Cadmium is a prevalent environmental contaminant, and current research indicates that exposure to cadmium is a significant risk factor contributing to the increased incidence of sarcopenia. However, the precise mechanisms by which cadmium exposure leads to skeletal muscle damage remain to be fully elucidated. Utilizing an in vitro culture model of mouse C2C12 myoblasts, this study exposed cells to 0, 2, 4, and 8 μmol/L cadmium chloride for 24 hours to evaluate the cellular damage and explore the potential mechanisms. Our present data of this study demonstrate that cadmium treatment results in a reduction of C2C12 cell viability, an increased release of lactate dehydrogenase, and an imbalance in the oxidative-antioxidant system characterized by an excessive accumulation of reactive oxygen species, elevated malondialdehyde production, and decreased superoxide dismutase activity. Additionally, there is an upregulation of nuclear factor-erythroid 2-related factor 2, heme oxygenase-1, NAD(P)H quinone oxidoreductase 1, and glutamate-cysteine ligase catalytic subunit protein expression, along with a downregulation of superoxide dismutase 1 protein expression. Furthermore, cadmium exposure mediates an increase in cysteinyl aspartate specific proteinase-dependent apoptosis via the mitochondrial pathway, as indicated by an increased apoptosis rate, elevated Bcl-2 associated X protein and cysteinyl aspartate specific proteinase 3 protein expression, and a decreased expression of B-cell lymphoma-2 protein. Our findings elucidate the mechanisms of cadmium-induced cytotoxic damage in skeletal muscle cells from the perspectives of oxidative injury and apoptosis, thereby providing a theoretical basis for the prevention and treatment of cadmium toxicity.

Laparoscopic sleeve gastrectomy (LSG) is an effective treatment for obesity, but early weight loss outcomes vary owing to individual nutritional and metabolic differences. We developed a nomogram model to predict early weight loss after LSG, incorporating computed tomography (CT)-based body composition metrics and preoperative inflammatory-nutritional markers.

We retrospectively analyzed 305 patients with obesity who underwent LSG at the Affiliated Hospital of Qingdao University between January 2016 and June 2023. An external validation cohort of 105 patients from a separate institution was also included. Patients were categorized into optimal remission (%total weight loss [%TWL] ≥ 25%) and suboptimal remission (%TWL < 25%) weight loss groups one year postoperatively. Predictive variables were identified using Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression. A nomogram was constructed based on the significant predictors. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration curves, decision curve analysis (DCA), and clinical impact curve (CIC).

Independent predictors of suboptimal remission included BMI > 40 kg/m2, elevated total cholesterol, high neutrophil-to-lymphocyte ratio, high cortisol, low skeletal muscle index, and elevated visceral-to-subcutaneous adipose tissue area ratio. The constructed nomogram demonstrated strong predictive performance, with AUCs of 0.864 and 0.842 in the training and external validation cohorts, respectively. Calibration curves indicated excellent agreement between predicted and observed outcomes. DCA and CIC confirmed the model's clinical utility in both cohorts.

The developed nomogram effectively predicts early weight loss outcomes after LSG, supporting targeted perioperative management and personalized nutritional interventions.

Nutritional status and levels of oxidative stress may be modifiable risk factors for the development of sarcopenia. The Oxidative Balance Score (OBS) is a comprehensive measure of oxidative balance in diet and life exposures. We conducted a cross-sectional study to investigate the association between OBS and sarcopenia in US adults.

Based on the 2011-2018 National Health and Nutrition Examination Survey (NHANES), this study included 3084 participants. Weighted logistic regression analysis and restricted cubic spline regression (RCS) were used to assess the association between OBS and sarcopenia, as well as gender differences in this association.

OBS and sarcopenia are negatively associated (OR = 0.951, 0.919-0.983, p = 0.004). Compared with the lowest quartile of OBS, the highest quartile was significantly negatively associated with sarcopenia (OR = 0.431, 0.202-0.917, p for trend = 0.01). Both dietary OBS and lifestyle OBS were significantly negatively associated with sarcopenia (OR = 0.963, 0.930-0.997, p = 0.032; OR = 0.634, 0.562-0.715, p < 0.001). In gender subgroup analysis, a significant negative association between OBS and sarcopenia was observed in women (OR = 0.916, 0.862-0.973, p = 0.005), while the association was not significant in men. The RCS showed a significant linear correlation between total population OBS, female OBS and sarcopenia (p for nonlinear >0.05, p for overall <0.05).

Higher oxidative balance scores are associated with a lower prevalence of sarcopenia, particularly among women. These findings support the importance of antioxidant-rich diets and healthy lifestyles in mitigating sarcopenia risk, especially in aging female populations.

The prevalence of sarcopenia is high in older patients with type 2 diabetes mellitus (T2DM).

We evaluated the accuracy of the Strength, Assistance in Walking, Rise from a Chair, Climb Stairs, and Falls (SARC-F) questionnaire, the SARC-F combined with the Calf Circumference (SARC-CalF) questionnaire, the SARC-F incorporating Elderly and Body Mass Index Information (SARC-F+EBM) questionnaire, the MiniSarcopenia Risk Assessment 5-item (MSRA-5) questionnaire, the MiniSarcopenia Risk Assessment 7-item (MSRA-7) questionnaire, and the Ishii test score (Ishii) as screening tools for sarcopenia in older patients with T2DM.

Patients with T2DM aged 60 years and older were enrolled. The Asian Working Group for Sarcopenia 2019 diagnostic criteria were used to determine the presence of sarcopenia in patients. The accuracy of the 6 screening methods was assessed using sensitivity, specificity, and area under the receiver operating characteristic curve (AUC).

In total, 225 older patients (111 men; 114 women) with T2DM participated in the study. The overall prevalence of sarcopenia was 24%, with 34.23% in men and 14.04% in women. Among all participants, the sensitivity of the 6 screening tools for sarcopenia was 18.52% to 92.59%, the specificity was 31.58% to 92.98%, and the AUC was 0.588 to 0.863. Among the 6 screening tools, the Ishii test has the highest AUC for screening both men and women, and its sensitivity and specificity are relatively balanced, both above 75%.

Of the 6 screening tools, the Ishii test proved to be the most suitable for early sarcopenia screening within this population.

Low muscle mass (LMM) is a critical complication in patients with obesity and diabetes, exacerbating metabolic and cardiovascular risks. Novel obesity indices, such as the body roundness index (BRI), conicity index, and relative fat mass, have shown promise for assessing body composition. This study aimed to investigate the associations of these indices with LMM and to develop machine learning models for accurate and accessible LMM prediction.

Data from NHANES 2011-2018 (n = 2,176) were analyzed. Obesity was defined by body fat percentage, and LMM was determined using skeletal muscle mass index thresholds adjusted for BMI. Predictive models were developed using logistic regression, random forest, and other algorithms, with feature selection via LASSO regression. Validation included NHANES 2005-2006 data (n = 310). Model performance was evaluated using AUROC, Brier scores, and SHapley Additive exPlanations (SHAP) for feature importance.

BRI was independently associated with LMM (odds ratio 1.39, 95% confidence interval 1.22-1.58; P < 0.001). Eight features were included in the random forest model, which achieved excellent discrimination (AUROC = 0.721 in the validation set) and calibration (Brier score = 0.184). Feature importance analysis highlighted BRI, creatinine, race, age, and HbA1c as key contributors to the model's predictive performance. SHAP analysis emphasized BRI's role in predicting LMM. An online prediction tool was developed.

BRI is a significant predictor of LMM in patients with obesity and diabetes. The random forest model demonstrated strong performance and offers a practical tool for early LMM detection, supporting clinical decision-making and personalized interventions.

Sarcopenia is increasingly recognized as a significant complication in type 2 diabetes mellitus (T2DM), yet its prevalence and risk factors in Asian populations remain incompletely understood using the updated Asian Working Group for Sarcopenia (AWGS) 2019 criteria. The present review aimed to evaluate the prevalence of sarcopenia among Asian T2DM patients and identify associated risk factors using AWGS-2019 criteria through systematic review and meta-analysis.

A comprehensive systematic review of PubMed, SCOPUS, Crossref, Google Scholar, Semantic Scholar, and OpenAlex followed PRISMA guidelines to identify observational studies assessing the magnitude of sarcopenia in type-2 Diabetes mellitus. Random-effect models were used to estimate pooled prevalence and odds ratios (OR) for associated factors. Heterogeneity was quantified using I2 statistics and Cochran's Q test, where I2 values of 25%, 50%, and 75% indicated low, moderate, and high heterogeneity, respectively. Subgroup analyses and meta-regression explored heterogeneity sources across all studies. The quality of the studies was assessed by the Joanna Briggs Institute (JBI) criteria. Publication bias was assessed by funnel plot and Egger's test.

Thirty nine studies, including approximately 19,902 participants, were analyzed. The pooled prevalence of confirmed sarcopenia was 23% (95% CI: 18%-27%, p < 0.001) among Asian T2DM patients, with notably higher rates of possible sarcopenia at 61% (95% CI: 28%-86%, p < 0.001) and lower rates of severe sarcopenia at 12.1% (95% CI: 8.4%-16.7%, p < 0.001). Regional variations showed a higher prevalence in Southeast Asia (37.46%) compared to Western Pacific (21.95%). Meta-analysis revealed significant risk factors including older age (OR: 1.13, 95% CI: 1.11-1.16, p < 0.0001), male gender (OR: 2.37, 95% CI: 1.33-4.21, p = 0.0033), hypertension (OR: 3.65, 95% CI: 1.06-12.65, p = 0.0409), diabetes duration (OR: 1.35, 95% CI: 1.05-2.13, p = 0.02), and reduced physical activity (OR: 2.54, 95% CI: 1.92-3.36, p < 0.0001). Higher BMI (OR: 0.63, 95% CI: 0.53-0.75, p < 0.0001) and better vitamin D levels (OR: 0.91, 95% CI: 0.87-0.95, p < 0.001) demonstrated protective effects. Recent studies (2023-2024) showed a higher prevalence than pre-2022 studies (27.85% vs 18.42%, p = 0.0440). DXA-based measurements yielded higher prevalence estimates than BIA-based assessments (29.86% vs 19.52%, p = 0.7121).

Sarcopenia affects nearly one-quarter of Asian T2DM patients, with significant regional variations. Age, male gender, hypertension, and physical inactivity were key risk factors, while maintaining a healthy BMI and good nutrition appeared protective. These findings emphasize the importance of regular screening and early intervention strategies, particularly for high-risk patients.

Type 2 diabetes mellitus-related sarcopenia (T2DMRS) is a common complication in elderly and advanced diabetes patients that affects long-term prognosis and quality of life. Skeletal muscle is the main unit of glucose metabolism, and it is surrounded by extracellular matrix (ECM), which is a microenvironment that acts as an efficient highway system. The ECM is essential for cellular communication and nutrient transport and supports muscle cell growth and repair. When this "ECM highway" fails to function effectively because of damage or blockage, the development of T2DMRS can be triggered or exacerbated. In recent years, the ECM has been widely demonstrated to play a critical role in insulin resistance and skeletal muscle regeneration. However, how the remodeling of skeletal muscle ECM components specifically affects the T2DMRS mechanism of action has not been scientifically described in detail. In this review, we comprehensively summarize the T2DMRS-related mechanisms of ECM remodeling, suggesting that collagen and integrins may be potential therapeutic targets.

The high prevalence of sarcopenia among hypertensive adults is a global health issue. Growing literature demonstrates that a high antioxidant diet can protect against sarcopenia. However, little attention has been paid to the association between the dietary composite antioxidant intake and sarcopenia in hypertension. To investigate the potential efficacy of the composite dietary antioxidant index (CDAI) on sarcopenia among hypertensive adults.

This study included 6995 hypertensive adults from the National Health and Nutrition Examination Survey (NHANES) 2001-2006 and 2013-2018, with 3212 (45.92%) females and 3783 (54.08%) males. Appendicular lean mass (ALM) and sarcopenia were assessed by dual-energy X-ray absorptiometry (DEXA). All hypertensive adults participating in NHANES were eligible to participate in dietary interviews, and the average intake of six antioxidants over two days was used to calculate the CDAI. Logistic regression was conducted to determine odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses and restricted cubic spline (RCS) regressions were additionally utilized.

The mean age was 48.47 ± 0.27 years old, and 1059 (15.14%) were considered to have sarcopenia. The highest quartile had a 61% decreased risk of sarcopenia (OR = 0.39, 95% CI: 0.25, 0.60) compared with the lowest quartile of CDAI. RCS revealed a linear association between CDAI with sarcopenia and ALM. Subgroup analyses demonstrated a more pronounced inverse correlation between CDAI and sarcopenia in females.

In summary, our results indicated a reverse correlation between CDAI and sarcopenia in hypertension. These findings highlighted the beneficial role of an antioxidant-rich diet in prevention and provided a valid method for managing sarcopenia in hypertensive adults.

The link between serum insulin level and low muscle mass among older adults is not yet fully understood. This study seeks to investigate this association using data from a nationally representative large-scale survey.

The study utilized data from two waves of the China Health and Nutrition Survey (CHNS) conducted in 2009 and 2015. Subjects meeting the inclusion criteria were classified according to the Asia Working Group for Sarcopenia 2019 criteria. The study employed ordinary least squares (OLS) regression models to analyze the cross-sectional association between appendicular skeletal muscle mass (ASM) and serum insulin level. Additionally, based on the median insulin level in the population without low muscle mass in 2009, these individuals were divided into high insulin and low insulin groups. Logistic regression models were utilized to examine the longitudinal association between low muscle mass and serum insulin level.

In 2009, a cross-sectional association study enrolled a total of 2329 participants aged over 60 years, with 53.1% women and a median age of 68.00 years. The prevalence of low muscle mass in the study population was 30.83%, with females accounting for 60.03%. In the adjusted OLS regression model based on blood biomarker, serum insulin level was positively associated with ASM (β = 0.075, 95% confidence interval (95% CI): 0.034-0.117, P < 0.01). A total of 944 individuals from the 2009 population without low muscle mass were divided into high insulin and low insulin groups based on the median insulin level, and were followed up until 2015. It was found that there was a significant difference in the incidence of low muscle mass between the two groups. (12.44% vs. 7.45%, P = 0.01). The adjusted logistic regression models indicated that higher serum insulin levels were associated with a reduced incidence of low muscle mass (Hazard ratio = 0.958, 95% CI: 0.925-0.989, P = 0.01).

Adequate serum insulin level could potentially serve as a protective factor in preserving healthy muscle mass among Chinese adults aged 60 and above.

Not applicable.

To identify independent risk factors for urosepsis in diabetic patients with upper urinary tract stones (UUTS) and develop a prediction model to facilitate early detection and diagnosis, we retrospectively reviewed medical records of patients admitted between January 2020 and June 2023. Patients were divided based on the quick Sequential Organ Failure Assessment (qSOFA) score. The least absolute shrinkage and selection operator (LASSO) regression analysis was used for variable selection to form a preliminary model. The model was optimized and validated using the receiver operating characteristic (ROC) curve, the Hosmer-Lemeshow test and calibration curve, and decision curve analysis (DCA). A nomogram was constructed for visualization. A total of 434 patients were enrolled, with 66 cases and 368 controls. Six optimal predictors were identified: underweight, sarcopenia, poor performance status, midstream urine culture, urinary leukocyte count, and albumin-globulin ratio (AGR). The midstream urine culture was excluded due to its inability to provide rapid results. The final model demonstrated good prediction accuracy and clinical utility, with no significant difference in performance compared to the initial model. The study developed a prediction model for urosepsis risk in diabetic patients with UUTS, presenting a convenient tool for timely diagnosis, particularly in non-operated patients.

Beyond its established glucose-lowering and weight-reducing benefits, glucagon-like peptide-1 receptor agonists (GLP-1RAs) such as liraglutide may also mitigate sarcopenia. This study investigates the effects of liraglutide on diabetic sarcopenia and its underlying mechanisms.

A type 2 diabetic SD rat model was induced using a high-fat, high-sugar diet supplemented with a low dose of streptozotocin. Comparisons were made among control (Con), diabetic (DM), and liraglutide-treated (Li) groups for gastrocnemius muscle wet weight and length, histology (HE staining), immunofluorescence for muscle fiber typing, and Western blotting for aging-related proteins and YAP/TAZ pathway components. Concurrently, C2C12 myoblasts were differentiated into myotubes, treated with 60 mM glucose to model diabetic conditions, and assessed for morphological changes, senescence (SA-β-gal staining), and protein expression dynamics.

Diabetic rats displayed significant reductions in muscle mass, length, and cross-sectional area, along with disorganized fiber architecture, all of which were improved by liraglutide. In vitro, C2C12 myotubes showed accelerated aging and atrophy under high-glucose conditions, which were significantly reduced by liraglutide. Analysis revealed increased expression of aging markers P53 and P21 and decreased YAP/TAZ/TEAD and Cyclin D1 levels in diabetic conditions, which were reversed following liraglutide treatment. The inhibition of YAP significantly negated the protective effects of liraglutide.

High glucose promotes muscle cell aging and sarcopenia, processes that liraglutide can attenuate by modulating the YAP/TAZ signaling pathway. This study underscores liraglutide's potential to alleviate muscle degeneration in diabetic sarcopenia through its regulatory impact on critical aging pathways.

Intramuscular fat (IMF) is a complex adipose tissue within skeletal muscle, appearing specially tissue heterogeneous, and the factors influencing its formation remain unclear. In conditions such as diabetes, aging, and muscle wasting, IMF was deposited in abnormal locations in skeletal muscle, damaged the normal physiological functions of skeletal muscle. Here, we used Longissimus dorsi muscles from pigs with different IMF contents as samples and adopted a method combining spatial transcriptome (ST) and single-nucleus RNA-seq to identify the spatial heterogeneity of IMF. ST revealed that genes involved in TGF-β signaling pathways were specifically highly enriched in IMF. In lean pigs, IMF autocrine produces more TGF-β2, while in obese pigs, IMF received more endothelial-derived TGF-β1. In vitro experiments have proven that porcine endothelial cells in a simulated high-fat environment released more TGF-β1 than TGF-β2. Moreover, under obesity mice, the addition of TGF-β after muscle injury abolished IMF production and slowed muscle repair, whereas TGF-β inhibition accelerated muscle repair. Our findings demonstrate that the TGF-β pathway specifically regulates these processes, suggesting it as a potential therapeutic target for managing muscle atrophy in obese patients and enhancing muscle repair while reducing IMF deposition.

Sarcopenia is a known risk factor for cardiovascular disease (CVD) in individuals with diabetes or prediabetes, but the impact of changes in sarcopenia status on CVD risk remains unclear. This study aimed to examine how changes in sarcopenia status between baseline and the second follow-up survey, conducted 2 years later, influence the risk of developing incident CVD. Incident CVD was identified based on self-reported physician diagnoses of heart disease, such as angina, myocardial infarction, heart failure, or stroke. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for potential confounders. The results showed that participants who progressed from non-sarcopenia to possible sarcopenia or sarcopenia had a higher risk of developing CVD. Their risk was significantly greater compared to those who remained non-sarcopenic (HR 1.37, 95% CI 1.08-1.73). Conversely, individuals who recovered from sarcopenia to non-sarcopenia or possible sarcopenia had a lower risk of CVD. Their risk was lower than those who remained sarcopenic (HR 0.40, 95% CI 0.20-0.82). Among individuals with possible sarcopenia at baseline, those who recovered to non-sarcopenia had a reduced CVD risk. This reduction was significant compared to those who remained in possible sarcopenia (HR 0.62, 95% CI 0.46-0.84). These findings suggest that changes in sarcopenia status have a significant impact on CVD risk, with worsening sarcopenia increasing the likelihood of CVD and recovery lowering the risk in individuals with diabetes or prediabetes.

People with type 2 diabetes (T2D) have a 2-3-time higher risk of developing sarcopenia, a musculoskeletal disease marked by a progressive loss of skeletal muscle mass and strength, compared to people without T2D. This narrative review examines the effectiveness of lifestyle interventions in enhancing muscle mass and strength in people with T2D, emphasizing their growing importance with advancements in obesity treatments. PubMed and Google Scholar were utilized to identify the most relevant published studies based on the authors' knowledge. The maintenance of skeletal muscle strength and mass in people with T2D is becoming more prominent due to the advent of weight loss therapies such as low-energy diets, bariatric surgery and pharmacotherapies. Although the weight loss is to be commended, a large proportion (20-50%) of the weight loss comes from lean mass, indicative of a loss in muscle mass. There are currently no pharmacotherapies to increase, or mitigate the loss of, lean mass, with lifestyle strategies prominent in this arena. Resistance exercise is the most effective method to increase muscle mass and strength in people with T2D, but there is some evidence of an anabolic resistance. Aerobic exercise and increased dietary protein intake may result in small increases in muscle mass and strength, with no evidence of an anabolic resistance to these stimuli. Exercise and protein supplementation can increase, or aid in the retention of, muscle strength and mass in individuals with T2D, but further research is needed to explore their benefits in patients undergoing concomitant pharmaceutical and surgical treatments.

Sarcopenia is a common complication in patients with stroke, adversely affecting recovery and increasing mortality risk. However, no standardised tool exists for its screening in this population. This study aims to identify factors influencing sarcopenia in patients with stroke, develop a risk prediction model and evaluate its predictive performance.

Data from 794 patients with stroke were analysed to assess demographic and clinical characteristics. Variable selection was performed using least absolute shrinkage and selection operator (LASSO) regression, followed by multivariate regression analysis. Logistic regression (LR), random forest (RF) and XGBoost algorithms were used to construct prediction models, with the optimal model subjected to external validation. Internal validation was conducted via bootstrap resampling, and external validation involved an additional cohort of 159 patients with stroke. Model performance was assessed using the area under the curve (AUC), calibration curves and decision curve analysis (DCA).

Seven variables were identified through LASSO and multivariate regression analysis. The LR model achieved the highest AUC (0.805), outperforming the RF (0.796) and XGBoost (0.780) models. Additionally, the LR model exhibited superior accuracy, precision, recall, specificity and F1-score. External validation confirmed the LR model's robustness, with an AUC of 0.816. Calibration and DCA curves demonstrated their accuracy and clinical applicability.

A predictive model, presented as a nomogram and an online risk calculator, was developed to assess sarcopenia risk in patients with stroke. Early screening using this model may facilitate timely interventions and improve patient outcomes.

Sarcopenia is an age-related condition characterized by the progressive loss of skeletal muscle mass and strength. With the global aging population, its incidence is rapidly increasing. Lipid peroxidation is a critical biochemical process that generates reactive oxygen species (ROS), leading to the destruction of muscle cell structure and function. It plays a pivotal role in the onset and progression of sarcopenia. This review summarizes the mechanisms by which lipid peroxidation contributes to sarcopenia, with a focus on its regulatory effects on cell membrane damage, mitochondrial dysfunction, and cell death. In addition, we discuss the protective role of antioxidant factors such as GPX4 (glutathione peroxidase 4) and antioxidant peptides like SS peptides in mitigating lipid peroxidation and delaying the progression of sarcopenia. Finally, the potential of various strategies, including natural compounds, supplements, natural extracts, and lifestyle interventions, in inhibiting lipid peroxidation and promoting muscle health is explored.

Sarcopenia, characterized by a gradual decline in skeletal muscle mass and function with age, significantly impacts both quality of life and mortality. Autophagy plays a crucial role in maintaining muscle health. There is growing interest in leveraging autophagy to mitigate muscle ageing effects. The impact of natural autophagy activators on skeletal muscle ageing remains elusive. This study aims to identify natural autophagy activators and assess their effects on skeletal muscle ageing.

To discover novel autophagy activators, we screened 493 natural products and identified Castanea crenata flower extract (CCFE) as a promising candidate. We investigated the effect of CCFE on cellular senescence in C2C12 cells induced by etoposide. In animal experiments, aged mice (18 months old) were fed a diet supplemented with 0.1% and 0.2% CCFE for 3 months. We assessed exercise capacity, mitochondrial function and autophagic flux to determine the impact of CCFE on skeletal muscle ageing. The components present in CCFE were analysed using LC-MS/MS, and their functional properties were examined.

CCFE enhanced autophagic flux (LC3II 80% increase, p < 0.05) and reduced senescence-associated β-galactosidase activity (32.78% decrease, p < 0.001). In aged mice, a 3-month supplementation with CCFE improved muscle weight (18% increase, p < 0.05) and function (treadmill performance increased by 60%, p < 0.5; grip strength increased by 25%, p < 0.05). It alleviated mitochondrial dysfunction (basal oxygen consumption rate increased by 59%, p < 0.05) and restored autophagy. CCFE enhanced autophagy by activating AMPK (80% increase, p < 0.01) and inhibiting Atg5 protein acetylation (65% decrease, p < 0.001), with contributions from ellagic acid and polyamines. CCFE supplementation restored polyamine levels (serum spermidine increased from 0.98 ± 0.08 to 2.22 ± 0.05 μg/mL, p < 0.001) and increased urolithin levels (serum urolithin A increased from 0 to 18.79 ± 0.062 ng/mL, p < 0.001), metabolites produced by the gut microbiome from ellagic acid in aged mice.

CCFE effectively suppressed skeletal muscle ageing by preventing mitochondrial dysfunction and restoring autophagic flux in aged mice. It achieved this by modulating AMPK and EP300 acetyltransferase activity, with contributions from its constituents, ellagic acid and polyamines. These findings highlight the potential of CCFE as a therapeutic agent for extending healthspan and mitigating sarcopenia, providing a basis for future clinical trials.

Sarcopenia refers to a neuromuscular disease characterized by age-related declines in muscle mass and function. Since Professor Rosenberg first introduced the concept of sarcopenia in 1989, numerous operational paradigms have been proposed, tested, and validated against negative outcomes. The most recent recommendations advocate that dynapenia, or reduced of muscle strength, should be used alongside low muscle mass for the identification of sarcopenia. This approach is based on the understanding that impairments in muscle strength are a major consequence of muscle failure. However, empirical evidence has yielded conflicting results regarding the ability of current sarcopenia definitions to identify individuals at higher risk of adverse health-related events. Muscle power - the capacity to generate strength rapidly - has emerged as a critical domain of physical performance in old age. Not only does it decline earlier and more drastically than other measures (e.g., muscle strength), but it is also more strongly associated with adverse outcomes. In this view point, we provide an appraisal of muscle power as a more reliable indicator of muscle failure, compared with other measures (e.g., strength), for identifying individuals with sarcopenia in both geriatric and non-geriatric settings. We also discuss major challenges hindering the conduct of meaningful investigations on this subject.

This review highlights emerging evidence supporting the premise of precision diabetes care including but not limited to monogenic diabetes and discuss potential opportunities, challenges, and limitations for clinical adoption.

Driven by a single gene mutation, monogenic diabetes remains the best use-case for precision diabetes care. However, the increasing prevalence of diabetes among adolescents and young adults in an obesogenic environment makes triaging potential patients for genetic screening clinically challenging. High-dimensional molecular biomarkers (i.e., multiomics) can improve the risk prediction for incident type 2 diabetes (T2D), over and above a well established prediction model based on clinical variables alone. Machine learning approaches using clinical variable-based clustering methods have generated novel and reproducible T2D subgroups with distinct phenotypic and omics characteristics that are associated with differential long-term outcomes. This stratification-strategy may inform clinical decisions. However, on-going discussion and research will be needed to understand the clinical utility of sub-phenotyping T2D for precision care.

Precision diabetes care has extended from uncommon monogenic diabetes to T2D which will need more complex approaches like multiomics and machine-learning methods. The successful clinical translation will require cumulative evidence and close collaboration among the stake holders.

Type 2 diabetes mellitus (T2DM) requires the maintenance of high physical activity levels and specific interventions tailored to the characteristics of each patient. We hypothesized that T2DM combined with diabetic kidney disease (DKD) could increase muscle fatigability, becoming a specific contributor to physical inactivity. This study aimed to determine the association between muscle fatigability and DKD complications and investigate the relationship between muscle fatigability and physical activity in patients with T2DM.

Overall, 50 patients with T2DM aged 40-65 years and with an estimated glomerular filtration rate of 30 mL/min/1.73 m2 or higher were included. Muscle function was assessed using an isokinetic dynamometer. Muscle fatigability (maximal voluntary concentric contraction [ΔMVCC] velocity, maximal voluntary isometric contraction [ΔMVIC] torque), which indicated the decrease in angular velocity and muscle strength associated with the exercise task, was calculated. The patient characteristics, physical activity (IPAQ-SV), knee extensor strength, and skeletal muscle index were evaluated. Participants were divided into two groups (DKD and non-DKD) according to the presence of DKD, and ΔMVCC velocity and ΔMVIC torque were compared.

ΔMVCC velocity was significantly higher in the DKD group than in the non-DKD group (p < 0.05). Similarly, ΔMVIC torque was significantly higher in the DKD group than in the non-DKD group (p < 0.05). Subgroup analyses showed that ΔMVCC velocity was independently associated with physical activity in the DKD group (odds ratio: 0.93, 95 % confidence interval: 0.88-0.99).

Muscle fatigability increased with DKD in patients with T2DM and might be related to physical activity.

Patients with Type 2 diabetes mellitus (T2DM) have elevated late-night cortisol levels and a flattened circadian rhythm. Cortisol oversecretion mediates muscle breakdown and reduces muscle strength and mass, thus possibly leading to sarcopenia. This study first investigated the association between cortisol circadian rhythm and sarcopenia in patients with T2DM.

Patients with T2DM and adrenal nodules were screened for eligibility. Skeletal muscle index (SMI) and skeletal muscle density (SMD) were obtained by analysing computed tomography images at Lumbar 3 level. Sarcopenia was defined as the presence of both myopenia and myosteatosis. Cortisol and adrenocorticotropic hormone levels at 8 AM, 4 PM and 0 AM were measured. The cumulative logit models and receiver operating characteristic (ROC) curve analyses were performed to evaluate the association between cortisol circadian rhythm and sarcopenia.

In total, 128 patients with T2DM and nonfunctional adrenal adenomas were enrolled in this study, of whom 25 were diagnosed with sarcopenia. The mean age was 54.4 years, and 83 (64.8%) patients were male. Patients with sarcopenia showed higher nighttime cortisol levels at 0 AM (Cor 0 AM) (4.91 [4.05, 9.95] vs. 2.44 [1.55, 4.77] μg/dL, p < 0.001) than those without. The Cor 0 AM was negatively correlated with both SMI and SMD (r = -0.318, p < 0.001 and -0.284, p < 0.001, respectively). As the Cor 0 AM tertiles increased, the odds ratios (ORs) for sarcopenia consistently increased (OR = 4.69 [0.93, 23.53], p = 0.061, for the intermediate group and OR = 11.39 [2.41, 53.84], p = 0.002, for the high group). After adjustment for multiple risk factors, the high Cor 0 AM group still showed a significantly higher risk of sarcopenia than the low group (OR = 7.92 [1.45, 43.29], p = 0.017). ROC curve analyses showed that Cor 0 AM had the highest predictive power for sarcopenia, with an area under the ROC curve (AUC) of 0.760, compared to haemoglobin, age, alanine transaminase and sex (AUC = 0.703, 0.695, 0.679, and 0.633, respectively).

The cortisol circadian rhythm is associated with sarcopenia in patients with T2DM. Patients with higher levels of nighttime cortisol, rather than morning or afternoon cortisol, have a higher risk of sarcopenia. This result offers a new strategy for the further research of sarcopenia.

Sarcopenia may affect the onset of gestational diabetes mellitus (GDM). However, the causal relationship between sarcopenia and GDM remains unclear. In this study, we used a bi-directional Mendelian randomization (MR) approach to explore this intricate relationship.

This study utilized data from FinnGen datasets and genome-wide association studies. A bi-directional MR study was conducted. First, a forward MR analysis evaluated the causality of sarcopenia on GDM risk, with sarcopenia-related traits as exposures and GDM as the outcome. Second, in the reverse MR analysis, we assessed whether GDM influenced sarcopenia-related traits. Finally, sensitivity analysis was conducted to assess the robustness of the MR analysis.

Forward MR analysis revealed that appendicular lean mass (odds ratio [OR] = 1.2182, 95% confidence interval [CI]: 1.1397-1.3021, P < 0.0001), right-hand grip strength (OR= 1.4194, 95% CI: 1.0773-1.8701, P= 0.0128), left-hand grip strength (OR= 1.6064, 95% CI: 1.2829-2.0115, P < 0.0001), and usual walking pace (OR= 3.3676, 95% CI: 1.8769-6.0423, P < 0.0001) were associated with an increased risk of GDM. However, according to the reverse MR results, GDM had no causal effect on sarcopenia. No pleiotropy was observed.

In summary, sarcopenia had a significant causal influence on GDM, while GDM did not causally affect sarcopenia.

The presence of sarcopenia at the time of stroke may deteriorate the rehabilitation and functional outcomes. There is no consensus on the factors associated with stroke-related sarcopenia because previous studies produced inconsistent and disputed results. Therefore, we screened the possible risk factors by meta-analysis.

Studies published before March 2024 on risk factors with stroke-related sarcopenia were searched through PubMed, Embase, Web of Science, CINAHL, Cochrane Library, CNKI, Wan Fang, CBM, and VIP library databases. Two researchers independently screened the articles to extract the information and to evaluate their quality. Meta-analysis was then performed using Revman 5.4 software to determine the significant risk factors for patients with stroke-related sarcopenia.

A total of 14 studies (n = 3,113) were selected to determine the following factors that were statistically significant in patients with stroke-related sarcopenia: Age (OR = 1.04; 95% CI: 1.02, 1.06; P < 0.0001), tube feeding (OR = 3.98; 95% CI: 2.12, 7.47; P < 0.0001), pre-stroke sarcopenia (OR = 1.84; 95% CI: 1.39, 2.43; P < 0.0001), atrial fibrillation (OR = 1.53; 95% CI: 1.15, 2.02; P = 0.003), NIHSS score (OR = 1.48; 95% CI: 1.21, 1.81; P = 0.0001), and osteoporosis (OR = 1.801; 95% CI: 58, 2.04; P < 0.00001). BMI (P = 0.71), FOIS (P = 0.80), time since stroke (P = 0.34), and calf circumference reduction (P = 0.48) were not identified as risk or protective factors after stroke (P < 0.05).

Our results identified various risk factors for stroke-related sarcopenia which should be considered and studied by healthcare organizations and professionals to improve the health of stroke patients.

PROSPERO, Identifier CRD42024545757.

Globally, the progressive increase in the aging population has led to social and health problems associated with age-related chronic diseases, such as type 2 diabetes mellitus (T2DM) and sarcopenia. Recent studies have highlighted that sarcopenia and diabetes have a bidirectional relationship. Nutritional therapy is a key element in the treatment of both sarcopenia and diabetes. To date, there are no nutritional guidelines for the management of sarcopenia in T2DM. The aim of this study was to evaluate the efficacy of a muscle-targeted nutritional intervention in older people with sarcopenia and type 2 diabetes based on the Italian nutrition guidelines.

A total of 211 subjects (117 M and 94 F) affected by T2DM with a mean age of 74 ± 6.0 years were screened for sarcopenia, using EWGSOP2 diagnosis criteria, and enrolled to receive personalized dietary plans with two main targets: a daily energy intake of 25-30 kcal/kg body weight and a daily protein intake of at least 1.1-1.2 g/kg body weight.

In total, 34 subjects (24 M and 10 F) were sarcopenic with a prevalence of 16%, which was higher in men. After six months of treatment, handgrip strength increased by 0.83 kg (19.57 ± 5.70 kg vs. 20.40 ± 6.10 kg, p = 0.649), protein intake improved (0.91 ± 0.28 g/kg body weight vs. 1.03 ± 0.40 g/kg body weight, p = 0.115), and the glycated hemoglobin decreased (7.39 ± 0.49% to 6.82 ± 0.98%, p = 0.010). Seven younger subjects had an improvement of sarcopenia with a decrease in HbA1c (7.50 ± 0.59% vs. 6.91 ± 0.79, p = 0.19). The difference over time in the consumption of saturated fatty acids (OR 0.6, 95% CI 0.33-1.09, p = 0.096) and simple sugars (OR 0.91, 95% CI 0.80-1.01, p = 0.090) appeared to be associated with an improvement of sarcopenia status. A total of 177 subjects did not meet the criteria for a diagnosis of sarcopenia, and 148 subjects were assessed. The handgrip strength (26.22 ± 9.36 vs. 26.18 ± 9.24 kg, p0.974) and the glycated hemoglobin (7.21 ± 1.07 vs. 7.27 ± 0.98%, p = 0.735) remained stable over time, while protein intake at six months increased (0.81 ± 0.29 vs. 0.91 ± 0.29 g/kg body weight, p = 0.024). Four people were diagnosed with sarcopenia at follow-up, with a lower handgrip strength test result. These subjects were older and had worse glycemic control (HbA1c + 0.5%).

Lifestyle modification is important to prevent or reverse the development of the disease. Nutritional therapy in this population is therefore aimed at meeting all nutritional needs and promoting better glycemic control, in terms of glycated hemoglobin, in order to reduce the development of sarcopenia. Although promising, the intervention requires validation in larger studies with control groups.

Sarcopenia (SP), an age-associated condition marked by muscle weakness and loss has been strongly connected with metabolic factors according to substantial evidence. Nevertheless, the causal correlation between SP and serum metabolites, and the biological signaling pathways involved, is still not well understood. We performed a bidirectional two-sample Mendelian randomization (MR) analysis to examine the causal relationships between 1091 levels and 309 ratios of metabolites with SP traits, alongside investigating the relevant biological signaling pathways. Additionally, we explored the differential expression of plasma metabolites and potential biological signaling pathways in an animal model of SP. When SP was utilized as the outcome, we identified 11 robust causal associations between seven metabolite levels/ratios and SP-related traits using Bonferroni's correction (threshold: p < 0.05). We verified the stable causal association of glycine levels and SP in the validation. As for the reverse MR analysis, there were 11 strong causal relationships with 11 plasma metabolite levels/ratios remaining after multiple contrast correction. Additionally, biological signaling pathway analysis showed that glycine metabolism, insulin resistance, and cAMP signaling pathways may contribute to the connection between metabolites and SP. Mendelian validation of various datasets and observations in animal serum metabolomics suggests a strong association between glycine metabolism and SP. Our results indicate that the identified metabolites and biosignaling pathways could serve as important circulatory metabolic biomarkers for the screening and prevention of SP in clinical settings. Additionally, they represent potential molecules for future exploration of mechanisms and selection of drug targets.

To assess the prevalence of osteosarcopenia (OS) in elderly patients with type 2 diabetes mellitus (T2DM) and explore the related risk factors for developing this condition.

This cross-sectional study enrolled hospitalized T2DM patients aged 60 years and older. Patients underwent assessments of total hip bone mineral density (BMD), grip strength, the Short Physical Performance Battery (SPPB), and body composition. Based on the 2019 Asian Working Group for Sarcopenia (AWGS) criteria, appendicular skeletal muscle mass (ASM), grip strength, and SPPB were measured to diagnose sarcopenia. BMD and T values of the lumbar spine and hip were measured using dual-energy X-ray absorptiometry (DXA). Osteosarcopenia was defined when both sarcopenia and osteoporosis criteria were met. Statistical analysis included binary logistic regression to identify significant risk factors.

A total of 254 hospitalized T2DM patients (80 males and 174 females) were included. They were divided into T2DM-OS (n = 58) and T2DM-NOS (n = 196) groups based on the presence of osteosarcopenia. The average ages were 72.724 ± 6.463 and 69.265 ± 6.035 years, respectively. The prevalence of osteosarcopenia in T2DM patients was 22.8%, with 20.7% (12 males) and 79.3% (46 females) in the T2DM-OS group. After adjusting for confounding factors, it was found that male gender (OR: 5.738, 95% CI: 1.602-20.551, P = 0.007), fasting plasma glucose (OR: 0.904, 95% CI: 0.821-0.995, P = 0.038), and ASMI (OR: 0.049, 95% CI: 0.013-0.184, P < 0.001) were major influencing factors for the development of osteosarcopenia in elderly T2DM patients.

The prevalence of T2DM-OS is relatively high, with male gender, low fasting plasma glucose, and low ASMI identified as risk factors.

The present study examined the associations between the dietary intake of polyunsaturated fatty acids (PUFAs), physical function, and the prevalence of sarcopenia in Italian community-dwelling older adults.

Cross-sectional study.

Unconventional settings across Italy (e.g., exhibitions, health promotion campaigns).

Older adults (65+ years) who provided a written informed consent.

Physical function was evaluated according to isometric handgrip strength (IHG) and 5-time sit-to-stand (5STS) performances. Muscle power parameters were estimated based on 5STS values. Sarcopenia was operationalized according to the presence of low physical function (IHG or 5STS) plus low appendicular skeletal muscle mass (ASM), estimated according to calf circumference. A 12-item food questionary was used to estimate the dietary intake of PUFAs, which included omega-3 (α-linolenic acid, eicosapentaenoic acid, docosahexaenoic acid) and omega-6 fatty acids.

Multiple linear regression results indicate negative and significant associations between the dietary intake of α-linolenic acid and muscle power, and between docosahexaenoic acid consumption and ASM. No significant associations were found between PUFAs-related variables and sarcopenia.

Results of the present study indicate that PUFAs-related variables were negatively and significantly associated with physical function and body composition in older adults. Nevertheless, no significant associations were found with sarcopenia. These findings suggest that a more detailed analysis of covariates should be conducted in future investigations that aim to examine the associations between the dietary intake of PUFAs and sarcopenia-related parameters.

Diabetes is a significant risk factor for sarcopenia, a muscle dystrophy affecting older individuals. Sarcopenia management typically involves resistance exercise and oral supplements. Given the limitations of resistance training for many elderly individuals, oral supplements play a crucial role in treatment. This study is a protocol for evaluating the efficacy of the Sarcomeal® supplement, a mixture of whey protein, creatine, branch-chained amino acids (BCAAs), glutamine, and hydroxyl-methyl-butyrate (HMB) in diabetic people who also have sarcopenia. METHODS AND ANALYSIS: This study is a randomized clinical trial, in which sixty diabetic sarcopenia patients who meet the inclusion criteria will be randomly assigned to the control or the intervention group with a 1:1 allocation. The intervention group will receive one Sarcomeal® supplement sachet plus 1000 IU of vitamin D daily and both groups will be recommended to consume protein-rich food, be educated about the disease, and perform light exercises for 12 weeks. Anthropometric measurements, body composition analysis, muscle strength assessments, and blood tests will be conducted at the trial's start and end.

It is hypothesized that the Sarcomeal® supplement plus vitamin D may be beneficial for the management of diabetic sarcopenia by reducing inflammation, oxidative stress, and glucose metabolism. The outcome of this trial will provide a basis for prescribing sarcomeal to patients with diabetic sarcopenia.

This protocol is registered at the Iranian Registry of Clinical Trials (IRCT20230831059311N1) and also is approved by the ethics committee of Tehran University of Medical Sciences (September 2023, IR.TUMS.EMRI.REC.1402.071).

Iranian Registry of Clinical Trials (ID: IRCT20230831059311N1).

Chronic hyperglycemia can damage the microcirculation, which impairs the function of various organs and tissues and predisposes individuals to chronic complications. Sarcopenia (SP) is the age-related decline in muscle mass and function that contributes to the sequelae of type 2 diabetes. In particular, diabetic patients are at higher risk of SP because of insulin resistance, chronic inflammation, and decreased physical activity.

To identify SP-associated factors in middle-aged and elderly male type 2 diabetes mellitus (T2DM) patients and their correlation with bone mineral density (BMD).

A retrospective analysis was conducted on 196 middle-aged and elderly male T2DM inpatients in the First Affiliated Hospital of Chongqing Medical University between June 2021 and June 2023, with 60 concurrent healthy individuals as the control group. Differences in general information, blood biochemistry, glycosylated hemoglobin, muscle strength, and detection rate of SP were compared between groups. The BMD, appendicular skeletal muscle (ASM), and fat mass, as well as grip strength and gait speed, were determined for each patient, and the ASM index (ASMI) was counted. The quantitative data were subjected to correlation and logistic regression analyses to identify risk factors for SP.

Fifty-one of the 196 middle-aged and elderly male T2DM patients were diagnosed with SP, which accounted for 26.02%. The middle-aged and elderly T2DM patients with SP exhibited a longer diabetes mellitus (DM) course and a lower body mass index (BMI) and 25(OH)D3 compared with the non-SP patients. The T2DM + SP patients exhibited lower BMI, ASM, ASMI, left- and right-hand grip strength, gait speed, and muscle and fat mass of the upper and lower limbs compared with the diabetic non-SP patients. The femoral neck, total hip, and lumbar spine L1-4 BMD were markedly lower in T2DM + SP patients compared with those in the non-SP diabetics. Long-term DM course, low BMI, and low BMD of the femoral neck, lumbar spine L1-4, and total hip were identified as risk factors for the development of SP.

T2DM patients are at risk for SP; however, measures can be taken to prevent the related risk factors.

The association between the geriatric nutritional risk index (GNRI) and osteosarcopenia in older adults with type 2 diabetes mellitus (T2DM) is not clear.

A total of 573 individuals with T2DM were included in this cross-sectional study. Osteosarcopenia was defined as the presence of both osteoporosis and sarcopenia. Appendicular skeletal muscle mass and bone mineral density (BMD) was measured by dual energy X-ray absorptiometry to diagnose sarcopenia and osteoporosis. Multivariate analyses were used to assess the association between Geriatric Nutritional Risk Index (GNRI) and osteosarcopenia.

The patients were divided into four groups: robust (n = 367), osteoporosis alone (n = 154), sarcopenia alone (n = 29), and osteosarcopenia (n = 23). The GNRI was the lowest in osteosarcopenia group and was positively correlated with skeletal muscle index (SMI) (r = 0.122, p = 0.004), grip strength (r = 0.154, p < 0.001), gait speed (r = 0.123, p = 0.004), and BMD of lumbar spine 2-4, femoral neck, and total hip (r = 0.137, p = 0.002; r = 0.096, p = 0.028; r = 0.086, p = 0.049, respectively). In the logistic regression model low GNRI was significantly associated with an increased risk of osteosarcopenia (adjusted OR, 4.164; 95% CI, 1.283-13.514, p = 0.018). Age provided a discriminatory effect of osteosarcopenia with an area under the curve (AUC) of 0.764. When GNRI values were added to the model, the value of the ROC curve was further improved, with an AUC of 0.842.

Low GNRI was associated with an increased risk of osteosarcopenia in older adults with T2DM. Comprehensive clinical evaluation of nutritional status by a simple tool such as GNRI might be helpful for early identification of those at high risk for osteosarcopenia in older diabetic individuals.

To investigate the relationship between obesity indices and sarcopenia in postmenopausal patients with type 2 diabetes mellitus (T2DM) at different body mass index (BMI) levels.

This retrospective cross-sectional study included 298 hospitalized postmenopausal women diagnosed with T2DM. We collected demographic, biochemical, and anthropometric data on each subject. Body composition was measured using dual-energy X-ray absorptiometry (DXA), and skeletal muscle mass index (SMI) and body fat percentage (%BF) were calculated. According to BMI stratification, the patients were divided into normal group A (18.5 kg/m2≤BMI < 24 kg/m2), overweight group B (24.0 kg/m2≤BMI < 28 kg/m2), and obesity group C (28.0 kg/m2 ≤BMI < 35 kg/m2).

From group A to group C, SMI (5.21±0.56 vs 5.48±0.56 vs 6.03±0.69) increased gradually (P < 0.05). Logistic regression analysis indicated that for each 1-unit increase in BMI, the risk of sarcopenia decreased by 63.2% (OR=0.368, 95% CI 0.215-0.629, P=0.000) in group A. Age (OR=1.077, 95% CI 1.015-1.144, P=0.015) and %BF (OR=1.094, 95% CI 1.010-1.186, P=0.028) increased the risk of sarcopenia by 1.077 and 1.094 times, respectively, in group B. While every 1-unit increase in BMI, the risk of sarcopenia decreased by 35% (OR=0.650, 95% CI 0.430-0.983, P=0.041) in group B. %BF (OR=1.459, 95% CI 1.093-1.949, P=0.010) increased the risk factors of sarcopenia by 1.459 times in group C.

In postmenopausal patients with T2DM, BMI had a protective effect on the occurrence of sarcopenia within a certain range, and with the increase of BMI, the risk of sarcopenia was increasing by increased %BF levels in overweight and obese patients.

Objective Myosteatosis affects the pathogenesis of metabolic dysfunction-associated steatotic liver disease (MASLD) and may be a potential therapeutic target. This study aimed to examine the effects of ipragliflozin on myosteatosis in patients with type 2 diabetes mellitus (T2D) and MASLD. Methods Patients were treated with ipragliflozin (IPR group) or a control (CTR group) for 72 weeks in a randomized trial. Changes in myosteatosis of the lumbar skeletal muscles were evaluated using computed tomography (CT). The response of myosteatosis to treatment and the baseline characteristics of the patients were analyzed. Patients 44 participants (IPR group, 23; CTR group, 21) with MASLD complicated by T2D Results Myosteatosis increased in the CTR group (n=23) but remained unchanged in the IPR group (n=21). The changes were apparent at 24 weeks (P=0.004), but were not significant after 24 weeks. A hierarchical cluster analysis was performed to identify clusters with and without improvement in myosteatosis. The clusters with decreasing intramuscular adipose tissue content (IMAC) at 48 and 72 weeks were not treated, but they had lower visceral fat area and severe liver steatosis at baseline. Improvements in glycemic control and resistance to decreasing abdominal skeletal muscle area from baseline to 24 weeks affected the decrease in IMAC at 48 and 72 weeks. Conclusion Ipragliflozin had a limited effect on skeletal muscle adiposity in patients with T2D and MASLD. Regardless of the treatment, a specific phenotype of adiposity and hepatic steatosis before treatment is associated with the long-term outcomes of myosteatosis. Maintaining skeletal muscle mass and better glycemic control during treatment are essential for the future improvement of myosteatosis.

Sarcopenia is defined by low measures of muscle quantity, quality and reduced physical performance. It is associated with higher levels of frailty. Individuals with diabetes mellitus (DM) undergo sarcopenia at an accelerated rate resulting in structural changes potentially culminating in limb loss.

To review the evidence on methods of detecting and measuring sarcopenic changes on magnetic resonance imaging (MRI) in the foot in patients with diabetes.

A literature review was conducted in accordance with PRISMA guidelines. We searched Embase and Medline (via Ovid), CINAHL (via Ebsco Host), Web of Science and Scopus as well as the grey literature. The MeSH terms "sarcopenia" AND "diabetes mellitus" AND "magnetic resonance imaging" were employed in the primary search string.

874 studies were identified. 404 articles were excluded in the title and abstract screening. 33 studies were assessed for eligibility after abstract and title screening was completed by two reviewers. 7 studies evaluating sarcopenia in the foot were included in the final review.

Sarcopenic changes are evident on MRI of the foot in patients with diabetes and is profound in patients with diabetic neuropathy. The general extent and severity of sarcopenia seems to correlate with clinical scores to assess neuropathy and is implicated in the development of diabetic foot disease.

In recent years, systemic inflammation has emerged as a pivotal player in the development and progression of various degenerative diseases. This complex, chronic inflammatory state, often undetected, can have far-reaching consequences for the body's physiology. At the molecular level, markers such as C-reactive protein, cytokines and other inflammatory mediators serve as indicators of systemic inflammation and often act as predictors of numerous musculoskeletal diseases and even certain forms of cancer. The concept of 'meta-inflammation', specifically referring to metabolically triggered inflammation, allows healthcare professionals to understand inflammatory responses in patients with metabolic syndrome. Driven by nutrient excess and the expansion of adipose tissue, meta-inflammation is closely associated with insulin resistance, further propagating the metabolic dysfunction observed in many Western societies. Wound persistence, on the other hand, exacerbates the detrimental effects of prolonged inflammation at the local level. Acute inflammation is a beneficial and essential process for wound healing and infection control. However, when inflammation fails to resolve, it can impede the healing process, leading to chronic wounds, excessive scarring and even the activation of fibrotic pathways. This approach significantly reduces the efficacy of regenerative biological therapies. Our review focuses on the vital role of proteins, vitamins and minerals in collagen synthesis and cell proliferation for tissue healing. We also examine hormonal influences on regeneration, noting the negative effects of imbalances, and emphasize glucose regulation's importance in creating a stable environment for chronic wound healing.

Sarcopenia is an important indicator of ill health and is linked to increased mortality and a reduced quality of life. Age-associated muscle mass indices provide a critical tool to help understand the development of sarcopenia. This study aimed to develop sex- and age-specific percentiles for muscle mass indices in a Chinese population and to compare those indices with those from other ethnicities using the National Health and Nutrition Examination Survey (NHANES) data.

Whole-body and regional muscle mass was measured by dual-energy X-ray absorptiometry (DXA) in participants of the China Body Composition Life-course (BCL) study (17 203 healthy Chinese aged 3-60 years, male 48.9%) and NHANES (12 663 healthy Americans aged 8-59 years, male 50.4%). Age- and sex-specific percentile curves were generated for whole-body muscle mass and appendicular skeletal muscle mass using the Generalized Additive Model for Location Scale and Shape statistical method.

Values of upper and lower muscle mass across ages had three periods: an increase from age 3 to a peak at age 25 in males (with the 5th and 95th values of 41.5 and 66.4 kg, respectively) and age 23 in females (with the 5th and 95th values of 28.4 and 45.1 kg, respectively), a plateau through midlife (30s-50s) and then a decline after their early 50s. The age at which muscle mass began to decline was 52 years in men with the 5th and 95th percentile values of 43.5 and 64.6 kg, and 51 years in women with the 5th and 95th percentile values of 31.6 and 46.9 kg. Appendicular skeletal muscle mass decreased earlier than whole body muscle mass, especially leg skeletal muscle mass, which decreased slightly after age 49 years in both sexes. In comparison with their US counterparts in the NHANES, the Chinese participants had lower muscle mass indices (all P < 0.001) and reached a muscle mass peak earlier with a lower muscle mass, with the exception of similar values compared with adult Mexican and White participants. The muscle mass growth rate of Chinese children decreased faster than that of other races after the age of 13.

We present the sex- and age-specific percentiles for muscle mass and appendicular skeletal muscle mass by DXA in participants aged 3-60 from China and compare them with those of different ethnic groups in NHANES. The rich data characterize the trajectories of key muscle mass indices that may facilitate the clinical appraisal of muscle mass and improve the early diagnosis of sarcopenia in the Chinese population.