b_leftb_right
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Letter to the Editor

Considering technique of assessment and method for normalizing skeletal muscle mass

Masakazu Saitoh*, Junichi Ishida, Jochen Springer

Version of Record online: 31 AUG 2017

DOI: 10.1002/jcsm.12230


How to Cite

Saitoh, M., Ishida, J., and Springer, J. (2017) Considering technique of assessment and method for normalizing skeletal muscle mass. Journal of Cachexia, Sarcopenia and Muscle, doi: 10.1002/jcsm.12230.

Author Information

Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany


Sarcopenia is defined as loss of skeletal muscle mass accompanied by a reduction in muscle strength or physical performance,[1] may be more severe among elderly individuals[2] and patients with chronic disease such as those with chronic kidney disease (CKD).[3] There is no consensus regarding operational criteria for sarcopenia in patients with advanced pre-dialysis CKD or maintenance hemodialysis. Kittiskulnam et al. also reported that muscle mass normalized to height-squared may underestimate sarcopenia particularly in the setting of excess adiposity.[4] Sarcopenic obesity was first defined by Baumgartner, who represents a reduced skeletal muscle mass coupled with an increase in fat mass.[5-7] Sarcopenic obesity specifically was highly prevalent among persons with CKD and not those without CKD.[8] Sarcopenic obesity may have a particularly poor prognosis and associated with an increased risk of death in patients with end-stage renal disease (ESRD).[9] Early detection of sarcopenic obesity in patients on maintenance hemodialysis is therefore of importance. However, overweight or obese individuals whose muscle mass is low relative to their body size may not be defined as sarcopenic when muscle mass is adjusted only for height.[1, 10] Furthermore, assessing skeletal muscle mass may be confounded by the presence of edema, particularly in patients with ESRD. Normalization by height alone may underestimate the prevalence of sarcopenia, especially in obese population with excess adiposity or with excess edematous or overhydration in patients with ESRD.[10] Muscle mass adjusted more generally for body size rather than height alone is more strongly correlated with physical function than muscle mass indexed to height-squared.[4] Consequently, some experts have recommended alternative approaches, requiring adjustment for body size among overweight or obese individuals.[11-13] Moreover, in a previous report by Lamarca and colleagues among elderly patients on maintenance hemodialysis, prevalence of loss of muscle mass ranged from 4 to 74% depending on the method of body composition, including anthropometric measurement, bioelectrical impedance spectroscopy and dual-energy X-ray absorptiometry.[14] Hence, it remains unclear what is the best way to assess and normalize the skeletal muscle mass among overweight or obese patients, particularly advanced pre-dialysis CKD or ESRD.

Acknowledgements

We acknowledge support by the German Research Foundation and the Open Access Publication Funds of the Göttingen University. We certify that we comply with the ethical guidelines for publishing in the Journal of Cachexia, Sarcopenia and Muscle: update 2015.[15]

References


1Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. European working group onsarcopeniain older people. Sarcopenia: European consensus on definition and diagnosis: report of the european working group on sarcopenia in older people. Age Ageing 2010;39:412423.2Brown JC, Harhay MO, Harhay MN. Sarcopenia and mortality among a population-based sample of community-dwelling older adults. J Cachexia Sarcopenia Muscle 2016;7:290298.3von Haehling S, Anker MS, Anker SD. Prevalence and clinical impact of cachexia in chronic illness in Europe, USA, and Japan: facts and numbers update 2016. J Cachexia Sarcopenia Muscle 2016;7:507509.4Kittiskulnam P, Carrero JJ, Chertow GM, Kaysen GA, Delgado C, Johansen KL. Sarcopenia among patients receiving hemodialysis: weighing the evidence. J Cachexia Sarcopenia Muscle 2017;8:5768.5Baumgartner RN. Body composition in healthy aging. Ann N Y Acad Sci 2000;904:437448.6Tyrovolas S, Koyanagi A, Olaya B, Ayuso-Mateos JL, Miret M, Chatterji S, et al. Factors associated with skeletal muscle mass, sarcopenia, and sarcopenicobesityin older adults: a multi-continent study. J Cachexia Sarcopenia Muscle 2016;7:312321.7Barbat-Artigas S, Garnier S, Joffroy S, Riesco É, Sanguignol F, Vellas B, et al. Caloric restriction and aerobic exercise insarcopenic and non-sarcopenic obese women: an observational and retrospective study. J Cachexia Sarcopenia Muscle 2016;7:284289.8Sharma D, Hawkins M, Abramowitz MK. Association of sarcopenia with eGFR and misclassification of obesity in adults with CKD in the United States. Clin J Am Soc Nephrol 2014;9:20792088.9Honda H, Qureshi AR, Axelsson J, Heimburger O, Suliman ME, Barany P, et al. Obese sarcopenia in patients with end-stage renal disease is associated with inflammation and increased mortality. Am J Clin Nutr 2007;86:633638.10Cawthon PM, Peters KW, Shardell MD, McLean RR, Dam TT, Kenny AM, et al. Cutpoints for low appendicular lean mass that identify older adults with clinically significant weakness. J Gerontol A Biol Sci Med Sci 2014;69:567575.11Dam TT, Peters KW, Fragala M, Cawthon PM, Harris TB, McLean R, et al. An evidence-based comparison of operational criteria for the presence of sarcopenia. J Gerontol A Biol Sci Med Sci 2014;69:584590.12Delmonico MJ, Harris TB, Lee JS, Visser M, Nevitt M, Kritchevsky SB, et al. Health, Aging and Body Composition Study. Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women. J Am Geriatr Soc 2007;55:769774.13Newman AB, Kupelian V, Visser M, Simonsick E, Goodpaster B, Nevitt M, et al. Health ABC Study Investigators. Sarcopenia: alternative definitions and associations with lower extremity function. J Am Geriatr Soc 2003;51:16021609.14Lamarca F, Carrero JJ, Rodrigues JC, Bigogno FG, Fetter RL, Avesani CM. Prevalence of sarcopenia in elderly maintenance hemodialysis patients: the impact of different diagnostic criteria. J Nutr Health Aging 2014;18:710717.15von Haehling S, Morley JE, Coats AJS, Anker SD. Ethical guidelines for publishing in the Journal of Cachexia, Sarcopenia and Muscle: update 2015. J Cachexia Sarcopenia Muscle 2015;6:315316.