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Background & Aim: Several randomized controlled trials indicated that an increase in protein intake decreases intramuscular adipose tissue of the thigh in mobility-limited or pre-frail older persons and stroke patients. However, whether the increase in protein intake in older inpatients is related to decreasing intramuscular adipose tissue remains unclear. The aim of this study was to examine the longitudinal relationship between intramuscular adipose tissue of the quadriceps and protein intake in older inpatients., Methods: This longitudinal study included 193 older inpatients (aged ≥65 years) (median [IQR] age: 83.0 [77.0-88.0]). The primary outcomes were changes in intramuscular adipose tissue of the quadriceps and protein intake. Intramuscular adipose tissue and muscle mass of the quadriceps were examined using ultrasound images (i.e., quadriceps echo intensity and thickness). The changes in quadriceps echo intensity and protein intake were calculated by subtracting the quadriceps echo intensity and protein intake at admission from those values at discharge. Multiple linear regression analysis adjusting for confounding factors was used to determine whether the change in protein intake was independently and significantly related to changes in quadriceps echo intensity and thickness., Results: Quadriceps echo intensity at discharge (81.3 ± 20.6 [a.u.]) was significantly lower than at admission (84.0 ± 20.5 [a.u.]). Protein intake at discharge (1.2 [1.0-1.4] g/kg/day) was significantly higher than at admission (1.2 [0.9-1.4] g/kg/day). Change in protein intake was negatively and significantly related to the change in quadriceps echo intensity. In contrast, change in protein intake was not independently and significantly related to change in quadriceps thickness., Conclusions: Our results indicate that an increase in protein intake is related to a decrease in intramuscular adipose tissue of the quadriceps in older inpatients. Nutritional intervention for increasing protein intake in older inpatients may be essential for decreasing intramuscular adipose tissue of the quadriceps., (Copyright © 2023 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Background: In 2021, the International Society of Physical and Rehabilitation Medicine (ISPRM) special interest group on sarcopenia included the quadriceps thickness assessed with ultrasound image as an indicator of muscle mass in the diagnosis criteria of sarcopenia. If quadriceps echo intensity of older inpatients is to be a strong predictor of quadriceps thickness, muscle quality of the quadriceps may be estimated by the muscle mass when diagnosing sarcopenia using the criteria of ISPRM., Objective: This study aimed to examine the association between muscle mass and fraction of intramuscular adipose tissue of the quadriceps in older inpatients., Methods: This cross-sectional study included 399 inpatients aged ≥ 65 years. Primary outcomes were muscle mass and fraction of intramuscular adipose tissue of the quadriceps. Images were acquired using a B-mode ultrasound. Muscle mass and fraction of intramuscular adipose tissue of the quadriceps were assessed based on the muscle thickness and echo intensity, respectively. A multiple regression analysis (forced entry method) was performed to confirm whether quadriceps echo intensity was related to quadriceps thickness even after adjusting for other factors., Results: In the multiple regression analyses for both male and female models, quadriceps echo intensity (male: β = - 0.537, p < 0.001; female: β = - 0.438, p < 0.001), Geriatric Nutritional Risk Index (male: β = 0.236, p < 0.001; female: β = 0.213, p < 0.001), and subcutaneous fat thickness of the thigh (male: β = 0.197, p < 0.001; female: β = 0.248, p < 0.001) were independently and significantly associated with quadriceps thickness., Conclusions: Our results show that there is a negative and significant association between muscle mass and fraction of intramuscular adipose tissue in older inpatients. Muscle quality of the quadriceps in older inpatients may be estimated to some extent by the muscle mass., Competing Interests: The authors have declared that no competing interests exist.

Background & Aims: Recent studies have shown that increased intramuscular adipose tissue of the quadriceps in older people is more strongly related to decreased muscle strength, sit-up and sit-down ability, and gait ability than is loss of muscle mass. However, whether increased intramuscular adipose tissue of the quadriceps is more strongly related to declines in activities of daily living (ADL) than is loss of muscle mass in older inpatients remains unclear. This study was performed to examine the relationships of intramuscular adipose tissue and muscle mass of the quadriceps with ADL in older inpatients., Methods: This cross-sectional study included 371 inpatients aged ≥65 years. The primary outcomes were ADL and intramuscular adipose tissue of the quadriceps. ADL were assessed using the motor-Functional Independence Measure (FIM). Ultrasound images were acquired using B-mode ultrasound imaging. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed based on echo intensity and muscle thickness, respectively. A stepwise multiple regression analysis was performed to identify factors independently associated with the motor-FIM score. The independent variables were the echo intensity and muscle thickness of the quadriceps, age, sex, length of hospital stay, Food Intake Level Scale (FILS), Geriatric Nutritional Risk Index (GNRI) score, C-reactive protein (CRP) concentration, updated Charlson comorbidity index (UCCI), number of medications, and subcutaneous fat thickness of the thigh., Results: Quadriceps echo intensity (β = - 0.17), FILS (β = 0.38), GNRI score (β = 0.24), UCCI (β = - 0.16), subcutaneous fat thickness of the thigh (β = - 0.11), and length of hospital stay (β = 0.09) were independently and significantly associated with the motor-FIM score. Quadriceps thickness (β = 0.10), age (β = - 0.07), sex (β = - 0.04), CRP concentration (β = - 0.04), and number of medications (β = 0.03) were not associated with the motor-FIM score., Conclusions: Increased intramuscular adipose tissue of the quadriceps is more strongly related to declines in ADL than is loss of muscle mass. Randomized controlled trials are needed to determine whether decreasing intramuscular adipose tissue of the quadriceps in older inpatients leads to improvement of ADL., Competing Interests: Conflict of interest The authors declare that there is no conflict of interest., (Copyright © 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background & Aims: The relationship between malnutrition risk and intramuscular adipose tissue of the quadriceps in older inpatients remains unclear, although a high rate of malnutrition risk has been observed in these patients. Understanding this relationship would be necessary for a management plans for older inpatients. This study aimed to examine the relationship between malnutrition risk and intramuscular adipose tissue of the quadriceps in older inpatients., Methods: Three-hundred and twenty-three older inpatients participated in this cross-sectional study. Malnutrition risk was assessed using the Geriatric Nutritional Risk Index (GNRI). Intramuscular adipose tissue of the quadriceps was assessed based on ultrasound echo intensity. Higher echo-intensity indicates greater amounts of intramuscular adipose tissue. Multiple regression analysis was used to identify the factors that were independently associated with quadriceps echo intensity. GNRI, age, sex (male = 1, female = 2), number of medications, C-reactive protein, updated Charlson comorbidity index, Food Intake Level Scale, the subcutaneous fat thickness of the thigh, motor-Functional Independence Measures, and length of hospital stay were set as the independent variables., Results: GNRI (β = -0.18), age (β = 0.18), sex (β = 0.22), number of medications (β = 0.09), the subcutaneous fat thickness of the thigh (β = -0.29), motor-FIM (β = -0.12), and length of hospital stay (β = 0.11) were significantly and independently associated with the quadriceps echo intensity., Conclusions: The current results revealed that higher malnutrition risk was associated with increased intramuscular adipose tissue of the quadriceps of older inpatients even after adjusting for other characteristics. Nutritional intervention may be necessary for decreasing intramuscular adipose tissue of the quadriceps in older inpatients who have higher malnutrition risk., (Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objective: The aim of this study was to examine the quantitative features of intramuscular adipose tissue of the quadriceps and their association with gait independence in older inpatients., Methods: This was a cross-sectional study with 216 inpatients ≥65 y of age. We also recruited 40 community-dwelling healthy individuals in the same age group who were able to walk independently for matched-pair analysis to determine the quantitative features of intramuscular adipose tissue in older inpatients. Participants were assigned to total assistance (Functional Independence Measure [FIM] gait score 1 or 2), partial assistance (FIM gait score 3-5), and independent (FIM gait score 6 or 7) groups. Ultrasound images were acquired using B-mode ultrasound imaging. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed based on echo intensity and muscle thickness, respectively., Results: Echo intensity of the quadriceps of older inpatients was increased to ~1.66 times that of matched healthy older people. Echo intensity of the independent group was significantly lower than that of the total and partial assistance groups. No differences were found in quadricep thickness among the three groups., Conclusions: The results from the present study suggested that intramuscular adipose tissue of the quadriceps of older inpatients was increased to ~1.7 times that of healthy older individuals matched for demographic characteristics. More intramuscular adipose tissue of the quadriceps was observed among older inpatients who were unable to walk independently compared with older inpatients who were able to walk independently., (Copyright © 2019 Elsevier Inc. All rights reserved.)

The purpose of this study was to examine the relationship between intramuscular adipose tissue of the quadriceps and dysphagia in older inpatients. We hypothesized that increased intramuscular adipose tissue of the thigh may indirectly reflect severe dysphagia in older inpatients. This study was cross-sectional, and 103 older inpatients participated. Patients who had stroke that was the obvious cause of dysphagia were excluded. Primary outcomes were intramuscular adipose tissue of the quadriceps and severity of dysphagia. Transverse ultrasound images were acquired using B-mode ultrasound imaging. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed based on echo intensity and muscle thickness, respectively. Severity of dysphagia was assessed using the Food Intake Level Scale (FILS). We used multiple regression analysis to identify the factors that were independently associated with FILS scores. Echo intensity, age, sex, body mass index, number of medications, C-reactive protein, Geriatric Nutritional Risk Index (GNRI), updated Charlson Comorbidity Index, muscle thickness, subcutaneous fat thickness of the thigh, and length of hospital stay were the independent variables. Echo intensity (β = -0.28), number of medications (β = 0.22), GNRI (β = 0.27), and subcutaneous fat thickness of the thigh (β = -0.29) were significantly independently associated with FILS scores. Muscle thickness was not significantly independently related to FILS scores (β = 0.08). In conclusion, our results suggest that increased intramuscular adipose tissue of the quadriceps in older inpatients is associated with dysphagia. Furthermore, this relationship was stronger than that between loss of muscle mass and dysphagia., (Copyright © 2019 Elsevier Inc. All rights reserved.)