The three and a half day conference began with an overview of the issues and perspectives of experts from organizations with an interest in aging and muscle. Subsequent sessions presented participant characteristics of the studies that contributed data to the pooled analyses, the rationale and methodological approaches to analyses, preliminary cutpoints for clinically relevant weakness and low lean mass, and their predictive validity. After that, breakout groups and panels commented on strengths, limitations, and need for further work based on these preliminary findings. On the last day, panels addressed unresolved issues related to clinical trial design to test novel agents that have the potential to benefit older persons with weakness and low lean mass. Also, representatives from professional organizations provided feedback and recommendations. Conference attendees were asked to respond to a survey regarding level of agreement with key statements related to the work of the FNIH Project. The conference agenda and key presentations can be found at http://biomarkersconsortium.org/sarcopenia_pdfs.html .
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Disorders
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Disease or Syndrome
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Sarcopenia
Sarcopenia
Sarcopenia is a condition characterized by the progressive loss of skeletal muscle mass and strength, often associated with aging.
This condition can lead to frailty, increased risk of falls, and impaired physical function.
Sarcopenia research aims to identify effective protocols and products that can help prevent, manage, or reverse this debilitating condition.
PubCompare.ai leverages AI-driven comparisons to help researchers locate the most reproducible and accurate approaches, optimizing their efforts and driving scientific advancement in the field of Sarcopenia.
This condition can lead to frailty, increased risk of falls, and impaired physical function.
Sarcopenia research aims to identify effective protocols and products that can help prevent, manage, or reverse this debilitating condition.
PubCompare.ai leverages AI-driven comparisons to help researchers locate the most reproducible and accurate approaches, optimizing their efforts and driving scientific advancement in the field of Sarcopenia.
Most cited protocols related to «Sarcopenia»
Cachexia
Europeans
Frailty Syndrome
Physical Examination
Sarcopenia
Wasting Syndrome
SARC‐F includes five components: strength, assistance walking, rise from a chair, climb stairs, and falls. SARC‐F items were selected to reflect health status changes associated with the consequences of sarcopenia.3 , 4 SARC‐F scale scores range from 0 to 10 (i.e. 0–2 points for each component; 0 = best to 10 = worst) and were dichotomized to represent symptomatic (4+) vs. healthy (0–3) status. The SARC‐F scale was constructed using the same questions in AAH and BLSA. Strength was measured by asking respondents how much difficulty they had lifting or carrying 10 lbs. (0 = no difficulty, 1 = some, and 2 = a lot or unable to do). Assistance walking was assessed by asking participants how much difficulty they had walking across a room and whether they use aids or need help to do this (0 = no difficulty, 1 = some difficulty, and 2 = a lot of difficulty, use aids, or unable to do without personal help). Rise from a chair was measured by asking respondents how much difficulty they had transferring from a chair or bed and whether they used aids or needed help to do this (0 = no difficulty, 1 = some difficulty, and 2 = a lot of difficulty, use aids, or unable to do without help). Climb stairs was measured by asking respondents how much difficulty they had climbing a flight of 10 steps (0 = no difficulty, 1 = some, and 2 = a lot or unable to do). Falls was scored a 2 for respondents who reported falling four or more times in the past year, 1 for respondents who reported falling 1–3 times in the past year, and 0 for those reporting no falls in the past year. SARC‐F construction in NHANES used the same strength and climb stairs items as in AAH and BLSA. There were minor wording differences in the NHANES items for assistance walking (assessed by asking difficulty walking between rooms on the same floor) and rise from a chair (assessed by asking difficulty standing up from armless chair). NHANES did not ask participants to report the specific number of falls in the past year but did ask about difficulty with balance or falling in past year. The NHANES SARC‐F falls was scored a 2 for respondents who reported falling problems in the past year, 1 for respondents who reported only balance problems in the past year, and 0 for those reporting no falling or balance problems in the past year.
Acquired Immunodeficiency Syndrome
BAD protein, human
Iodine
Sarcopenia
Walking speed less than 0.8 m/s was selected as the primary outcome for the FNIH Sarcopenia Project because of its strong longitudinal associations with disability and mortality and because its use has been recommended by other experts (refs. (9 (link)) and (10 (link))). Detailed descriptions of gait speed assessment are available elsewhere (10 (link)).
Grip strength was selected as the primary measure of strength for several reasons. It is clearly related to mobility outcomes (4 (link),6 (link),27 (link)) and is easy to use in both clinical and community settings. Standard protocols are available for use without a high level of investigator training, and similar protocols were used across Project studies. Conversely, measures of lower extremity strength were inconsistent across participating studies. Preliminary analysis suggested that grip strength explained a similar amount of variance in walking speed compared with knee extension strength (R2 for grip strength = .01–.16, R2 for knee extension strength = .04–.17).
Grip strength was measured by handheld dynamometer (28 (link)). A summary of study protocols is available inSupplementary Appendix Table 1 ). The majority of studies (11 out of 13 cohorts) utilized Jamar dynamometers. The maximum strength value in either hand was analyzed.
Grip strength was selected as the primary measure of strength for several reasons. It is clearly related to mobility outcomes (4 (link),6 (link),27 (link)) and is easy to use in both clinical and community settings. Standard protocols are available for use without a high level of investigator training, and similar protocols were used across Project studies. Conversely, measures of lower extremity strength were inconsistent across participating studies. Preliminary analysis suggested that grip strength explained a similar amount of variance in walking speed compared with knee extension strength (R2 for grip strength = .01–.16, R2 for knee extension strength = .04–.17).
Grip strength was measured by handheld dynamometer (28 (link)). A summary of study protocols is available in
Disabled Persons
Knee
Lower Extremity
Range of Motion, Articular
Sarcopenia
Studies were included if [1 ] participants were aged 65 years or older within well-defined samples, with a clear description of the inclusion and exclusion criteria; [2 (link)] sarcopenia and frailty were considered as outcomes, in which HGS was used to identify this condition; [3 (link)] a description of the protocol used to measure handgrip strength was provided; [4 (link)] the outcome measures described are: type of dynamometer for the assessment of HGS, individual’s position (including shoulder, elbow, arm and handle position and posture), hand dominance, number of repetitions, acquisition and rest time, encouragement and handgrip strength values.
Randomised control trials, cohort studies, case control studies and cross-sectional studies were included, and meta-analyses or review articles, case reports, case series, meetings’ proceedings, conference summaries and duplicate records were excluded. Articles were not included if information about either the posture of the individual, or concerning the arm position (shoulder, elbow or wrist) was absent. When the complete procedure was not described but a reference was made to another article, we searched for the missing parts of the procedure. If the article did not add more details regarding the procedure, it was still excluded. In case of disagreement about the inclusion of a study, the reviewers discussed their opinions to reach consensus. The studies were divided into two subgroups: [1 ] articles about sarcopenia and [2 (link)] articles about frailty. Final studies selected for inclusion in each category were independently compiled in data tables. Articles which presented the same data as an earlier study were still excluded.
Randomised control trials, cohort studies, case control studies and cross-sectional studies were included, and meta-analyses or review articles, case reports, case series, meetings’ proceedings, conference summaries and duplicate records were excluded. Articles were not included if information about either the posture of the individual, or concerning the arm position (shoulder, elbow or wrist) was absent. When the complete procedure was not described but a reference was made to another article, we searched for the missing parts of the procedure. If the article did not add more details regarding the procedure, it was still excluded. In case of disagreement about the inclusion of a study, the reviewers discussed their opinions to reach consensus. The studies were divided into two subgroups: [1 ] articles about sarcopenia and [2 (link)] articles about frailty. Final studies selected for inclusion in each category were independently compiled in data tables. Articles which presented the same data as an earlier study were still excluded.
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Conferences
Elbow
Sarcopenia
Shoulder
Wrist
Most recents protocols related to «Sarcopenia»
Seventy-seven patients aged ≥ 65 years old with similar diet and environmental conditions in the Second Xiangya Hospital of Central South University were enrolled in this study. Patients were classified into the following 3 categories: 33 HF patients without sarcopenia (HF group), 29 HF patients with sarcopenia (SHF group), and 15 control individuals (Control group). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 Guidelines (Chen et al., 2020 (link)). Low skeletal muscle mass was defined as muscle mass < 7.0 kg/m2 (male) or < 5.7 kg/m2 (female) by bioelectrical impedance analysis using the InBodyS10 body composition analyzer (Chen et al., 2014 (link)). Low muscle strength was defined as handgrip strength <28 kg for male and <18 kg for female. Criteria for low physical performance is a 6-m walk speed < 1 m/s. Sarcopenia was defined as low muscle mass plus either diminished muscle strength or physical performance. Exclude subjects included recurrent diarrhea or constipation, unusual dietary habits (vegetarians), edema, those with tumors, diabetes, intestinal inflammation, irritable bowel syndrome, history of intestinal surgery, being treated with antibiotics or probiotics within 1 month. Demographic characteristics and clinical laboratory examinations were documented for all patients. The study was approved by the local Ethics Committee of the Second Xiangya Hospital of Central South University. Written informed consent was obtained from all participants. This study was conducted under the Declaration of Helsinki.
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Antibiotics, Antitubercular
Asian Persons
Bioelectrical Impedance
Body Composition
Clinical Laboratory Services
Constipation
Diabetes Mellitus
Diarrhea
Edema
Inflammation
Intestines
Irritable Bowel Syndrome
Males
Muscle Strength
Muscle Tissue
Neoplasms
Operative Surgical Procedures
Patients
Performance, Physical
Physical Examination
Probiotics
Regional Ethics Committees
Sarcopenia
Skeletal Muscles
Therapy, Diet
Vegetarians
Woman
Data analyses were performed using R software, version 4.2.0 (R foundation, Vienna, Austria). Baseline characteristics are shown as mean ± SD for normally distributed continuous variables or median (interquartile range) for those with a skewed distribution. Discrete variables are shown as counts (percentages). Differences between groups were evaluated using t-test or continuous variables and Pearson’s chi-square test or Fisher’s exact test for categorical data.
The cumulative overall survival (OS) rate was estimated using the Kaplan–Meier method and significant differences in survival distributions were tested by the log-rank test. Vital status (death or alive) was obtained from the civil registry up to December 31, 2021. Survival time was defined as the interval between the first TACE session for HCC and death or December 31, 2021 if the patient was alive.
A scatter plot was used to show the correlation between SMD and SMI. The degree of correlation was quantified with the correlation coefficient (R2). The association between myosteatosis or sarcopenia and mortality was assessed in multivariable Cox regression models. Adjusted variables included age, chronic lung disease, and chronic kidney disease since these variables had prognostic impact on mortality and were associated with myosteatosis and sarcopenia19 (link)–23 (link). Multivariable logistic regression analysis was used to determine the association between myosteatosis or sarcopenia and TACE response (response versus no response). The adjusted variables in the logistic regression model were the variables used in the adjusted Cox model. P values less than 0.05 were considered to be statistically significant.
The cumulative overall survival (OS) rate was estimated using the Kaplan–Meier method and significant differences in survival distributions were tested by the log-rank test. Vital status (death or alive) was obtained from the civil registry up to December 31, 2021. Survival time was defined as the interval between the first TACE session for HCC and death or December 31, 2021 if the patient was alive.
A scatter plot was used to show the correlation between SMD and SMI. The degree of correlation was quantified with the correlation coefficient (R2). The association between myosteatosis or sarcopenia and mortality was assessed in multivariable Cox regression models. Adjusted variables included age, chronic lung disease, and chronic kidney disease since these variables had prognostic impact on mortality and were associated with myosteatosis and sarcopenia19 (link)–23 (link). Multivariable logistic regression analysis was used to determine the association between myosteatosis or sarcopenia and TACE response (response versus no response). The adjusted variables in the logistic regression model were the variables used in the adjusted Cox model. P values less than 0.05 were considered to be statistically significant.
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ADAM17 protein, human
Chronic Kidney Diseases
Disease, Chronic
Lung
Lung Diseases
Patients
Sarcopenia
CT scans within 1 month prior to TACE or in the first post-TACE were selected to measure body composition. Pre-TACE scans were preferentially chosen. When these were unavailable, the earliest post-TACE scans were used in the study. The CT images at the level of the third lumbar vertebra (L3) were carefully chosen and archived as Digital Imaging and Communications in Medicine (DICOM) data. All DICOM data calculated body composition using in-house software developed by MATLAB (The MathWorks, Natick, MA, USA) and freeware Python 3.6.13 (Anaconda, Inc.), to generate the measurement model based on neural network architecture also known as UNet. The valid accuracy of the model was 99.17% and validity of the intersect over union co-efficiency was 89.40%17 (link).
The L3 skeletal muscle index (SMI) is used to identify sarcopenia and is calculated by dividing the cross-sectional area of the muscle by the square of the patient's height (cm2/m2). Sarcopenia was defined as SMI ≤ 36.2 cm2/m2 and ≤ 29.6 cm2/m2 for males and females, respectively11 (link). The areas of the abdominal wall and back muscles were used to calculate the SMD based on the areas of the pixels with attenuation between − 29 and + 150 HU. Myosteatosis was defined as SMD ≤ 44.4 HU or ≤ 39.3 HU in males and females, respectively11 (link). In addition, patients were classified into four groups according to their sarcopenia and myosteatosis status (Group A—neither sarcopenia nor myosteatosis, Group B—sarcopenia without myosteatosis, Group C—myosteatosis without sarcopenia, and Group D—sarcopenia with myosteatosis).
The L3 skeletal muscle index (SMI) is used to identify sarcopenia and is calculated by dividing the cross-sectional area of the muscle by the square of the patient's height (cm2/m2). Sarcopenia was defined as SMI ≤ 36.2 cm2/m2 and ≤ 29.6 cm2/m2 for males and females, respectively11 (link). The areas of the abdominal wall and back muscles were used to calculate the SMD based on the areas of the pixels with attenuation between − 29 and + 150 HU. Myosteatosis was defined as SMD ≤ 44.4 HU or ≤ 39.3 HU in males and females, respectively11 (link). In addition, patients were classified into four groups according to their sarcopenia and myosteatosis status (Group A—neither sarcopenia nor myosteatosis, Group B—sarcopenia without myosteatosis, Group C—myosteatosis without sarcopenia, and Group D—sarcopenia with myosteatosis).
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ADAM17 protein, human
Anaconda
Body Composition
Females
Males
Muscle, Back
Muscle Tissue
Patients
Pharmaceutical Preparations
Python
Radionuclide Imaging
Sarcopenia
Skeletal Muscles
Vertebrae, Lumbar
Wall, Abdominal
X-Ray Computed Tomography
Both patients and family members completed the questionnaires about sociodemographic and ACP attitudes, and functional capacity assessment by comprehensive geriatric assessment (CGA) was only investigated by the patients. Patients and family members separately expressed their own perspectives on ACP through face-to-face interviews.
Sociodemographic data including age, sex, marital status (categorized by married, divorced, widow, or single), educational level (classified as high school or below), medical insurance, religion, the relationship between patients and caregivers, self-reported family support (coded as poor, fair, and good), self-reported health status (coded as poor, fair, and good), concurrent diseases (including coronary artery disease, hypertension, diabetes, cerebrovascular disease, respiratory disease, and osteoarticular diseases), and prescription medications were recorded.
The functional capacity assessment was conducted by CGA based on the Chinese expert consensus recommendation (20 (link)). In this study, the activity of daily living was assessed by the Modified Barthel Index (MBI), and the higher the MBI score indicated the better the activity of daily living (21 (link)). The Short-Form Mini-Nutritional Assessment (MNA-SF) was used to ascertain the degree of malnutrition risk (22 (link)). Depressive symptoms were evaluated using the 15-item Geriatric Depression Scale (GDS-15), with higher scores indicating more depressive symptoms (23 (link)). Cognitive function was assessed using the Mini-Mental State Examination (MMSE) (24 (link)). Higher MMSE score indicated better cognitive function. Frailty was detected by the Clinical Frailty Scale (CFS) which was scored from 1 (very fit) to 9 (severely frail) (25 (link)). Based on the clinical judgment, a higher CFS score was considered a higher degree of frailty. The SARC-F questionnaire was used to screen sarcopenia, with higher values indicating a greater likelihood of sarcopenia (26 (link)).
A structured questionnaire about ACP attitudes was completed independently by patients and their family members. The questionnaire included prior experience with relatives and friends being rescued (coded as yes or no), attitudes toward death (categorized by fear, avoid discussing, and accept discussing), ACP knowledge, determination surrogate, value statement about end-of-life (coded as active treatment, relieving uncomfortable symptoms, maintenance of daily function, and quality of life or unknown), preferences for end-of-life treatments (including cardiopulmonary resuscitation, invasive mechanical ventilation support, non-invasive ventilation support, renal replacement therapy, gastrointestinal colostomy, nasal tube, deep vein catheterization, urinary catheter, and transfusion), and desired place of death. Discordance attitudes were defined based on patients' and family members' responses to the question about whether to consider ACP engagement of patients if patients cannot make decisions due to a medical condition (such as coma).
Sociodemographic data including age, sex, marital status (categorized by married, divorced, widow, or single), educational level (classified as high school or below), medical insurance, religion, the relationship between patients and caregivers, self-reported family support (coded as poor, fair, and good), self-reported health status (coded as poor, fair, and good), concurrent diseases (including coronary artery disease, hypertension, diabetes, cerebrovascular disease, respiratory disease, and osteoarticular diseases), and prescription medications were recorded.
The functional capacity assessment was conducted by CGA based on the Chinese expert consensus recommendation (20 (link)). In this study, the activity of daily living was assessed by the Modified Barthel Index (MBI), and the higher the MBI score indicated the better the activity of daily living (21 (link)). The Short-Form Mini-Nutritional Assessment (MNA-SF) was used to ascertain the degree of malnutrition risk (22 (link)). Depressive symptoms were evaluated using the 15-item Geriatric Depression Scale (GDS-15), with higher scores indicating more depressive symptoms (23 (link)). Cognitive function was assessed using the Mini-Mental State Examination (MMSE) (24 (link)). Higher MMSE score indicated better cognitive function. Frailty was detected by the Clinical Frailty Scale (CFS) which was scored from 1 (very fit) to 9 (severely frail) (25 (link)). Based on the clinical judgment, a higher CFS score was considered a higher degree of frailty. The SARC-F questionnaire was used to screen sarcopenia, with higher values indicating a greater likelihood of sarcopenia (26 (link)).
A structured questionnaire about ACP attitudes was completed independently by patients and their family members. The questionnaire included prior experience with relatives and friends being rescued (coded as yes or no), attitudes toward death (categorized by fear, avoid discussing, and accept discussing), ACP knowledge, determination surrogate, value statement about end-of-life (coded as active treatment, relieving uncomfortable symptoms, maintenance of daily function, and quality of life or unknown), preferences for end-of-life treatments (including cardiopulmonary resuscitation, invasive mechanical ventilation support, non-invasive ventilation support, renal replacement therapy, gastrointestinal colostomy, nasal tube, deep vein catheterization, urinary catheter, and transfusion), and desired place of death. Discordance attitudes were defined based on patients' and family members' responses to the question about whether to consider ACP engagement of patients if patients cannot make decisions due to a medical condition (such as coma).
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Attitude to Death
Blood Transfusion
Cardiopulmonary Resuscitation
Catheterization
Cerebrovascular Disorders
Chinese
Clinical Reasoning
Cognition
Colostomy
Comatose
Coronary Artery Disease
Depressive Symptoms
Diabetes Mellitus
Face
Family Member
Fear
Friend
Geriatric Assessment
High Blood Pressures
Malnutrition
Mechanical Ventilation
Mini Mental State Examination
Noninvasive Ventilation
Nose
Patient Engagement
Patients
Prescription Drugs
Renal Replacement Therapy
Respiration Disorders
Sarcopenia
Urinary Catheter
Veins
Widow
Sarcopenia was defined in three stages: probable sarcopenia, sarcopenia and severe sarcopenia. Probable sarcopenia was confirmed if low muscle strength was identified (grip strength lower than 27 kg for men and 16 kg for women and/or chair stand test was completed in more than 15 s for five rises), sarcopenia was confirmed if low muscle strength was noted in addition to SMI lower than 7.0 kg/m2 for men and 5.5 kg/m2 for women was identified, severe sarcopenia was confirmed when participants were diagnosed with low muscle strength and low physical performance measured with gait speed and/or TUG and/or SPPB (gait speed cut-off ≤0.8 m/s, TUG cut-off ≥20 s, SPPB cut-off ≤8 point score).
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Muscle Strength
Performance, Physical
Sarcopenia
Woman
Top products related to «Sarcopenia»
Sourced in United States, United Kingdom, New Zealand
The QDR 4500A is a dual-energy X-ray absorptiometry (DXA) system designed for bone density measurements. It is a diagnostic medical device used to assess bone mineral density (BMD) and evaluate the risk of osteoporosis.
Sourced in Japan
The TKK 5401 is a compact and versatile laboratory instrument designed for precise measurements. It features a high-accuracy sensor and advanced digital signal processing capabilities, enabling reliable data acquisition across a wide range of applications.
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SAS 9.4 is an integrated software suite for advanced analytics, data management, and business intelligence. It provides a comprehensive platform for data analysis, modeling, and reporting. SAS 9.4 offers a wide range of capabilities, including data manipulation, statistical analysis, predictive modeling, and visual data exploration.
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Stata 15 is a comprehensive, integrated statistical software package that provides a wide range of tools for data analysis, management, and visualization. It is designed to facilitate efficient and effective statistical analysis, catering to the needs of researchers, analysts, and professionals across various fields.
Sourced in Japan
SYNAPSE VINCENT is a high-performance medical imaging platform designed for use in healthcare facilities. It provides integrated solutions for the storage, management, and distribution of digital medical images and patient data. The core function of SYNAPSE VINCENT is to enable efficient and secure access to medical imaging information across various departments and locations.
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SPSS version 25 is a statistical software package developed by IBM. It is designed to analyze and manage data, providing users with a wide range of statistical analysis tools and techniques. The software is widely used in various fields, including academia, research, and business, for data processing, analysis, and reporting purposes.
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The Lunar iDXA is a dual-energy X-ray absorptiometry (DXA) system used for the measurement of bone mineral density and body composition. It provides accurate and precise assessments of bone, lean, and fat mass.
Sourced in United States, Denmark, Austria, United Kingdom, Japan, Canada
Stata version 14 is a software package for data analysis, statistical modeling, and graphics. It provides a comprehensive set of tools for data management, analysis, and reporting. Stata version 14 includes a wide range of statistical techniques, including linear regression, logistic regression, time series analysis, and more. The software is designed to be user-friendly and offers a variety of data visualization options.
More about "Sarcopenia"
Sarcopenia is a progressive condition characterized by the loss of skeletal muscle mass and strength, often associated with aging.
This debilitating condition can lead to frailty, increased risk of falls, and impaired physical function.
Researchers in the field of Sarcopenia are working to identify effective protocols and products that can help prevent, manage, or even reverse this condition.
Sarcopenia is closely related to terms such as muscle wasting, age-related muscle loss, and senile muscle atrophy.
Abbreviations commonly used include SPE and SCN.
Key subtopics within Sarcopenia research include muscle physiology, nutrition, exercise interventions, and pharmacological treatments.
To enhance Sarcopenia research, tools such as QDR 4500A, TKK 5401, SAS version 9.4, Stata 15, SYNAPSE VINCENT, and SPSS version 25 can be utilized for body composition analysis, muscle strength assessment, and data analysis.
The Lunar iDXA is a widely used dual-energy X-ray absorptiometry (DXA) system for evaluating body composition, including muscle mass.
Stata version 14 is another statistical software package that can aid in the analysis of Sarcopenia-related data.
By leveraging these insights and resources, researchers can optimize their efforts and drive scientific advancement in the field of Sarcopenia, ultimately leading to improved prevention, management, and treatment of this debilitating condition.
This debilitating condition can lead to frailty, increased risk of falls, and impaired physical function.
Researchers in the field of Sarcopenia are working to identify effective protocols and products that can help prevent, manage, or even reverse this condition.
Sarcopenia is closely related to terms such as muscle wasting, age-related muscle loss, and senile muscle atrophy.
Abbreviations commonly used include SPE and SCN.
Key subtopics within Sarcopenia research include muscle physiology, nutrition, exercise interventions, and pharmacological treatments.
To enhance Sarcopenia research, tools such as QDR 4500A, TKK 5401, SAS version 9.4, Stata 15, SYNAPSE VINCENT, and SPSS version 25 can be utilized for body composition analysis, muscle strength assessment, and data analysis.
The Lunar iDXA is a widely used dual-energy X-ray absorptiometry (DXA) system for evaluating body composition, including muscle mass.
Stata version 14 is another statistical software package that can aid in the analysis of Sarcopenia-related data.
By leveraging these insights and resources, researchers can optimize their efforts and drive scientific advancement in the field of Sarcopenia, ultimately leading to improved prevention, management, and treatment of this debilitating condition.