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Purpose: A high score determined by SARC-F, a simple screening questionnaire for sarcopenia, has been reportedly associated with worse medical outcomes. However, information regarding whether high SARC-F scores are associated with a poor prognosis in patients with advanced cancer remains limited. We clarified whether a SARC-F score ≥ 4 predicts poor prognosis in patients with cancer receiving palliative care.Methods: We conducted a retrospective cohort study of patients with cancer who received palliative care at a university hospital between May 2019 and April 2020. Patient characteristics including age, sex, height, weight, cancer type, serum albumin level, C-reactive protein level, presence of edema, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS), SARC-F score, history of anticancer therapy, and clinical outcomes were collected from electronic medical records.Results: Of 304 patients, 188 had a SARC-F score < 4, and 116 patients had a SARC-F score ≥ 4. The overall survival of patients with a SARC-F score ≥ 4 was 40 days (95% CI 29-47), which was significantly worse than 121 days (95% CI 95-156) for patients with a SARC-F score < 4 (p < 0.001). SARC-F score ≥ 4 (hazard ratio: HR 1.56), edema (HR 1.94), head and neck cancer (HR 0.51), C-reactive protein (HR 1.05), ECOG-PS ≥ 3 (HR 1.47), and radiotherapy (HR 0.52) were associated with overall survival. The ability to climb stairs was a SARC-F sub-item significantly associated with mortality (HR 1.59).Conclusion: The SARC-F questionnaire is a useful predictor of prognosis for patients with cancer receiving palliative care because a SARC-F ≥ 4 score predicts worse overall survival. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to develop appendicular skeletal muscle mass (ASM) estimating formulas that also consider the presence of paralysis for older adults and people with disabilities. Methods: This retrospective study analyzed 315 consecutive patients, post‐stroke, aged ≥65 years, in a rehabilitation hospital. Six different ASM estimating formulas were developed using a five‐fold cross‐validation method and compared with the measured ASM obtained from bioelectrical impedance analysis. These formulas included age, gender, height, weight, arm circumference, triceps skinfold, calf circumference and presence of paralysis. Using Pearson's correlation coefficients (r) and intraclass correlation coefficient (ICC), we examined the correlation between the formulas and the measured ASM. The accuracy of the ASM estimating formula for detecting decreased muscle mass was evaluated using the F‐value and Matthew's correlation coefficient. Results: Patients' mean ± SD age was 79.0 ± 8.1 years, and 51.4% of them were men. The mean ± SD bioelectrical impedance analysis‐measured ASM was 13.7 ± 4.3 kg. Furthermore, 241 (76.5%) patients had decreased measured ASM. The mean adjusted R2 of the developed six formulas was 0.861–0.871. In all formulas, the r and ICC of the estimated ASM for the measured ASM were strong (r = 0.936–0.930 and ICC = 0.928–0.934). These formulas revealed excellent sensitivity (86.0–88.2%), specificity (72.5–81.1%), accuracy (0.838–0.870), F‐value (0.899–0.918) and Matthew's correlation coefficient (0.509–0.612) for measured ASM depletion. Conclusions: We successfully developed ASM estimating formulas using anthropometric measurements considering the presence of paralysis. Thus, these formulas are beneficial for diagnosing sarcopenia in older adults, without requiring any special equipment. Geriatr Gerontol Int 2020; 20: 1145–1150. [ABSTRACT FROM AUTHOR]

Aim: Calf circumference, which is a known simple indicator of muscle mass, increases during edema. However, the extent to which edema increases calf circumference in older adults is unclear. Methods: This retrospective cross‐sectional study included patients aged ≥65 years whose nutritional status was assessed by nutrition support teams. Two different types of matching models in each sex were created according to the presence of edema on the right lower limb. All models were adjusted by age, body height, handgrip strength and performance status. Sarcopenia was diagnosed based on both reduced calf circumference and decline of handgrip strength. The prevalence of sarcopenia was estimated before and after adjustment for increment of calf circumference. Results: In total, 2101 patients were included. Multifactor matching models showed that the mean difference in calf circumference between pairs was 1.6 cm (95% confidence interval [CI] 1.1–2.1, P < 0.001) for women and 2.1 cm (95% CI 1.6–2.7, P < 0.001) for men. The propensity score matching model similarly showed a mean difference of 1.6 cm (95% CI 1.1–2.1, P < 0.001) for women and 2.0 cm (95% CI 1.5–2.6, P < 0.001) for men. The prevalence of sarcopenia before and after adjusting for an edema‐related increase in calf circumference was 42.6%/48.6% for women and 35.3%/38.5%–38.7% for men. Conclusions: Edema in the lower limb increased the calf circumference by approximately 2 cm. When using calf circumference to assess muscle mass in patients with edema, the increase in circumference should be subtracted from the baseline circumference for an accurate assessment. Geriatr Gerontol Int 2019; 19: 993–998. [ABSTRACT FROM AUTHOR]

Aim: The relationship between oral health‐related quality of life (OHRQoL) and sarcopenia is unknown. The purpose of the present study was to clarify the prevalence of sarcopenia in older dental clinic outpatients and its relationship with OHRQoL and oral health status. Methods: This cross‐sectional study used data from consecutive dental clinic outpatients aged ≥65 years. The Oral Health Impact Profile‐14 was used for the evaluation of OHRQoL, and the Oral Health Assessment Tool was used to assess oral health status. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia criteria. Uni‐ and multivariable analyses were carried out to investigate the relationship between sarcopenia and Oral Health Impact Profile‐14 and Oral Health Assessment Tool scores. Results: This study involved 279 patients (173 women, 106 men) with a mean age of 76 ± 7.5 years. The sarcopenia prevalence rate was 30.2%, and patients with sarcopenia had significantly poorer OHRQoL and oral health status than did patients without sarcopenia. Furthermore, sarcopenia was independently associated with Oral Health Impact Profile‐14 and Oral Health Assessment Tool scores even after adjusting for confounding factors, such as age, sex, nutritional status, activities of daily living, dysphagia, comorbidities, polypharmacy and clinical dental findings. Conclusions: Sarcopenia was associated with OHRQoL and oral health status in older dental clinic outpatients. The prevalence of sarcopenia in older outpatients visiting the dental clinic was relatively high. Rehabilitation nutrition together with dental care might be necessary for sarcopenia treatment and prevention. Geriatr Gerontol Int 2018; 18: 915–921 [ABSTRACT FROM AUTHOR]

Aim: Texture‐modified diets (TMD) have significantly lower energy and protein content than normal diets. Therefore, TMD can cause malnutrition and loss of muscle mass. However, few studies have reported the relationship between TMD and decreased skeletal muscle mass. The aim of the present study was to clarify the association between TMD and decreased skeletal muscle mass. Methods: We reviewed data of 188 older adult patients who were admitted to a rehabilitation hospital. TMD were defined based on the Japanese Dysphagia Diet Criteria 2013 proposed by the Japanese Society of Dysphagia Rehabilitation. The Mini Nutritional Assessment‐Short Form was used to assess nutritional status; dual‐energy X‐ray absorptiometry was used to measure the skeletal muscle mass index, and the cut‐off values for decreased skeletal muscle mass index were based on the Asian Working Group for Sarcopenia; the Functional Independence Measure was used to evaluate activities of daily living. Results: The patients’ mean age was 80.6 ± 7.5 years, and 62% were women. A total of 22 patients (11.7%) consumed TMD. A total of 104 patients (55.3%) had decreased skeletal muscle mass, and approximately 90% of them consumed TMD. Decreased skeletal muscle mass index (odds ratio 7.199, 95% confidence interval 1.489–34.805, P ≤ 0.01) and Functional Independence Measure scores (odds ratio 0.972, 95% confidence interval 0.952–0.992, P ≤ 0.01) were independently related to TMD in the multivariate analysis. Conclusions: The TMD group was associated with decreased skeletal muscle mass. Future, prospective studies are necessary to investigate causality. Geriatr Gerontol Int 2018; 18: 698–704 [ABSTRACT FROM AUTHOR]

Background: Dysphagia is a known risk factor for malnutrition and pneumonia. Although sarcopenia is hypothesized to cause dysphagia, its causality remains unclear. Thus, this study aimed to investigate causality and the risk factors for sarcopenic dysphagia.Methods: We enrolled 95 hospitalized patients aged 65 years or older who had restricted oral intake without dysphagia. The skeletal muscle index and Functional Oral Intake Scale were used to evaluate muscle mass and swallowing ability, respectively. Nutritional status, assessed by body mass index, the Mini Nutritional Assessment-Short Form, and energy intake; activity of daily living, assessed by the Barthel Index; hand-grip strength; duration of oral intake restriction; and cognitive status were measured. Dysphagia (Functional Oral Intake Scale ≤ 5) was determined after 2 months.Results: The participants' mean age was 83.2 ± 8.0 years; 63% were women. Of the surviving 82 patients, 63 (77%) had sarcopenia and 21 (26%) developed dysphagia, all of whom had sarcopenia (p = .002). Most variables were risk factors for dysphagia on univariate analysis. Decreased skeletal muscle index (odds ratio [OR] 24.0, 95% confidence interval [CI] 3.6-159.0, p = .001), Barthel Index (OR 12.9, 95% CI 2.1-78.4, p = .005), and body mass index (OR 11.4, 95% CI 1.8-70.5, p = .009) were independent predictors of dysphagia in the multivariate analysis.Conclusion: This study provides evidence for sarcopenic dysphagia and its risk factors. Preventive and therapeutic interventions require further study. [ABSTRACT FROM AUTHOR]

Background/Aims: The ability to readily diagnose sarcopenia and malnutrition in a clinical setting is essential. This study is aimed at clarifying the calf circumference (CC) cut-off values for decreased skeletal muscle mass (SMM), according to the Asian Work Group for Sarcopenia's criteria definition of sarcopenia, and those for European Society for Clinical Nutrition and Metabolism-defined malnutrition, in hospitalized Japanese patients. Methods: The study involved 1,164 patients aged ≥ 65 years. Predictive CC cut-off values were determined using receiver operating curve (ROC) analyses. The predictive validity of the cut-off values was confirmed against in-hospital mortality. Results: There were 654 females and 510 males (mean age, 83.5 ± 8.2 years). Decreased SMM and malnutrition were observed in 80.4 and 32.8% of all patients, respectively. ROC analyses identified CCs of ≤ 29 cm (female, area under the curve [AUC] 0.791) and ≤ 30 cm (male, AUC 0.832) as cut-off values for decreased SMM, and CCs of ≤ 26 cm (female, AUC 0.798) and ≤ 28 cm (male, AUC 0.837) for malnutrition. CC cut-off values for SMM and malnutrition were independently correlated with inhospital mortality. Conclusions: The study determined appropriate cut-off values for CC to identify decreased SMM and malnutrition according to the relevant guidelines. [ABSTRACT FROM AUTHOR]

Aim: Older adults often present with several comorbidities, including sarcopenia. However, the prevalence of sarcopenia and its associations with other comorbidities in hospitalized older adults are unknown. The present study aimed to determine the prevalence of sarcopenia, and its associations with other comorbidities in hospitalized older adults. Methods: The present cross-sectional study included 619 patients admitted to a geriatric hospital. The prevalence of comorbidities in the presence and absence of sarcopenia, nutritional status (according to body mass index and the Mini-Nutritional Assessment-Short Form), and activities of daily living (according to the Barthel Index) were assessed. Sarcopenia was defined as skeletal muscle loss evaluated by both bioelectrical impedance and handgrip strength analyses. Results: Of the 619 participants (mean age 83.0 ± 8.2 years), 417 (67.4%) and 87 (14.1%) had definitive and possible sarcopenia, respectively. The prevalence rates of cognitive impairment and stroke were significantly higher in patients with definitive sarcopenia and those with possible sarcopenia than in those without sarcopenia (cognitive impairment 54.4%, 70.1% and 20.9%, respectively, P < 0.001; stroke 31.2%, 48.3% and 19.1%, respectively, P < 0.001). Multivariate logistic regression analysis showed that cognitive impairment was independently associated with sarcopenia after adjusting for age, sex, the Mini-Nutritional Assessment-Short Form score, Barthel Index and primary disease (adjusted odds ratio 1.98, 95% confidence interval 1.06–3.71; P = 0.032). Conclusions: Sarcopenia might be highly prevalent among hospitalized older adults. Furthermore, cognitive impairment might be an independent explanatory variable of sarcopenia. Therefore, further studies on sarcopenia in patients with cognitive impairment are warranted. [ABSTRACT FROM AUTHOR]

Objectives To investigate the association between loss of muscle mass and aspiration pneumonia ( AP). Design Prospective observational cohort. Setting Acute geriatric hospital. Participants Individuals admitted to the hospital for AP (N = 151; mean age 85.9; 49.7% male). Measurements Appendicular skeletal muscle index ( ASMI; appendicular skeletal muscle mass divided by height squared) was used to evaluate muscle mass. Data on age, sex, body mass index, Mini Nutritional Assessment-Short Form score, Barthel Index score, Charlson Comorbidity Index score, and pneumonia severity (Japanese version of the CURB-65 (C (confusion), U (blood urea nitrogen ≥20 mg/ dL), R (respiratory rate ≥30 breaths/min), B (systolic blood pressure <90 mmHg or diastolic blood pressure ≤60 mmHg), 65 (aged ≥65) severity score (A- DROP)) were obtained. Outcomes included 30- and 90-day mortality. Results Mild, moderate, severe, and extremely severe AP were observed in 1.3%, 70.2%, 25.8%, and 2.6% of participants, respectively. On Kaplan-Meier analysis, participants in the lowest ASMI quartile for each sex were more likely to die than those in the other quartiles (log-lank test P = .005). Multivariate logistic analyses showed that ASMI and A- DROP were independent predictors of 90-day mortality; only A- DROP was a significant predictor of 30-day mortality ( P < .001). Cox regression analysis also showed that the first ASMI quartile was independently associated with mortality (hazard ratio = 2.19; 95% confidence interval = 1.06-4.52; P = .03). Conclusion Low muscle mass is a potential predictor of long-term mortality in individuals with AP. Prospectively preventing muscle mass deterioration may be beneficial for recovery from AP in older adults. [ABSTRACT FROM AUTHOR]

Aim Sarcopenia can cause varying physical function disorders, including dysphagia. Malnutrition, a potential result of dysphagia, can also cause sarcopenia. However, the association between sarcopenia and dysphagia is not fully understood, despite evidence suggesting correlations between deglutition disorders and degenerative loss of muscle mass. The present study investigated the prevalence of dysphagia among patients with sarcopenia, and the association between the two conditions. Methods We included 224 older adults (mean age 82.5 ± 8.4 years; 37.9% men). Individuals who had a stroke or other diseases that could directly cause dysphagia were excluded. Logistic regression analyses were carried out after adjusting for potential causes of sarcopenia, including malnutrition, a low activity of daily living levels and aging, to investigate the relationship between the skeletal muscle index ( SMI), prevalence of sarcopenia diagnosed based on a low SMI and grip strength, and swallowing functions. The Mini-Nutritional Assessment short form was used to assess their nutritional status, and the Barthel Index was used to evaluate their activities of daily living. Results The prevalences of sarcopenia and dysphagia were 76.8% and 30.0%, respectively. Multivariate analysis showed that Barthel Index, SMI and presence of sarcopenia were significant independent factors for the prevalence of dysphagia, after adjusting for sex, age and nutritional status. Furthermore, subgroup analysis showed that SMI in males, and both hand-grip strength and SMI in females were lower in dysphagic subjects than in non-dysphagic subjects ( P ≤ 0.01). Conclusion Sarcopenia was an independent risk factor for dysphagia among older individuals. However, further studies are required to define causality. Geriatr Gerontol Int 2016; 16: 515-521. [ABSTRACT FROM AUTHOR]

• Report of diagnostic accuracy of possible sarcopenia against sarcopenia by AWGS 2019. • Diagnostic accuracy of possible sarcopenia for definitive sarcopenia is excellent. • Definitive sarcopenia may be missed in case-finding with extremely reduced CC. • Possible sarcopenia is appropriate for the detection of definitive sarcopenia. The Asian Working Group for Sarcopenia 2019 (AWGS 2019) proposed a simple assessment of sarcopenia called "possible sarcopenia" for the purpose of early detection and intervention of sarcopenia. The purpose of this study was to report the accuracy of possible sarcopenia against definitive sarcopenia and the characteristics of false-negative cases. This was a cross-sectional study using a research registry with outpatients aged ≥65 years who visited a frailty clinic at a geriatric hospital. The diagnosis of possible sarcopenia and sarcopenia was performed according to the AWGS 2019 criteria, using calf circumference (CC) for case-finding. The accuracy of the diagnosis of sarcopenia in participants with possible sarcopenia was evaluated by calculating sensitivity, specificity, and F-value. Of the 349 patients (mean age, 78.0±6.0 years; 63% women) analyzed, 86 (24.6%) revealed possible sarcopenia. Possible sarcopenia predicted sarcopenia with a sensitivity of 0.893 and 0.921, specificity of 0.990 and 0.870, and F-values of 0.926 and 0.714 for men and women, respectively. When either the grip strength test or 5-time chair stand test result was examined, the sensitivity of possible sarcopenia to predict sarcopenia decreased, whereas the specificity remained at 0.990–1.000 in men and 0.890–0.940 in women. An extremely decreased CC was identified as a significant characteristic of patients with sarcopenia not detected in the simplified assessment. The diagnostic accuracy of possible sarcopenia for definitive sarcopenia is excellent. Sarcopenia should be actively examined in patients with extremely decreased CC. [ABSTRACT FROM AUTHOR]

• More than half of the older patients with stroke have sarcopenia. • The AWGS 2019 recommended CC cut-off values are valid for case-finding of sarcopenia. • Predictive characteristics of sarcopenia were different among men and women. The Asia Working Group for Sarcopenia 2019 (AWGS) recommended using the calf circumference (CC) cut-off values to facilitate the case-finding of sarcopenia. However, the validity of the proposed cut-offs has not been examined in older patients with stroke. This study investigated the validity of the AWGS-recommended CC cut-off values for identifying sarcopenia among older patients with stroke. This cross-sectional study enrolled consecutive patients with stroke, aged 65 years and older, admitted to a convalescent rehabilitation ward. Sarcopenia was diagnosed based on the AWGS 2019 criteria. We drew a receiving operating characteristic curve to assess the ability of CC to predict sarcopenia diagnosis. Subsequently, we estimated the sensitivity, specificity, accuracy, F-value, and Matthews correlation coefficient (MCC) of the considered cut-off values. We enrolled 256 patients (43 % women) (mean age, 76.6 ± 7.5 years). The prevalence of sarcopenia was 63.7 %. Among men who presented with CC < 34 cm (the AWGS-recommended cut-off value), sensitivity and specificity were 85 % and 66 %, respectively. Concurrently, estimates of accuracy, F-value, and MCC were the highest at cut-off value <34 cm. Among women, at <33 cm of the AWGS-recommended cut-off value, the sensitivity and specificity were 91 % and 28 %, respectively. At cut-off value <32 cm, sensitivity was maintained at 80 %, while specificity increased to 56 %; suggesting that this cut-off value might be a useful indicator for the case-finding of sarcopenia. The AWGS-recommended CC cut-off values are valid. The predictive characteristics of sarcopenia differed among men and women with stroke. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to create a formula to estimate the third lumbar vertebra (L3)1 level skeletal muscle cross-sectional area (CSA), known as a standard value to evaluate skeletal muscle mass on computed tomography (CT), using the twelfth thoracic vertebra (Th12) level skeletal muscle CSA on chest CT.Materials and Methods: This retrospective observational study included patients aged 40 + years with a diagnosis of oral squamous cell carcinoma (n = 164). Skeletal muscle CSA on CT images was measured using the Th12 and the L3 levels of pretreatment CT scans. The predictive formula was created based on the five-fold cross-validation method with a linear regression model. Correlations between the predicted L3-level CSA and the actual L3-level CSA were evaluated using r and Intraclass Correlation Coefficients (ICC).Results: The predictive formula for L3-level CSA from Th12-level CSA was: CSA at L3 (cm2) = 14.143 + 0.779 * CSA at Th12 (cm2) - 0.212 * Age (y) + 0.502 * Weight (kg) + 13.763 * Sex. Correlations between the predicted and measured L3-level CSA were r = 0.915 [0.886-0.937] and ICC = 0.911 [0.881-0.934].Conclusion: We developed a formula for predicting skeletal muscle mass from the Th12-level CT slice. The predicted L3-level CSA correlated with the measured L3-level CSA. [ABSTRACT FROM AUTHOR]

A review of the article "Effects of aging and sarcopenia on tongue pressure and jaw-opening force" by Machida N, Tohara H, Hara K et al, which appeared in the periodical "Geriatrics & Gerontology International" in 2016, is presented.

A letter to the editor is presented in response to an article about a decreased skeletal muscle mass index a novel risk factor for dysphagia in older adults requiring long-term care.

We defined respiratory sarcopenia as a coexistence of respiratory muscle weakness and decreased respiratory muscle mass. Although respiratory muscle function is indispensable for life support, its evaluation has not been included in the regular assessment of respiratory function or adequately evaluated in clinical practice. Considering this situation, we prepared a position paper outlining basic knowledge, diagnostic and assessment methods, mechanisms, involvement in respiratory diseases, intervention and treatment methods, and future perspectives on respiratory sarcopenia, and summarized the current consensus on respiratory sarcopenia. Respiratory sarcopenia is diagnosed when respiratory muscle weakness and decreased respiratory muscle mass are observed. If respiratory muscle mass is difficult to measure, we can use appendicular skeletal muscle mass as a surrogate. Probable respiratory sarcopenia is defined when respiratory muscle weakness and decreased appendicular skeletal muscle mass are observed. If only respiratory muscle strength is decreased without a decrease in respiratory function, the patient is diagnosed with possible respiratory sarcopenia. Respiratory muscle strength is assessed using maximum inspiratory pressure and maximum expiratory pressure. Ultrasonography and computed tomography are commonly used to assess respiratory muscle mass; however, there are insufficient data to propose the cutoff values for defining decreased respiratory muscle mass. It was jointly prepared by the representative authors and authorized by the Japanese Society for Respiratory Care and Rehabilitation, Japanese Association on Sarcopenia and Frailty, Japanese Society of Respiratory Physical Therapy and Japanese Association of Rehabilitation Nutrition. Geriatr Gerontol Int 2023; 23: 5–15. [ABSTRACT FROM AUTHOR]

• We investigated the prevalence of postoperative dysphagia in older orthopedic patients. • The prevalence of dysphagia after orthopedic surgery was 16–32 %. • Factors related to postoperative dysphagia included being older, and sarcopenia. • Non-neurogenic dysphagia present in orthopedic patients, and sarcopenia may contribute. Oropharyngeal dysphagia is one of the most prevalent health complications in older adults. The prevalence of postoperative dysphagia is expected to rise with the increasing number of older patients undergoing orthopedic surgery; however, the specific prevalence and contributing factors remain unclear. This scoping review aimed to identify the prevalence and factors related to postoperative dysphagia in older orthopedic patients. This review included studies published up to September 2022 on postoperative patients aged ≥ 60 years who underwent orthopedic surgery. We searched MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science, and Ichushi-Web. In total, 21 of the 2158 identified studies were reviewed. The studies were classified into the three categories according to the surgical site: cervical spine disease (n = 12), hip fracture (n = 7), and others (n = 2). The estimated dysphagia prevalence rates [95 % confidence interval] of cervical spine disease, hip fractures, and others were 16 % [8–27], 32 % [15–54], and 6 % [4–8], respectively. Factors related to postoperative dysphagia included cervical alignment in cervical spine disease, being older within the cohort, preoperative health status, malnutrition, and sarcopenia in hip fractures. The prevalence of postoperative dysphagia after orthopedic surgery was highest for hip fractures, followed by cervical spine and others. These results suggest non-neurogenic dysphagia in older patients undergoing orthopedic surgery and indicate that sarcopenia may contribute to postoperative dysphagia in this population. Therefore, further research should clarify the trajectory of postoperative dysphagia and the effectiveness of rehabilitation for postoperative dysphagia after orthopedic surgery. [ABSTRACT FROM AUTHOR]

In many cases, swallowing function is impaired after the onset of stroke and gradually improves. However, delayed dysphagia has been reported in some post-stroke patients. Recently, several studies have reported that low muscle strength and decreased muscle mass cause dysphagia. This study aimed to investigate whether these conditions are associated with delayed dysphagia after stroke. A multicenter prospective observational cohort study. Participants included 165 patients with post-stroke dysphagia (mean age 79.1 ± 8.0 years, 53.3% women) admitted to rehabilitation wards for post-stroke rehabilitation. Swallowing function was assessed using the Functional Oral Intake Scale. Delayed dysphagia was defined as dysphagia that occurred more than 7 days after stroke onset. We used logistic regression to examine the independent association between low muscle strength and decreased muscle mass and delayed dysphagia development. Furthermore, we examined the relationship between improvement in dysphagia and delayed dysphagia. Delayed dysphagia was observed in 18 (10.9%) patients. The combination of severely low muscle strength and decreased muscle mass was independently associated with the development of delayed dysphagia (adjusted odds ratio: 4.423, 95% confidence interval: 1.400–13.974, P =.011). Delayed dysphagia had an adverse effect on the improvement of dysphagia during in-hospital rehabilitation (adjusted odds ratio: 0.278, 95% confidence interval: 0.078–0.986, P =.047). The development of delayed dysphagia was influenced by a combination of severely low muscle strength and decreased muscle mass. Furthermore, delayed dysphagia adversely affects the improvement of dysphagia in patients with stroke and needs to be identified early. Identifying delayed dysphagia using the methods proposed in this study and incorporating early intervention may prevent or delay dependency conditions in this population. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented considering a study published in the journal on the link of age, body mass index (BMI), dietary variety score (DVS), locomotive syndrome, and household status to sarcopenia.

This report was written by the Japanese Society of Dysphagia Rehabilitation, the Japanese Association of Rehabilitation Nutrition, the Japanese Association on Sarcopenia and Frailty, and the Society of Swallowing and Dysphagia of Japan to consolidate the currently available evidence on the topics of sarcopenia and dysphagia. Histologically, the swallowing muscles are of different embryological origin from somatic muscles, and receive constant input stimulation from the respiratory center. Although the swallowing muscles are striated, their characteristics are different from those of skeletal muscles. The swallowing muscles are inevitably affected by malnutrition and disuse; accumulating evidence is available regarding the influence of malnutrition on the swallowing muscles. Sarcopenic dysphagia is defined as dysphagia caused by sarcopenia of the whole body and swallowing‐related muscles. When sarcopenia does not exist in the entire body, the term "sarcopenic dysphagia" should not be used. Additionally, sarcopenia due to neuromuscular diseases should be excluded; however, aging and secondary sarcopenia after inactivity, malnutrition and disease (wasting disorder and cachexia) are included in sarcopenic dysphagia. The treatment of dysphagia due to sarcopenia requires both dysphagia rehabilitation, such as resistance training of the swallowing muscles and nutritional intervention. However, the fundamental issue of how dysphagia caused by sarcopenia of the swallowing muscles should be diagnosed remains unresolved. Furthermore, whether dysphagia can be caused by primary sarcopenia should be clarified. Additionally, more discussion is required on issues such as the relationship between dysphagia and secondary sarcopenia, as well as the diagnostic criteria and means for diagnosing dysphagia caused by sarcopenia. Geriatr Gerontol Int 2019; 19: 91–97. [ABSTRACT FROM AUTHOR]

Background and Objectives: The rates of sarcopenia and cachexia evaluations by different occupational groups at different settings are unclear. The objectives are to evaluate and compare the relative use of sarcopenia and cachexia evaluations among dietitians and associated healthcare professionals in a diverse range of settings.Methods and Study Design: Participants were 4,621 members from the Japanese Association of Rehabilitation Nutrition. Settings included acute general wards, convalescent rehabilitation wards, long-term care wards, homecare service, and other settings. A questionnaire-based cross-sectional study was performed to evaluate assessments for sarcopenia and cachexia among dietitians and other professionals. Multiple comparisons based on Bonferroni method and logistic regression analysis were used.Results: 718 (15.5%) answered the questionnaire. Data from 683 valid questionnaires were analyzed. Muscle strength, muscle mass, physical function, and cachexia were assessed by 53.4%, 51.1%, 53.4%, and 17.4% of dietitians. At convalescent rehabilitation wards, these rates were 81.8%, 62.0%, 82.5%, and 14.0%. The use of muscle strength and physical function evaluations was significantly lower among dietitians than among physical therapists and occupational therapists. The use of muscle mass and cachexia evaluations was not significantly different among the occupations. The use of muscle mass and strength evaluations was significantly higher in convalescent rehabilitation wards than in acute general wards, long-term care wards and facilities, and other settings, but not in homecare services. Cachexia evaluations were not significantly different between all settings.Conclusions: Raising the awareness of cachexia and sarcopenia among dietitians is a key issue, which should be addressed. [ABSTRACT FROM AUTHOR]

Osteosarcopenia is a new definitional approach that can increase the risk of falls and fractures in elderly compared with that of osteoporosis and sarcopenia alone. However, biomarkers for osteosarcopenia have not been well identified. Thus, we aimed to explore the biomarkers of osteosarcopenia, including bone, muscle, and geriatric markers. Outpatients attending a frailty clinic were enrolled in the study. Osteosarcopenia was defined as the coexistence of osteoporosis and sarcopenia. Osteoporosis was defined according to the criteria of the Japan Osteoporosis Society. Sarcopenia was defined according to the Asian Working Group for Sarcopenia consensus (2019). We selected 35 blood/serum pathological parameters, including bone, inflammation, nutritional, and aging markers for the study. Logistic regression analysis for osteosarcopenia was performed to explore the biomarkers of osteosarcopenia. Of the total 600 patients with a mean age of 76.6 years, 595 were enrolled in the registry during the study period. Logistic regression analysis for osteosarcopenia showed that elevated thyroid-stimulating hormone (TSH) (odds ratio [OR]:1.375; 95 % confidence interval [CI]: 1.092–1.731), bone-specific alkaline phosphatase (BAP) (OR: 1.059; 95 % CI: 1.002–1.120), and estimated glomerular filtration rate (eGFR) (OR: 1.029; 95 % CI: 1.007–1.053) increased the likelihood of osteosarcopenia. On the other hand, elevated 25-hydroxyvitamin D (25OHD) (OR: 0.905; 95 % CI: 0.841–0.974), blood urea nitrogen (BUN) (OR: 0.895; 95 % CI: 0.829–0.966) and K (OR: 0.241; 95 % CI: 0.081–0.717) decreased the likelihood of osteosarcopenia. It is worthwhile to examine these biomarkers for older adult outpatients attending a frailty clinic for screening osteosarcopenia. Further studies are needed to investigate the effects of other markers of bone metabolism. • Osteosarcopenia biomarkers needed for early detection and preventing deterioration. • Elevated TSH, BAP, and eGFR increase the likelihood of osteosarcopenia. • In contrast, elevated 25OHD and BUN decrease the likelihood of osteosarcopenia. [ABSTRACT FROM AUTHOR]

• Patients with decreased tongue strength had poorer recovery of their swallowing function, higher incidence of pneumonia, and poorer life expectancy. Whether decreased tongue strength is associated with poor clinical outcomes is unclear. This systematic review investigated the effect of decreased tongue strength on the clinical outcomes of adults requiring medical treatment. Systematic review. Systematic reviews, randomized control trials, intervention studies, and longitudinal observational studies involving patients with decreased tongue strength requiring medical treatment were included. Articles published between January 2000 and June 2021 were retrieved from MEDLINE, CINAHL, Ichushi-web (in Japanese), Web of Science, ClinicalTrials.gov, UMIN, the Cochrane Library, and Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the Risk of Bias Assessment Tool for Nonrandomized Studies. The study protocol was pre-registered in XXX. After screening 3040 articles and excluding duplicates, 74 articles were retrieved; after full-text evaluation of the 74 articles, seven articles (with 787 patients) were found to meet the inclusion criteria. The cut-off values for determining decreased tongue strength ranged from 13.8 to 21.6 kPa. Patients with decreased tongue strength had poorer recovery of their swallowing function, higher incidence of pneumonia, and poorer life expectancy than those with high tongue strength. However, tongue strength in older patients with decreased tongue strength increased when they performed physical exercise interventions and followed strict nutritional management plans. Decreased tongue strength was related to poor clinical outcomes in in- and outpatients. Oral frailty in older patients should be given increased attention in hospitals, and further research is needed to improve the clinical outcomes for older people with reduced tongue strength. [ABSTRACT FROM AUTHOR]

• Osteosarcopenia was independently associated with cognitive frailty. • Osteosarcopenia had a higher odds ratio than each alone in association with cognitive frailty. • Decreased executive functions and orientation were associated with osteosarcopenia. Osteosarcopenia and cognitive frailty are both risk factors for falls and fractures. The purpose of this study was to determine the association between osteosarcopenia and cognitive frailty. This was a cross-sectional secondary data analysis of the Frailty Registry Study with outpatients aged ≥65 years who visited a frailty clinic at a geriatric hospital. Osteoporosis was defined as a bone mineral density < 70% of the young adult mean. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. Cognitive frailty was defined as the coexistence of physical frailty and mild cognitive impairment. Physical frailty was evaluated according to Japanese Cardiovascular Health Study criteria, whereas mild cognitive impairment was defined as a Mini-Mental State Examination score ≥ 24 points and a score ≤ 25 points on the Japanese version of the Montreal Cognitive Assessment. We performed multivariable logistic regression analysis to investigate the association between osteosarcopenia and cognitive frailty. The data of 432 patients were analysed. The prevalence of osteosarcopenia and cognitive frailty was 10.2% and 20.8%, respectively. Logistic regression analysis revealed that osteosarcopenia was independently associated with cognitive frailty with a higher odds ratio than osteoporosis or sarcopenia alone. Lost points in visuospatial abilities/executive functions and orientation were significantly associated with osteosarcopenia. Combination of osteoporosis and sarcopenia is more likely to be associated with physical and cognitive decline than osteoporosis and sarcopenia alone. The mechanism by which osteosarcopenia is associated with decreased visuospatial abilities/executive functions and orientation needs to be addressed. [ABSTRACT FROM AUTHOR]