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.
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Generalized loss of muscle mass is associated with increased morbidity and mortality in patients with cancer. The gold standard to measure muscle mass is by using computed tomography (CT). However, the aim of this prospective observational cohort study was to determine whether point-of-care ultrasound (POCUS) could be an easy-to-use, bedside measurement alternative to evaluate muscle status. Patients scheduled for major abdominal cancer surgery with a recent preoperative CT scan available were included. POCUS was used to measure the muscle thickness of mm. biceps brachii, mm. recti femoris, and mm. vasti intermedius 1 day prior to surgery. The total skeletal muscle index (SMI) was derived from patients’ abdominal CT scan at the third lumbar level. Muscle force of the upper and lower extremities was measured using a handheld dynamometer. A total of 165 patients were included (55% male; 65 ± 12 years). All POCUS measurements of muscle thickness had a statistically significant correlation with CT-derived SMI (r ≥ 0.48; p < 0.001). The strongest correlation between POCUS muscle measurements and SMI was observed when all POCUS muscle groups were added together (r = 0.73; p < 0.001). Muscle strength had a stronger correlation with POCUS-measured muscle thickness than with CT-derived SMI. To conclude, this study indicated a strong correlation between combined muscle thickness measurements performed by POCUS- and CT-derived SMI and measurements of muscle strength. These results suggest that handheld ultrasound is a valid tool for the assessment of skeletal muscle status.
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Rationale: Currently use of muscle thickness measured with ultrasound is suggested as an indicator for overall muscle mass in nutritional assessment. However, not much is known about how the muscle thickness measured in patients with chronic obstructive pulmonary disease (COPD) compares to the muscle thickness in healthy persons. This study explores body mass index (BMI) and rectus femoris (RF) muscle thickness in patients with advanced COPD matched with healthy controls. Methods: Patients with advanced COPD at the start of a pulmonary rehabilitation program were matched for age (5 years difference tolerance), sex (exact match), and stature (0.1 m difference tolerance) with healthy controls in a 1:4 case control ratio. BMI (kg/m2) was calculated and muscle thickness (mm) of the RF was measured with a Bodymetrix device. Paired sample t-tests were performed. BMI and RF muscle thickness of the cases were paired with the average BMI and RF of their controls. A p-level of <0.05 was considered significant and 95% CI were presented for the mean difference. Results: In total, 21 cases (median GOLD score 3 [interquartile range 3-4]; age 64.5±6.4y; female 62%; height 1.68±0.07m; BMI 26.9±6.1 kg/m2; RF 12.4±3.4mm) and 84 controls (age 64.5±6.4y; female 62%; height 1.71±0.09 m; BMI 25.8±4.5; RF 14.6±4.5mm) were included in the analyses. In the paired test, BMI was not significantly different between cases and controls (p=0.645, mean difference 0.95 kg/m2 [CI:-2.12 – 4.01]), whereas RF muscle thickness of cases was significantly lower (p=0.003, mean difference -2.33 mm [CI:-3.73 - -0.92]). Conclusion: In this limited sample of patients with COPD, RF muscle thickness in cases was significantly lower than RF muscle thickness in matched controls. Research in bigger samples is needed to confirm whether RF muscle thickness measured with US provides more useful information about body composition for clinicians than BMI in patients with COPD.
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