Misaka Kimura

Echo intensity obtained from ultrasonography images reflecting muscle strength in elderly men

Background It is well known that loss of muscle mass (quantitative change) is a major change that occurs with aging. Qualitative changes in skeletal muscle, such as increased intramuscular fat, also occur as one ages. Enhanced echo intensity (EI) on ultrasonography images of skeletal muscle is believed to reflect muscle quality. Recent studies evaluating the quality of skeletal muscle using computer-aided gray scale analysis showed that EI is associated with muscle strength independently of age or muscle size in middle-aged and elderly women. The aim of the present study was to investigate whether muscle quality based on EI is associated with muscle strength independently of muscle size for elderly men. Methods A total of 184 elderly men (65–91 years) living independently in Kyoto, Japan, participated in this study. The EI, muscle thickness (MT), and subcutaneous fat thickness (FT) of the anterior compartment of the right thigh were determined by assessing ultrasonography images. The maximum isometric torque of knee extension at a knee angle of 90° was measured. Results The EI showed a significant negative correlation with muscle strength (r = −0.333, P < 0.001). Multivariate regression analysis revealed that the MT and EI of the knee extensor muscle were independently associated with maximum isometric knee extension strength. Even when partial correlation analysis was performed with age, height, weight, and FT as control variables, EI was still significantly correlated with muscle strength. Conclusion The results of this study indicate that aging-related changes in muscle quality contribute to diminishing muscle strength. Ultrasonography is a low-cost, easily accessible, and safe method suitable for the assessment of EI as an index of muscle quality.

Extracellular Water May Mask Actual Muscle Atrophy During Aging

BACKGROUND Skeletal muscle tissue holds a large volume of water partitioned into extracellular water (ECW) and intracellular water (ICW) fractions. As the ECW may not be related to muscle strength directly, we hypothesized that excluding ECW from muscle volume would strengthen the correlation with muscle strength. METHODS A total of 119 healthy men aged 20-88 years old participated in this study. Knee isometric extension strength, vertical jump, and standing from a chair were measured as indices of muscle strength and power in the lower extremities. The regional lean volume (LV), total water (TW), ICW, and ECW in the lower leg were estimated by anthropometry (skinfold and circumference measurements) and segmental multifrequency bioelectrical impedance spectroscopy (S-BIS). Then, we calculated the ECW/TW and ICW/TW ratios. RESULTS Although ICW and the LV index decreased significantly with age (p < .001), no significant changes in ECW were observed (p = .134). Consequently, the ECW/TW ratio increased significantly (p < .001) with age (young adult, 27.0 +/- 2.9%; elderly, 34.3 +/- 4.9%; advanced elderly, 37.2 +/- 7.0%). Adjusting for this by including the ICW/TW ratio in our models significantly improved the correlation between the LV index and strength-related measurements and correlated with strength-related measurements independently of the LV index (p < .001). CONCLUSIONS The ECW/TW ratio increases in the lower leg with age. The results suggest that the expansion of ECW relative to ICW and the LV masked actual muscle cell atrophy with aging.

Oral motor function and masticatory performance in the community-dwelling elderly

This study was performed to ascertain the relationships between oral motor functions, such as those of the tongue and lips, and age in the community-dwelling elderly, as well as to investigate the effects of these factors on masticatory performance. The subjects were 268 healthy elderly Japanese living in Kyoto. They were divided into four age groups and further classified into the following two groups by the presence or absence of posterior occlusal support: Eichner A or B1-B3 (group A), and Eichner B4 or C (group B). They were wearing removable or fixed dentures if they had missing teeth. Oral function evaluation items included (1) masticatory performance and (2) oral motor skills. Significant differences were noted among the age groups in tongue pressure within group A (P < 0.01) and group B (P < 0.05), and in the number of repetitions of the syllables /ta/ and /ka/ in group B (/ta/: P < 0.05, /ka/; P < 0.01). The number of natural teeth (β = 0.463, P < 0.001) in group A and tongue pressure (β = 0.436, P < 0.001) in group B were the only predictors of masticatory performance when the data were analyzed by multiple regression analysis. The tongue may compensate for the missing teeth in masticatory performance of those elderly who have lost their natural teeth. The results of this study highlight the importance of tongue function in masticatory performance.

Comparison of single- or multifrequency bioelectrical impedance analysis and spectroscopy for assessment of appendicular skeletal muscle in the elderly

Bioelectrical impedance analysis (BIA) is used to assess skeletal muscle mass, although its application in the elderly has not been fully established. Several BIA modalities are available: single-frequency BIA (SFBIA), multifrequency BIA (MFBIA), and bioelectrical impedance spectroscopy (BIS). The aim of this study was to examine the difference between SFBIA, MFBIA, and BIS for assessment of appendicular skeletal muscle strength in the elderly. A total of 405 elderly (74.2 ± 5.0 yr) individuals were recruited. Grip strength and isometric knee extension strength were measured. Segmental SFBIA, MFBIA, and BIS were measured for the arms and upper legs. Bioelectrical impedance indexes were calculated by squared segment length divided by impedance (L2/Z). Impedance at 5 and 50 kHz (Z5 and Z50) was used for SFBIA. Impedance of the intracellular component was calculated from MFBIA (Z250-5) and BIS (RICW). Correlation coefficients between knee extension strength and L2/Z5, L2/Z50, L2/RICW, and L2/Z250-5 of the upper legs were 0.661, 0.705, 0.790, and 0.808, respectively (P < 0.001). Correlation coefficients were significantly greater for MFBIA and BIS than SFBIA. Receiver operating characteristic curves showed that L2/Z250-5 and L2/RICW had significantly larger areas under the curve for the diagnosis of muscle weakness compared with L2/Z5 and L2/Z50. Very similar results were observed for grip strength. Our findings suggest that MFBIA and BIS are better methods than SFBIA for assessing skeletal muscle strength in the elderly.

Correlation between dental and nutritional status in community-dwelling elderly Japanese

Aim:  The purpose of this study was to clarify the correlation between dental and nutritional status among community‐dwelling elderly Japanese people.

Estimation of thigh muscle cross-sectional area by single- and multifrequency segmental bioelectrical impedance analysis in the elderly

Bioelectrical impedance analysis (BIA) has been used to estimate skeletal muscle mass, but its application in the elderly is not optimal. The accuracy of BIA may be influenced by the expansion of extracellular water (ECW) relative to muscle mass with aging. Multifrequency BIA (MFBIA) can evaluate the distribution between ECW and intracellular water (ICW), and thus may be superior to single-frequency BIA (SFBIA) to estimate muscle mass in the elderly. A total of 58 elderly participants aged 65-85 years were recruited. Muscle cross-sectional area (CSA) was obtained from computed tomography scans at the mid-thigh. Segmental SFBIA and MFBIA were measured for the upper legs. An index of the ratio of ECW and ICW was calculated using MFBIA. The correlation between muscle CSA and SFBIA was moderate (r = 0.68), but strong between muscle CSA and MFBIA (r = 0.85). ECW/ICW index was significantly and positively correlated with age (P < 0.001). SFBIA tends to significantly overestimate muscle CSA in subjects who had relative expansion of ECW in the thigh segment (P < 0.001). This trend was not observed for MFBIA (P = 0.42). Relative expansion of ECW was observed in older participants. The relative expansion of ECW affects the validity of traditional SFBIA, which is lowered when estimating muscle CSA in the elderly. By contrast, MFBIA was not affected by water distribution in thigh segments, thus rendering the validity of MFBIA for estimating thigh muscle CSA higher than SFBIA in the elderly.

The Extracellular to Intracellular Water Ratio in Upper Legs is Negatively Associated With Skeletal Muscle Strength and Gait Speed in Older People.

Skeletal muscles contain a large volume of water that is classified into intracellular (ICW) and extracellular (ECW) water fractions. Nuclear magnetic resonance-based biomarkers suggest that increased water T2 heterogeneities, as well as elevated water T2 relaxation in the quadriceps occurs in the elderly when compared with young adults. However, nuclear magnetic resonance is difficult to apply to a large-scale study or a clinical setting for sarcopenia and frailty screening. Segmental bioelectrical impedance spectroscopy is a unique tool used to assess the segmental ratio of ECW/ICW in the limbs. We evaluated 405 community-living people aged between 65 and 90 years. ECW and ICW in the upper legs were assessed by segmental bioelectrical impedance spectroscopy. Isometric knee extension strength, gait speed, and skeletal muscle mass were measured. Thigh ECW/ICW was negatively correlated with knee extension strength and gait speed (r = -.617 and -.431, respectively, p < .001) and increased with age (p < .001). Thigh ECW/ICW was a significant predictor of knee extension strength and gait speed independent of age, sex, body mass index, and skeletal muscle mass. Relative expansion of ECW against ICW in the thigh muscles is a factor in decreased muscle quality and a biomarker of muscle aging.

Age-Related Ultrasound Changes in Muscle Quantity and Quality in Women

This study investigated the age-related changes in muscle quantity and quality in the trunk and limbs of women. A total of 128 females were divided into four age groups: young, middle-aged, young-old and old-old. Muscle thickness (MT) and echo intensity (EI) of the biceps brachii, quadriceps femoris, rectus abdominis, external oblique, internal oblique and transversus abdominis were measured using B-mode ultrasonography. The EIs of the biceps brachii, quadriceps femoris and transversus abdominis were significantly higher in the middle-aged group than in the young group; however, there were no significant differences in MT. Compared with the young group, all other groups had significant changes in both MT and EI of the rectus abdominis, external oblique and internal oblique muscles. Thus, qualitative changes in muscle may occur earlier than quantitative changes, and loss of muscle mass may occur earlier in the superficial abdominal muscles than in the other muscles.

Association of sagittal spinal alignment with thickness and echo intensity of lumbar back muscles in middle-aged and elderly women

OBJECTIVE Quantitative changes, such as a decrease in muscle mass, and qualitative changes, such as an increase in the amount of intramuscular non-contractile tissue, occur with aging. However, it is unclear whether quantitative or qualitative changes in back muscles are associated with spinal alignment in the standing position. We investigated the association of sagittal spinal alignment with muscle thickness as an index of the mass of lumbar back muscles and muscle echo intensity as an index of the amount of non-contractile tissue within these muscles. METHODS Study participants comprised 36 middle-aged and elderly women. Thickness and echo intensity of erector spinae, psoas major, and lumbar multifidus muscles were measured using an ultrasound imaging device. Standing sagittal spinal alignment, determined from thoracic kyphosis and lumbar lordosis angles, and the sacral anterior inclination angle was measured using the Spinal Mouse. RESULTS Stepwise regression analysis performed using muscle thickness, echo intensity, and age as independent variables showed that erector spinae muscle thickness was a significant determinant of the thoracic kyphosis angle. Psoas major muscle thickness and echo intensity of the lumbar multifidus muscle were significant determinants of the sacral anterior inclination angle. CONCLUSION Our results suggest that an increase in thoracic kyphosis is associated with a decrease in the mass of the erector spinae muscle, and that a decrease in pelvic anterior inclination is associated with a decrease in the mass of the psoas major muscle and an increase in the amount of non-contractile tissue within the lumbar multifidus muscle.

Application of segmental bioelectrical impedance spectroscopy to the assessment of skeletal muscle cell mass in elderly men

It is important to assess not only the total skeletal muscle mass, but also the intracellular and extracellular compartments of skeletal muscle to examine the actual relationship between skeletal muscle mass and physical functions. Segmental bioelectrical impedance spectroscopy is a unique tool with which to assess intracellular and extracellular water in the limbs. The aim of the present study was to examine the application of segmental bioelectrical impedance spectroscopy to the assessment of skeletal muscle mass in the elderly.