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Skeletal muscle mass or appendicular muscle mass? That is the question

European Journal of Clinical Nutrition (2024)Cite this article

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Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease characterized by an irreversible obstructive ventilation disorder, most often related to tobacco smoking [1]. COPD patients commonly experience comorbidities such as sarcopenia and undernutrition, which are closely linked to increased mortality rates and heightened susceptibility to disease exacerbations [2]. The development of sarcopenia and undernutrition in the progression of COPD involves various mechanisms, including elevated resting metabolism, increased daily energy expenditure, and insufficient food intake [3].

In a previous publication in EJCN, Perrot et al. [4] describe their observational study of 54 hospitalized COPD patients in a Respiratory Department of the University Hospital of Clermont-Ferrand, France; who were followed up with an assessment of their nutritional status and respiratory function during their hospitalization and six months later. From the data presented, skeletal muscle mass (SMM) and skeletal muscle mass index (SMI) were calculated by bioelectrical impedance measurement using an impedance equation to predict appendicular skeletal muscle mass (ASMM): [0.401 × (height2/resistance) + (3.825 × gender) − (0.071 × age) + 5.102]. Nevertheless, it’s worth pointing out a certain level of confusion concerning the various parameters discussed in this study. To clarify, the equation proposed to determine the ASMM corresponds to the one originally introduced by Janssen et al. [5] for the evaluation of the SMM, not the ASMM, the latter represents the muscle mass of the upper and lower limbs of the body, and is considered as a part of the overall SMM (73–75% of the total SMM) [6]. Using the device featured in this study, the Bodystat Quadscan 4000 Ltd, Isle of Man, UK, it is possible to measure the free fat mass FFM (kg and %), as well as the absolute value of the SMM (kg). This value can be converted into SMI by dividing it by the square of a person’s height in meters (kg/m2); as well as the other parameters of the body composition but it doesn’t offer measurements of ASMM. Furthermore, the assessment of sarcopenia in this context relied on the measurement of SMI and FFMI, coupled with the evaluation of muscular strength. It’s important to note that these two parameters are no longer considered primary screening tools for sarcopenia, as per the updated guidelines of the European Working Group on Sarcopenia in Older People EWGCOP [7]. Instead, the current recommendation from EWGCOP suggests the measurement of ASMM as the parameter for confirming sarcopenia. Additionally, the cut-off value chosen for the SMI set at 8.87 kg/m2 for men and 6.42 kg/m2 for women was derived from a previous study involving Taiwanese subjects [8], knowing the differences of corpulence between this ethnic group and those of the Caucasian population studied in this work, these SMI values have the potential to significantly impact the observed results.

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References

  1. Venkatesan P. GOLD COPD report: 2023 update. Lancet Respir Med. 2023;11:18. https://doi.org/10.1016/S2213-2600(22)00494-5.

    Article  PubMed  Google Scholar 

  2. Kaluźniak-Szymanowska A, Krzymińska-Siemaszko R, Deskur-Śmielecka E, Lewandowicz M, Kaczmarek B, Wieczorowska-Tobis K. Malnutrition, sarcopenia, and malnutrition-sarcopenia syndrome in older adults with COPD. Nutrients. 2021;14:44. https://doi.org/10.3390/nu14010044.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Deng M, Lu Y, Zhang Q, Bian Y, Zhou X, Hou G. Global prevalence of malnutrition in patients with chronic obstructive pulmonary disease: systemic review and meta-analysis. Clin Nutr. 2023;42:848–58. https://doi.org/10.1016/j.clnu.2023.04.005.

    Article  PubMed  Google Scholar 

  4. Perrot L, Greil A, Boirie Y, Farigon N, Mulliez A, Costes F, et al. Prevalence of sarcopenia and malnutrition during acute exacerbation of COPD and after 6 months recovery. Eur J Clin Nutr. 2020;74:1556–64. https://doi.org/10.1038/s41430-020-0623-6.

    Article  CAS  PubMed  Google Scholar 

  5. Janssen I, Heymsfield SB, Baumgartner RN, Ross R. Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Phys. 2000;89:465–71. https://doi.org/10.1152/jappl.2000.89.2.465.

    Article  CAS  Google Scholar 

  6. Sergi G, De Rui M, Stubbs B, Veronese N, Manzato E. Measurement of lean body mass using bioelectrical impedance analysis: consideration of the pros and cons. Aging Clin Exp Res. 2017;29:591–7. https://doi.org/10.1007/s40520-016-0622-6.

    Article  PubMed  Google Scholar 

  7. Fernandes LV, Paiva AEG, Silva ACB, de Casto IC, Santiago AF, de Oliveira EP, et al. Prevalence of sarcopenia according to EWGSOP1 and EWGSOP2 in older adults and their associations with unfavorable health outcomes: a systematic review. Aging Clin Exp Res. 2022;34:505–14. https://doi.org/10.1007/s40520-021-01951-7.

    Article  PubMed  Google Scholar 

  8. Chien M-Y, Huang T-Y, Wu Y-T. Prevalence of sarcopenia estimated using a bioelectrical impedance analysis prediction equation in community-dwelling elderly people in Taiwan. J Am Geriatr Soc. 2008;56:1710–5. https://doi.org/10.1111/j.1532-5415.2008.01854.x.

    Article  PubMed  Google Scholar 

  9. Vogele D, Otto S, Sollmann N, Haggenmüller B, Wolf D, Beer M, et al. Sarcopenia - definition, radiological diagnosis, clinical significance. Sarkopenie – Definition, radiologische Erfassung, klinische Bedeutung. Rofo. 2023;195:393–405. https://doi.org/10.1055/a-1990-0201.

    Article  PubMed  Google Scholar 

  10. Sergi G, De Rui M, Veronese N, Bolzetta F, Berton L, Carraro S, et al. Assessing appendicular skeletal muscle mass with bioelectrical impedance analysis in free-living Caucasian older adults. Clin Nutr. 2015;34:667–73. https://doi.org/10.1016/j.clnu.2014.07.010.

    Article  PubMed  Google Scholar 

  11. Scafoglieri A, Clarys JP, Bauer JM, Verlaan S, Van Malderen L, Vantieghem S, et al. Predicting appendicular lean and fat mass with bioelectrical impedance analysis in older adults with physical function decline - the PROVIDE study. Clin Nutr. 2017;36:869–75. https://doi.org/10.1016/j.clnu.2016.04.026.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Faculty of Medicine, Tahri Mohamed University, Bechar, 08000, Algeria

    Lotfi Rahal

  2. Department of clinical physiology and functional explorations, Public Hospital Establishment, Bechar, 08000, Algeria

    Lotfi Rahal

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LR was responsible for designing and writing the letter. The author read and approved the final manuscript.

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Rahal, L. Skeletal muscle mass or appendicular muscle mass? That is the question. Eur J Clin Nutr (2024). https://doi.org/10.1038/s41430-023-01397-2

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