Vitamin D Status and Its Relation to Muscle Mass and Muscle Fat in Young Women
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Previous studies have demonstrated that increased muscle lipid content is associated with reduced muscle strength and physical performance, independent of muscle mass. An association between elevated muscle lipid content with skeletal muscle attenuation has been reported in a large number of studies. The relationship between vitamin D serum levels and muscle strength is well established. Patients with vitamin D deficiency have increased body fat and decreased muscle strength. A similar association between vitamin D levels and muscle strength has been reported both in the elderly and in healthy adolescent postmenarcheal girls. In several studies, skeletal muscle attenuation was demonstrated in vitamin D deficient patients with neuromuscular disorders. It is unclear whether vitamin D insufficiency is also related to adipose tissue infiltration in muscle. In the present study, the investigators hypothesized that there was an inverse relationship between serum vitamin D levels and adipose tissue infiltration in muscle, which is independent of muscle mass. This cross-sectional study tested this hypothesis by examining the relationship between serum 25-hydroxyvitamin D (25OHD) and skeletal muscle lipid content and muscle mass in a cohort of healthy young women. The study subjects were 90 postpubertal females, aged 16 to 22 years. Study outcome measures included anthropometric characteristics, serum 25OHD values determined with radioimmunoassay, and values of fat, muscle mass, and percent muscle fat determined using computed tomography (CT). The participants were divided into 2 groups based on baseline vitamin D levels: 41% (n = 37) were 25OHD sufficient (≥30 ng/mL) and 59% (n = 53) were 25OHD insufficient (≤29 ng/mL); 24% of the latter were 25OHD deficient (≤20 ng/mL). The data demonstrated a strong inverse relationship between serum 25OHD levels and CT measurements of percent muscle fat (r = −0.37; P < 0.0003), whereas no such relationship was found between the 2 vitamin D groups for fat infiltration in the thigh muscle area (r = 0.16; P = 0.14). Multiple regression analysis showed that the association between 25OHD levels and percent muscle fat was independent of body mass or CT measures of subcutaneous and visceral fat. Compared with the vitamin D sufficient group, percent muscle fat was significantly higher in the vitamin D insufficient group (3.15 ± 1.4 vs. 3.90 ± 1.9; P = 0.038). These findings indicate that vitamin D insufficiency has an inverse association with fat infiltration in muscle, which is independent of body mass.Keywords:
Muscle tissue
We thank Dr. Clintosun and colleagues for their interest in our study.1 They are accurate in pointing out that the European Working Group on Sarcopenia in Older People (EWGSOP) defined sarcopenia as a loss of muscle mass and low muscle strength or low physical performance.2 The lack of information regarding strength and performance is an acknowledged limitation of our study. Yet one would expect that if some patients with low muscle mass and preserved muscle function were inappropriately classified as sarcopenic in our study, the effect would be even greater than we determined. Furthermore, multiple definitions of the term “sarcopenia” remain in use in the literature. Although many contain criteria involving strength and performance in addition to muscle mass, the use of sarcopenia is not uniform. It is important to note that both younger patients and those with internal malignancies were not specifically targeted by the EWGSOP. Indeed, an international consensus group met to define and classify cancer cachexia. They defined sarcopenic muscle mass as appendicular muscle mass of <7.26 kg/m2 in men and 5.45 kg/m2 in women,3 which is the definition used in our study.1 This finding was validated in a recent international multicenter study4 and in a number of retrospective studies. Accordingly, criteria consistent with sarcopenia have been defined as low appendicular skeletal muscle mass relative to height, low muscle strength, and/or low physical performance.5 This definition of sarcopenia has been used successfully to identify risk in a number of human malignancies. Finally, we would disagree that analysis of a single-slice computed tomography scan at L3 is not an appropriate technique with which to assess skeletal muscle mass. This technique has been validated and used in numerous previous studies to assess muscle mass and predict outcomes. Indeed, the EWGSOP and others characterize both computed tomography and dual-energy x-ray absorptiometry as preferred alternatives for the assessment of muscle mass. No specific funding was disclosed. The authors made no disclosures. Matthew K. Tollefson, MD Sarah P. Psutka, MD Department of Urology Mayo Clinic Rochester, Minnesota
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Sarcopenia is the presence of low muscle mass and low muscle function. The aim of this study was to establish cutoffs for low muscle mass using three published methods and to compare the prevalence of sarcopenia in older Australians.Gender specific cutoffs levels were identified for low muscle mass using three different methods. Low grip strength was determined using established cutoffs of <30 kg for men and <20 kg for women to estimate the prevalence of sarcopenia.Gender specific cutoffs levels for low muscle mass identified were (a) <6.89 kg/m(2) for men and <4.32 kg/m(2) for women, <2 standard deviation (SD) of a young reference population; (b) <7.36 kg/m(2) for men and <5.81 kg/m(2) for women from the lowest 20% percentile of the older group; and (c) <-2.15 for men and <-1.42 for women from the lowest 20% of the residuals of linear regressions of appendicular skeletal mass, adjusted for fat mass and height. Prevalence of sarcopenia in older (65 years and older) people by these three methods for men was 2.5%, 6.2%, and 6.4% and for women 0.3%, 9.3%, and 8.5%, respectively.Sarcopenia is common but consensus on the best method to confirm low muscle mass is required.
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Sarcopenia is a progressive and generalized loss of muscle mass and either a loss of muscle strength or physical performance. Its prevalence increases with age and is associated with multiple unfavorable clinical outcomes. The operational definitions and diagnostic strategy of sarcopenia in Asia is currently based on the consensus of the Asian Working Group of Sarcopenia (AWGS) which requires measurements of muscle mass, muscle strength, and physical performance. This article reviewed the epidemiology, impact, pathophysiology, recommended tools and their cut-offs for diagnosis of sarcopenia in Asia according to the consensus of the AWGS and existing evidence in Asia. It is clear that exercise, diet and nutrition are beneficial for sarcopenic adults in the areas of prevention and treatment but no medications are currently proven. Future study in Asia should be straight forward to include intervention for prevention and treatment of sarcopenia.
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Sarcopenia in old age has been associated with a higher mortality, poor physical functioning, poor outcome of surgery and higher drug toxicity. There is no general consensus on the definition of sarcopenia. The aim of the research presented in this thesis was to assess the implications of the use of different diagnostic criteria for sarcopenia, and to define the most accurate criteria for sarcopenia. Currently used diagnostic criteria for sarcopenia can be divided into criteria based on (1) low muscle mass, (2) low muscle strength, and (3) low walking speed. This thesis describes how muscle mass can be further divided into relative muscle mass and absolute muscle mass. A higher body or fat mass is associated with a lower relative muscle mass and with a higher absolute muscle mass. Higher relative muscle mass at old age is associated with better physical performance and with less insulin resistance. It is suggested to reserve the term sarcopenia to describe a low muscle mass and dynapenia to describe a low muscle strength. Most importantly, this research illustrates that it is impossible to compare studies about sarcopenia in scientific literature due to the use of different diagnostic criteria for sarcopenia.
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Sarcopenia, the loss of muscle mass and strength with age, is becoming recognized as a major cause of disability and morbidity in the elderly population. Sarcopenia is part of normal aging and does not require a disease to occur, although muscle wasting is accelerated by chronic diseases. Sarcopenia is thought to have multiple causes, although the relative importance of each is not clear. Neurological, metabolic, hormonal, nutritional, and physical-activity-related changes with age are likely to contribute to the loss of muscle mass. In this review, we discuss current concepts of the pathogenesis, treatment, and prevention of sarcopenia.
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The term 'sarcopenia' was proposed by Irwin Rosenberg as a coined word which originally means 'loss of muscle mass' in Greek. Although several diagnostic criteria of sarcopenia has been suggested by academic societies in Europe, Asia, and the United States of America, it is reported that most of them showed similar prognostic abilities for incident disability or mortality. Those criteria include muscle weakness or muscle function or both of them in addition to low muscle mass because longitudinal studies indicated that muscle mass correlated with muscle strength less than expected before, and that muscle weakness progressed with advancing age more rapidly and influenced more on incident dependency than loss of muscle mass. It is important how we implement the diagnosis of sarcopenia into daily practice and how we manage it based on the diagnosis.
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Abstract The role of sarcopenia in the elderly has received increased attention across a number of disciplines in recent years. In 2010 the European Working Group on Sarcopenia in Older People (EWGSOP) defined the condition as the loss of muscle mass plus low muscle strength or low physical performance, associated with age. There is little published research on this issue in Colombia and South America. The purpose of this study was to determine the prevalence of sarcopenia according to the criteria of the EWGSOP in the elderly population of Colombia who live in the community. Two hundred and ten subjects were studied. Muscle mass (The main component of sarcopenia as it is defined) was estimated by bioelectrical impedance analysis from which the skeletal muscle mass index was calculated. Muscle strength was measured through hand dynamometry and physical performance using the Short Physical Performance Battery (SPPB). Based on the reference values which are themselves based on U.S. or Asian population reference cut off points, an overall prevalence of sarcopenia of 52.8% or 15.7% respectively was found. The prevalence of sarcopenia in the studied population is within the ranges reported worldwide in different populations. However, there are variations depending on the cut off points and diagnostic tools used for its definition and to estimate muscle mass.
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