Search Results (2,818)

Sarcopenia is an age-related skeletal muscle disorder characterized by reduced muscle mass, strength, and physical performance, as well as increased risk of disability, hospitalization, and mortality. Emerging evidence suggests that gut microbiota alterations may contribute to muscle decline via a microbiota–gut–muscle axis, acting as a context-dependent modulator rather than a primary causal driver. This narrative review synthesizes mechanistic, clinical, and translational evidence linking gut dysbiosis to sarcopenia. Preclinical studies show that microbiota modulation (e.g., antibiotics, probiotics, prebiotics, postbiotics, fecal microbiota transplantation) affects muscle mass, strength, and metabolism through pathways including inflammation, mitochondrial dysfunction, altered short-chain fatty acid production, and impaired anabolic signaling. In humans, observational studies associate lower microbial diversity and reduced short-chain fatty acid-producing taxa with poorer muscle outcomes, but findings are heterogeneous and non-causal. Interventional trials remain limited and characterized by small sample sizes, with effects more consistent for functional outcomes than muscle mass. Overall, the gut microbiota represents a modifiable contributor within the complex biology of sarcopenia. Future studies should integrate microbiome profiling and multi-omics approaches within well-designed clinical trials to identify responder phenotypes and define the role of microbiota-targeted strategies within multimodal interventions. Full article

Background/Objectives: Sarcopenia frequently coexists with other geriatric syndromes, and its severity may influence their clinical manifestation. This study examines the prevalence of geriatric syndromes in older adults with non-severe and severe sarcopenia and explores the associations between sarcopenia severity and individual geriatric syndromes in Vietnam. Methods: A cross-sectional study was conducted among 726 older outpatients with sarcopenia. Non-severe and severe sarcopenia were diagnosed according to the Asian Working Group for Sarcopenia algorithm. Fifteen geriatric conditions spanning physical and psychological health, functional status, and social circumstances were assessed using components of the Comprehensive Geriatric Assessment. Logistic regression models were used to examine associations between sarcopenia severity and geriatric syndromes. Results: A total of 726 older patients with sarcopenia (mean age 74.4 years, 77.4% females) were included, of whom 53.4% had severe sarcopenia. A significantly higher prevalence of geriatric syndromes was observed in patients with severe compared with non-severe sarcopenia, including sleep disturbances (79.4% vs. 67.5%), frailty (71.4% vs. 54.7%), malnourishment/risk of malnutrition (61.9% vs. 50.0%), depression (54.9% vs. 34.9%), polypharmacy (49.5% vs. 42.0%), impairment in activities of daily living (52.8% vs. 32.5%), and impairment in instrumental activities of daily living (58.2% vs. 39.3%). After adjustment for potential confounders, severe sarcopenia remained associated with sleep disturbance (adjusted OR 1.49, 95%CI 1.02–2.18, p = 0.046), depression (adjusted OR 1.90, 95%CI 1.36–2.66, p < 0.001), and mobility impairment (adjusted OR 3.01, 95%CI 2.12–4.27, p < 0.001). Conclusions: Older Vietnamese adults with sarcopenia had a high burden of geriatric syndromes, particularly among those with severe disease. Severe sarcopenia was independently associated with sleep disturbance, depression, and impaired mobility—clinically relevant and potentially modifiable conditions. These findings highlight the importance of evaluating sarcopenia within a broader geriatric framework and may inform early identification and prioritization of coexisting geriatric syndromes, especially in resource-limited settings. Full article

Skeletal muscle is vital for movement and metabolism, and its dysfunction underpins disorders like muscular dystrophy and sarcopenia, severely impacting life quality. In these diseases, various cell death pathways are pivotal, driving core pathological features such as fiber loss and chronic inflammation. This study reviews the central role of cell death in skeletal muscle diseases, and analyzes its roles and mechanisms in genetic muscle disorders such as Duchenne muscular dystrophy (DMD), glycogen storage diseases (GSD), mitochondrial myopathies, as well as acquired muscle disorders such as idiopathic inflammatory myopathy, sarcopenia, rhabdomyolysis, and myasthenia gravis (MG). We also explore the potential of cell death-related molecules as biomarkers and discuss emerging therapeutic strategies that target these pathways, aiming to provide new insights for diagnosis and treatment. Full article

Background/Objectives: Sarcopenia and age-related muscle weakness pose significant global health challenges, highlighting the need for innovative and sustainable exercise interventions for older adults. This study developed and evaluated an Interactive Smart Mirror Exercise Program and investigated the factors associated with older adults’ usage intention toward the program based on the Decomposed Theory of Planned Behavior (DTPB). Methods: A cross-sectional survey was conducted with 92 community-dwelling older adults in northern Taiwan. Structural equation modeling was applied to test the proposed framework and examine the relationships among the study variables. Results: The results showed a satisfactory model fit (SRMR = 0.071). Attitude, subjective norms, and perceived behavioral control together explained 41.6% of the variance in usage intention. In addition, perceived usefulness, perceived compatibility, interpersonal influence, and self-efficacy were identified as factors significantly associated with usage intention, both directly and indirectly. Conclusions: These findings might support the applicability of the DTPB framework in explaining older adults’ usage intention toward technology-assisted exercise programs and provide insights for the design and implementation of digital exercise interventions in community settings. Full article

Background/Objectives: Beyond glycemic control, oral antidiabetic drugs (OADs) may exert class-specific effects on muscle mass and hematologic parameters. However, real-world evidence comparing these effects across OAD classes remains limited. This study aimed to evaluate the differential effects of commonly prescribed OADs on skeletal muscle mass (SMM) and hemoglobin (Hb) levels in adults with type 2 diabetes mellitus (T2DM). Methods: In this prospective observational cohort study, 60 adults with newly initiated OAD therapy were followed for six months at a tertiary care center in Türkiye. Patients were classified according to the OAD class newly added to their regimen (metformin, sulfonylureas, dipeptidyl peptidase-4 inhibitors, pioglitazone, or sodium–glucose cotransporter-2 inhibitors [SGLT2-i]). Multi-frequency bioelectrical impedance analysis was used to evaluate body composition, and hematologic parameters including Hb were obtained at both time points. To account for potential confounders—including age, sex, BMI, baseline Hb, and eGFR—binary logistic regression analyses were performed. Results: Patients initiated on pioglitazone (n = 11) demonstrated a borderline within-group increase in SMM in unadjusted analysis (median delta +0.17 kg, IQR −0.55 to +0.50; p = 0.050); however, this association was attenuated and no longer statistically significant after multivariable adjustment (OR 2.16, 95% CI 0.60–7.83; p = 0.240). In contrast, SGLT2-i users (n = 28) showed a significant increase in Hb (median delta +0.10 g/dL, IQR −0.30 to +0.50; p = 0.022), which remained significant after adjustment (OR 4.22, 95% CI 1.32–13.44; p = 0.015). Other OAD classes were not associated with meaningful changes in SMM or Hb. Conclusions: In this real-world prospective cohort, pioglitazone showed a trend toward increased SMM in unadjusted analysis that did not reach significance after adjustment, suggesting a hypothesis-generating signal warranting further investigation. SGLT2 inhibitors were independently associated with increased Hb levels, though the observed median increment was modest in absolute terms. These findings highlight potentially clinically relevant, non-glycemic effects of OAD classes and may inform individualized treatment selection, particularly in patients at risk of sarcopenia or anemia. Adequately powered, prospective studies are needed to validate and extend these preliminary observations. Full article

With growing global life expectancy, age-related physical problems, including balance impairments, are becoming more prevalent, increasing the risk of falls, mobility limitations, and loss of independence. This review summarizes current evidence on how balance may be influenced and improved by training modalities including reactive, strength-based, and functional exercises, through neuromuscular adaptations relevant to postural control and functional stability in older adults. Emerging evidence suggests that gut microbiota may influence neuromuscular health via neuroimmune, metabolic, and mitochondrial pathways across the gut–muscle–brain axis. However, most studies focus on muscle metabolism, inflammation, and systemic physiological processes rather than direct assessments of balance or postural control. Gut dysbiosis has been associated with sarcopenia and impaired physical function, although evidence linking microbiota alterations to balance outcomes remains limited and mainly observational. Exercise has beneficial effects on neuromuscular function and gut microbial composition, including increased diversity and metabolite production. While exercise-induced neuromuscular adaptations are well supported experimentally, little direct evidence shows the contribution of gut-related mechanisms to balance regulation. Overall, neuromuscular and gut-related processes seem to be associated with balance capacity in older adults; however, further mechanistic and interventional studies are required to clarify the role of the gut–muscle–brain axis for balance. Full article

Background/Objectives: The objective of this investigation was to assess the prevalence of sarcopenia and identify its related risk factors in patients with rheumatoid arthritis (RA) using data from the nationally representative 2008–2011 Korea National Health and Nutrition Examination Survey (KNHANES). Methods: We analyzed data from the 2008–2011 KNHANES to identify the factors associated with sarcopenia in patients with RA. Sarcopenia was defined as the ratio of appendicular skeletal muscle mass to total body weight (multiplied by 100), with cut-offs of <29.0% for men and <22.9% for women. To identify the specific factors independently associated with sarcopenia, a multivariate logistic regression model was employed, accounting for sample weights and the complex survey design. Results: Among 238 patients with RA included in the analysis, 44 (weighted prevalence: 22.7%) had sarcopenia. The sarcopenia group had a higher proportion of males (55.0% vs. 15.3%, p < 0.001), body mass index (BMI) (26.1 vs. 23.3 kg/m², p < 0.001), and waist circumference (86.9 vs. 79.0 cm, p < 0.001) than the non-sarcopenia group. After adjustment for potential confounders, including age, sex, obesity, physical activity, and daily protein intake, male sex (odds ratio [OR]: 4.17; 95% confidence interval [CI]: 1.48–11.77, p = 0.007) and obesity (OR: 3.06; 95% CI: 1.16–8.07, p = 0.024) were independently associated with sarcopenia. In sex-specific analyses, low physical activity was significantly associated with sarcopenia only in male patients (OR: 13.00; 95% CI: 1.90–88.75, p = 0.012). Conclusions: Our findings indicate that being male and having a higher BMI are significant independent indicators of sarcopenia risk within the Korean RA population. This highlights their critical role in the development of sarcopenia among RA patients. Full article

Background: Esophagectomy remains the definitive curative treatment for esophageal cancer but is historically burdened by significant procedure-related morbidity. Anastomotic leakage (AL) is still the “Achilles’ heel” of esophageal surgery, serving as a primary benchmark for surgical quality due to its profound impact on patient recovery, healthcare costs, and long-term oncological outcomes. While surgical expertise and perioperative care have matured, reported AL rates remain persistently high. This necessitates a shift in focus from purely technical modifications toward integrated, data-driven preventive strategies. Purpose: Five years after our initial review, this update synthesizes the rapid evolution in AL prevention. We evaluate the transition from empirical surgical pragmatism to evidence-based protocols, integrating recent breakthroughs in real-time perfusion monitoring, prophylactic endoluminal technologies, and multidisciplinary patient optimization. This work provides a contemporary “roadmap” for navigating the complexities of esophageal reconstruction. Conclusions: The prevention of AL has evolved into a multimodal “bundle” that begins well before the index operation. This review highlights the critical shift toward quantitative perfusion assessment via indocyanine green fluorescence angiography, which is increasingly replacing subjective visual inspection as the standard for anastomotic site selection. We discuss the emerging role of gastric ischemic preconditioning as a biological strategy to enhance conduit vascularity, alongside the paradigm of proactive management using preemptive endoluminal vacuum therapy to mitigate septic sequelae in high-risk cases. Furthermore, we examine technical refinements in conduit construction and conditioning—focusing on the ‘tension-perfusion’ relationship—and the essential role of structured prehabilitation within enhanced recovery after surgery frameworks. While the quality of evidence remains heterogeneous, the move toward standardized reporting and objective monitoring marks a new era of precision in esophageal surgery. Full article

Background/Objectives: Older patients with fractures often present with a complex interplay of factors associated with frailty and functional decline. The emerging concept of Orthogeriatric Fracture Syndrome (OFS) aims to characterize these distinct relationships of pathologies and outcomes. Despite increasing recognition of OFS in clinical practice, due to the distributed nature of fragility factors across medical disciplines, it remains poorly defined in the literature. Methods: We used large-scale text mining of 26 million PubMed abstracts to quantify the occurrence and interrelationship of OFS-related concepts across all disciplines in biomedical research. Results: OFS terms were more prevalent in fragility fractures than in other fracture types, particularly osteoporosis (0.52 vs. 0.09, p < 0.05). In pairwise keyword correlation (Pearson φ), the correlations presented between OFS keywords are comparable to the ones in the more established metabolic syndrome (e.g., φ = 0.07 between stroke and hypertension, p < 0.05). For OFS, osteoporosis emerged as the central node linking OFS outcomes and pathologies, correlating with fragility fracture (φ = 0.176, p < 0.05) and sarcopenia (φ = 0.03, p < 0.05). Sarcopenia in turn correlated with gait (φ = 0.04, p < 0.05), malnutrition (φ = 0.05, p < 0.05), and frailty (φ = 0.032, p < 0.05). Old age keywords showed substantially higher association with OFS keywords (e.g., φ = 0.06 for elderl* and hip fracture, p < 0.05) than with metabolic syndrome terms (elderl* and insulin resistance, p > 0.05). Conclusions: Overall, the analysis showed statistically significant associations between keywords representing OFS outcomes, pathologies and old age. The combined occurrence of osteoporosis, sarcopenia, frailty and risk of falls may help conceptually identify older adults at risk and inform preventive measures. This large-scale bibliometric analysis supports OFS as a conceptually coherent, proposed theoretical framework for cross-disciplinary awareness and coordinated care, with a literature-level organizational pattern comparable to metabolic syndrome, however, pending prospective clinical validation. This study reframes fragility fractures as the endpoint of a broader, potentially modifiable risk constellation and underscores the need for further clinical and epidemiological validation. Full article

Male reproductive aging is increasingly recognized as a systemic process in which inflammaging drives progressive dysfunction of urogenital tissues. Key mechanisms include immune–metabolic alterations, activation of the NOD-like receptor protein 3 (NLRP3) inflammasome, as well as epigenetic remodeling. Evidence from experimental and clinical studies suggests that these processes are often investigated independently, and integrative models in humans remain limited. Here, we propose a conceptual framework linking the prostate, testis, and skeletal muscle, in which oxidative stress may act as a mediator amplifying systemic dysregulation at different levels during the aging process. Lifestyle and metabolic interventions, including caloric restriction, resistance exercise, and selected nutraceuticals, may act as key modulators of inflammaging pathways, thus highlighting new potential targets for precision medicine approaches. Full article

Aging is characterized by progressive degeneration of neuromuscular junctions (NMJs), which significantly contributes to muscle weakness and the development of sarcopenia. Photobiomodulation (PBM), a non-invasive therapeutic method based on the use of low-intensity light, has shown promising results in mitigating muscle degeneration in both experimental and clinical studies. The aim of this study was to evaluate the ultrastructural effects of photobiomodulation on neuromuscular junctions and skeletal muscle fibers in the m. vastus lateralis muscle of aged rats using light and transmission electron microscopy. Male Wistar rats (18 months old, body weight 650–800 g, n = 10) were subjected to photobiomodulation of the right m. vastus lateralis muscle (650 nm, 6 J/cm², four consecutive daily sessions of 3 min each). The contralateral left limb served as an untreated control. Muscle samples were analyzed by light and transmission electron microscopy. Histological examination revealed typical age-related changes in control muscles, including variability in muscle fiber diameter, centrally located nuclei, and an increased volume of connective tissue. Ultrastructural analysis confirmed signs of skeletal muscle aging, such as myofibril fragmentation, sarcomere disorganization, lipofuscin accumulation, and tubular aggregate formation. Morphometric analysis of neuromuscular junctions after photobiomodulation showed an increase in the number of active zones on the presynaptic membrane, elongation of the postsynaptic membrane, and a reduction in the width of the synaptic cleft. In addition, mitochondrial hyperplasia was observed in presynaptic terminals, while the total number of synaptic vesicles decreased. These findings indicate a compensatory reorganization of neuromuscular junctions and suggest that photobiomodulation can enhance their functional activity in aged skeletal muscle. Full article

Background/Objectives: Sarcopenia is a progressive skeletal muscle disorder linked to adverse outcomes. Computed Tomography (CT) can quantify skeletal muscle, while the Charlson Comorbidity Index (CCI) predicts mortality by categorising comorbidities. This study examined whether Computed Tomography of the Kidneys, Ureters, and Bladder (CT-KUB)-derived skeletal muscle measurements correlate with CCI scores in hospitalised patients. Methods: This retrospective study included all patients admitted with renal colic to the Urology Department, Blacktown Hospital and underwent cystoscopy between June 2022 and June 2025. Data were obtained from electronic medical records. CCI scores, incorporating age and comorbidities, generated 10-year survival estimates. CT-KUB scans were reviewed for psoas muscle perimeter, area, height, width and Hounsfield unit at the aortic bifurcation. Skeletal Muscle Index (SMI) was calculated as skeletal muscle area (SMA)/height². Associations between CCI, psoas muscle metrics and outcomes (length of stay, Intensive Care Unit (ICU) admission, Emergency Department (ED) re-presentation) were assessed using Pearson’s correlations and between-group comparisons. Results: A total of 397 patients were analysed. Median Length of Stay (LOS) was 1 day (mean = 1.92, SD = 1.88). ICU admission occurred in 2.3% of patients, and 18.6% re-presented to ED within 30 days. Both CCI survival percentage and psoas muscle metrics (including SMI) were significantly associated with LOS. Lower SMA, Hounsfield unit (HU), length and perimeter were linked to higher ICU admission risk. Neither CCI nor muscle measures predicted ED re-presentation. Conclusions: CCI and CT-derived muscle metrics were independently associated with outcomes such as LOS and ICU admission. Combining these measures may improve risk stratification, warranting further prospective evaluation. Full article

Background/Objectives: Constipation is a common gastrointestinal problem in older adults and is associated with reduced quality of life, functional decline, frailty, and an increased risk of delirium and cognitive impairment. Its pathogenesis is multifactorial, involving age-related changes in gastrointestinal motility, neural regulation, comorbidities, and polypharmacy. However, this condition has traditionally been regarded as a localized gastrointestinal disorder, which may not fully reflect its systemic clinical significance in older populations. While prior narrative reviews have described multifactorial contributors to constipation, none have formally applied a geriatric syndrome framework to integrate these dimensions. This review proposes a three-criterion operational definition—multifactorial pathogenesis, association with functional decline and frailty, and contribution to adverse systemic outcomes—to characterize constipation in older adults as a “systemic geriatric syndrome,” and evaluates available evidence against each criterion. Methods: A narrative literature search was conducted using PubMed to identify relevant studies published between 1 January 2023, and 31 December 2025. MeSH terms included “Constipation” [Major Topic] and “Aged” [MeSH Terms]. Eligible articles included English-language original studies, systematic reviews, and clinical or epidemiological studies involving individuals aged ≥65 years. Results: Diagnosis in older adults is often complicated by secondary causes, including medications and neurological disorders, as well as atypical symptom presentations in individuals with cognitive impairment. Key pathophysiological mechanisms include reductions in interstitial cells of Cajal, impaired smooth muscle contractility, dysfunction of the enteric and autonomic nervous systems, and gut microbiota dysbiosis, which may promote chronic low-grade inflammation. Major contributing factors include physical inactivity, sarcopenia, dehydration, inappropriate defecation posture, and polypharmacy, particularly opioids and anticholinergic agents. Importantly, these factors interact through the brain–gut–microbiota axis, contributing not only to gastrointestinal dysfunction but also to systemic outcomes such as frailty, cognitive decline, and increased healthcare burden, thereby supporting a multidimensional disease framework. Conclusions: The available evidence collectively supports the plausibility of framing constipation in older adults as a systemic geriatric syndrome, though formal validation of this classification requires further longitudinal and mechanistic research. Comprehensive and individualized management strategies, extending beyond simple laxative use, are essential to reduce complications and preserve functional health in aging populations. Further studies are required to validate this framework. Full article

Background: Major morbidity and mortality remain important concerns after colorectal cancer (CRC) surgery. Cancer-related sarcopenia and heightened systemic inflammation may increase the risk of early postoperative major complications. Methods: In this retrospective single-center study, we analyzed 190 patients undergoing major CRC surgery. Skeletal muscle gauge (SMG) and the pan-immune-inflammation value (PIV) were assessed as preoperative risk markers, and 30-day major complications were evaluated. Results: Low SMG was strongly associated with major complications (OR 6.50, 95% CI 3.24–13.05; p < 0.001), and high PIV was also associated with increased risk (OR 3.51, 95% CI 1.77–6.99; p < 0.001). In multivariable analysis adjusting for age, surgical urgency, and procedure type, low SMG and emergency surgery remained independent predictors of 30-day major complications. The highest-risk phenotype (high PIV/low SMG; n = 23) had a major complication rate of 78.3% (18/23) (p < 0.001). A clinical model including age, urgency, and procedure type yielded an AUC of 0.739 (95% CI 0.661–0.816). Adding low SMG improved discrimination (AUC 0.784, 95% CI 0.711–0.857), with only a small additional increase after adding high PIV (AUC 0.791, 95% CI 0.717–0.864). Conclusions: Preoperative low SMG was independently associated with 30-day major complications after CRC surgery, while PIV provided complementary risk-stratification value. The combined high-PIV/low-SMG phenotype identified patients with particularly high postoperative risk. Full article

Background/Objectives: This study aimed to compare the diagnostic performance of usual gait speed (UGS), maximal gait speed (MGS), and gait speed reserve (GSR) for identifying sarcopenia in older adults with type 2 diabetes (T2D), and to examine whether combining gait indices improves diagnostic performance. Methods: This cross-sectional study included 117 older adults with T2D hospitalized for glycemic control. UGS and MGS were measured in the central 10-m section of a 16-m course, which included 3-m acceleration and deceleration zones on either side. GSR was calculated as the difference between MGS and UGS. Sarcopenia was diagnosed according to the AWGS 2025 criteria. Multivariable logistic regression was used to examine the associations between each gait index and sarcopenia. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis, and the usefulness of a combined criterion based on UGS and GSR was also assessed. Results: Sarcopenia was identified in 32 participants (27.4%). UGS, MGS, and GSR were each associated with sarcopenia independently of clinical factors. UGS showed the highest sensitivity (90.6%), suggesting its potential usefulness as a screening measure, whereas GSR showed the highest specificity (83.5%), suggesting its potential usefulness in reducing false positives when identifying sarcopenia. In the ROC analysis of the three gait-related indices, the area under the curve (AUC) for MGS was the highest (0.79), but it was not significantly different from the AUC for UGS. The combined criterion of UGS < 1.07 m/s and GSR < 0.21 m/s improved specificity and yielded a high positive likelihood ratio (PLR = 6.5). Conclusions: UGS, MGS, and GSR each exhibit distinct diagnostic characteristics for sarcopenia. UGS may be useful for screening, whereas GSR may help improve specificity. In particular, combining UGS and GSR may provide complementary diagnostic information for identifying sarcopenia in older adults with T2D. Full article