Muscle. Sarcopenia. Muscle mass. Muscle matters! sarx flesh. penia deminished. low skeletal muscle mass. 640 muscles. contraction = movement

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1 Muscle 640 muscles Muscle matters! Andrea Maier, MD PhD Professor of Medicine Gerontology VU University Medical Center, Amsterdam, NL contraction = movement glucose metabolisme protein storage Modifyable! Vesalius Sarcopenia sarx flesh penia deminished 21 jr 63 jr low skeletal muscle mass Muscle mass Muscle mass Muscle strength Movement = = = 45-90% lean mass 10-40% fat mass Ling et al., J Nutr 2011; Ling et al., Age

2 Muscle strength 60 General population Grip strength (kg) Grip strength Quadriceps strength Age (years) Beenakker et al., Ageing Res Rev, 2010 meta-regression lines with 95% confidence band (adjusted to 50% female) Life trajectories Muscle strength and survival 89 years Ling et al., CMAJ 2009 HR 3.7, CI HR 2.6, CI Physical performance Physical performance Mobility Andreas Vesalius

3 Muscle strength and cognition 27 Mean handgrip strength [kg] both p for trend < MMSE 85 years MMSE 89 years Taekema et al Lowest tertile Middle tertile Highest tertile Interrelations HEALTH Sarcopenia interrelates with organ systems. SARCOPENIA MUSCLE Ageing x Disease MOBILITY Muscle strength and age Used definitions Grip strength (kg) General population? Code Formula Cut-off point Cohort used as reference population Reference Sarcopenia present Men Women A ALM/height 2 > 2 SD below RP 7.26 kg/m kg/m 2 Rosetta Study ( ) non-hispanic white men and women aged years B ALM/height 2 Under 20th percentile 7.25 kg/m kg/m 2 Health ABC Study (1997/1998), 2976 men and women years old black and white, Pittsburgh, Pennsylvania and Memphis, Tenessee C ALM/height 2 > 2 SD below RP 6.19 kg/m kg/m 2 NHANES survey ( ) white men D E F ALM with height and fat mass mass/body mass * 100% and women aged 20 years Baumgartner 1998 Delmonico Kelly 2009 Under 20th percentile NA NA NA Delmonico >2 SD below RP is class II 1-2 SD below RP is class I 31% 37% 22% 28% NHANES III ( ), 6414 men and women aged years non-hispanic white, non-hispanic black and Mexican-American mass/ height 2 ROC analysis kg/m NHANES III ( ), 60 years plus, non-hispanic white, black and Mexican- American Janssen 2002 Janssen Age (years) Beenakker et al., Age Res Rev 2010 G Optimal cutpoint Below optimal cutpoint 30.3 kg 19.3 kg InCHIANTI ( ), 1030 subjects aged Lauretani for grip strength, years,, 2003 walking slower than 0.8 m/s Bijlsma et al. 2012, Age; Reijnierse et al. under review 3

4 Concordance Used definitions - no concordance Middle aged Elderly Code Formula Cut-off point Cohort used as reference population Reference Sarcopenia present Men Women A ALM/height 2 > 2 SD below RP 7.26 kg/m kg/m 2 Rosetta Study ( ) non-hispanic white men and women aged years B ALM/height 2 Under 20th percentile 7.25 kg/m kg/m 2 Health ABC Study (1997/1998), 2976 men and women years old black and white, Pittsburgh, Pennsylvania and Memphis, Tenessee C ALM/height 2 > 2 SD below RP 6.19 kg/m kg/m 2 NHANES survey ( ) white men D E F ALM with height and fat mass mass/body mass * 100% and women aged 20 years Baumgartner 1998 Delmonico Kelly 2009 Under 20th percentile NA NA NA Delmonico >2 SD below RP is class II 1-2 SD below RP is class I 31% 37% 22% 28% NHANES III ( ), 6414 men and women aged years non-hispanic white, non-hispanic black and Mexican-American mass/ height 2 ROC analysis kg/m NHANES III ( ), 60 years plus, non-hispanic white, black and Mexican- American Janssen 2002 Janssen 2004 Bijlsma et al. 2012, Age; Reijnierse et al. under review G Optimal cutpoint Below optimal cutpoint 30.3 kg 19.3 kg InCHIANTI ( ), 1030 subjects aged Lauretani for grip strength, years,, 2003 walking slower than 0.8 m/s Bijlsma et al. 2012, Age; Reijnierse et al. under review European consensus International consensus Sarcopenia with limited mobility is defined as a person with muscle loss whose walking speed is equal to or less than 1 m/s or who walks less than 400 m during a 6-minute walk, and who has a lean appendicular mass corrected for height squared of 2 standard deviations or more below the mean of healthy persons between 20 and 30 years of age of the same ethnic group. Cruz-Jentoft et al., Age Ageing 2010 Morley et al. JAMDA 2011 Sarcopenia interrelates with organ systems. Urgent need for a consensus definition of. 4

5 Hepatocellular carcinoma - survival 196 pt hepatocellular carcinoma undergoing hepatectomy, CT L3, 40% sarcopenic Harimoto., Brit J Surg 2013 Hepatocellular carcinoma - survival 217 pt hepatocellular cancer, any treatment, CT L3 Hepatocellular carcinoma - survival 217 pt hepatocellular cancer, any treatment, CT L3 Iritani, J Gastroenterol 2014 Iritani, J Gastroenterol 2014 Bladder cancer - survival 205 pt bladder cancer, radical cystectomy, CT L3, 69% sarcopenic Endomentrial cancer - survival 122 pt endometrial cancer, L3 CT, 50% sarcopenic Psutka, Cancer 2014 Kuroki, Ann Surg Oncol

6 Renal cancer - dose limiting toxicity 55 pt metastatic renal cell cancer, L3 CT Metastatic colorectal cancer - toxicity 51 pt mcrc, CT L3, 71% sarcopenic Antoun, Annals Oncol 2010 Barret, Nutr Cancer 2014 a.maier@vumc.nl Sarcopenia interrelates with organ systems. Urgent need for a consensus definition of. Sarcopenia associates strongly with detrimental outcome in cancer patients. Targeted intervention! 6