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SARCOPENIA AND ISOTOPIC 40K
AKOUAOUACH H,GARCIA C, BERGMANN P,PEPERSACK T, METS T, TSEPELIDIS E, BEYER I.
Sarcopenia and isotopic ?K
Akouaouach H*, Garcia C*, Bergmann P*, Pepersack T*, Mets T*, Tsepelidis E, Beyer I*
*University Hospital Brugmann and ?Acadaemic Hospital Erasmus, ULB, Brussels
Introduction: Sarcopenia, the loss of muscle mass and strength with age, is becoming recognized as a major cause of disability and morbidity in the elderly population.
Isotopic potassium 40 (?K) is radioactive and responsible for the most of the naturally occurring internal radioactivity in the body. Total body potassium has been used as a measure of lean body mass.
Objectives: Evaluate lean body mass (LBM) in geriatric patients at admission and during the third week, and determine the relationship between LBM and nutritional parameters, markers of inflammation, cognitive and functional status of the patient.
Methods: Prospective observational study in an acute geriatric ward of a general teaching hospital. Patients were included between March and May 2005. Patients with poor prognosis or antibiotic resistant microbial infections were excluded.
Naturally occuring ?K isotope was measured in a whole body counter and whole body potassium and lean body mass were calculated on the basis of formerly published data[1].
These measures of LBM were compared with our comprehensive geriatric assessment: anthropometric parameters (age, sex, body mass index [BMI]), ADL score (activities of daily living, [Katz]), cognitive evaluation (MMSE), biological indicators of nutritional status (albumin, prealbumin, vitamin D) and serum inflammatory markers (CRP, sedimentation rate). Muscle function was assessed by grip strength measurement.
Statistics : Student's t-test was used to compare continuous variables. Paired Student?s t-test was used to compare the admission?s variables with the follow-up data.
Results: 31 patients were included in this study; 1 patient died and 6 patients left the hospital before the 3rd week. The study subjects presented with a geriatric profile (mean age 84 years, 84% women, 25% from nursing homes, mean ADL score 12 and poor cognitive function in most patients).
LBM measured by ?K was positiveley correlated to body weight (p<0,01), BMI (p<0,01), grip strength (p<0,05) on admission. An inverse correlation was observed between ?K and ADL.
24 patients (77%) underwent a second evaluation of LBM during the third week. A positive correlation persisted between LBM and grip strength (p<0,04). Only six patients increased their LBM during hospitalisation. Comparison of the first and fourth quartiles of these 24 patients indicated a positive correlation with vitamin D status on admission (p=0,03) and with the length of stay of the patients (p<0,02).
Discussion and conclusion: LBM measured by ?K in our patients seems to be a good measure of muscle mass as the results were correlated with weight, BMI and grip strength. Lower lean body mass is associated with worse function in ADL. This could be explained by a lack of strength in the execution of tasks; on the other hand functional limitations probably make it more difficult to maintain muscle mass.
The follow-up measures indicate that loss of muscle mass after admission is associated with a greater length of stay. These results should contribute to a better awareness of the implications of sarcopenia in acute geriatric wards.
R?f?rences:
[1]DELWAIDE, P.A. ; LEFEBURE, P.; VAN CAUWENBERGE, H.; HEUSGHEM, C.Acta Clinica Belgica 25 (4) , 193-214, 1970
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