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SARCOPENIA1SARCOPENIA: definition 2003GREENLUND LJ et al Mech Ageing Dev 2003; 124: 287

Atrophy and loss of individual muscle cellslinked to diminished: - synthesis of muscle proteins- function of mitochondriaCauses2SARCOPENIA: definition 2006GOODPASTER BH et al J Gerontol Med Sci 2006; 61A: 1059-64Age-associated loss of skeletal muscle mass,postulated to be a major factor in the strength decline with ageingMoreover, sarcopenia is related to:- functional impairment- disability- falls- loss of independenceConsequences3Living 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 -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 drugsLiving conditionsStarvationBed rest /immobility /deconditioningWeightlessness CRUZ JENTOFT A et al Curr Opin Clin Nutr Metab Care 2010; 13: 1-7Cancer ?Chronic inflammatory disease ?Constitutional factorsFemale genderLow birth rateGenetic susceptibilityRisk factors of Sarcopenia44Different kinds of weight lossCachexiaAnorexiaMalabsorptionSarcopeniaHypermetabolismWeight lossLean tissueFat tissueAppetite=AnemiaYesNoNoProteolysisYesNoNoYesYesCRP====Vitamin A====Albumin==MORLEY JE et al Nutrition 2008; 24: 815-95Table II: Sarcopenia is a geriatric syndromeSARCOPENIAConstitutional 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: 1-7Risk factorsFrailtyPoor outcomes MobilityImpaired gaitFallsLow endurance Physical performanceDisabilityPoor 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 LifePhysical Frailty ?66

Sarcopenia: Causes and Implications12 12. Kamel, Hosam. Sarcopenia and Aging. Nutrition Reviews. 61(5): 157-167. May 2003. IGF-1= insulin-like growth factorGH= growth hormoneADLS= activities of daily livingBMR= basal metabolic rate 7