were monitored as described in Figure 2. Western blots were performed using anti-Dll1 and anti-GFP antibodies.</p

Down-regulation of glucosylceramide synthase (GCS) affects Notch activation.

<p>(A) After lentivirus-mediated transduction with shRNA targeting GCS (GCS) or control shRNA (NT), MEFs stably expressing VSV-Dll1 were selected with puromycin before being assayed for actin and GCS mRNA by semi-quantitative RT-PCR. (B) Cells stably transduced with the GCS or the control shRNA were surface labeled on ice with CTXB-Cy3 prior to fixation. Images were acquired using a 20x objective. Scale bar 20 µm. (C) Whole cell extracts of cells transduced with the GCS or the control shRNA were analyzed by Western blot using Dll1 antibody. (D) The impact of GCS silencing on Notch activation was tested in a coculture assay. Cells described in panel A were cocultured with a U2OS line expressing the Notch1 receptor. Notch activation was evaluated using a CSL reporter strategy as described in Figure 7. Error bars represent standard variation. The presented result is representative of four independent experiments.</p