Background & aims: Optimal nutritional support during the acute phase of critical illness remains controversial. We hypothesized that patients with low skeletal muscle area and -density may specifically benefit from early high protein intake. Aim of the present study was to determine the association between early protein intake (day 2–4) and mortality in critically ill intensive care unit (ICU) patients with normal skeletal muscle area, low skeletal muscle area, or combined low skeletal muscle area and -density. Methods: Retrospective database study in mechanically ventilated, adult critically ill patients with an abdominal CT-scan suitable for skeletal muscle assessment around ICU admission, admitted from January 2004 to January 2016 (n = 739). Patients received protocolized nutrition with protein target 1.2–1.5 g/kg/day. Skeletal muscle area and -density were assessed on abdominal CT-scans at the 3rd lumbar vertebra level using previously defined cut-offs. Results: Of 739 included patients (mean age 58 years, 483 male (65%), APACHE II score 23), 294 (40%) were admitted with normal skeletal muscle area and 445 (60%) with low skeletal muscle area. Two hundred (45% of the low skeletal muscle area group) had combined low skeletal muscle area and -density. In the normal skeletal muscle area group, no significant associations were found. In the low skeletal muscle area group, higher early protein intake was associated with lower 60-day mortality (adjusted hazard ratio (HR) per 0.1 g/kg/day 0.82, 95%CI 0.73–0.94) and lower 6-month mortality (HR 0.88, 95%CI 0.79–0.98). Similar associations were found in the combined low skeletal muscle area and -density subgroup (HR 0.76, 95%CI 0.64–0.90 for 60-day mortality and HR 0.80, 95%CI 0.68–0.93 for 6-month mortality). Conclusions: Early high protein intake is associated with lower mortality in critically ill patients with low skeletal muscle area and -density, but not in patients with normal skeletal muscle area on admission. These findings may be a further step to personalized nutrition, although randomized studies are needed to assess causality.
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OBJECTIVES: Amplitude-mode (A-mode) ultrasonography is a promising technique to monitor loss and recovery of skeletal muscle in patients with burns. However, its clinimetric properties are unknown. Therefore, we determined its feasibility, interrater, and intrarater reliability, and clinical utility.METHODS: Skeletal muscle thickness of upper arms and legs was assessed longitudinally in hospitalized adult patients with ≥ 5 % total body surface area (TBSA) burns, by pairs of two out of five raters. Feasibility was evaluated by % successful assessments, reliability by intra-class correlation coefficients (ICCs), and clinical utility by smallest detectable change (SDC).RESULTS: Thirty-four patients participated (77 % male; mean age 48 ± 17 y, median TBSA burned 12 % [IQR 7-19]). Images were acquired on 69 % of planned occasions, and 89 % of images could be analyzed. Overall interrater ICCs were ≥ 0.84 (for pairs: 0.63-0.99) and intrarater ICCs were ≥ 0.95 (for pairs: 0.45-0.99). The overall interrater SDC was ≤ 33 % of the measured mean (for pairs: 3-52 %), while intrarater SDC was ≤ 20 % (for pairs: 3-48 %). All five raters could measure legs with moderate to excellent reliability, whereas for arms some demonstrated poor reliability.CONCLUSION: A-mode ultrasonography assessment of skeletal muscle in patients with burns is feasible. However, reliability and clinical utility are rater-dependent; therefore we recommend assessments by the same rater.
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BACKGROUND: Muscle quantity at intensive care unit (ICU) admission has been independently associated with mortality. In addition to quantity, muscle quality may be important for survival. Muscle quality is influenced by fatty infiltration or myosteatosis, which can be assessed on computed tomography (CT) scans by analysing skeletal muscle density (SMD) and the amount of intermuscular adipose tissue (IMAT). We investigated whether CT-derived low skeletal muscle quality at ICU admission is independently associated with 6-month mortality and other clinical outcomes.METHODS: This retrospective study included 491 mechanically ventilated critically ill adult patients with a CT scan of the abdomen made 1 day before to 4 days after ICU admission. Cox regression analysis was used to determine the association between SMD or IMAT and 6-month mortality, with adjustments for Acute Physiological, Age, and Chronic Health Evaluation (APACHE) II score, body mass index (BMI), and skeletal muscle area. Logistic and linear regression analyses were used for other clinical outcomes.RESULTS: Mean APACHE II score was 24 ± 8 and 6-month mortality was 35.6%. Non-survivors had a lower SMD (25.1 vs. 31.4 Hounsfield Units (HU); p < 0.001), and more IMAT (17.1 vs. 13.3 cm(2); p = 0.004). Higher SMD was associated with a lower 6-month mortality (hazard ratio (HR) per 10 HU, 0.640; 95% confidence interval (CI), 0.552-0.742; p < 0.001), and also after correction for APACHE II score, BMI, and skeletal muscle area (HR, 0.774; 95% CI, 0.643-0.931; p = 0.006). Higher IMAT was not significantly associated with higher 6-month mortality after adjustment for confounders. A 10 HU increase in SMD was associated with a 14% shorter hospital length of stay.CONCLUSIONS: Low skeletal muscle quality at ICU admission, as assessed by CT-derived skeletal muscle density, is independently associated with higher 6-month mortality in mechanically ventilated patients. Thus, muscle quality as well as muscle quantity are prognostic factors in the ICU.TRIAL REGISTRATION: Retrospectively registered (initial release on 06/23/2016) at ClinicalTrials.gov: NCT02817646 .
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Background & aims: Low muscle mass and -quality on ICU admission, as assessed by muscle area and -density on CT-scanning at lumbar level 3 (L3), are associated with increased mortality. However, CT-scan analysis is not feasible for standard care. Bioelectrical impedance analysis (BIA) assesses body composition by incorporating the raw measurements resistance, reactance, and phase angle in equations. Our purpose was to compare BIA- and CT-derived muscle mass, to determine whether BIA identified the patients with low skeletal muscle area on CT-scan, and to determine the relation between raw BIA and raw CT measurements. Methods: This prospective observational study included adult intensive care patients with an abdominal CT-scan. CT-scans were analysed at L3 level for skeletal muscle area (cm2) and skeletal muscle density (Hounsfield Units). Muscle area was converted to muscle mass (kg) using the Shen equation (MMCT). BIA was performed within 72 h of the CT-scan. BIA-derived muscle mass was calculated by three equations: Talluri (MMTalluri), Janssen (MMJanssen), and Kyle (MMKyle). To compare BIA- and CT-derived muscle mass correlations, bias, and limits of agreement were calculated. To test whether BIA identifies low skeletal muscle area on CT-scan, ROC-curves were constructed. Furthermore, raw BIA and CT measurements, were correlated and raw CT-measurements were compared between groups with normal and low phase angle. Results: 110 patients were included. Mean age 59 ± 17 years, mean APACHE II score 17 (11–25); 68% male. MMTalluri and MMJanssen were significantly higher (36.0 ± 9.9 kg and 31.5 ± 7.8 kg, respectively) and MMKyle significantly lower (25.2 ± 5.6 kg) than MMCT (29.2 ± 6.7 kg). For all BIA-derived muscle mass equations, a proportional bias was apparent with increasing disagreement at higher muscle mass. MMTalluri correlated strongest with CT-derived muscle mass (r = 0.834, p < 0.001) and had good discriminative capacity to identify patients with low skeletal muscle area on CT-scan (AUC: 0.919 for males; 0.912 for females). Of the raw measurements, phase angle and skeletal muscle density correlated best (r = 0.701, p < 0.001). CT-derived skeletal muscle area and -density were significantly lower in patients with low compared to normal phase angle. Conclusions: Although correlated, absolute values of BIA- and CT-derived muscle mass disagree, especially in the high muscle mass range. However, BIA and CT identified the same critically ill population with low skeletal muscle area on CT-scan. Furthermore, low phase angle corresponded to low skeletal muscle area and -density. Trial registration: ClinicalTrials.gov (NCT02555670).
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The results of this study indicate that whole body metabolic and cardiovascular responses to 140 min of either steady state or variable intensity exercise at the same average intensity are similar, despite differences in skeletal muscle carbohydrate metabolism and recruitment
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Om inzicht te krijgen in spierveroudering is genexpressie gemeten in vastus lateralis biopten van jonge en oude mannen en vrouwen. We vonden dat tijdens het ouder worden bij beide geslachten dezelfde categorieën genen in spieren worden aan- en uitgeschakeld (“gereguleerd”); de mate van deze zogenaamde differentiële expressie was echter geslachtsspecifiek. Bij mannen was oxidatieve fosforylering het meest in het oog springende proces, en bij vrouwen was dit celgroei gemedieerd door AKT-signalering. De conclusie is dat dezelfde processen zijn geassocieerd met skeletspierveroudering bij mannen en vrouwen, maar dat de differentiële expressie van die processen geslachtsspecifiek is.
MULTIFILE
Training-induced adaptations in muscle morphology, including their magnitude and individual variation, remain relatively unknown in elite athletes. We reported changes in rowing performance and muscle morphology during the general and competitive preparation phases in elite rowers. Nineteen female rowers completed 8 weeks of general preparation, including concurrent endurance and high-load resistance training (HLRT). Seven rowers were monitored during a subsequent 16 weeks of competitive preparation, including concurrent endurance and resistance training with additional plyometric loading (APL). Vastus lateralis muscle volume, physiological cross-sectional area (PCSA), fascicle length, and pennation angle were measured using 3D ultrasonography. Rowing ergometer power output was measured as mean power in the final 4 minutes of an incremental test. Rowing ergometer power output improved during general preparation [+2 ± 2%, effect size (ES) = 0.22, P = 0.004], while fascicle length decreased (−5 ± 8%, ES = −0.47, P = 0.020). Rowing power output further improved during competitive preparation (+5 ± 3%, ES = 0.52, P = 0.010). Here, morphological adaptations were not significant, but demonstrated large ESs for fascicle length (+13 ± 19%, ES = 0.93), medium for pennation angle (−9 ± 15%, ES = −0.71), and small for muscle volume (+8 ± 13%, ES = 0.32). Importantly, rowers showed large individual differences in their training-induced muscle adaptations. In conclusion, vastus lateralis muscles of elite female athletes are highly adaptive to specific training stimuli, and adaptations largely differ between individual athletes. Therefore, coaches are encouraged to closely monitor their athletes' individual (muscle) adaptations to better evaluate the effectiveness of their training programs and finetune them to the athlete's individual needs.
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Purpose: Measurement of muscle mass is paramount in the screening and diagnosis of sarcopenia. Besides muscle quantity however, also quality assessment is important. Ultrasonography (US) has the advantage over dual-energy X-ray absorptiometry (DEXA) and bio-impedance analysis (BIA) to give both quantitative and qualitative information on muscle. However, before its use in clinical practice, several methodological aspects still need to be addressed. Both standardization in measurement techniques and the availability of reference values are currently lacking. This review aims to provide an evidence-based standardization of assessing appendicular muscle with the use of US. Methods: A systematic review was performed for ultrasonography to assess muscle in older people. Pubmed, SCOPUS and Web of Sciences were searched. All articles regarding the use of US in assessing appendicular muscle were used. Description of US-specific parameters and localization of the measurement were retrieved. Results: Through this process, five items of muscle assessment were identified in the evaluated articles: thickness, cross-sectional area, echogenicity, fascicle length and pennation angle. Different techniques for measurement and location of measurement used were noted, as also the different muscles in which this was evaluated. Then, a translation for a clinical setting in a standardized way was proposed. Conclusions: The results of this review provide thus an evidence base for an ultrasound protocol in the assessment of skeletal muscle. This standardization of measurements is the first step in creating conditions to further test the applicability of US for use on a large scale as a routine assessment and follow-up tool for appendicular muscle.
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Rationale: Patients with cancer of the upper gastrointestinal tract or lung are more likely to present with malnutrition at diagnosis than, for instance, patients with melanoma. Low muscle mass is an indicator of malnutrition and can be determined by computed tomography (CT) analysis of the skeletal muscle index (SMI) at the 3rd lumbar vertebra (L3) level. However, CT images at L3 are not always available. At each vertebra level, we determined if type of cancer, i.e., head and neck cancer (HNC), oesophageal cancer (OC) or lung cancer (LC) vs. melanoma (ME) was associated with lower SMI. Methods: CT images from adult patients with HNC, OC, LC or ME were included and analyzed. Scans were performed in the patient’s initial staging after diagnosis. MIM software version 7.0.1 was used to contour the muscle areas for all vertebra levels. Skeletal muscle area was corrected for stature to calculate SMI (cm2/m2). We tested for the association of HNC, OC, or LC diagnosis vs ME with SMI by univariate and multivariate linear regression analyses. In the multivariate analyses, age (years), sex, and body mass index (BMI; kg/m2) were included. Betas (B;95%CI) were calculated and statistical significance was set at p
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This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of skeletal muscle training on functional performance in people with spinal muscular atrophy (SMA) type 3 and to identify any adverse effects
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