University of Groningen

Gaining insight in factors associated with successful ageing: body composition, nutrition, andcognitionNijholt, Willemke

DOI:10.33612/diss.102704591

IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.

Document VersionPublisher's PDF, also known as Version of record

Publication date:2019

Link to publication in University of Groningen/UMCG research database

Citation for published version (APA):Nijholt, W. (2019). Gaining insight in factors associated with successful ageing: body composition, nutrition,and cognition. [Groningen]: Rijksuniversiteit Groningen. https://doi.org/10.33612/diss.102704591

CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).

Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.

Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.

Download date: 05-06-2020

Response to: “Theuseofultrasoundforthe estimation of muscle mass: one site fits most?”2

WillemkeNijholt,HarriëtJager-Wittenaar,AldoScafoglieri,HansHobbelen,Cees P. van der Schans

JCachexiaSarcopeniaMuscle.2018;9(3):627-628DOI:10.1002/jcsm.12293

B

Chapter 2B

46

The use of ultrasound for the estimation of muscle mass: one site fits most?Takashi Abe1,JeremyP.Loenneke1 and Robert S. Thiebaud2

1 KevserErminAppliedPhysiologyLaboratory,DepartmentofHealth,ExerciseScience,&RecreationManagement,TheUniversityofMississippi,University,MS,38677,USA.

2 DepartmentofKinesiology,TexasWesleyanUniversity,1201WesleyanSt,FortWorth,TX,76105,USA Correspondingauthor:TakashiAbe(t12abe@gmail.com)

During the last twodecades,DXA-derivedappendicular leansoft tissuemasshasservedasamajorcriterionfordiagnosingtheage-relatedlossofskeletalmusclemass(i.e.sarcopenia).1 From a clinical perspective, however, DXA measurements are costly, and the device has limitedavailability. Apossiblealternativemethodformeasuringmusclesize(e.g.musclethickness)inhumansmaybeB-modeultrasound.Itiswellknownthatultrasoundisanon-invasive,quick,valid,andreliableimagingtechniquetoestimatemusclethicknessinmusclesoftheextremityandtrunk.2,3

With this in mind, we read with great interest the article by Nijholt and colleagues,4 where they reportedthevalidityandreliabilityofultrasoundtoquantifymusculatureinolderadults.TheauthorsalsoreportedontwopredictionequationsforestimatingDXA-derivedmusclemass.Although not reported within this paper, we previously noted that two of those prediction equationsselectedbyNijholtetal.includedsystematicerror.5 Over the last couple of years, we have published several prediction equations for estimating DXA-derived appendicularlean mass in older adults.6–8Unfortunately,thoseequationswerenotincludedinthearticlebyNijholt et al.4Interestingly, a single site measurement of forearm muscle thickness was found tobegoodpredictorofDXA-derivedleansofttissuemassinolderCaucasianadults,6 and the equationwasalsofoundtobeaccurateinolderJapaneseadults.7 Notably, the standard error oftheestimatewas1.95kgfortheequationthatusedasinglemusclethicknesssite,whereasthestandarderroroftheestimateoftheequationthatincludedeightpredictorswas1.13kg.6 Theamountoftimerequiredforasingleultrasoundmeasurementisgenerallylessthan1minper person, so this estimate appears both valid and pragmatic.

In summary, our previous studies6,7suggest that forearm muscle thickness measurements are a tolerable and less demanding assessment to use for older adults, and ultrasound estimated appendicular lean mass from the forearm muscle thickness may be a useful indicator for evaluating muscularity in older adults. Although additional research is needed, our recent work along with others noted within the Nijholt et al.4 review may be useful with the development of ultrasound evaluation for health screenings as well as for the primary diagnosis of sarcopenia.

Acknowledgements

The authors certify that they comply with the ethical guidelines for authorship and publishing oftheJournalofCachexia,SarcopeniaandMuscle.9

Response to: “The use of ultrasound for the estimation of muscle mass: one site fits most?”

47

References1. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al.Sarcopenia: European consensus on definitionanddiagnosis:ReportoftheEuropeanWorkingGroup on Sarcopenia in Older People. Age Ageing 2010;39:412–423.

2. Abe T, Loenneke JP, Thiebaud RS, Loftin M.Morphological and functional relationshipswith ultrasound measured muscle thickness of the upper extremity and trunk. Ultrasound. 2014;22:229–235.

3. Abe T, Loenneke JP, Thiebaud RS.Morphological and functional relationshipswith ultrasound measured muscle thickness of the lower extremity: A brief review.Ultrasound. 2015;23:166–173.

4. Nijholt W, Scafoglieri A, Jager-Wittenaar H,Hobbelen JS, van der Schans CP. The reliabilityand validity of ultrasound to quantify musclesin older adults: a systematic review. J Cachexia Sarcopenia Muscle.2017;8:702–712.

5. Abe T, Loenneke JP, Young KC, ThiebaudRS, Nahar VK, Hollaway KM, et al. Validity ofultrasound prediction equations for total andregional muscularity in middle-aged andolder men and women. Ultrasound Med Biol. 2015;41:557–564.

6. Abe T, Thiebaud RS, Loenneke JP, YoungKC. Prediction and validation of DXA-derivedappendicular lean soft tissue mass by ultrasound in older adults. Age. 2015;37:114.

7. Abe T, Fijita E, Thiebaud RS, Loenneke JP,Akamine T.Ultrasound-derived forearmmusclethickness is a powerful predictor for estimating DXA-derived appendicular lean mass inJapanese older adults. Ultrasound Med Biol. 2016;42:2341–2344.

8. Abe T, Loenneke JP, Thiebaud RS, Fujita E,Akamine T, Loftin M. Prediction and validationof DXA-derived appendicular fat-free adiposetissue by a single ultrasound image of the forearm in Japanese older adults. J Ultrasound Med. 2018;37(2):347-353.

9.vonHaehlingS,MorleyJE,CoatsAJS,AnkerSD.EthicalguidelinesforpublishingintheJournalofCachexia,SarcopeniaandMuscle:update2015.J Cachexia Sarcopenia Muscle.2015;6:315–316.

Chapter 2B

48

Response to: “The use of ultrasound for the estimation of muscle mass: one site fits most?”Willemke Nijholt1,2, Harriët Jager-Wittenaar1,3, Aldo Scafoglieri4, Hans Hobbelen1,5 and Cees P. van der Schans CP1,2,6

1 Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands

2 Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

3 DepartmentofMaxillofacialSurgery,UniversityofGroningen,UniversityMedicalCenterGroningen,Groningen,TheNetherlands4 FacultyofMedicineandPharmacy,VrijeUniversiteitBrussel,Brussels,Belgium5 Department ofGeneral Practice and ElderlyCareMedicine,University ofGroningen,UniversityMedical CenterGroningen,

Groningen, The Netherlands6 University of Groningen University Medical Center Groningen, Department of Health Psychology Research, Groningen,

The Netherlands

WethankTakashiAbe,JeremyP.LoennekeandRobertS.ThiebaudfortheirvaluableresponsetooursystematicreviewintheirLetterentitled“Theuseofultrasoundfortheestimationofmuscle mass: one site fits most?”.1

We feel encouraged by their response that ultrasound has the potential to play an important role in assessing muscle mass in daily practice in the future. The authors remarked that we includedonlytwostudiesinoursystematicreviewthatevaluatedthevalidityofultrasound-derivedpredictionequationsforthepredictionofmusclemassinolderadults.2 The authors elaborate on three other studies that indicate that forearm muscle thickness measurements could be used for the prediction of muscle mass in older adults. Although these articles provide additional information on the possibilities of muscle ultrasound for the prediction of muscle mass, we did not include these three articles in our systematic review because these articles were published later than the period included in our search,3,4 or did not meet our inclusion criterion for age.5

The authors’ suggestion of using forearm muscle thickness measurements for the prediction of muscle mass is interesting for daily practice. It is very promising that the size of peripheral musclesisassociatedwith(wholebody)musclemass.However,wedonotfullyagreewiththestatement that one site fits most. Despite the fact that the current definitions of sarcopenia andmalnutrition focuson theassessmentof (wholebody)musclemass,6,7 we would like to emphasize that the assessment of peripheral muscles is of utmost importance. It has previously been observed that the loss of muscle mass is not uniform across all muscles.8 In general,thelossofmusclemassofthelowerlimbsisaconsequenceofinactivity,whereastheloss of muscle mass in the upper limbs is more prone to nutritional depletion.9 This illustrates the importance of assessing peripheral muscles. Peripheral muscles can be quantifiedusingmuscle ultrasound, butmuscle ultrasound can also be used to qualify themuscle,

Response to: “The use of ultrasound for the estimation of muscle mass: one site fits most?”

49

e.g., to assess the amount of intramuscular fat. This intramuscular fat results in increased echogenicity, i.e., the reflectance of the emitted ultrasound signal,10 and is associated with decreased muscle function in older adults.11 These findings implicate that not only the size of the muscle matters, but also the composition of muscles needs to be assessed.

In summary, we agree with Abe, Loenneke and Thiebaud that ultrasound has high potential for the assessment of muscles in daily practice. However, we believe that assessing peripheral muscles isequally,ormaybeevenmore, important than thepredictionofmusclemass.Therefore,weproposeaparadigmshiftfromtheassessmentof(wholebody)musclemasstoquantifyingandqualifyingperipheralmuscles.

Acknowledgements

TheauthorscertifythattheycomplywiththeethicalguidelinesforpublishingintheJournalofCachexia,SarcopeniaandMuscle:update2015.12

Chapter 2B

50

References 1.AbeT, Loenneke JP, ThiebaudRS. Theuseofultrasound for the estimation of muscle mass: one site fits most? J Cachexia Sarcopenia Muscle. 2018;9(1):213.

2. Nijholt W, Scafoglieri A, Jager-Wittenaar H,HobbelenJSM,vanderSchansCP.Thereliabilityand validity of ultrasound to quantify musclesin older adults: A systematic review. J Cachexia Sarcopenia Muscle. 2017;8:702-712.

3. Abe T, Fujita E, Thiebaud RS, LoennekeJP, Akamine T. Ultrasound-derived forearmmuscle thickness is a powerful predictor for estimatingDXA-derivedappendicularleanmassin Japanese older adults. Ultrasound Med Biol. 2016;42:2341-2344.

4. Abe T, Loenneke JP, Thiebaud RS, Fujita E,Akamine T, Loftin M. Prediction and validationof DXA-derived appendicular fat-free adiposetissue by a single ultrasound image of the forearm in Japanese older adults. J Ultrasound Med. 2018;37(2):347-353.

5. Abe T, Thiebaud RS, Loenneke JP, YoungKC. Prediction and validation of DXA-derivedappendicular lean soft tissue mass by ultrasound in older adults. Age. 2015:37:114.

6. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al.Sarcopenia: European consensus on definitionanddiagnosis: reportof theEuropeanWorkingGroup on Sarcopenia in Older People. Age Ageing.2010;39:412-423.

7. Cederholm T, Bosaeus I, Barazzoni R, et al.Diagnostic criteria for malnutrition–an ESPENconsensus statement. Clin Nutr. 2015:34(3):335-340.

8. Janssen I, Heymsfield SB, Wang Z, Ross R.Skeletal muscle mass and distribution in 468menandwomenaged18–88yr. J Appl Physiol. 2000;89(1):81-88.

9.HeymsfieldSB,TigheA,WangZM.Nutritionalassessment by anthropometric and biochemical methods. Modern nutrition in health and disease. 1994;8:812.

10. Arts IM, Pillen S, Schelhaas HJ, OvereemS, Zwarts MJ. Normal values for quantitativemuscle ultrasonography in adults. Muscle & nerve.2010;41(1):32-41.

11.WatanabeY,YamadaY,FukumotoY, IshiharaT, Yokoyama K, Yoshida T, et al. Echo intensityobtained from ultrasonography images reflecting muscle strength in elderly men.  Clin Interv Aging. 2013;8:993.

12.vonHaehlingS,MorleyJE,CoatsAJS,AnkerSD.EthicalguidelinesforpublishingintheJournalofCachexia,SarcopeniaandMuscle:update2015.J Cachexia Sarcopenia Muscle. 2015;6:315-316.

Response to: “The use of ultrasound for the estimation of muscle mass: one site fits most?”

51