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  1. Article ; Online: Optimal management of sarcopenia.

    Burton, Louise A / Sumukadas, Deepa

    Clinical interventions in aging

    2010  Volume 5, Page(s) 217–228

    Abstract: Sarcopenia is the progressive generalized loss of skeletal muscle mass, strength, and function which occurs as a consequence of aging. With a growing older population, there has been great interest in developing approaches to counteract the effects of ... ...

    Abstract Sarcopenia is the progressive generalized loss of skeletal muscle mass, strength, and function which occurs as a consequence of aging. With a growing older population, there has been great interest in developing approaches to counteract the effects of sarcopenia, and thereby reduce the age-related decline and disability. This paper reviews (1) the mechanisms of sarcopenia, (2) the diagnosis of sarcopenia, and (3) the potential interventions for sarcopenia. Multiple factors appear to be involved in the development of sarcopenia including the loss of muscle mass and muscle fibers, increased inflammation, altered hormonal levels, poor nutritional status, and altered renin-angiotensin system. The lack of diagnostic criteria to identify patients with sarcopenia hinders potential management options. To date, pharmacological interventions have shown limited efficacy in counteracting the effects of sarcopenia. Recent evidence has shown benefits with angiotensin-converting enzyme inhibitors; however, further randomized controlled trials are required. Resistance training remains the most effective intervention for sarcopenia; however, older people maybe unable or unwilling to embark on strenuous exercise training programs.
    MeSH term(s) Aged ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Exercise Therapy ; Hormones/therapeutic use ; Humans ; Sarcopenia/diagnosis ; Sarcopenia/drug therapy ; Sarcopenia/physiopathology
    Chemical Substances Angiotensin-Converting Enzyme Inhibitors ; Hormones
    Language English
    Publishing date 2010-09-07
    Publishing country New Zealand
    Document type Journal Article ; Review
    ZDB-ID 2364924-0
    ISSN 1178-1998 ; 1176-9092
    ISSN (online) 1178-1998
    ISSN 1176-9092
    DOI 10.2147/cia.s11473
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  2. Article ; Online: Acceptability and feasibility of magnetic femoral nerve stimulation in older, functionally impaired patients.

    Beveridge, Louise A / Price, Rosemary J G / Burton, Louise A / Witham, Miles D / Struthers, Allan D / Sumukadas, Deepa

    BMC research notes

    2018  Volume 11, Issue 1, Page(s) 394

    Abstract: Objective: Magnetic femoral nerve stimulation to test muscle function has been largely unexplored in older people. We assessed acceptability, feasibility, along with reproducibility and correlation with other physical function measures.: Results: ... ...

    Abstract Objective: Magnetic femoral nerve stimulation to test muscle function has been largely unexplored in older people. We assessed acceptability, feasibility, along with reproducibility and correlation with other physical function measures.
    Results: Study 1 recruited older people with sarcopenia. Stimulation was performed at baseline and 2 weeks along with six minute walk (6MW), maximum voluntary quadriceps contraction, short physical performance battery and grip strength. Acceptability was measured using visual analog scales. Study 2 used baseline data from a trial of older people. We correlated stimulation results with 6MW, maximal voluntary contraction and muscle mass. Maximum quadriceps twitch tension was measured in both studies, evoked using biphasic magnetic stimulation of the femoral nerve. In study 1 (n = 12), magnetic stimulation was well tolerated with mean discomfort rating of 9% (range 0-40%) on a visual analog scale. Reproducibility was poor (intraclass correlation coefficient 0.06; p = 0.44). Study 2 (n = 64) showed only weak to moderate correlations for maximum quadriceps twitch tension with other measures of physical function (6 minute walk test r = 0.24, p = 0.06; maximal voluntary contraction r = 0.26; p = 0.04). We conclude that magnetic femoral nerve stimulation is acceptable and feasible but poorly reproducible in older, functionally impaired people.
    MeSH term(s) Activities of Daily Living ; Aged ; Aged, 80 and over ; Feasibility Studies ; Female ; Femoral Nerve/physiology ; Humans ; Magnetic Field Therapy/methods ; Male ; Outcome Assessment, Health Care ; Patient Acceptance of Health Care ; Quadriceps Muscle/physiopathology ; Reproducibility of Results ; Sarcopenia/therapy
    Language English
    Publishing date 2018-06-15
    Publishing country England
    Document type Journal Article
    ZDB-ID 2413336-X
    ISSN 1756-0500 ; 1756-0500
    ISSN (online) 1756-0500
    ISSN 1756-0500
    DOI 10.1186/s13104-018-3493-4
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  3. Article ; Online: Activin type I receptor polymorphisms and body composition in older individuals with sarcopenia-Analyses from the LACE randomised controlled trial.

    Bashir, Tufail / Achison, Marcus / Adamson, Simon / Akpan, Asangaedem / Aspray, Terry / Avenell, Alison / Band, Margaret M / Burton, Louise A / Cvoro, Vera / Donnan, Peter T / Duncan, Gordon W / George, Jacob / Gordon, Adam L / Gregson, Celia L / Hapca, Adrian / Hume, Cheryl / Jackson, Thomas A / Kerr, Simon / Kilgour, Alixe /
    Masud, Tahir / McKenzie, Andrew / McKenzie, Emma / Patel, Harnish / Pilvinyte, Kristina / Roberts, Helen C / Rossios, Christos / Sayer, Avan A / Smith, Karen T / Soiza, Roy L / Steves, Claire J / Struthers, Allan D / Tiwari, Divya / Whitney, Julie / Witham, Miles D / Kemp, Paul R

    PloS one

    2023  Volume 18, Issue 11, Page(s) e0294330

    Abstract: Background: Ageing is associated with changes in body composition including an overall reduction in muscle mass and a proportionate increase in fat mass. Sarcopenia is characterised by losses in both muscle mass and strength. Body composition and muscle ...

    Abstract Background: Ageing is associated with changes in body composition including an overall reduction in muscle mass and a proportionate increase in fat mass. Sarcopenia is characterised by losses in both muscle mass and strength. Body composition and muscle strength are at least in part genetically determined, consequently polymorphisms in pathways important in muscle biology (e.g., the activin/myostatin signalling pathway) are hypothesised to contribute to the development of sarcopenia.
    Methods: We compared regional body composition measured by DXA with genotypes for two polymorphisms (rs10783486, minor allele frequency (MAF) = 0.26 and rs2854464, MAF = 0.26) in the activin 1B receptor (ACVR1B) determined by PCR in a cross-sectional analysis of DNA from 110 older individuals with sarcopenia from the LACE trial.
    Results: Neither muscle mass nor strength showed any significant associations with either genotype in this cohort. Initial analysis of rs10783486 showed that males with the AA/AG genotype were taller than GG males (174±7cm vs 170±5cm, p = 0.023) and had higher arm fat mass, (median higher by 15%, p = 0.008), and leg fat mass (median higher by 14%, p = 0.042). After correcting for height, arm fat mass remained significantly higher (median higher by 4% padj = 0.024). No associations (adjusted or unadjusted) were seen in females. Similar analysis of the rs2854464 allele showed a similar pattern with the presence of the minor allele (GG/AG) being associated with greater height (GG/AG = 174±7 cm vs AA = 170 ±5cm, p = 0.017) and greater arm fat mass (median higher by 16%, p = 0.023). Again, the difference in arm fat remained after correction for height. No similar associations were seen in females analysed alone.
    Conclusion: These data suggest that polymorphic variation in the ACVR1B locus could be associated with body composition in older males. The activin/myostatin pathway might offer a novel potential target to prevent fat accumulation in older individuals.
    MeSH term(s) Male ; Female ; Humans ; Aged ; Sarcopenia/genetics ; Myostatin ; Activin Receptors ; Cross-Sectional Studies ; Body Composition/genetics ; Activins/genetics ; Muscle, Skeletal
    Chemical Substances Myostatin ; Activin Receptors (EC 2.7.11.30) ; Activins (104625-48-1)
    Language English
    Publishing date 2023-11-14
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0294330
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  4. Article ; Online: ACE I/D genotype associates with strength in sarcopenic men but not with response to ACE inhibitor therapy in older adults with sarcopenia: Results from the LACE trial.

    Rossios, Christos / Bashir, Tufail / Achison, Marcus / Adamson, Simon / Akpan, Asangaedem / Aspray, Terry / Avenell, Alison / Band, Margaret M / Burton, Louise A / Cvoro, Vera / Donnan, Peter T / Duncan, Gordon W / George, Jacob / Gordon, Adam L / Gregson, Celia L / Hapca, Adrian / Hume, Cheryl / Jackson, Thomas A / Kerr, Simon /
    Kilgour, Alixe / Masud, Tahir / McKenzie, Andrew / McKenzie, Emma / Patel, Harnish / Pilvinyte, Kristina / Roberts, Helen C / Sayer, Avan A / Smith, Karen T / Soiza, Roy L / Steves, Claire J / Struthers, Allan D / Tiwari, Divya / Whitney, Julie / Witham, Miles D / Kemp, Paul R

    PloS one

    2023  Volume 18, Issue 10, Page(s) e0292402

    Abstract: Background: Angiotensin II (AII), has been suggested to promote muscle loss. Reducing AII synthesis, by inhibiting angiotensin converting enzyme (ACE) activity has been proposed as a method to inhibit muscle loss. The LACE clinical trial was designed to ...

    Abstract Background: Angiotensin II (AII), has been suggested to promote muscle loss. Reducing AII synthesis, by inhibiting angiotensin converting enzyme (ACE) activity has been proposed as a method to inhibit muscle loss. The LACE clinical trial was designed to determine whether ACE inhibition would reduce further muscle loss in individuals with sarcopenia but suffered from low recruitment and returned a negative result. Polymorphic variation in the ACE promoter (I/D alleles) has been associated with differences in ACE activity and muscle physiology in a range of clinical conditions. This aim of this analysis was to determine whether I/D polymorphic variation is associated with muscle mass, strength, in sarcopenia or contributed to the lack of response to treatment in the LACE study.
    Methods: Sarcopenic individuals were recruited into a 2x2 factorial multicentre double-blind study of the effects of perindopril and/or leucine versus placebo on physical performance and muscle mass. DNA extracted from blood samples (n = 130 72 women and 58 men) was genotyped by PCR for the ACE I/D polymorphism. Genotypes were then compared with body composition measured by DXA, hand grip and quadriceps strength before and after 12 months' treatment with leucine and/or perindopril in a cross-sectional analysis of the influence of genotype on these variables.
    Results: Allele frequencies for the normal UK population were extracted from 13 previous studies (I = 0.473, D = 0.527). In the LACE cohort the D allele was over-represented (I = 0.412, D = 0.588, p = 0.046). This over-representation was present in men (I = 0.353, D = 0.647, p = 0.010) but not women (I = 0.458, D = 0.532, p = 0.708). In men but not women, individuals with the I allele had greater leg strength (II/ID = 18.00 kg (14.50, 21.60) vs DD = 13.20 kg (10.50, 15.90), p = 0.028). Over the 12 months individuals with the DD genotype increased in quadriceps strength but those with the II or ID genotype did not. Perindopril did not increase muscle strength or mass in any polymorphism group relative to placebo.
    Conclusion: Our results suggest that although ACE genotype was not associated with response to ACE inhibitor therapy in the LACE trial population, sarcopenic men with the ACE DD genotype may be weaker than those with the ACE I/D or II genotype.
    MeSH term(s) Male ; Humans ; Female ; Aged ; Sarcopenia/drug therapy ; Sarcopenia/genetics ; Perindopril/therapeutic use ; Peptidyl-Dipeptidase A/genetics ; Cross-Sectional Studies ; Leucine ; Hand Strength ; Genotype ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use
    Chemical Substances Perindopril (Y5GMK36KGY) ; Peptidyl-Dipeptidase A (EC 3.4.15.1) ; Leucine (GMW67QNF9C) ; Angiotensin-Converting Enzyme Inhibitors
    Language English
    Publishing date 2023-10-20
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0292402
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  5. Article ; Online: Mineralocorticoid antagonism: a novel way to treat sarcopenia and physical impairment in older people?

    Burton, Louise A / McMurdo, Marion E T / Struthers, Allan D

    Clinical endocrinology

    2011  Volume 75, Issue 6, Page(s) 725–729

    Abstract: Dysregulation of the renin-angiotensin-aldosterone system has been associated with a number of age-related pathologies including hypertension, heart failure and chronic kidney disease. More recently, it has been suggested that alterations within the RAAS ...

    Abstract Dysregulation of the renin-angiotensin-aldosterone system has been associated with a number of age-related pathologies including hypertension, heart failure and chronic kidney disease. More recently, it has been suggested that alterations within the RAAS may contribute to the development of sarcopenia and subsequent decline in physical function. There is growing interest in developing interventions to prevent age-associated decline in muscle function. We postulate that inhibition of the RAAS with the mineralocorticoid antagonist spironolactone may have a role in countering the effects of physical impairment in older people by improving skeletal muscle function. Spironolactone may prevent skeletal myocyte apoptosis, improve vascular endothelial function and enhance muscle contractility by increasing muscle magnesium and sodium-potassium pumps. This article will review the literature underpinning the hypothesis that spironolactone may have a role in maintaining muscle function in older people.
    MeSH term(s) Aged ; Aged, 80 and over ; Aging/drug effects ; Aging/physiology ; Humans ; Mineralocorticoid Receptor Antagonists/therapeutic use ; Mobility Limitation ; Motor Activity/drug effects ; Restraint, Physical/physiology ; Sarcopenia/drug therapy ; Spironolactone/therapeutic use
    Chemical Substances Mineralocorticoid Receptor Antagonists ; Spironolactone (27O7W4T232)
    Language English
    Publishing date 2011-09-20
    Publishing country England
    Document type Evaluation Study ; Journal Article ; Review
    ZDB-ID 121745-8
    ISSN 1365-2265 ; 0300-0664
    ISSN (online) 1365-2265
    ISSN 0300-0664
    DOI 10.1111/j.1365-2265.2011.04148.x
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  6. Article ; Online: Effect of spironolactone on physical performance in older people with self-reported physical disability.

    Burton, Louise A / Sumukadas, Deepa / Witham, Miles D / Struthers, Allan D / McMurdo, Marion E T

    The American journal of medicine

    2013  Volume 126, Issue 7, Page(s) 590–597

    Abstract: Background: Interventions that improve muscle function may slow decline in physical function and disability in later life. Recent evidence suggests that inhibition of the renin-angiotensin-aldosterone system may maintain muscle function. We evaluated ... ...

    Abstract Background: Interventions that improve muscle function may slow decline in physical function and disability in later life. Recent evidence suggests that inhibition of the renin-angiotensin-aldosterone system may maintain muscle function. We evaluated the effect of aldosterone blockade on physical performance in functionally impaired older people without heart failure.
    Methods: In this parallel-group, double-blind, randomized, placebo-controlled trial, community-dwelling participants aged ≥65 years with self-reported problems with activities of daily living were randomized to receive 25 mg spironolactone or identical placebo daily for 20 weeks. The primary outcome was change in 6-minute walking distance over 20 weeks. Secondary outcomes were changes in Timed Up and Go test, Incremental Shuttle Walk Test, Functional Limitation Profile, EuroQol EQ-5D, and Hospital Anxiety and Depression Scale over 20 weeks.
    Results: Participants' mean (standard deviation) age was 75 (6) years. Of the 93% of participants (112/120) who completed the study, 106 remained on medication at 20 weeks. There was no significant difference in change in 6-minute walking distance at 20 weeks between the spironolactone and placebo groups (mean change, -3.2 m; 95% confidence interval, -28.9 to 22.5; P = .81). Quality of life improved significantly at 20 weeks, with an increase in EuroQol EQ-5D score of 0.10 (95% confidence interval, 0.03-0.18; P < .01) in the spironolactone group relative to the placebo group. There were no significant differences in between-group change for other secondary outcomes.
    Conclusions: Spironolactone was well tolerated but did not improve physical function in older people without heart failure. Quality of life improved significantly, and the possible mechanisms for this require further study.
    MeSH term(s) Activities of Daily Living ; Aged ; Aged, 80 and over ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Double-Blind Method ; Exercise/physiology ; Female ; Humans ; Male ; Quality of Life ; Renin-Angiotensin System/drug effects ; Spironolactone/pharmacology ; Spironolactone/therapeutic use ; Surveys and Questionnaires ; Walking/physiology
    Chemical Substances Angiotensin-Converting Enzyme Inhibitors ; Spironolactone (27O7W4T232)
    Language English
    Publishing date 2013-05-23
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 80015-6
    ISSN 1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
    ISSN (online) 1555-7162 ; 1873-2178
    ISSN 0002-9343 ; 1548-2766
    DOI 10.1016/j.amjmed.2012.11.032
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    Ua VI Zs.289: Show issues Location:
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  7. Article ; Online: Hospital-acquired pneumonia incidence and diagnosis in older patients.

    Burton, Louise A / Price, Rosemary / Barr, Karen E / McAuley, Sean M / Allen, Jennifer B / Clinton, Aoibhinn M / Phillips, Gabby / Marwick, Charis A / McMurdo, Marion E T / Witham, Miles D

    Age and ageing

    2016  Volume 45, Issue 1, Page(s) 171–174

    Abstract: Background: hospital-acquired pneumonia poses a hazard to older people who are hospitalised, yet few data exist on the incidence or risk factors in non-intensive care patients. This study aimed to determine the incidence of hospital-acquired pneumonia ( ... ...

    Abstract Background: hospital-acquired pneumonia poses a hazard to older people who are hospitalised, yet few data exist on the incidence or risk factors in non-intensive care patients. This study aimed to determine the incidence of hospital-acquired pneumonia (HAP) in a sample of hospitalised older people.
    Methods: prospective survey of hospitalised older patients (>65 years) at a single centre over a 12-month period. Casenote and chart data were collected on acute medical, orthopaedic and Medicine for the Elderly wards. HAP was defined in accordance with the European and Scottish National Prevalence Survey 2011 definition. Key analyses were incidence of clinically suspected and case definition clinically confirmed HAP.
    Results: one thousand three hundred and two patients were included in the analysis. Five hundred and thirty-nine (41%) were male; mean age was 82 years (SD 8). Median length of hospital stay was 14 days (IQR 20). One hundred and fifty-seven episodes of HAP were clinically suspected in 143 patients (10.9% of admissions), but only 83 episodes in 76 patients met the diagnostic criteria (5.8% of admissions). The risk of HAP was 0.3% per day in hospital. Reasons for failure to meet the diagnostic criteria in 75 cases were lack of radiographic evidence in 60/75; lack of evidence of inflammation in 42/75, and lack of respiratory signs or symptoms in 13/75; 35/75 (47%) of cases lacked evidence in two or more domains.
    Conclusion: HAP is common but over-diagnosed in older hospitalised patients.
    MeSH term(s) Age Factors ; Aged ; Aged, 80 and over ; Cross Infection/diagnosis ; Cross Infection/epidemiology ; Diagnostic Errors ; Female ; Health Care Surveys ; Humans ; Incidence ; Male ; Pneumonia/diagnosis ; Pneumonia/epidemiology ; Predictive Value of Tests ; Prospective Studies ; Risk Assessment ; Risk Factors ; Scotland/epidemiology ; Time Factors
    Language English
    Publishing date 2016-01
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 186788-x
    ISSN 1468-2834 ; 0002-0729
    ISSN (online) 1468-2834
    ISSN 0002-0729
    DOI 10.1093/ageing/afv168
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  8. Article ; Online: Effect of perindopril or leucine on physical performance in older people with sarcopenia: the LACE randomized controlled trial.

    Achison, Marcus / Adamson, Simon / Akpan, Asangaedem / Aspray, Terry / Avenell, Alison / Band, Margaret M / Bashir, Tufail / Burton, Louise A / Cvoro, Vera / Donnan, Peter T / Duncan, Gordon W / George, Jacob / Gordon, Adam L / Gregson, Celia L / Hapca, Adrian / Henderson, Emily / Hume, Cheryl / Jackson, Thomas A / Kemp, Paul /
    Kerr, Simon / Kilgour, Alixe / Lyell, Veronica / Masud, Tahir / McKenzie, Andrew / McKenzie, Emma / Patel, Harnish / Pilvinyte, Kristina / Roberts, Helen C / Rossios, Christos / Sayer, Avan A / Smith, Karen T / Soiza, Roy L / Steves, Claire J / Struthers, Allan D / Sumukadas, Deepa / Tiwari, Divya / Whitney, Julie / Witham, Miles D

    Journal of cachexia, sarcopenia and muscle

    2022  Volume 13, Issue 2, Page(s) 858–871

    Abstract: Background: This trial aimed to determine the efficacy of leucine and/or perindopril in improving physical function in older people with sarcopenia.: Methods: Placebo-controlled, parallel group, double-blind, randomized two-by-two factorial trial. We ...

    Abstract Background: This trial aimed to determine the efficacy of leucine and/or perindopril in improving physical function in older people with sarcopenia.
    Methods: Placebo-controlled, parallel group, double-blind, randomized two-by-two factorial trial. We recruited adults aged ≥ 70 years with sarcopenia, defined as low gait speed (<0.8 m/s on 4 m walk) and/or low handgrip strength (women < 20 kg, men < 30 kg) plus low muscle mass (using sex and body mass index category-specific thresholds derived from normative UK BioBank data) from 14 UK centres. Eligible participants were randomized to perindopril 4 mg or placebo, and to oral leucine powder 2.5 g or placebo thrice daily. The primary outcome was the between-group difference in the short physical performance battery (SPPB) score over 12-month follow-up by repeated-measures mixed models. Results were combined with existing systematic reviews using random-effects meta-analysis to derive summary estimates of treatment efficacy.
    Results: We screened 320 people and randomized 145 participants compared with an original target of 440 participants. For perindopril [n = 73, mean age 79 (SD 6), female sex 39 (53%), mean SPPB 7.1 (SD 2.3)] versus no perindopril [n = 72, mean age 79 (SD 6), female sex 39 (54%), mean SPPB 6.9 (SD 2.4)], median adherence to perindopril was lower (76% vs. 96%; P < 0.001). Perindopril did not improve the primary outcome [adjusted treatment effect -0.1 points (95%CI -1.2 to 1.0), P = 0.89]. No significant treatment benefit was seen for any secondary outcome including muscle mass [adjusted treatment effect -0.4 kg (95%CI -1.1 to 0.3), P = 0.27]. More adverse events occurred in the perindopril group (218 vs. 165), but falls rates were similar. For leucine [n = 72, mean age 78 (SD 6), female sex 38 (53%), mean SPPB 7.0 (SD 2.1)] versus no leucine [n = 72, mean age 79 (SD 6), female sex 40 (55%), mean SPPB 7.0 (SD 2.5)], median adherence was the same in both groups (76% vs. 76%; P = 0.99). Leucine did not improve the primary outcome [adjusted treatment effect 0.1 point (95%CI -1.0 to 1.1), P = 0.90]. No significant treatment benefit was seen for any secondary outcome including muscle mass [adjusted treatment effect -0.3 kg (95%CI -1.0 to 0.4), P = 0.47]. Meta-analysis of angiotensin converting enzyme inhibitor/angiotensin receptor blocker trials showed no clinically important treatment effect for the SPPB [between-group difference -0.1 points (95%CI -0.4 to 0.2)].
    Conclusions: Neither perindopril nor leucine improved physical performance or muscle mass in this trial; meta-analysis did not find evidence of efficacy of either ACE inhibitors or leucine as treatments to improve physical performance.
    MeSH term(s) Aged ; Female ; Hand Strength/physiology ; Humans ; Leucine/therapeutic use ; Male ; Meta-Analysis as Topic ; Perindopril/therapeutic use ; Physical Functional Performance ; Sarcopenia/drug therapy ; Sarcopenia/physiopathology ; Treatment Outcome
    Chemical Substances Leucine (GMW67QNF9C) ; Perindopril (Y5GMK36KGY)
    Language English
    Publishing date 2022-02-16
    Publishing country Germany
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 2586864-0
    ISSN 2190-6009 ; 2190-5991
    ISSN (online) 2190-6009
    ISSN 2190-5991
    DOI 10.1002/jcsm.12934
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