Increased intramuscular adipose tissue of the quadriceps is more strongly related to declines in ADL than is loss of muscle mass in older inpatients

Akazawa, Naoki; Kishi, Masaki; Hino, Toshikazu; Tsuji, Ryota; Tamura, Kimiyuki; Moriyama, Hideki

doi:10.1016/j.clnu.2020.08.029

Cited by 26 publications

(67 citation statements)

References 68 publications

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“…The validity of intramuscular adipose tissue and muscle mass measurements using ultrasound has been confirmed in recent studies using magnetic resonance imaging 25–27 . Images of the rectus femoris and vastus intermedius were obtained at 30% of the distance from the anterior superior iliac spine to the proximal end of the patella 4,6,11,18,19,24 . The participants lay in the supine position with their lower limbs relaxed, while a water‐soluble transmission gel was applied to the skin surface of the thigh.…”

Section: Methodsmentioning

confidence: 91%

“…A more recent cross‐sectional study 19 reported that greater intramuscular adipose tissue in the quadriceps is more strongly related to declines in ADL than less muscle mass in older inpatients. In this prospective study, a similar relationship was observed.…”

Section: Discussionmentioning

confidence: 99%

“…Transverse ultrasound images were obtained using a B‐mode ultrasound system (NanoMaxx; SonoSite Japan, Tokyo, Japan) with a linear‐array probe (L25n/13–6 MHz; Nanomaxx; SonoSite Japan). The intramuscular adipose tissue and muscle mass of the rectus femoris and vastus intermedius of all participants were assessed based on the echo intensity and muscle thickness 1–8,10,11,18,19,21–24 . The validity of intramuscular adipose tissue and muscle mass measurements using ultrasound has been confirmed in recent studies using magnetic resonance imaging 25–27 .…”

Section: Methodsmentioning

confidence: 99%

“…All ultrasound images were recorded by the same investigator, who had sufficient training in echo intensity and muscle thickness measurements. Echo intensity was measured in one region of interest in the rectus femoris and vastus intermedius; the region selected included the maximum possible regions, while avoiding the bone and surrounding fascia 4,6,11,18,19,24 . To standardize all echo intensity measurements, the gain status was normalized to the initial setting of the ultrasound system.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, the image depth was uniformed at 60 mm for all echo intensity and muscle thickness measurements. The rectus femoris thickness was determined as the distance between the superficial adipose tissue–muscle interface and the deep muscle–muscle interface, 4,6,11,18,19,24 and that of the vastus intermedius was determined as the distance between the superficial muscle–muscle interface and the bone–muscle interface 4,6,11,18,19,24 . Echo intensity and muscle thickness were measured using ImageJ 1.49 software (National Institutes of Health, Bethesda, MD, USA) 1–8,11,18,19,21,22,24,26,27 .…”

Section: Methodsmentioning

confidence: 99%

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Intramuscular adipose tissue in the quadriceps is more strongly related to recovery of activities of daily living than muscle mass in older inpatients

Akazawa

Kishi

Hino

et al. 2021

J cachexia sarcopenia muscle

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Background The relationship between intramuscular adipose tissue at admission and recovery of activities of daily living (ADL) remains unclear. This study aimed to examine the relationship between intramuscular adipose tissue in the quadriceps at admission and recovery of ADL in older inpatients. Methods This prospective study included 404 inpatients aged ≥65 years (54.7% female). Recovery of ADL during hospital stay was assessed using the Barthel Index (BI) score at discharge, BI score change, and BI efficiency. Higher BI at discharge, BI score change, and BI efficiency indicate more improvement in ADL. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed using echo intensity and muscle thickness on ultrasound images, respectively. Multiple regression analysis was performed to identify factors independently associated with BI score at discharge, BI score change, and BI efficiency. The independent variables were BI score at admission, echo intensity and muscle thickness of the quadriceps, age, sex, number of medications, C‐reactive protein concentration, updated Charlson Comorbidity Index score, Food Intake Level Scale, Geriatric Nutritional Risk Index score, days from onset disease, length of hospital stay, number of units of rehabilitation therapy, and subcutaneous fat thickness of the thigh. Results The medians (inter‐quartile range) of the BI score at discharge, BI score change, and BI efficiency were 60.0 (35.0–80.0), 10.0 (0.0–25.0), and 0.11 (0.00–0.37), respectively. The median (inter‐quartile range) of the length of hospital stay (days) and days from onset disease were 58.0 (39.0–92.0) and 79.0 (49.0–112.0), respectively. Quadriceps echo intensity was independently and significantly associated with the BI score at discharge (β = −0.13, P < 0.01), BI score change (β = −0.23, P < 0.01), and BI efficiency (β = −0.21, P < 0.01). Quadriceps thickness was not independently and significantly associated with the BI score at discharge (β = −0.02, P = 0.68), BI score change (β = −0.02, P = 0.79), and BI efficiency (β = 0.03, P = 0.67). Conclusions Our study indicates that greater intramuscular adipose tissue in the quadriceps at admission is more strongly related to worse recovery of ADL than less muscle mass in older inpatients. Greater intramuscular adipose tissue in the quadriceps in older inpatients is considered to be a predictor of worse recovery of ADL, and intervening for greater intramuscular adipose tissue may be important for improving ADL in older inpatients.

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Section: Methodsmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Intramuscular adipose tissue in the quadriceps is more strongly related to recovery of activities of daily living than muscle mass in older inpatients

Akazawa

Kishi

Hino

et al. 2021

J cachexia sarcopenia muscle

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Altered features of body composition in older adults with type 2 diabetes and prediabetes compared with matched controls

Bell

Paris

Avrutin

et al. 2022

J cachexia sarcopenia muscle

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Background Ageing is accompanied by muscle loss and fat gain, which may elevate the risk of type 2 diabetes (T2D). However, there is a paucity of data on the distribution of regional lean and fat tissue in older adults with T2D or prediabetes compared with healthy controls. The objective of this study was to compare regional body composition [by dual‐energy x‐ray absorptiometry (DXA)], muscle and subcutaneous adipose tissue (SAT) thicknesses (by ultrasound), and ultrasound‐based muscle texture features in older adults with T2D or prediabetes compared with normoglycaemic controls. Methods Eighteen adults > 60 years with T2D or prediabetes (T2D group) were individually matched to normoglycaemic participants [healthy matched (HM) group] for age (±5 years), sex, and body fat (±2.5%). In a single study visit, all participants received a whole‐body DXA scan and ultrasound assessment of the abdomen and anterior thigh. At these two landmarks, we used ultrasound to measure muscle and SAT thickness, as well as texture features of the rectus femoris and rectus abdominis. We also conducted an exploratory subanalysis on a subset of participants (n = 14/18 in the T2D group and n = 10/18 in the HM group) who underwent additional assessments including strength testing of the knee extensors (using a Biodex dynamometer), and a fasting blood sample for the measurement of circulating markers of glucose metabolism [glucose, insulin, c‐peptide, and the homoeostatic model assessment of insulin resistance (HOMA‐IR)]. Results The T2D group was 72 ± 8 years old (mean ± SD), predominantly male (n = 15/18; 83%), and overweight (BMI: 27.8 ± 4.2 kg/m2, 33.2 ± 5.3% body fat). DXA‐derived upper arm lean mass was 0.4 kg greater (P = 0.034), and leg fat mass was 1.4 kg lower (P = 0.048), in the T2D vs. HM group. Ultrasound‐based texture features were distinct between the groups [rectus abdominis blob size: 0.07 ± 0.06 vs. 0.30 ± 0.43 cm2, P = 0.045; rectus femoris local binary pattern (LBP) entropy: 4.65 ± 0.05 vs. 4.59 ± 0.08 A.U., P = 0.007]. When all participants who underwent additional assessments were pooled (n = 24), we observed that certain ultrasound‐based muscle texture features correlated significantly with muscle strength (rectus abdominis histogram skew vs. power during an isokinetic contraction at 60°/s: r = 0.601, P = 0.003) and insulin resistance (rectus femoris LBP entropy vs. HOMA‐IR: r = 0.419, P = 0.042). Conclusions Our findings suggest a novel body composition phenotype specific to older adults with T2D or prediabetes. We are also the first to report that ultrasound‐based texture features correspond with functional outcomes. Future larger scale studies are needed to uncover the mechanisms underpinning these regional body composition differences.

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Association of medial gastrocnemius adiposity with poststroke severe malnutrition and functional performance of activities of daily living in older patients: A prospective analysis

et al. 2022

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Background: Relationships among medial gastrocnemius intramuscular adipose tissue, nutrition status, and functional outcomes of patients after a stroke are unknown. This study was conducted to determine the relationship between nutrition status and gastrocnemius intramuscular adipose tissue and whether medial gastrocnemius intramuscular adipose tissue affects functional outcomes of older patients after a stroke.Methods: This prospective cohort study included 217 patients with stroke. Nutrition status was evaluated by the Global Leadership Initiative on Malnutrition. The medial gastrocnemius intramuscular adipose tissue was assessed using ultrasound echographic intensity. Multivariate linear regression analysis was used to determine the relationship between nutrition status at admission and medial gastrocnemius intramuscular adipose tissue. Furthermore, we examined the influence of medial gastrocnemius intramuscular adipose tissue on the Functional Independence Measure (FIM)-motor score at discharge and FIM-motor efficiency, which indicates FIM-motor changes during the hospital stay.Results: Severe malnutrition had a positive influence on medial gastrocnemius intramuscular adipose tissue on the nonparalyzed side (β = 0.175; P = 0.044). Additionally, the medial gastrocnemius intramuscular adipose tissue on the nonparalyzed side was negatively correlated with the FIM-motor score at discharge (β = −0.102; P = 0.005) and FIM-motor efficiency (β = −0.273; P = 0.005).

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Increased intramuscular adipose tissue of the quadriceps is more strongly related to declines in ADL than is loss of muscle mass in older inpatients

Cited by 26 publications

References 68 publications

Intramuscular adipose tissue in the quadriceps is more strongly related to recovery of activities of daily living than muscle mass in older inpatients

Intramuscular adipose tissue in the quadriceps is more strongly related to recovery of activities of daily living than muscle mass in older inpatients

Altered features of body composition in older adults with type 2 diabetes and prediabetes compared with matched controls

Association of medial gastrocnemius adiposity with poststroke severe malnutrition and functional performance of activities of daily living in older patients: A prospective analysis

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