Quantitative features of intramuscular adipose tissue of the quadriceps and their association with gait independence in older inpatients: A cross-sectional study

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

doi:10.1016/j.nut.2019.110600

Cited by 23 publications

(75 citation statements)

References 40 publications

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“…In addition, the present study revealed that the quadriceps MT in the paretic limb was a predictor of gait independence [9] because MT in the paretic limb is known to reflect the MVC force of knee extension [7]. The muscle EI, as an index of the ratio of adipose tissues [15][16][17], is also associated with the MVC force and other physical functions such as maximal gait speed and sitting-to-standing time in healthy middle-aged and older adults and/or patients [7,12,18,[25][26][27][28]. These previous studies suggest that an increased ratio of adipose tissues in skeletal muscle decreases physical function.…”

Section: Relationships Of Quadriceps Mt and Ei Of The Paretic Limb Wimentioning

confidence: 69%

“…These parameters, measured by US, are correlated with MVC strength [12] in healthy subjects and chronic stroke survivors [7]. In these reports, it has been shown that stroke survivors and older inpatients with smaller MT and higher EI of the quadriceps femoris need assistance for gait [9,18]. One study reported that MT of both limbs in nonindependent walkers after hemiparetic stroke (with an average Fugl-Meyer lower extremity assessment score of 21.8) was approximately 20-30% smaller than that in healthy subjects [9].…”

Section: Introductionmentioning

confidence: 97%

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Quadriceps Thickness and Echo Intensity Predict Gait Independence in Individuals with Severe and Mild Hemiparetic Stroke

Maeda

Imada²,

Ishida

et al. 2020

Eur Neurol

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Introduction: Smaller muscle size and higher adipose tissue ratio of the quadriceps femoris are often observed after stroke. However, it is unclear whether muscle size and the intramuscular fat ratio of the quadriceps measured with ultrasonography (US) reflect gait independence in individuals with mild or severe hemiparetic stroke. Objective: The present study was performed to examine the relationships of gait independence with muscle thickness (MT) and echo intensity (EI) of the quadriceps femoris in individuals with hemiparesis after stroke. Methods: We examined 43 individuals with hemiparetic stroke. We assessed functional independence measure (FIM) gait scores and measured thickness and EI of the quadriceps using US. The relationships of FIM gait scores with MT and EI were examined using Spearman’s correlation coefficients in mild (n = 21) and severe (n = 22) hemiparetic stroke groups. Results: In the mild hemiparetic group, FIM gait scores were correlated with paretic limb MT (rho = 0.60, p < 0.01) and EI (rho = −0.57, p < 0.01). In the severe hemiparetic group, FIM gait scores were correlated with paretic limb MT (rho = 0.67, p < 0.01) and EI (rho = −0.43, p < 0.05), as well as non-paretic limb MT (rho = 0.86, p < 0.01) and EI (rho = −0.56, p < 0.01). Conclusions: Quadriceps thickness and EI were associated with the degree of gait independence. Atrophy and increased intramuscular fat of the quadriceps may be limiting factors for achieving gait independence.

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Section: Relationships Of Quadriceps Mt and Ei Of The Paretic Limb Wimentioning

confidence: 69%

Section: Introductionmentioning

confidence: 97%

Quadriceps Thickness and Echo Intensity Predict Gait Independence in Individuals with Severe and Mild Hemiparetic Stroke

Maeda

Imada²,

Ishida

et al. 2020

Eur Neurol

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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%

“…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%

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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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Longitudinal relationship between intramuscular adipose tissue of the quadriceps and activities of daily living in older inpatients

Akazawa

Kishi²,

Hino³

et al. 2021

J cachexia sarcopenia muscle

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Background The longitudinal relationship between intramuscular adipose tissue of the quadriceps and activities of daily living (ADL) in older inpatients remains unclear. This study aimed to examine whether decrease of intramuscular adipose tissue of the quadriceps in older inpatients is related to the recovery of ADL than increase of muscle mass. Methods This longitudinal study included 202 inpatients aged ≥65 years [median age: 83.0 (77.0–88.0), 56.4% female]. Recovery of ADL during hospital stay was assessed using the change in Barthel index (BI) score (i.e. BI score at discharge minus BI score at admission) and BI score at discharge. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed using echo intensity and muscle thickness on ultrasound images, respectively. Higher echo intensity indicates greater intramuscular adipose tissue. Multiple regression analysis was performed to identify the factors independently associated with the change in BI score and BI score at discharge. Changes in quadriceps echo intensity and thickness and subcutaneous fat thickness of the thigh, quadriceps echo intensity and thickness, and subcutaneous fat thickness of the thigh at admission, age, sex, days from onset disease, BI score at admission, and disease were set as independent variables. Results The means of the change in quadriceps echo intensity and thickness were −2.3 ± 15.7 and 0.1 ± 0.4 cm, respectively. The median of the change in BI score was 15.0 (0.0–30.0). The quadriceps echo intensity at discharge was significantly lower than at admission (P = 0.043). The quadriceps thickness (P = 0.004) and BI score at discharge (P < 0.001) were significantly higher than those at admission. Change in quadriceps echo intensity was independently and significantly associated with the change in BI score (β = −0.25, P = 0.006) and BI score at discharge (β = −0.18, P = 0.006). In contrast, change in quadriceps thickness was not independently and significantly associated with the change in BI score (β = 0.09, P = 0.244) and BI score at discharge (β = 0.06, P = 0.244). Conclusions Our study indicates that a decrease of intramuscular adipose tissue of the quadriceps is related to the recovery of ADL than an increase of muscle mass in older inpatients. Intramuscular adipose tissue of the quadriceps in older inpatients is considered to be a predictor for the recovery of ADL, and intervening for intramuscular adipose tissue may be important for improving ADL in older inpatients.

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Quantitative features of intramuscular adipose tissue of the quadriceps and their association with gait independence in older inpatients: A cross-sectional study

Cited by 23 publications

References 40 publications

Quadriceps Thickness and Echo Intensity Predict Gait Independence in Individuals with Severe and Mild Hemiparetic Stroke

Quadriceps Thickness and Echo Intensity Predict Gait Independence in Individuals with Severe and Mild Hemiparetic Stroke

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

Longitudinal relationship between intramuscular adipose tissue of the quadriceps and activities of daily living in older inpatients

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