Search Results (147)

Background/Objectives: Sarcopenia, defined as the progressive loss of muscle mass and function, is increasingly recognized in pediatric cancer patients as a significant clinical and prognostic factor. Sarcopenia in children arises from malignancy-related inflammation, malnutrition, and treatment toxicity, negatively affecting treatment response, recovery, and quality of life. Methods: We searched MEDLINE and Scopus for English-written articles published over the last five years using synonyms for the terms “sarcopenia” and “pediatric cancer”. Screening and data extraction were performed in a duplicate-blinded method. We qualitatively synthesized eligible articles. Results: Recent studies identify pre-treatment sarcopenia as a marker of poor prognosis, especially in hepatoblastoma and neuroblastoma. Total psoas muscle area (tax) and skeletal muscle index (SMI) are emerging diagnostic tools, though standardized methods remain lacking. Sarcopenia’s etiology is multifactorial, involving impaired mitochondrial metabolism, chemotherapy-induced appetite loss, and systemic inflammation. Sarcopenic obesity is common, particularly among leukemia survivors, often masked by normal BMI. Survivors also face reduced bone density, impaired immunity, and persistent muscle loss, linked to prior therapies such as radiotherapy and hematopoietic stem cell transplantation. Increase in muscle mass post-treatment correlates with better survival outcomes. Conclusions: Early detection of sarcopenia can support timely interventions such as nutritional support and physical activity. Yet, significant diagnostic heterogeneity across existing studies hampers definitive conclusions regarding its true prevalence and the optimal assessment method. Standardized diagnostic criteria are urgently needed to enable more reliable prevalence estimates and evidence-based clinical strategies. Full article

Background: Emergency laparotomy (EL) carries high morbidity and mortality relative to elective abdominal surgery. While Enhanced Recovery After Surgery (ERAS) principles improve outcomes in elective care, their translation to emergencies is inconsistent. The emergency department (ED) provides a window for rapid risk stratification and pre-optimization, provided that interventions do not delay definitive surgery. Methods: We conducted a PRISMA-ScR–conformant scoping review to map ED-initiated, ERAS-aligned strategies for EL. PubMed, Scopus, and Cochrane were searched in February 2025. Eligible sources comprised ERAS guidelines, systematic reviews, cohort studies, consensus statements, and programmatic reports. Evidence was charted across five a priori domains: (i) ERAS standards, (ii) comparative effectiveness, (iii) ED-feasible pre-optimization, (iv) risk stratification (Emergency Surgery Score [ESS], frailty, sarcopenia), and (v) oncological emergencies. Results: Thirty-four sources met inclusion. ERAS guidelines codify rapid assessment, multimodal intraoperative care, and early postoperative rehabilitation under a strict no-delay rule. Meta-analysis and cohort data suggest ERAS-aligned pathways reduce complications and length of stay, though heterogeneity persists. ED-feasible measures include multimodal analgesia, goal-directed fluids, early safe nutrition, respiratory preparation, and anemia/micronutrient optimization (IV iron, vitamin B12, folate, vitamin D). Sarcopenia, frailty, and ESS consistently predicted adverse outcomes, supporting targeted bundle activation. Evidence from oncological emergencies indicates feasibility under no-delay governance. Conclusions: A minimal, ED-initiated, ERAS-aligned bundle is feasible, guideline-concordant, and may shorten hospitalization and reduce complications in EL. We propose a practical framework that links rapid risk stratification, opportunistic pre-optimization, and explicit continuity into intra- and postoperative care; future studies should test fidelity, costs, and outcome impact in pragmatic emergency pathways. Full article

The COVID-19 pandemic has revealed significant secondary complications affecting musculoskeletal (MSK) health, especially in patients with pre-existing conditions. This review synthesizes data from clinical and experimental studies on key MSK biomarkers, including cartilage oligomeric matrix protein (COMP), hyaluronic acid (HA), osteocalcin, alkaline phosphatase (ALP), procollagen type I N-terminal peptide (PINP), osteopontin (OPN), matrix metalloproteinases (MMP-3 and MMP-9), myostatin, IGF-1, follistatin, and creatine kinase. COVID-19 is associated with decreased COMP and osteocalcin levels, indicating cartilage degradation and impaired bone formation, alongside elevated HA, ALP, PINP, OPN, and MMPs, reflecting increased joint inflammation, bone remodeling, and tissue breakdown. Changes in myostatin, IGF-1, follistatin, and creatine kinase levels have been shown to be linked with COVID-19-related sarcopenia. These biomarker alterations provide insight into the underlying mechanisms of MSK damage in COVID-19 patients and highlight the potential for using these markers in early diagnosis and management of post-COVID musculoskeletal disorders. Further longitudinal research is essential to develop targeted therapies aimed at mitigating long-term MSK complications in affected individuals. Full article

Background/Objectives: Immune checkpoint inhibitors targeting the PD-1/PD-L1 axis have become a standard in the treatment of all stages of non-small lung cancer. Beyond tumor-intrinsic biomarkers like PD-L1 expression, evidence points to the role of patient-related factors, such as body mass index, sarcopenia, and cachexia. These body composition parameters may reflect metabolic reserve or even immune competence and could help stratify outcomes in patients treated with PD-1 and PD-L1. This systematic review aims to evaluate the impact of body composition—specifically BMI, pretreatment weight loss, sarcopenia, and cachexia—on clinical outcomes such as progression-free and overall survival in NSCLC patients treated with immune checkpoint inhibitors. Methods: A systematic literature search was conducted across multiple databases including PubMed, Google Scholar, and Science Direct. We included full-text original research articles (1 January 2020–1 May 2025) reporting clinical outcomes of NSCLC patients treated with PD-1 or PD-L1 inhibitors, in relation to body composition factors (BMI, pretreatment weight loss, sarcopenia, cachexia). Eligible studies involved adults (>18 years) and included observational cohorts or controlled trials; animal or in vitro studies were excluded. Data extraction and risk of bias assessments were performed independently by two reviewers, with discrepancies being resolved through a third one. Results: From 12,358 records identified, 21 studies met the inclusion criteria. Most were retrospective cohorts assessing the impact of pre-treatment weight loss, cachexia, and sarcopenia on ICI outcomes in NSCLC. These factors consistently predicted poorer survival and response, while BMI alone showed limited prognostic value. Considerable heterogeneity in body composition definitions and outcome reporting was observed. Conclusions: Body composition—particularly weight loss, cachexia, and sarcopenia—significantly impacts survival and response in NSCLC patients treated with ICIs. These factors reflect immune–metabolic dysfunction that may impair treatment efficacy. BMI alone is insufficient; routine assessment of muscle mass and cachexia could improve risk stratification. Full article

Background and Objectives: Breast cancer is a leading cause of cancer-related mortality, particularly in aggressive subtypes such as HER2-positive and triple-negative breast cancer (TNBC). Achieving a pathological complete response (pCR) after neoadjuvant therapy is strongly associated with improved survival outcomes in these subgroups, making the prediction of pCR a clinical priority. Sarcopenia, a progressive loss of skeletal muscle mass and strength, is increasingly recognized in cancer patients and has been linked to chemotherapy toxicity and poorer survival. However, its specific impact on pCR in HER2-positive and TNBC patients remains unclear. This study aimed to evaluate the association between radiologically defined sarcopenia, or a low skeletal muscle index (SMI), and pathological response in these subtypes, and to explore its potential as a predictive biomarker. Materials and Methods: This retrospective study included patients with HER2-positive or TNBC who received neoadjuvant therapy between January 2015 and October 2023. SMI was assessed using pre-treatment positron emission tomography images at the L3 vertebral level, with values < 38.5 cm²/m² considered as low. Univariate and multivariate logistic regression analyses were performed to identify factors associated with pCR. Results: A total of 85 patients were included, with low SMI present in 35 (41.2%). In univariate analysis, clinical stage and low SMI were associated with pCR. However, in the multivariate model, only low SMI remained an independent predictor. Patients without low SMI had higher odds of achieving pCR (odds ratio [OR] 4.13; 95% confidence interval [CI] 1.55–10.95; p = 0.004). Low SMI was also associated with higher rates of treatment-related toxicity (42.9% vs. 20.0%, p = 0.023). Conclusions: Pre-treatment low SMI is strongly associated with lower pCR rates in patients with HER2-positive and TNBC undergoing neoadjuvant therapy. These findings underscore the importance of early identification and management of radiologically defined sarcopenia to optimize treatment response and improve clinical outcomes. Full article

Dietary protein is an essential macronutrient derived from both plant and animal sources required for muscle building, immune function, and wound healing. However, in the United States, protein consumption worsens as individuals age, with 30% of men and 50% of women over 71 consuming inadequate dietary protein due to a variety of factors, including changes in gut function, loss of appetite, tooth loss, financial concerns, and social isolation. The aim of this review is to underscore the need for increased protein requirements in aging populations, highlight potential barriers, synthesize these protein requirements, and also recommend strategies to meet these increased protein needs. Achieving adequate protein status, especially when facing chronic or acute health concerns, is essential to promote muscle and bone strength (because aging is associated with significant decreases in postprandial muscle protein synthesis), to support immune health (due to immunosenescence), and to maintain a good quality of life. For older adults, the literature suggests that a dietary protein intake of at least 1.0–1.2 g/kg/day is required in healthy, aging populations, and intakes of 1.2–1.5 g/kg/day are necessary for those with chronic or acute conditions. These protein intake recommendations can increase to 2.0 g/kg/day in more severe cases of illness, malnutrition, and chronic conditions. The reviewed literature also suggests that evenly balanced protein distributions of 25–30 g of dietary protein (0.4 g/kg) per meal from animal and plant protein sources alike are sufficient to maximize muscle protein synthesis (MPS) rates in older populations. Additionally, pre-sleep protein feeds of 40 g/night may be another strategy to improve daily MPS and amino acid utilization. Full article

Despite the benefits of resistance training in mitigating sarcopenia, adherence among frail older adults is often limited by osteoarticular pain, comorbidities, and logistical barriers. Pulsed electromagnetic field (PEMF) therapy has emerged as a potential alternative. However, evidence regarding its effects on functional and psychological parameters remains scarce. Objectives: To assess the effects of 12 PEMF therapy sessions on knee extensor strength and functional performance (Timed Up and Go test—TUG) in older adults with sarcopenia. Secondary outcomes included changes in calf circumference (CC), SARC-F + CC scores, and depressive symptoms. Methods: A controlled, non-randomized experimental design was employed, with a pre-intervention control group serving as a baseline reference (PEMF group: n = 25; control group: n = 16). Participants received 12 PEMF therapy sessions (three times per week) targeting the quadriceps and gastrocnemius muscles. Outcomes were measured using knee-extension dynamometry, TUG, CC, SARC-F + CC, and the Yesavage Geriatric Depression Scale. Statistical analyses included ANCOVA, with baseline values as covariates. Results: Significant improvements were observed in knee-extension strength, which increased from 13.05 ± 4.8 kgf to 18.56 ± 8 kgf (p < 0.001); TUG test time improved from 23.1 ± 14.4 to 18.7 ± 10 s (p = 0.048); SARC-F + CC scores decreased from 11.6 ± 8.2 to 6.5 ± 7.6 (p < 0.001), though the interaction effect with time was not significant (p = 0.252). No statistically significant changes were observed in CC, which increased from 34.0 ± 4.0 cm to 36.0 ± 3.9 cm following the intervention (p = 0.548). Yesavage Geriatric Depression Scale scores improved significantly (7.9 ± 2.4 to 5.4 ± 1.7, p = 0.0013). Conclusions: PEMF therapy significantly improved lower-limb muscle strength and functional mobility in elderly individuals with sarcopenia. Additionally, depressive symptoms were significantly reduced. However, no significant changes were observed in CC or SARC-F + CC. Full article

Background: Sarcopenia (loss of muscle mass) and dynapenia (loss of strength) are prevalent in older adults aged 70 years and over. Both have an impact on their functional ability and quality of life, with type II muscle fibres being particularly affected. Although traditional resistance training (TRT) is effective, it presents technical difficulties and an increased risk of injury among this vulnerable population. Isometric strength training (IST) is a potentially safer, more accessible and more effective alternative. Objective: To describe the protocol of a single-arm, pre-post intervention trial designed to evaluate the efficacy and applicability of a 16-week IST programme on muscle strength, skeletal muscle mass, quality of life and applicability (safety, acceptability, perceived difficulty) in 18 older adults aged 70 years and above with a diagnosis of sarcopenia and dynapenia. The influence of genetic and environmental factors on the variability of response to IST will also be explored. Methodology: The participants, who have all been diagnosed with sarcopenia according to EWGSOP2 (European Working Group on Sarcopenia in Older People 2) criteria, will perform two IST sessions per week for 16 weeks. Each 30-min session will consist of one progressive set (total duration 45 s to 90 s) for each of the eight major muscle groups. This series will include phases at 20% and 40% of individual Maximal Voluntary Isometric Contraction (MVIC), culminating in 100% Maximal Effort (ME), using the CIEX SYSTEM machine with visual feedback. The primary outcome variables will be: change in knee extensor MVIC and change in Appendicular Skeletal Muscle Mass Index (ASMMI). Secondary variables will be measured (other components of sarcopenia, quality of life by EQ-5D-5L, use of Likert scales, posture and physiological variables), and saliva samples will be collected for exploratory genetic analyses. The main statistical analyses will be performed with t-tests for related samples or their non-parametric analogues. Discussion: This protocol details a specific IST intervention and a comprehensive evaluation plan. The results are expected to provide evidence on the feasibility and effects of IST among older adults with sarcopenia and dynapenia. Understanding individual variability in response, including genetic influence, could inform the design of more personalised and effective exercise strategies for this population in the future. Full article

Background: Sarcopenia is characterized by low muscle mass and strength, as well as impaired physical performance. Older adults with sarcopenia experience decreased cardiorespiratory fitness. Physical exercise is recommended for the prevention and treatment of sarcopenia. Virtual reality (VR) exercise was introduced to improve physical activity. However, the effect of VR on cardiorespiratory function in older adults with sarcopenia has not been fully explored. This study aimed to explore the effects of home-based VR aerobic exercise combined with resistive exercise on cardiorespiratory performance in community-dwelling older adults with sarcopenia. Subjects and Methods: In a randomized controlled trial, 53 older adults with sarcopenia were divided into a home-based VR (n = 26) and a control group (CG; n = 27). The VR program combined aerobic and resistance exercises, performed three times per week for 12 weeks, while the CG received knowledge regarding the benefit of exercise and continued with their regular daily activities. All participants were required to undergo respiratory muscle strength and functional capacity tests before and after the 12-week intervention. Two-way mixed repeated ANOVA was conducted to compare within and between groups in cardiorespiratory performance. Results: The home-based VR exercise group showed significant improvement in pre-post (i.e., maximal inspiratory pressure (12.96 ± 1.49 cmH₂O), maximal expiratory pressure (13.73 ± 1.72 cmH₂O), functional capacity (28.32 ± 3.48 m), and between-group (maximal expiratory pressure (F (1,51) = 10.446, p = 0.002, np² = 0.170). In contrast, the CG displayed a reduction in maximal expiratory pressure (−3.93 ± 1.69 cmH₂O, p = 0.024) and functional capacity (−10.39 ± 3.42 m, p = 0.004) after the 12-week program. Conclusions: The home-based VR program provides older adults with sarcopenia an alternative exercise modality that can improve their cardiovascular performance. Full article

Background: Prior studies suggest that patients’ body composition changes following transjugular intrahepatic portosystemic shunt (TIPS) implantation, potentially influencing complications and survival. Method: A prototype artificial intelligence (AI)-based, automated computed tomography (CT) body composition analysis tool was used to assess body composition imaging parameters in pre- and postinterventional scans of TIPS patients: visceral (VAT) and subcutaneous adipose tissue (SAT) areas, psoas muscle area (PMA), and total abdominal muscle area (TAMA). Sarcopenia was defined as a lumbar skeletal muscle index (LSMI) ≤ 38.5 cm²/m² in women and ≤52.4 cm²/m² in men. We analyzed longitudinal changes in body composition and investigated the impact of sarcopenia at TIPS implantation on the risk of TIPS thrombosis, hepatic encephalopathy, complications, and death using Cox regression models. Results: No clear trend emerged regarding changes in body composition parameters during postinterventional follow-up. Sarcopenia at TIPS implantation increased the instantaneous risk of postinterventional complications (hazard ratio (HR) 1.67; 95% confidence interval (CI) 0.95–2.93), development of hepatic encephalopathy (HR 1.65; 0.81–3.33), as well as the risk of dying within one year (HR 1.39; 0.66–2.92). Conclusions: CT body composition analysis may help in identifying high-risk patients undergoing TIPS implantation. Sarcopenia was associated with increased mortality and a higher incidence of postinterventional complications, particularly hepatic encephalopathy. Full article

Background: Sarcopenia, defined as the progressive loss of skeletal muscle mass and strength, is a critical predictor of morbidity and mortality in patients with cirrhosis. In chronic liver disease, sarcopenia exacerbates adverse clinical outcomes and deteriorates quality of life. Physical activity, particularly resistance training, has demonstrated beneficial effects in reversing muscle depletion in various chronic conditions. Aim: This systematic review aimed to evaluate the impact of resistance training on sarcopenia among cirrhotic patients, with a focus on both pre-liver transplant and post-liver transplant populations, to improve clinical outcomes and enhance quality of life. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed/MEDLINE databases were searched for randomized controlled trials (RCTs) using a standardized search command combining MESH terms and Boolean operators. Studies meeting eligibility criteria and reporting improvements in sarcopenia following resistance training were selected for data extraction. Results: Out of 109 references identified, 12 RCTs were included—10 in pre-transplant and 2 in post-transplant populations. Across studies, resistance training led to measurable improvements in key outcomes: peak VO₂ increased by up to 5.3 mL/kg/min, 6 min walk distance improved by 18–97 m, quadriceps muscle thickness increased by up to 1.05 cm, and grip strength gains ranged from 0.4 to 3.8 kg. Postoperative studies reported reductions in fatigue severity scores and length of hospital stay, along with improvements in respiratory pressures and peripheral muscle strength. Conclusions: Resistance training is effective in ameliorating sarcopenia in cirrhotic patients, thereby enhancing pre-transplant status and postoperative quality of life. Clinically, structured exercise programs should be routinely implemented. Full article

Backgrounds and Objectives: In this study, we aimed to assess preoperative frailty among hospitalized patients over 60 undergoing colorectal cancer surgery. We investigated the impacts of frailty and sarcopenia on postoperative recovery, complications, and discharge time, while also identifying a cost-effective, bedside-accessible USG parameter for diagnosing sarcopenia among patients assessed using the “Sonographic Thigh Adjustment Ratio” method. Materials and Methods: In this prospective study, we investigated the impacts of frailty and sarcopenia on the postoperative outcomes of 42 geriatric patients (with American Society of Anesthesiologists (ASA) scores of I–III) undergoing colorectal cancer surgery under general anesthesia. Frailty was assessed using the FRAIL scale, and sarcopenia was evaluated using the STAR (sonographic thigh adjustment ratio). Ultrasonographic measurements of rectus femoris and vastus intermedius muscle thicknesses were taken, and thigh lengths (TLs) were recorded. Ratios, including rectus femoris thickness/TL (RFT/TL), vastus intermedius thickness/TL (VIT/TL), and total muscle thickness/TL (TMT/TL), were calculated. Postoperative anesthesia recovery was monitored using the Modified Aldrete Score, indicating the time until discharge from the recovery unit. Complications were classified using the Clavien–Dindo system, and hospital discharge times were noted. Results: We observed significant differences between frailty status and ASA scores, as well as between age and frailty status. Muscle thickness significantly differed between the frail and pre-frail patients. Among the sarcopenic patients, age differences were significant. In men, VIT/TL was significantly correlated with sarcopenia diagnosis, whereas, in women, RFT/TL, VIT/TL, and TMT/TL were all correlated with sarcopenia. Conclusions: Based on our results, we conclude that VIT/TL measurement can serve as a predictive marker for preoperative sarcopenia, optimizing patient health before surgery. Full article

Background/Objectives: Sarcopenia and frailty are interrelated conditions and have a high incidence in older adults. They contribute to increased morbidity and mortality and poor quality of life. There is emerging evidence that healthy diets such as the Mediterranean diet could delay the onset of sarcopenia and frailty. This review aims to evaluate the role of the MD in preventing these conditions. Methods: A literature search was conducted on PubMed (MEDLINE, NCBI) for English-language articles published within the last 10 years (2014–2024) using the search terms “Mediterranean diet”, “frailty”, “sarcopenia”, and “old people”. A total of 111 articles were identified, of which 36 were excluded during the initial screening. Subsequently, 75 manuscripts were assessed for eligibility. Subsequently, a further 62 articles were excluded (narrative reviews, articles not focused on the elderly population, or articles with different outcomes). Finally, 13 articles were included in the review. Results: The 13 selected studies comprised seven observational studies, three systematic reviews and meta-analyses, and three clinical trials. The findings suggest that adherence to the Mediterranean diet (MD), particularly when combined with physical activity, may improve body composition and cardiometabolic health and reduce indicators of sarcopenia in obese older adults. Furthermore, MD-based nutritional interventions were associated with improved physical functions such as balance, gait, fall risk, flexibility, and muscle strength (p < 0.05, all). The MD also demonstrated a preventive effect against frailty, particularly in pre-frail individuals. Conclusions: High adherence to the Mediterranean diet (MD) may delay the onset of sarcopenia and improve muscle function in older adults. However, the available scientific evidence is of low to moderate quality. Well-designed prospective intervention studies are needed to confirm whether the MD can modify the natural history of sarcopenia and/or frailty in older adults. Full article

Background/Objectives: Early intervention combining nutrition optimisation with exercise can potentially prevent frailty progression and reverse pre-frailty in older adults. Methods: This 4-month study examined the effectiveness of nutrition education (without oral nutrition supplement use) as part of a multi-domain intervention on the nutritional status and intake of pre-frail community-dwelling older adults and its relationship with sarcopenia markers. Results: Amongst 172 participants (≥55 years), 5.8% were malnourished, with no significant change in nutritional status throughout the study. Post-intervention, participants consumed significantly higher daily calories, protein, protein per body weight (BW), and calcium (p < 0.001); protein intake at lunch (p = 0.001) and dinner (p = 0.004) also increased. However, 6-month post-intervention daily protein (p = 0.025), protein per BW (p = 0.039), and calcium (p = 0.015) decreased significantly. Sarcopenia markers (handgrip strength (HGS), five-time chair stand test (5STS), and short physical performance battery score (SPPB)) showed no significant difference post-intervention. Well-nourished participants had better HGS (p = 0.005), 5STS (p = 0.026), and SPPB (p = 0.039). Practical nutrition education effectively improved nutritional intake, but the effect was not sustained 6-months post-intervention. Conclusions: Optimising nutritional status with a focus on improving protein intake, especially at breakfast, to meet minimal intake to stimulate muscle protein synthesis can help prevent sarcopenia and frailty. Future studies should examine factors driving sustainable improvement to prevent frailty progression in this population. Full article

Background and Objectives: Sarcopenia and frailty adversely affect morbidity and mortality in patients with liver cirrhosis. This study aimed to investigate the prevalence of sarcopenia and frailty in cirrhotic patients and to identify the contributing factors. Materials and Methods: This study was conducted in adult patients diagnosed with cirrhosis in a single-center cohort study who were under follow-up in the gastroenterology outpatient clinic. Patients were evaluated using the SARC-F questionnaire, FRAIL index, handgrip strength measurements, and various biochemical parameters. Results: Of the 100 patients included in the study, 58.7% were male, with a median age of 66.5 years. The prevalence of sarcopenia was 32%. Patients with sarcopenia had significantly lower body mass index (BMI) and higher model for end-stage liver disease (MELD)-Na and Child–Turcotte–Pugh (CTP) scores. According to the FRAIL scale, pre-frailty was highly prevalent among patients (60%). Significant negative correlations were observed between the SARC-F score and BMI, handgrip strength, albumin, vitamin D, and sodium levels. Conversely, significant positive correlations were identified between the SARC-F score and age, CTP score, MELD-Na score, bilirubin, AST, ALT, and ferritin levels. Conclusions: This study demonstrated a high prevalence of sarcopenia and frailty among cirrhotic patients. These findings warrants further investigation in longitudinal studies for hard clinical outcome and mortality. Full article