SARCOPENIA Towards a new management of sarcopenia & frailty.
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Transcript of SARCOPENIA Towards a new management of sarcopenia & frailty.
SARCOPENIA
Towards a new management of
sarcopenia & frailty
SARCOPENIAOrigins of the term
Different proposed definitions
Risk factors of sarcopenia
Sarcopenia and its closest concepts
Consequences of sarcopenia
Sarcopenia & frailty: KEY MESSAGES
SARCOPENIA: Origins
Relationship between lean body mass and strength
Origins of falls, fractures, loss independence
ROSENBERG IH Am J Clin Nutr 1989; 50: 1231-3 & ROSENBERG IH J Nutr 1997; 127: 990S-1S
1988 in Albuquerque « Sarcopenia »
In Greek: « Sarx » is Flesh and « Penia » is « Loss »
«There is probably no decline in structure and function
more dramatic than the decline in lean body mass or muscle mass
over the decades of life »
SARCOPENIA: Origins
« Age-related loss of muscle mass and function »
Is it a process of normative ageing?
When does this become a disease state?
Can this phenomenon be influenced?
ROSENBERG IH Am J Clin Nutr 1989; 50: 1231-3 & ROSENBERG IH J Nutr 1997; 127: 990S-1S
1988 in Albuquerque « Sarcopenia »
In Greek: « Sarx » is Flesh and « Penia » is « Loss »
19941st Sarcopenia Symposium - NIA
SARCOPENIAOrigins of the term
Different proposed definitions
Causes of sarcopenia
Sarcopenia and its closest concepts
Consequences of sarcopenia
Sarcopenia & frailty: KEY MESSAGES
SARCOPENIA: definition 1997
Involuntary loss of
skeletal muscle mass
that occurs
with advancing age
ROSENBERG IH J Nutr 1997; 127: 990S-1S
SARCOPENIA
SARCOPENIA: definition 2003
GREENLUND LJ et al Mech Ageing Dev 2003; 124: 287
Atrophy and loss of
individual muscle cellslinked to diminished:
- synthesis of muscle proteins- function of mitochondria
Causes
SARCOPENIA: definition 2006
GOODPASTER BH et al J Gerontol Med Sci 2006; 61A: 1059-64
Age-associated loss of skeletal muscle mass,
postulated to be a major factor in the strength decline with ageing
Moreover, sarcopenia is related to:- functional impairment
- disability- falls
- loss of independence
Consequences
SARCOPENIA: structures of current definitions
Loss of skeletal muscle mass
CAUSES (and sometimes physiopathology):Age, diet, disuse and « Combination »
CONSEQUENCES:Falls, functional decline, disability, loss of independence and mortality
Loss of strength
SARCOPENIAOrigins of the term
Different proposed definitions
Risk factors of sarcopenia
Sarcopenia and its closest concepts
Consequences of sarcopenia
Sarcopenia & frailty: KEY MESSAGE
Risk factors of Sarcopenia
Living habits
Ageing process Chronic health conditions
Living conditions
CRUZ JENTOFT A et al Curr Opin Clin Nutr Metab Care
2010; 13: 1-7
Constitutional factors
Living habits
Ageing process Chronic health conditions
Living conditions
CRUZ JENTOFT A et al Curr Opin Clin Nutr Metab Care
2010; 13: 1-7
Constitutional factors
Female genderLow birth rateGenetic susceptibility
Risk factors of Sarcopenia
SARCOPENIA in Caenorhabditis elegans
Behavioural phenotypes of ageing
A: Vigorous movement
B: Uncoordinated locomotion
C: Head and/or tail movements if stimulated
12 days after a synchronized egg lay 40 wild types animals
HERNDON LA et al Nature 2002; 419: 808-14
SARCOPENIA in Caenorhabditis elegans
HERNDON LA et al Nature 2002; 419: 808-14
4days 18days
Cross section of the pharynx
SARCOPENIA in Caenorhabditis elegans
HERNDON LA et al Nature 2002; 419: 808-14
4days 18days
Cross section of the pharynx
Genetic heterogeneityMitrochondrial DNA mutations
Stochastic damageRate of damage accumulation
Living habits Malnutrition Low protein intakeAlcohol abuseSmokingPhysical inactivity
Ageing process Increased muscle turnover Catabolic stimuli . Protein degradation . Subclinical inflammation Anabolic stimuli . Protein synthesisReduced number of muscle cells Myostatin ( recruitment) ApoptosisHormonal deregulation Testosterone, DHEA production Estrogen production 1-25 (OH)2 vitamin D Thyroid function Growth hormone, IGF-1 Insulin resistanceChanges in nervous system CNS input (loss of α-motor neurons) Neuro-muscular disjunctionMitochondrial dysfunction Peripheral vascular flow
Living conditions
StarvationBed rest /immobility /deconditioningWeightlessness
CRUZ JENTOFT A et al Curr Opin Clin Nutr Metab Care
2010; 13: 1-7
Constitutional factors
Female genderLow birth rateGenetic susceptibility
Risk factors of Sarcopenia
Sarcopenia speedInvoluntary degenerative loss
of skeletal muscle mass and function
occurs at the rate of
1-2% per yearafter the age of 30 years
andaccelerates with advancing age
Quoted in TIMMERMAN KL et al Curr Opin Clin Nutr Metab Care 2008;11:45-9.
SMI = Muscle mass/body mass x 100
Skeletal Muscle Mass (SMI) & Ageing
Man 38 y.o.
Man 78 y.o.
Living habits MalnutritionLow protein intakeAlcohol abuseSmokingPhysical inactivity
Ageing process Increased muscle turnover Catabolic stimuli . Protein degradation . Subclinical inflammation Anabolic stimuli . Protein synthesisReduced number of muscle cells Myostatin ( recruitment) ApoptosisHormonal deregulation Testosterone, DHEA production Estrogen production 1-25 (OH)2 vitamin D Thyroid function Growth hormone, IGF-1 Insulin resistanceChanges in nervous system CNS input (loss of α-motor neurons) Neuro-muscular disjunctionMitochondrial dysfunction Peripheral vascular flow
Chronic health conditions
Cognitive impairmentMood disturbancesDiabetes mellitusHeart failure Liver failureRenal failureRespiratory failure
OsteoarthritisChronic pain
Obesity
Catabolic effects of drugs
Living conditions
StarvationBed rest /immobility /deconditioningWeightlessness
CRUZ JENTOFT A et al Curr Opin Clin Nutr Metab Care
2010; 13: 1-7
Cancer ?Chronic inflammatory disease ?
Constitutional factors
Female genderLow birth rateGenetic susceptibility
Risk factors of Sarcopenia
SARCOPENIAOrigins of the term
Different proposed definitions
Risk factors of sarcopenia
Sarcopenia and its closest concepts
Consequences of sarcopenia
Sarcopenia & frailty: KEY MESSAGES
Weight loss in older persons:Causes
•Voluntary
Food restriction
Increased exercise
•Involuntary
Starvation Cachexia
AnorexiaSarcopenia
THOMAS DR Clin Nutr 2007; 26: 388-99
Weight loss in older persons:3 categories
STARVATION: Pure protein-energy deficiency(reduction of both fat and fat-free mass)
THOMAS DR Clin Nutr 2007; 26: 388-99
Malnutrition in aged adults
Malnutrition: definition
1. Undernutrition resulting from insufficient food intake
2. Overnutrition caused by excessive food intake
3. Specific nutrient deficiencies
4. Imbalance because of disproportionate intake
KELLER HH J Am Geriatr Soc 1993; 41: 1212-8Quoted by DONINI LM et al J Nutr Health Ageing 2007; 11: 421-32
Geriatric Medicine:
1.Any insufficient dietary intake among essential nutrients
3. Proteino-caloric malnutrition
Weight loss in older persons:3 categories
STARVATION: Pure protein-energy deficiency(reduction of both fat and fat-free mass)
CACHEXIA:Severe wasting accompanying
disease states such as cancer or immunodeficiency (reduction of both fat and fat-free mass)
THOMAS DR Clin Nutr 2007; 26: 388-99
CACHEXIAFrom the Greek words Kákos (bad) and hexis (appearance or condition)
Complex syndrome combining:- Weight loss (> 10%)
- Reduced food intake (< 1’500 Kcal /day)- Systemic inflammation (CRP > 10 mg / l)
+ Anorexia & Weakness
Alteringquality of life
FEARON KC et al Clin Nutr 2006; 83: 1345-50
Linked to the advanced stages of various (CHRONIC) illnesses
• Cancer• Heart failure
• Obstructive pulmonary disease. Kidney disease
• and (…)
Food intake
mass MUSCLE strength
CACHEXIA
Hypermetabolism
Pro-inflammatory cytokines
Adapted from THOMAS DR Clin Nutr 2007; 26: 388-99
Advanced stages of various conditions / illnesses
Weight loss in older persons:3 categories
STARVATION: Pure protein-energy deficiency(reduction of both fat and fat-free mass)
CACHEXIA:Severe wasting accompanying
disease states such as cancer or immunodeficiency (reduction of both fat and fat-free mass)
SARCOPENIA:Observed age-related decline in muscle mass
(reduction fat-free mass, but increase in fat mass)
THOMAS DR Clin Nutr 2007; 26: 388-99
SARCOPENIA: definition 2008
PADDON-JONES D et al Am J Clin Nutr 2008; 87: 1562S-6S
Complexmultifactorial process
facilitated by a combination of
voluntary and involuntary factorsincluding the adoption of
- more sedentary lifestyle and- a less than optimal diet
Different kinds of weight lossCachexia Anorexia Malab
sorption
Sarcopenia Hypermetabolism
Weight loss ± ± ±Lean tissue Fat tissue Appetite = Anemia Yes ± ± No No
Proteolysis Yes No No Yes Yes
CRP = = = =Vitamin A = = = =Albumin ± ± = =
MORLEY JE et al Nutrition 2008; 24: 815-9
Food intake
mass MUSCLE strength
CACHEXIA
Hypermetabolism
Pro-inflammatory cytokines
Adapted from THOMAS DR Clin Nutr 2007; 26: 388-99
Advanced stages of various conditions / illnesses
SARCOPENIA
Disuse :lack of gravity, bed rest or insufficient exercise
Inadequate diet
Hormonal dysregulations
AGEING
SARCOPENIAOrigins of the term
Different proposed definitions
Risk factors of sarcopenia
Sarcopenia and its closest concepts
Consequences of sarcopenia
Sarcopenia & frailty: KEY MESSAGES
Table II: Sarcopenia is a geriatric syndrome
SARCOPENIASARCOPENIA
Constitutional factorsFemale genderLow birth rateGenetic susceptibility
AgeingIncreased muscle turnoverReduced number of muscle cellsHormonal deregulationChanges in nervous systemMitochondrial dysfunction Peripheral vascular flow
Living habitsMalnutritionLow protein intakeAlcohol/ smokingPhysical inactivity
Chronic health conditionsCognitive impairmentMood disturbancesDiabetes mellitusHeart / liver / lung / renal failureOsteoarthritisChronic painDrugs
Living conditionsStarvationBed rest /immobility /deconditioningWeightlessness CRUZ JENTOFT A et al Curr Opin Clin Nutr Metab Care 2010; 13: 1-7
Risk factorsRisk factors
FrailtyFrailty Poor outcomesPoor outcomes
MobilityImpaired gaitFallsLow endurance
Physical performance
DisabilityPoor quality of lifeNursing home admissionMortality
Axial muscular tonus Falls Masticator force Venous flow Osteopenia / fractures
Body protein content Thermo regulation Insulin resistance Immunity Infections
Care costs
Qualiy of Life
Physical Frailty
?
SARCOPENIAOrigins of the term
Different proposed definitions
Risk factors of sarcopenia
Sarcopenia and its closest concepts
Consequences of sarcopenia
Sarcopenia & frailty: KEY MESSAGES
SARCOPENIA FRAILTY
REVERSIBILITY
NEED of . A consensual working definition
. Quantitative diagnostic tools
. Promising treatment options
Many thanks for your kind invitation