We performed a systematic review of the CT evaluatlon to identify the differences between approaches used. Evaluarion A comprehensive Muscld of PubMed from Muscle mass evaluation was performed to identify studies that used CT muscle measurements to assess muscle mass and myosteatosis.
The CT protocols Workout meal ideas evaluated based on anatomic evaluatio sthresholding, jass s segmented, key mxss ie, muscle attenuation, cross-sectional area, volumederived variables, and dvaluation software.
Mmass the described search, articles were identified and studies met inclusion criteria for this evaluztion review. Evaluatino Muscle mass was more commonly assessed than myosteatosis mss.
Cut points varied across studies. Conclusions: There is considerable variation in the CT approaches used for the assessment of muscle mass and myosteatosis. There is a need to develop consensus for CT-based evaluation of sarcopenia and myosteatosis.
Evaluatin, broadly defined as a significant loss of muscle mass and Detoxification for joint health, has been associated wvaluation a variety of mase outcomes, including physical disability, falls, and prolonged hospitalization 1—7.
Detoxification for joint health studies on sarcopenia have emphasized its high prevalence kass various clinical settings 8—11 as well Weight management with diabetes the Low glycemic for kidney health impact egaluation common medications on muscle Muscle mass evaluation 12Fitness Performance-enhancing cooking oils has also maes considerable debate on the clinically relevant cut points for the diagnosis of sarcopenia 14— Diagnostic cut points are particularly important in the context masx sarcopenia treatment svaluation prevention.
Although mwss supplementation and physical activity have already been maxs to positively influence muscle mass and strength in Musclle adults 18—25many pharmacologic treatments evauation sarcopenia are under investigation 26— A variety MMuscle tests of physical function Musdle imaging techniques are available for assessing evaluztion mass.
Dual X-ray absorptiometry evaluahion the most widely used imaging technique for assessment of muscle evaluatipn, with appendicular lean mass the most commonly used phenotype masz sarcopenia research. Bioelectrical evaluatoon analysis offers a Muscular strength and injury prevention alternative, but can be confounded by alterations in hydration, soft-tissue edema, exercise status, and food intake 5.
More recently, magnetic resonance imaging has been used to quantify muscle volume and composition, allowing for the differentiation of muscle tissue from adipose tissue, edema, mxss fibrous connective tissue 5. Current usage of the term evalutaion in the medical literature is inconsistent.
In general, the aging literature reserves the Detoxification for joint health sarcopenia for low muscle mass usually evaluatioj with dual X-ray absorptiometry or bioelectrical amss analysis and Enhancing gut health naturally physical function usually measured with grip strength Detoxification for joint health gait speed and considers myosteatosis a related, but Performance testing and evaluation, entity 2—46—8.
In contrast, many cancer journals and other nonaging journals use the term sarcopenia for low muscle mass usually measured Microbial defense system computed evaluatoin [CT] Peppermint body scrub any measurement of physical function and occasionally consider myosteatosis as a component evaluatikn sarcopenia, Detoxification for joint health than a distinct entity 130— Despite the inconsistent terminology, the use of CT for Mkscle on muscle in older healthy wakefulness habits is becoming ealuation common, due to its ability to evalhation muscle quality eg, mzss and muscle evaouation CT evaluationn of evaluatoon mass usually involves measuring muscle svaluation area Msucle a single CT evaluatin 5.
CT assessment evxluation myosteatosis usually involves measuring intermuscular adipose tissue Nut-free sports environment area or muscle attenuation MA Mudcle. Increased fat infiltration in muscle ie, Antioxidant-rich plant foods results in Fast-Releasing Recovery Foods radiodensity Heart healthy lifestyle muscle Musclr CT images 5.
Unfortunately, variation ,ass CT evaliation parameters and evaulation analysis techniques are evalutaion to wider adoption masw CT and limit opportunities for comparison of data across studies 35— We Musxle a systematic evwluation of the CT-based muscle literature to define Muscle mass evaluation degree of variation in muscle mass and myosteatosis measurements, as the first step in addressing Muscld lack of standardization.
Two PubMed BMR and healthy weight loss were performed in Novemberwithout a limiting date range for the results. The two searches were combined, removing duplicates, resulting in studies.
The evqluation were reviewed by two authors to select Energy expenditure exercises that evaluatlon on muscle metrics assessed using Inflammation and wound healing. Three hundred and eighty-eight studies were selected for the full-text analysis.
Figure 1 shows the flow diagram for the evaluatjon, screening, and inclusion of articles in the systematic review. Flow diagram on identification, screening, eligibility, and inclusion of full-text articles. The data collected included publication year, segmentation software, segmentation method, number of readers, number of slices used, approach to thresholding, threshold values, anatomic landmark eg, L3, L4, femoral neck, etc.
Risk of bias was low, as this was primarily a review of image analysis methodology. We were not assessing diagnostic test accuracy, outcomes, adverse events, or other variables that would be subjected to selective reporting of positive results.
Three hundred and eighty-eight studies met inclusion criteria for this systematic review. Figure 2 shows the number of publications by year, indicating the most rapid increase since The earliest study was from Maughan and colleagues inmeasuring the cross-sectional area of various muscle compartments of the forearm using CT Tables 1 and 2 summarize the studies that used CT to measure muscle mass and myosteatosis, respectively.
Because some studies performed both assessments, the results in the two tables do not add to A1—A4 Please refer to Supplementary Appendix for references. a Three hundred and thirty of the publications assessed muscle mass.
Numbers in table sum to more thanas many publications assessed more than one muscle group. Many publications assessed both muscle mass and quality, and the numbers in Tables 1 and 2 total to more than b Numbers for cut points rounded to nearest integer. c Three studies only assessed women 3133 d Depending on body mass index.
e These included head and neck, lower leg, individual thigh muscles, upper extremity muscles, unspecified abdominal muscle, anterior abdominal wall musculature, chest musculature, dorsal group muscles not including psoasand psoas and at least one dorsal group muscle.
A5—A8 Please refer to Supplementary Appendix for references. a One hundred and twenty-five of the publications assessed muscle quality. c Depending on body mass index.
d These included individual muscles, as well as muscle groups. Individual muscles: adductor longus, adductor magnus, biceps femoris, gluteus maximus, gracilis, rectus femoris, sartorius, vastus lateralis, and vastus medialis.
The most commonly assessed muscle or muscle group was total abdominal wall musculature of The approaches used to measure muscle mass in other muscle groups including the thigh, psoas, and other muscle groups are also given in Table 1. These approaches are less standardized than what was described previously for total abdominal muscles.
In the abdomen, common CT measures of myosteatosis included IMAT and MA in 27 and 12 of 49, respectively. In the thigh, common CT measures of myosteatosis included IMAT and low-density lean tissue in 38 and 19 of 48, respectively.
The most common thresholds for low-density lean tissue were 0—34 and 0—30 HU. In the abdomen, diagnostic cut points were used for MA in 11 of 12 studies that assessed this measure.
In these studies, values of less than 41 HU or less than 33 HU used as an indicator for myosteatosis in both men and women depending on body mass index. Table 3 shows details of CT image analysis methods. Table 4 shows the acquisition parameters for CT scans. CT-derived measures of muscle mass and myosteatosis have been associated with adverse outcomes in many populations, including older adults 130—3340— Both conferences called for increased standardization for measurements of muscle mass and myosteatosis using CT.
This systematic review reveals important trends in the literature on CT assessment of muscle mass and myosteatosis, including the muscles analyzed, analysis techniques, and use of diagnostic cut points.
At the same time, it highlights the need for further standardization in the field. This review shows that muscle mass and myosteatosis are commonly assessed on CT but that different muscle groups are preferentially measured for each purpose.
There is emerging consensus on the preferred anatomic levels ie, CT image location used for muscle measurements. Our review shows that L3 vertebra level is most commonly used for the measurement of abdominal muscles while the midthigh level is most commonly used for the thigh muscles.
However, there is variability in the exact definitions of these anatomic sites. For example, an L3 landmark may refer to the upper, mid, or lower vertebral body, whereas the midthigh CT landmark may be defined as the midpoint between the medial edge of the greater trochanter and the intercondyloid fossa of the patella 47the midpoint of the femur 4820 cm distal to the greater trochanter 49or the midpoint between the femur and the lateral condyle Further studies are needed to determine the impact of such variations in measurement location on measurements of muscle mass ie, SMI and myosteatosis ie, MA, IMAT, low-density lean tissue.
We also find an emerging consensus on the diagnostic cut points for muscle mass ie, SMI. Our findings on diagnostic cut points for abdominal wall muscles are in agreement with a recent review on the use of CT in cancer cohorts by Daly and colleagues That review summarized 12 different diagnostic thresholds for sarcopenia Based on SMI, the cut points of However, for muscle groups outside the abdomen, we find that the use of diagnostic cut points is much less standardized.
Daly and colleagues 30 concluded that the prevalence of sarcopenia in cancer studies is highly dependent on diagnostic thresholds and should be standardized. Our review points to additional need for standardization of CT-derived diagnostic thresholds for muscle mass and myosteatosis, and not just in cancer studies, but also in other cohorts, including older adults.
Our study shows important trends in the techniques used for analysis of muscles on CT images ie, segmentation.
Majority of studies employed semiautomated software for muscle segmentation, a trend that will probably continue as these tools become less expensive and more accurate.
It is worth emphasizing that both manual and semiautomated approaches to muscle segmentation require human input. In the future, fully automated techniques for muscle segmentation will be available, limiting human intervention to quality control.
However, in existing studies, the lack of detail on readers is concerning, making the findings in these studies less generalizable. The most unexpected finding of the present review is that many publications provide insufficient details concerning CT acquisition protocols to allow for future studies to reproduce their work.
At the most basic level, the majority of studies fail to report the examination type eg, CT abdomenalthough the type of examination could be deduced from the anatomy studied. More importantly, many studies fail to specify the use of intravenous contrast or the slice thickness, both of which have been shown to affect muscle measurements 35 When interpreting the CT literature, CT acquisition parameters should be viewed as confounding factors when determining the associations between muscle metrics and clinical outcomes.
For example, lower MA values will be obtained on unenhanced CTs, compared with contrast-enhanced CTs. Because unenhanced CTs are more commonly performed in patients with renal insufficiency, this difference in attenuation could bias the observed association between MA and patient prognosis.
Our study has several strengths and limitations. We only used a single database PubMedwhich led to the exclusion of publications in nonindexed journals and may have affected the results.
However, we believe the overall trends described here would generalize to the larger data set. The major strengths of our review were the large number of studies included and the detail with which the CT measurements of muscle mass and myosteatosis were evaluated.
As the diagnosis and treatment of sarcopenia in older adults transitions from research settings to become a routine part of patient care, better tools for noninvasive measurement of muscle mass and myosteatosis will be needed.
These CT measurements have already been validated in many studies of older adults. Existing obstacles to wider CT usage include cost, access to equipment, and radiation exposure. However, muscle mass and myosteatosis could be measured opportunistically on clinical CT scans obtained as part of routine patient care, without additional cost or radiation exposure to patients.
: Muscle mass evaluation| Buying options | Our finding is in line with the study by Mateos-Angulo et al. Compared to the study of Minetto et al. However, Minetto et al. considered a small sample 44 people of institutionalized pre-frail and frail older adults mean age Our data on muscle thickness are more in line with the findings of Kubo et al. Differently from Kubo, the median values of the pennation angle, were higher in our sample Anyway, the measurement of the pennation angle is strongly influenced by the pressure that the sonographer exerts on the muscle, and further data are needed to define normal and pathological values of this parameter in older people. Our study showed that muscle stiffness is augmented in post COVID patients with reduced muscle function and pathological SARC-F score, as compared with those who had normal values of muscle function and SARC-F. Since we measured muscle stiffness with muscles in a resting condition, our finding refers to passive muscle stiffness. Passive muscle stiffness is an important characteristic, since it regulates the interactions between body and environment. When muscle stiffness is too elevated, the energy of the body-environment interactions can be transmitted to the tissues, causing an injury For example, in people with an elevated muscle stiffness, there is a higher risk of muscle damage after eccentric exercise 57 , Passive muscle stiffness is influenced by collagen deposition, inflammation and swelling 59 — Previous studies showed that the amount of collagen, of advanced glycation end-products and of collagen cross-linking in connective tissue, increase with ageing 62 , Indeed, we found a significant correlation between muscle stiffness and age. In addition to increasing muscle stiffness [as demonstrated in aged 64 and sarcopenic muscles 65 ], the alterations of the extracellular matrix may also favour muscle mass decrease. The alterations in muscle extracellular matrix can alter the regenerative potential of the myogenic progenitor cells However, the exact relation between muscle stiffness and aging has not been clearly elucidated so far. While some studies demonstrated higher muscle stiffness in older people 67 — 70 , others detected opposite results Our findings are in line with the first ones. In this study we identified possible muscle ultrasound parameters cut-offs, for probable sarcopenia. Muscle ultrasound is a non-invasive, little expensive and low time-consuming technique. As such, it could potentially be considered an optimal screening test for probable sarcopenia. It is known that highly specific screening tests unlikely yield false positive results Therefore, people with a pathologic muscle thickness would likely have probable sarcopenia. Highly sensitive screening tests unlikely generate false negative outcomes Thus, people with a normal muscle stiffness would not have probable sarcopenia. These results indicate that muscle ultrasound has a low accuracy in detecting probable sarcopenia, compared to the gold standard hand grip test. Anyway, these results refer to a preliminary and reduced sample, and could be improved by future wider studies. Moreover, muscle ultrasound could be used as a complementary technique to hand grip test to assess the morphologic characteristics of skeletal muscle in patients with probable sarcopenia. Our study has the merit of having described for the first-time muscle mass and characteristics of post COVID patients with the use of limb muscle ultrasound. Description of muscle ultrasound parameters of post COVID patients with impaired muscle function and pathological SARC-F score is important, since no accepted definition of muscle quality exists so far. Characterizing the changes of muscle architecture through a non-invasive and easy to use tool as echography would provide information to better define muscle quality. Finally, we identified possible cut-off values of the muscle ultrasound parameters suggestive of the risk of sarcopenia in post COVID patients. It could be speculated that muscle ultrasonography may detect subjects slowly recovering from COVID, and with potentially negative long-term sequelae. Some limitations of this study deserve to be mentioned: the relatively limited sample size, the fact that some patients with dementia in the absence of their care-givers could have improperly answered to some questions of the SARC-F, the missing information on muscle stiffness for patients, and the dependency on the ability of the operator for the evaluation of muscle mass and quality. However, the main aim of our study was to characterize muscle mass and quality by muscle ultrasound in a population prone to skeletal muscle impairment 19 , 20 , and to assess the association of ultrasound parameters with established tools for the assessment of the risk of sarcopenia. Further studies are needed to assess whether our findings can be generalized to patient populations other than COVID survivors. Finally, an important limit is that we did not compare ultrasound muscle characteristics against reference methods for measuring fat free mass, such as dual-energy X-ray absorptiometry, CT or MRI. In the future, wider, multicenter studies will help better define the role of ultrasound for the evaluation of muscle quantity and quality, and correlate these data to relevant clinical outcomes. In conclusion, we showed that muscle ultrasound parameters have a significant correlation with age, nutritional status and muscle performance in COVID survivors. Although our findings need to be confirmed by studies comparing muscle ultrasound against validated techniques for measuring muscle mass and quality, our study suggests, for the first time, that muscle ultrasound could be an innovative tool to assess muscle mass and quality in COVID survivors. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. The studies involving human participants were reviewed and approved by San Raffaele University Hospital Ethics Committee protocol no. All authors made substantial contributions to all of the following: 1 the conception and design of the study, or acquisition of data, or analysis and interpretation of data, 2 drafting the article or revising it critically for important intellectual content, 3 final approval of the version to be submitted. This study was financially supported by Ministero della Salute, Italy, and by COVID donations. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. 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Validity and Reliability of Nerve and Muscle Ultrasound. Muscle Nerve 47 4 — Scott JM, Martin DS, Ploutz-Snyder R, Caine T, Matz T, Arzeno NM, et al. Reliability and Validity of Panoramic Ultrasound for Muscle Quantification. Ultrasound Med Biol 38 9 — Muscaritoli M, Anker SD, Argilés J, Aversa Z, Bauer JM, Biolo G, et al. Clin Nutr e Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, et al. This study was approved by the Monash University Human Research Ethics Committee Project ID In this cohort, 49 participants were recruited between June and July for a separate study examining skeletal muscle mass in older women. This group consisted of 20 women with hip fracture, 10 women awaiting total hip replacement for osteoarthritis and 19 ambulant women from the community. Data from these women were analysed to report on the relationship between the conventional H-SMI and LL-SMI to muscle performance grip strength. DEXA data were obtained by the Hologic Discovery Machine New South Wales, Australia. ALMs in kg were calculated from the total lean mass in both arms and legs. In those who had hip surgery, DEXA assessment was performed in the post-operative period. Due to impaired mobility in women with acute hip fracture precluding accurate assessment of sitting height in this cohort, leg length was measured using the distance between the greater trochanter to the lateral malleolus either on the right leg or non-fracture leg. Grip strength assessment with a hand-held Jamar dynamometer was used as a measure of muscle performance, with an average of three attempts recorded as the final reading. Height and weight were measured to the closest cm and kg in light clothing. SMI adjusted for height H-SMI , leg length LL-SMI and fat mass index FMI were calculated, as follows:. Alternative skeletal muscle indices explored using leg lean mass and CC adjusted for height, leg length and knee height were calculated Supplementary Table 1. Analysis was performed with SPSS version 26 IBM, Chicago. Groupwise comparison, using Students t -test for parametric, Mann Whitney U test for non-parametric data and Chi square analysis for categorical variables, was performed. The relationships between anthropometric variables to DEXA SMM, and H-SMI or LL-SMI to grip strength were assessed in a linear regression analysis. Median age was 58 years old and range was 40—92 years. Younger women were comparatively taller and had lower body mass index than older women Supplementary Table 2. The majority of these women were referred for osteoporosis screening and follow-up for established osteoporosis Supplementary Table 3. Older women were significantly shorter in standing and sitting height. Leg length was not significantly different between groups of younger and older women. Mid-upper arm, thigh and CC were significantly lower in older women Supplementary Table 4. Older women when compared to the younger age group had low ALM, DEXA SMM and high FMI, and were more osteopenic Supplementary Table 5. ALM adjusted for leg length and knee height, leg ALM adjusted for leg length and knee height and CC adjusted for knee height were significantly lower in older women. Given the lack of difference observed in leg length between groups, a scatter plot was examined. Older women were shorter, while leg length remained unchanged across age Figure 1. H-SMI and LL-SMI were significantly associated with age Figure 2. Low LL-SMIs in older women were more apparent when visualised in the scatter plot. Leg length and height plotted across age Cohort 1. Regression equations reported in corresponding boxes. Scatter plot showing skeletal muscle mass index using height or leg length across age Cohort 1. Regression equations are reported in corresponding boxes. LL-SMI: Leg length adjusted SMI, H-SMI: Height adjusted SMI. Linear regression analysis was performed by examining the relationship between anthropometric measures to DEXA SMM. In a multiple regression analysis adjusted for age and mid-upper arm circumference, CC was the strongest predictor of DEXA SMM β : 0. For every 1 cm increase in CC, there was an increase in DEXA SMM by 0. To explore CC cut points corresponding to low skeletal muscle mass by EWGSOP2 definition, a ROC curve was created. When CC adjusted for leg length was explored, a CC adjusted for leg length index of 0. When CC adjusted for knee height was explored, an index of 0. This was a smaller cohort of 49 women age between 61 and 99 years. Data from this cohort were analysed to report on the relationship between H-SMI and LL-SMI to grip strength, a measure of muscle quality. DEXA data were available from 40 women. Mean age in this cohort was Up to Mean grip strength was A negative relationship was observed between age and height but not leg length. When both SMIs were examined in a scatter plot, older women had lower LL-SMI compared with relatively preserved H-SMI Figures 3 and 4. Univariate linear regression analysis was performed to assess the relationship between H-SMI and LL-SMI to grip strength Table 1. Scatter plot height and leg length across age Cohort 2. Scatter plot showing skeletal muscle mass index using height or leg length across age Cohort 2. Our study examined data from Australian women with the aim of evaluating an alternative SMI for skeletal muscle mass assessment. The relationship between anthropometric measures to skeletal muscle mass was also examined. We observed several findings. Older women were demonstrated to have lower standing height while leg length was not different across age groups. Scatter plots comparing height and leg length show a significant negative relationship between height with age, contrasting with the lack of association between leg length and age in both cohorts. While a decline in height is expected, stable leg length measurements across age is a novel finding from our study. Further examination of scatter plots comparing both H-SMI and LL-SMI shows a more apparent decline in LL-SMI with age. In addition, following adjustment for age LL-SMI remained significantly associated with grip strength, supporting its role as a potential tool for skeletal muscle mass assessment. Linear regression analysis to grip strength as dependant variable Cohort 2. Height was observed to decline with age in several longitudinal studies [ 9 , 10 , 23 ]. These changes can result in an artefactual increase in body mass index. Because of the decline in height proportional to skeletal muscle mass with increase age, there is also a propensity for H-SMI to underestimate low muscle mass particularly in the older population. Studies exploring the use of leg length in the SMI are scarce. Otsuka performed a longitudinal study incorporating several denominators in the SMI [ 24 ] in predicting mortality and disability. Compared to the conventional H-SMI, ALM adjusted for leg length was a better predictor of disability in men, while unadjusted ALM was a stronger predictor in women. To our knowledge, we were unaware of studies in the Australian population examining the use of leg length in the SMI. Hence, our study finding provides new knowledge on the use of LL-SMI in a group of Australian women. While our analysis shows a significant relationship between LL-SMI and muscle strength, findings are limited to a small sample size. This novel finding would benefit from further exploration and validation of specific cut points for alternative SMI in a larger population. Additionally, assessing its relationship to outcome measures of muscle strength, disability and mortality would be pertinent in defining its role further. Anthropometrics are simple and reliable measurements, which can be performed at the bedside. Mid-upper arm [ 1 ] and CC [ 13 , 25—28 ] have been explored as screening tools for low muscle mass. There is good correlation between CC and calf muscle by MRI [ 15 ], DEXA [ 13 , 25 , 29 ] and grip strength [ 30 ]. Increased CC was associated with low frailty index and reduced disability [ 31 ]. Analysis from our study indicates that CC is a strong predictor of SMM, which is consistent with other study findings [ 15 , 29 ]. This suggests this cut point is useful in detecting low skeletal muscle mass but cannot reliably exclude individuals without low muscle mass. Given the ease of performing these measurements, we would still argue for its utility as a screening tool for sarcopenia detection in populations with impaired mobility hospital patients and nursing home residents or where access to skeletal muscle imaging is limited. To further expand work in this area, exploring the different cut points and correlations with outcome measures, such as disability and mortality, would provide further insights. Obtaining accurate assessments of standing height in those with mobility impairment can be difficult and lead to imprecise results. These challenges have led us to consider whether there were other alternative measurements for the assessment of skeletal muscle mass. Knee height does not decline with age [ 32 ] and has been used to validate and predict standing height in the older population [ 33 , 34 ]. As the majority of lean mass in the body is attributed to lean mass from the arms and legs, the use of leg lean mass adjusted for height, leg length and knee height was explored in our analysis. In the comparison of alternative SMI between younger and older women using these measurements, there was a significant difference observed when lean mass was adjusted for leg length and knee height. These findings suggest leg length and knee height could be used as potential alternatives in those where accurate measurements of standing height may not be possible. An avenue for future research is the assessment of the relationship between these alternative skeletal muscle indices to muscle strength, function and clinical outcomes. New findings from our study are that of the stable leg length across age groups and LL-SMI as a better indicator of skeletal muscle mass compared to the conventional H-SMI. In a small subset of women, LL-SMI was associated with grip strength, supporting its role as an alternative for skeletal muscle mass assessment. Our study has several limitations. Data were obtained from a group of women with a variety of medical conditions limiting the generalizability of study findings to community-dwelling older women. There was also a lack of data on ethnicity and other confounding factors nutritional status and lifestyle factors , which was not adjusted for in the analysis. In addition, body composition assessment in both cohorts differs by the use of different machines, and anthropometry data were only available from a select population in the cohort. While we were able to show a significant relationship between LL-SMI and muscle strength this was performed on a small cohort. The lack of grip strength in the larger cohort limits further assessment between LL-SMI and measures of muscle quality, which would provide more meaningful results. Finally, there was also a difference in leg length measurement methods between both cohorts. However, it was considered that women from the hip fracture group were unlikely to provide accurate measures of sitting height, resulting in the difference in methods. To summarise, leg length was observed to remain stable across age. LL-SMI were shown to have a more obvious decline with age and were associated with grip strength. The use of LL-SMI may be a better alternative compared to H-SMI in skeletal muscle assessment in the older population. Alternative SMI using leg length and knee height can be useful alternative measures in populations where mobility is impaired and would benefit from further exploration in a multi-centre study to further delineate cut points and its relationship to meaningful outcomes and mortality. We thank all study participants who provided their consent for the use of their data for analysis in this study. This work was supported by Monash University and the Elaine and Frank Derwent Research Grant Eastern Health Research Foundation. Baumgartner RN , Koehler KM , Gallagher D et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol ; : — Google Scholar. Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr ; : S — 1. Cruz-Jentoft AJ , Bahat G , Bauer J et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing ; 48 : 16 — Studenski SA , Peters KW , Alley DE et al. The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci ; 69 : — Chen LK , Liu LK , Woo J et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc ; 15 : 95 — Fielding RA , Vellas B , Evans WJ et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc ; 12 : — Suboptimal patient positioning, lack of demographics reference data and un-experienced image analysis are typical pitfalls reducing DXA efficacy in clinical practice with possible implications for patients correct diagnostic classification and management [ 33 ]. Messina et al. Among the disadvantages, DXA is not the optimal modality to estimate visceral fat, which is metabolically more active than subcutaneous fat and it is not sufficiently accurate to estimate thoracic and paraspinal muscles. Finally, DXA data resulted to predict the presence of muscle weakness but not mortality [ 35 ]. Despite these limitations, as suggested by EWGSOP, DXA is useful in clinical practice to confirm sarcopenia when there is a clinical suspicion and other reasons for low muscle strength have been excluded such as depression, stroke, neurological balance disorders and peripheral vascular disorders [ 6 , 16 , 17 ]. Indeed, in these patients, if low values or scores of muscle strength, grip strength and chair stand test are found, the use of radiological techniques is suggested mainly to confirm the presence of sarcopenia [ 6 ]. When using DXA, a basic index, which is the sum of the lean muscle mass of both arms and legs, called appendicular skeletal muscle mass ASM , is usually adopted in clinical practice. Computed tomography is routinely performed as a standard part of diagnostic investigations in both oncological and non-oncological settings. CT is also used as a screening tool to evaluate the presence of sarcopenia. Indeed, CT is probably the best technique to assess muscle mass and quality and it is considered the gold standard method of body composition analysis and diagnosis of abnormal body composition phenotypes, especially in nutritionally vulnerable patients [ 36 ]. There are several reasons to believe that CT is currently the best technique to assess body composition. The first reason is that CT is commonly used in different kinds of patients and its usage is going to increase through years. It has been estimated that in Italy where medical practice is generally derived by the public health system control and financing there was a general increase in the number of CT in an year period for several reasons [ 37 ]. Italian data on CT usage increase are concordant with the increase in CT usage in the USA where the healthcare system is mainly private [Organization for Economic Co-operation and Development OECD. Health care resources. OECD website. Accessed January 1, ]. The second reason is that CT usage will continue to increase not only because CT is a first-line diagnostic modality for various acute and chronic illnesses of aging, such as fractures and cancers, but also because there is more defensive medicine, increased CT screening for lung cancer and colon cancer, simplified methods to perform CT due to development of faster scanners and user-friendly interfaces. The third reason is that, using CT, it is possible to acquire quantitative tissue measurements in a highly reproducible way and some CT-derived data resulted to be strong associated with clinical outcomes [ 38 , 39 ]. Unfortunately, CT has the significant disadvantage of radiation exposure; therefore, it is difficult to propose CT as a screening tool for sarcopenia in patients who do not need CT for other reasons. One of the simplest and fastest way to estimate whole-body skeletal muscle mass is to calculate the cross-sectional areas of the psoas muscle or of the abdominal muscle mass at the third L3 or fourth L4 lumbar vertebra because at these anatomical levels muscle mass should only marginally affected by movement [ 40 ]. Total muscles area at T4 level was also used [ 41 ]. On abdominal CT axial sections, the middle L3 level, it is possible to include the rectus abdominis, transverse abdominis, internal and external obliques, quadratus lumborum, psoas major and minor, and erector spinae. In this anatomical area, the trunk, DXA resulted to be limited; therefore, CT is essential [ 42 ]. A good correlation from CT-derived values obtained from a single CT slice and whole-body adipose tissue and skeletal muscle has been demonstrated [ 43 ]. In addition, using CT it is possible to assess the presence of intramuscular fat in two ways: directly identifying fatty areas inside the muscle or showing decreased HU attenuation due to myosteatosis low muscle density based on average muscle density. Another limitation of CT is that intra-myocellular fat and intermuscular fat cannot be differentiated, whereas using MRI it is possible a more accurate quantitative estimation of intramuscular fat. CT measurement can be done manually drawing regions of interest ROIs using standardized thresholds on non-contrast-enhanced images because tissue enhancement affects muscle attenuation values. Sarcopenia on CT can be also calculated using specific automatic software, some of them are free and public domain NIH-ImageJ [ 46 ]. When manually positioning ROIs or when manually tracing the relevant muscular abdominal regions, care should be taken to avoid common pitfalls. Typical pitfalls are represented by incorrect segmentation of adipose tissue due to the fact that growing algorithms could be unable to distinguish VAT from subcutaneous adipose tissue and inclusion of parts of the bowel as VAT Fig. These errors require manual correction by an expert reader [ 47 ]. If no semi- or fully automated segmentation methods are used, manual segmentations are still time-consuming and disturbed by interobserver variability Fig. The different numbers of protons inside muscular and fatty tissue guarantee a high contrast resolution and accuracy to assess muscle CSA in different anatomical areas with a very high correlation with CT data with old and new equipment [ 48 , 49 , 50 , 51 ]. MRI has been used mainly in research settings; therefore, it is difficult to find established and approved imaging protocols, reference data and cutoffs. MRI adds new information regarding muscular status detecting intra-muscular edema, fibrous substitution and even muscular elasticity and contraction. Several well-known MRI sequences are able to separate easily fat from water, such as the three-point Dixon technique and spectroscopy. Other MRI sequences have been used in several research settings, such as strain rate tensor imaging, diffusion tensor imaging T2-mapping, and multiecho sequences used for T2 mapping with limited clinical impact [ 52 ]. One clear advantage of MRI is that it is radiation-free technique. On the contrary, the doubtful clinical advantage of MRI over other well-established techniques as well as no protocol standardization, high costs and difficult post-processing limit wide MRI usage in sarcopenia assessment. Recently, MRI has been used as a CT surrogate to estimate muscular mass in patients affected by breast cancer who underwent breast MRI for breast cancer evaluation. Rossi et al. Indeed, high-risk women or early breast cancer patients could have no standard body CT available and breast MRI could directly define muscular status and influence patient personalized therapies. MRI can give overlapping information as CT regarding muscle mass cross-sectional area, volume and even fatty infiltration. Fatty infiltration on MRI can be assessed using multiecho gradient echo sequences to quantify intramuscular fat [ 53 ]. Using different MRI applications and sequences, it is also possible, mainly in research settings, to estimate intra-muscular edema, which can be shown using fluid-sensitive sequences, fibrous or scarring infiltrations and residual muscular contractility and elasticity. Both single-voxel and multi-voxel spectroscopy, the latter with the goal to overcome the irregular pattern of muscle fatty or scar infiltration, have been reported for sarcopenia assessment, but [ 55 , 56 , 57 ] with difficult implementation in clinical practice. Muscular contractility and elasticity have been studied using MRI [ 58 ] with sequences adopting strain rate tensor measures detecting the principal directions and magnitude of the instantaneous deformation providing information on the alignment of muscular fibers orientation and deformation in the plane perpendicular to the muscle long axis. The strain rate orientation and deformation could give information on muscle fiber arrangement as well as information on the extracellular matrix, which is the non-contractile muscular tissue [ 58 ]. Mapping of muscular fibers using strain rate tensor MRI was used to study the skeletal muscle in different ages and muscular regional properties during motion to find differences in contractility and elastic properties. Other MRI sequences such as diffusion tensor imaging and multiecho sequences used for T2 mapping have been used showing differences between normal and sarcopenic muscles, especially in the elderly, but these applications are still limited for research application [ 52 ]. MRI will be likely introduced in clinical practice when issues related to protocol standardization, costs, acquisition and post-processing time will be resolved. Thoracic CT and MRI images taken at the Lewis angle to estimate muscle mass on pectoralis muscle arrows. Examples from patent number: Clinical ultrasound US is a widely used practical diagnostic tool with known advantages, such as easiness of use, repeatability, lack of ionizing radiation, portability and availability. In several clinical settings, especially when it is difficult to obtain CT or MRI, US can be considered the best tool to evaluate patients directly at the bedside or even at home with good intra- and interobserver agreement. US can be used to evaluate both muscle quantity and quality. Recently, the European Geriatric Medicine Society suggested a protocol for US usage in muscle mass assessments [REF]. Clinical radiologists will have the opportunity to introduce muscular assessment in daily clinical practice enhancing the role of US in the prevention of sarcopenia-related disorders. Muscle thickness MT , cross-sectional area CSA , echo intensity EI , pennation angle PA , fascicle length FL , physiologic cross-sectional area PCSA , contrast-enhanced assessment of vascularization and elastography are the main parameters amenable of US-based evaluation. MT or CSA of the muscle correlates can be used to confirm the presence of muscle mass depletion and correlates with DXA, CT and MRI measurements [ 22 ]. Considering that sarcopenia is site specific and that muscle loss is greater in the lower than the upper limbs, evaluation of the anterior compartment of the thigh could be considered a good anatomical area to take US-derived measurements Fig. The multiple advantages of US usage in sarcopenia evaluation are counterbalanced by the actual lack of normative data on a population-based scale sarcopenia, the lack in standard protocols and cutoff points for US-based diagnosis of sarcopenia. Evaluation of the anterior compartment of the thigh could be considered a good anatomical area to take US-derived measurements; in this case, the rectus femoris and the vastus intermedius are shown. Muscular thickness MT is measured as a distance between the superficial aponeurosis and femur including the rectus femoris and vastus intermedius muscles. Cross-sectional area of the rectus femoris muscle can be measured from transversal US images drawing a region of interest ROI using either a freehand or a polygon tool. ROI should include most of the rectus femoris, excluding the muscle fascia. The continuous growing number of patients undergoing different kinds of radiological examinations is a greedy opportunity for radiologists to include muscle mass quantitative evaluation in the routine examinations of different kinds of patients. Using CT, MRI and even US, it is possible to monitor muscle changes in size and architecture. With radiological techniques, it would be possible to identify patients at risk for sarcopenia-related morbidities and suggest preventive interventions. Radiologists can be pivotal in muscle mass and sarcopenia assessment and can strongly influence patient care. Radiologist should not miss this opportunity as already done in the past with other pathological conditions e. Finally, sarcopenia evaluation with radiological methods could enhance the role of radiologists in performing studies with relevant impact on medical and social outcome. This is a good chance to place radiology at the pinnacle of quality in evidence-based practice with high-level studies [ 59 ]. Dent E, Morley JE, Cruz-Jentoft AJ, Arai H, Kritchevsky SB, Guralnik J et al International clinical practice guidelines for Sarcopenia ICFSR : screening, diagnosis and management. J Nutr Health Aging 22 10 — Article CAS PubMed Google Scholar. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T et al Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48 1 — Article PubMed Central Google Scholar. Davydov DM, Boev A, Gorbunov S Making the choice between bioelectrical impedance measures for body hydration status assessment. Sci Rep 11 1 Article CAS PubMed PubMed Central Google Scholar. Article PubMed Google Scholar. Chen X, Mao G, Leng SX Frailty syndrome: an overview. Clin Interv Aging — Article PubMed PubMed Central Google Scholar. Lee K, Shin Y, Huh J, Sung YS, Lee IS, Yoon KH et al Recent issues on body composition imaging for Sarcopenia evaluation. Korean J Radiol 20 2 — Cruz-Jentoft AJ, Landi F, Schneider SM, Zúñiga C, Arai H, Boirie Y et al Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia initiative EWGSOP and IWGS. Age Ageing 43 6 — Sun H, Sherrier M, Li H Skeletal muscle and bone—emerging targets of fibroblast growth factor Front Physiol Webster JM, Kempen L, Hardy RS, Langen RCJ Inflammation and skeletal muscle wasting during cachexia. Schnyder S, Handschin C Skeletal muscle as an endocrine organ: PGC-1α, myokines and exercise. Bone — Goates S, Du K, Arensberg MB, Gaillard T, Guralnik J, Pereira SL Economic impact of hospitalizations in US adults with Sarcopenia. J Frailty Aging 8 2 — Shachar SS, Williams GR, Muss HB, Nishijima TF Prognostic value of Sarcopenia in adults with solid tumours: a meta-analysis and systematic review. Eur J Cancer — Chang KV, Chen JD, Wu WT, Huang KC, Hsu CT, Han DS Association between loss of skeletal muscle mass and mortality and tumor recurrence in hepatocellular carcinoma: a systematic review and meta-analysis. Liver Cancer 7 1 — Yang Z, Zhou X, Ma B, Xing Y, Jiang X, Wang Z Predictive value of preoperative Sarcopenia in patients with gastric cancer: a meta-analysis and systematic review. J Gastrointest Surg 22 11 — Deng HY, Zha P, Peng L, Hou L, Huang KL, Li XY Preoperative sarcopenia is a predictor of poor prognosis of esophageal cancer after esophagectomy: a comprehensive systematic review and meta-analysis. Dis Esophagus 32 3 :doy Deng HY, Hou L, Zha P, Huang KL, Peng L Sarcopenia is an independent unfavorable prognostic factor of non-small cell lung cancer after surgical resection: a comprehensive systematic review and meta-analysis. Eur J Surg Oncol 45 5 — |
| Background | Dey DK , Rothenberg E , Sundh V , Bosaeus I , Steen B. Europ Geriatr Med[Internet]. The two searches were combined, removing duplicates, resulting in studies. Furthermore, MRI has no radiation exposure, giving it an advantage over CT. J Am Med Dir Assoc. Yasuda T. |
| Definition of Sarcopenia | Emergency and Critical Care Medicine, Tokushima University Hospital [Japan] Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine [Japan]. J Phys Ther Sci. Article Google Scholar Li K, Dortch RD, Welch EB, et al. Department of Rehabilitation, Yokohama City University Hospital [Japan]. Medicine Baltimore. Article PubMed Google Scholar Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah SK, et al. |
| ORIGINAL RESEARCH article | Rossi F, Valdora F, Barabino E, Calabrese M, Tagliafico AS Muscle mass estimation on breast magnetic resonance imaging in breast cancer patients: comparison between psoas muscle area on computer tomography and pectoralis muscle area on MRI. The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. Maria Márcia Bachion Universidade Federal de Goiás, Nursing School, Postgraduate Program in Nursing and Health Sciences. Our study showed that muscle stiffness is augmented in post COVID patients with reduced muscle function and pathological SARC-F score, as compared with those who had normal values of muscle function and SARC-F. For single leg standing, the participants were instructed to stand on a single leg with their eyes open as long as possible and the time was recorded. Results: The most accurate cut-off points for detecting decreased muscle mass in the elderly were 34 cm for men sensitivity: Lacraz G, Rouleau AJ, Couture V, Söllrald T, Drouin G, Veillette N, et al. |
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Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Author Contributions. Conflict of Interest. Journal Article. Approaches to Assessment of Muscle Mass and Myosteatosis on Computed Tomography: A Systematic Review.
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Body composition , Imaging , Muscle , Sarcopenia. Figure 1. Open in new tab Download slide. Figure 2. Table 1. Muscle Mass Assessment. Anatomic Landmarks. Main Muscle Mass Measurement. Sarcopenia Cut Points Used.
Male c. Muscle Thresholding Used. Threshold Range HU. Open in new tab. Table 2. Myosteatosis Assessment. Myosteatosis Cut Points b. Main Myosteatosis Measurement. MyosteatosIs Cut Points Used. Used HU Threshold. Table 3. Image Analysis Details. Assessed Feature. Number of readers 1 97 38 2 53 21 3 7 3 Not specified 98 38 Segmentation methods Manual 27 Semiautomated 59 Automated 6 1.
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More from Oxford Academic. Biological Sciences. Clinical Medicine. Geriatric Medicine. Medicine and Health. The EWGSOP recommended using the SARC-F questionnaire for case finding in their revised definition of sarcopenia 9.
However, SARC-F and other screening questionnaires have low sensitivity and high specificity, suggesting that many true cases may be missed Contrarily, muscle mass measurements can be feasible, objective, and time-saving tests with high accuracy for sarcopenia mass screening.
In this review, we summarize the measurement methods and muscle mass indicators to highlight the issues with previous assessments. Skeletal muscle mass is measured using various direct and indirect methods.
The major direct methods include computed tomography CT , magnetic resonance imaging MRI , dual-energy X-ray absorptiometry DEXA , and skeletal muscle ultrasound.
On the other hand, the major indirect methods include bioelectric impedance analysis BIA and D 3 -creatine dilution methods. Each measurement method has advantages and disadvantages, which are presented in Table 2. CT is an assessment method that highly distinguishes skeletal muscle from other components, including bone and connective tissues; it is frequently used as the gold standard measurement method for muscle mass The advantage of CT is its ability to simultaneously measure both the skeletal muscle area quantity and density quality , which reflects intramuscular adiposity links to muscle function.
However, it requires the use of large equipment and exposes patients to high-level radiation. Radiation exposure increases the difficulty of using CT for the whole-body measurement of skeletal muscle mass among healthy individuals.
However, existing CT images for other purposes can be reanalyzed in a clinical setting for skeletal muscle assessment.
The prevalence of sarcopenia and its impact on adverse clinical outcomes have been investigated using CT among patients undergoing routine CT imaging, particularly those with cancer 14 , 15 , Generally, the skeletal muscle is assessed via CT at the 3 rd lumbar vertebra level 17 but is dependent on the routine CT imaging range, such as the cervical vertebra for head and neck cancers or thoracic vertebra for lung cancer MRI is another high-resolution method for skeletal muscle assessment and is considered a gold standard Because MRI can capture several weighted images, it enables a more thorough examination of muscle quantity and quality than CT.
Furthermore, MRI has no radiation exposure, giving it an advantage over CT. However, MRI requires participants to remain still for a longer period during imaging.
High cost and the lack of a reference value for diagnosing sarcopenia are also important limitations of MRI. DEXA is the most commonly used measurement method for skeletal muscle mass By emitting two different energy X-rays, DEXA measures lean mass in the whole body and body components as the subtraction of bone and fat.
Skeletal muscle and connective tissue make mass Therefore, DEXA cannot directly determine skeletal muscle mass or assess muscle quality as CT can.
However, DEXA has significantly lower radiation exposure than CT but has limited portability for skeletal muscle mass measurement compared with portable devices. Skeletal muscle ultrasound is an inexpensive method for bedside muscle assessment that has several benefits, including no radiation exposure, low cost, and portability.
It can assess muscle thickness, cross-sectional area, echo intensity, pennation angle, and fascicle length. However, the accuracy and comparability of skeletal muscle ultrasound measures could vary between technicians; guidelines have been published to standardize the measurement technique It is impractical to sequence whole body or appendicular muscle mass using skeletal muscle ultrasound due to the long sequence time.
Thus, muscle mass prediction formulas have been developed using selected muscle thickness measured by skeletal muscle ultrasound and validated compared with DEXA 22 , 23 , 24 and MRI Skeletal muscle ultrasound is a reliable and validated method for muscle mass measurement in the diagnosis of sarcopenia 26 , BIA is an indirect measurement method for muscle mass; it measures the impedance of body components using a combination of electrode positions and electric currents with single or multiple frequencies, as skeletal muscle and fat mass have different impedances BIA has no radiation exposure and is feasible for use in any setting owing to its portability.
However, it has the following limitations: some conditions, such as edema, increases measurement errors, and implant medical devices are not allowed for testing.
The validity and reliability in estimating muscle mass are high for multiple-frequency BIA and moderate for single-frequency BIA To improve validity, many equations have been proposed that modele age, sex, and anthropometric variables BIA also measures phase angle, which may reflect muscle quality and function Lower phase angle has been associated with lower muscle functions The D 3 -creatine dilution method indirectly assesses the skeletal muscle mass by linking it to total-body creatine pool size The skeletal muscle is the largest creatine pool in the whole body.
After creatine is absorbed from the intestine, it is diluted in the creatine pool and excreted in urine by the kidney. Then, creatine isotope D 3 -creatine diluted in the creatine pool and total-body creatine pool can be estimated by measuring the urinary concentration ratio of D 3 -creatine to total creatine.
D 3 -creatine dilution relies on four assumptions to accurately measure the total-body creatine pool. First, D 3 -creatine is absorbed without any loss. Second, it is completely diluted in the creatine pool before excretion.
Third, it is distributed only in the skeletal muscle. Fourth, its distribution is consistent in all skeletal muscles and is not altered by any condition. However, because the last three assumptions are not completely true, errors in the measurement of skeletal muscle mass occur when using the D 3 -creatine dilution method.
Although muscle mass measured by the D 3 -creatine dilution method is strongly correlated with the MRI- and DEXA-measured muscle mass, the D 3 -creatine dilution method measures muscle mass smaller than DEXA Furthermore, lower and decreased muscle mass measured by the D 3 -creatine dilution method is associated with worsened physical function, and a higher risk of physical disability and mortality, but DEXA-measured muscle mass adjusted for height is not 34 , 35 , 36 , Muscle mass can be measured using three indicators: cross-sectional area, thickness, and mass weight.
To accurately assess muscle mass, various indicators have been created. However, no single indicator has a consensus with the definition of sarcopenia. ALM and ASM are the crude measures of lean and muscle mass, respectively. ALM is the lean mass weight of all upper and lower limbs measured by DEXA.
Meanwhile, ASM is the skeletal muscle mass in all upper and lower limbs estimated by BIA. Owing to their similarities and shared uses, ALM is used as a common term for ALM and ASM in this review. Research has demonstrated that lower ALM is associated with a higher risk of mortality but not disability in US men In US women, no association between ALM and mortality and disability was observed.
It is noteworthy that the association of ALM with disability and mortality varies across different populations Therefore, ALM was added to the revised sarcopenia definition of EWGSOP as a muscle loss measure 9.
In that definition, the cutoff value of ALM was below 20 kg for men and below 15 kg for women. Nevertheless, it is noteworthy that ALM has a strong positive correlation with height and weight There are several approaches to adjusting for anthropometry in muscle mass assessment.
SMI was first proposed by Baumgartner RN et al. in Due to the strong correlation between muscle mass and height, SMI is measured as ALM divided by height squared, which is the best variable to minimize the correlation between ALM and height.
This indicator still has a moderate positive correlation with weight and BMI Although SMI is most frequently accepted as a muscle loss indicator in the definition of sarcopenia, lower SMI was associated with higher mortality but not with disability among men and women in the US 38 and Japan Conversely, an inverse association of SMI was apparent with the risk of disability and mortality among men and women in another Japanese cohort to adjust for nonskeletal muscle mass 8 , calculated as ALM divided by the whole-body weight.
In a Japanese study, no association was reported after age adjustment Because lower SMI was not strongly associated with physical function 44 , 45 , they determined which muscle mass indicator strongly predicts slow gait speed In addition, the residual of linear regression modeling was analyzed using ALM as the dependent variable and height and total fat mass as the explanatory variables A positive association between the residual and leg function was observed in both men and women, whereas a positive association between the residual and SMI was seen only in men.
However, the reference formula may not be generalizable to other populations. Further investigation is required to create the ideal reference formula. However, even after adjusting for these variables, the muscle indicators remained moderately correlated with body size. Therefore, the use of muscle indicators as part of the sarcopenia diagnosis criteria may have biased the diagnosed sarcopenia from the true sarcopenia.
Furthermore, the residual correlation between adjusted muscle indicators and body size may interfere with the appropriate assessment of muscle loss. Further research on muscle mass assessment is necessary to establish a clear definition of sarcopenia.
This article is based on the study, which received the Medical Research Encouragement Prize of The Japan Medical Association in Because this is not a research of human beings, approval from the institutional review board is not required.
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Background: acute illnesses, like Evvaluation, Detoxification for joint health evaluatiom as a catabolic Maes on muscles. So far, no study has Muscle mass evaluation Nutrient-dense post-workout snacks mass and quality through limb ultrasound in post-COVID patients. Methods: cross sectional observational study, including patients seen one month after hospital discharge for SARS-CoV-2 pneumonia. The patients underwent a multidimensional evaluation. Moreover, we performed dominant medial gastrocnemius ultrasound US to characterize their muscle mass and quality.
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