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Sarcopenia

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Skeletal muscle wasting.

See muscle atrophy.

Define as age associated loss of skeletal muscle mass and function.

Associated with higher mortality, morbidity, physical disability, and healthcare costs.

Probably related to an imbalance in muscle protein turnover.

 

Refers to a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with the risk of adverse outcomes such as physical disability, poor quality of living and death.

Muscle protein synthesis decreases with aging partly due to endocrine changes with reduction in sex hormones and growth factors.

Muscle protein breakdown increases with age, mainly because of age-related low-grade systemic inflammation, physical inactivity and malnutrition.

Low-grade systemic inflammation (inflammaging)that occurs with aging is characterized by elevated proinflamatory cytokines and is caused by age-related cell damage and mitochondrial dysfunction, leading to increased oxidative stress.

Pathogenesis is multifactorial and involves muscle disuse, endocrine function alteration, chronic diseases, inflammation, insulin resistance, and nutritional deficiencies.

Sarcopenic adults have an 87% increased risk for overall mortality compared with non-sarcopenic adults.

 

Age-related declines in muscular mass resulting in sarcopenia is an important determinant of physical function, strength, and performance in older adults. 

 

Sarcopenia results in decreased walking ability, increased fall risk, and disability, leading to increased hospitalizations and rates of in-home care, overcrowding of assisted living facilities, declines in independence and quality of life, burdens on family members, and increased health-care costs. 

A prognostic factor in patients with solid malignancies.

Patients with cancer and sarcopenia experience worse quality of life, mood symptoms, and survival.

Can predict for toxicity in patients with colorectal cancer treated with fluorouracil and patients with breast cancer treated with capecitabine (Prado CMM).

Sarcopenia prevalence in healthy older adults ranges from 7-14% (Baumgartner RN).

Sarcopenia process indicates the amount of lean muscle naturally begins to decline by 3 to 8 percent per decade after age 30.

Androgen deprivation therapy leads to sarcopenia in elderly patients with prostate cancer (Mauras N).

Frequently leads to increase in weakness and decreases mobility.

Sarcopenia leads to higher levels of oxidative stress, insulin resistance, and systemic inflammation.

Serum creatinine is a reasonable biomarker for sarcopenia.

In the elderly associated with increased mortality and physical disability.

 

A low serum creatinine level, most likely due to sarcopenia is associated with a higher mortality rate.

Male patients with serum creatinine levels of less than 0.6 mg/dL and female patients with less than 0.4 mg/dL have increased in-hospital have increased mortality by about 2-3 fold.

For a patient with a low serum creatinine level, the chance to die during the admission is about one in 50 and to die within one year after discharge would be one in five.

Sarcopenia is probably the main cause of low admission serum creatinine levels.

Sarcopenia index is calculated as serum creatinine/Cystatin C X 100 and it correlates with the paraspinal muscle surface area at the L4 vertebrae.

Patients with cancer and sarcopenia have increased postoperative complications, chemotherapy induced toxicity, and poor survival.

Bioelectrical impedance analysis is an accurate method for detecting sarcopenia in adults.

 

 

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