Sarcopenia its Assessement and How it's Correlates with Functional

Exploratory Workshop Exploratory Workshop The Future of Research in Sport Participation in the Lifespan (EThe Future of Research in Sport Participation in the Lifespan (EW10W10--170)170)Rome, Italy Rome, Italy -- September 14September 14--17, 201117, 2011Convened by: Laura Capranica, Jan Cabri and Romain MeeusenConvened by: Laura Capranica, Jan Cabri and Romain Meeusen

Sarcopenia its Assessement and How it’s Correlates with Functional

Performance in the Older Individuals

Prof. Giuseppe De Vito

University College Dublin

UCD Institute for Sport and Health

Standing Committees:European Medical Research Councils (EMSC), Humanities: (SCH), Social Sciences (SCSS)European Science Foundation ▪ 1 quai Lezay Marnésia ▪ BP90015 ▪ FR-67080 Strasbourg Cedex

Tel: +33 (0)3 88 76 71 36 or 46 ▪ Fax: +33 (0)3 88 37 05 32 ▪ Email: [email protected] ▪http://www.esf.org/workshops

(Exercise Physiology)

Exploratory Workshop Exploratory Workshop The Future of Research in Sport Participation in the Lifespan (EThe Future of Research in Sport Participation in the Lifespan (EW10W10--170)170)

Standing Committees:European Medical Research Councils (EMSC), Humanities: (SCH), Social Sciences (SCSS)

Educational Opportunities for Young Researchersat UCD.

PhD programs in: Health and Performance Science, Sport Management, Rehabilitation/Physiotherapy , Public health3-4 years (full time),

ECTS dedicated to research work: a minimum of 240

Main research in the area of sport: Exercise and Aging, Neuromuscular control, Sport rehabilitation and injury prevention, Exercise and Type2 diabetes,

Structured PhD Programme

1st step: Student is accepted

1 2 3 4

Thesis submission and FinalExam

Transition assessment

No MSc by research With a previous research MSc

Nomination of DSP***

In the first year every student must frequent the same classes and courses

irrespective of the area of specific interest

Then there will be the transition from stage 1to stage 2 with a presentation of a preliminary

project proposal in one of the relevant area in the School

Now a main supervisor is identified and the actual PhD project will commence

The thesis can be developed as a traditional format or as a collection of scientific articles either already published or submitted

Proposal for a thematic PhD programme

Some of the main researchers in the area of Sport and Exercise Science and

Management at UCD

Prof. Colin Boreham

Dr. Brian Caulfield

Dr. Eamonn Delahunt

Prof. Helen Roche

Dr. Brendan Egan

Dr. Deirdre Hurley-Osing

Prof. Mike GibneyProf. Giuseppe De Vito

Dr. John Shuttleworth

Multidisciplinarity• Prof. Colin Boreham: exercise and health in the life span, exercise

physiology.• Dr. Eamonn Delahunt: clinical exercise application, biomechanical and

neuromuscular insufficiencies associated with injury and their response to rehabilitation protocols .

• Dr. Brendan Egan: sport nutrition, molecular biology applied to exercise.• Dr. John Shuttleworth: exercise management.• Dr. Brian Caulfield: sport biomechanics, virtual reality training,

personalised health.• Prof. Helen Roche: Nutrigenomics, and insights into mechanisms and

nutrient based therapies.• Dr. Deirdre Hurley-Osing: Clinical Research and Measurement of Physical

Activity and Sleep using Innovative Technologies.• Prof. Giuseppe De Vito: neuromuscular function and adaptations to

exercise, exercise physiology and optimisation of exercise prescription in different populations.

• Prof. Mike Gibney: application of metabolomics technology to human nutrition, diet, lipids and the metabolic syndrome, personalised health.

Sarcopenia(Greek ‘sarx’ or flesh + ‘penia’ or

loss)

Exploratory Workshop Exploratory Workshop The future of Research in Sport Participation in the Lifespan (EThe future of Research in Sport Participation in the Lifespan (EW10W10--170)170)


Background

Main Aim was to develop a practical clinical definition and diagnostic criteria for age-related sarcopenia.

Multi-factorial aetiology of SarcopeniaDisuse

Decline in the neuromuscular function

Alteration in the endocrine function

Inflammation

Mitochondrial dysfunction

Apoptosis

Malnutrition

Modified from Goldspink, 2005

Quantitative definition

• ASM: Appendicular Skeletal Muscle Mass

• SMI: Skeletal Mass Index: ASM/stature (kg/m2)

• Sarcopenia if the ASM/m2 is less than 2 SD compared to a young reference population.– 7,26 kg/m2 in men– 4,45 kg/m2 in women donna

New definitions

• Sarcopenic obesity

• Dynapenia



A common characteristic feature of uncontrolled diabetes mellitus and aging is the marked muscle atrophy, a process called sarcopenia. This net loss of body protein results from both an increase in proteolysis and a decrease in protein synthesis.

Sarcopenia and Metabolic Fitness

Type 2 diabetics

Rate of fat oxidation and ROSgeneration

Handschin and Spiegelman 2008

Despite the strong associations of insulin resistance with obesity, the existence of lean/non-obese/low body weight T2DM patients has long been recognised. In Caucasian populations, the incidence of individuals with BMI less than 25 kg m-2, i.e. normal weight, but characterized as suffering of T2DM, ranges from approximately 10-25%. However, in Asian populations, this percentage is much higher, accounting for approximately 50% of the T2DM population.

“Lean” but Diabetics

High percentage of Trunk Fat is associated with increased prevalence of prediabetes and lower insulin sensitivity

Yunxian et al ,2010

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1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

Low

Mod

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Hig

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Low

Mod

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Hig

h

Low

Mod

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gh

BMI, 18.5-24.9 BMI, 25.0-29.9 BMI, 30.0-34.9

Haz

ard

ratio

Risk

of C

VD m

orta

lity

Cardiorespiratory fitness

Fat, but fit, associated with lower risk than lean, but lazy (unfit)

Church et al. (2005) Arch Int Med *Adj for age and examination year

p for trend <0.001p for trend <0.001

p for trend <0.001

Aerobic fitness protection across a range of BMIs

Nutrition

• In the older individual an inadequate caloric intake especially in respect to proteins could represent an impediment for the increase in muscle mass

• During a resistance training programme. A supplementation based on the use of specific amino acids and oligo-peptides combinations seems promising.



Open Questions

•To establish universally accepted thresholds for pre-sarcopenia especially in terms of prevention

•To explore further the role of optimal nutrition and exercise in preventing and counteracting the deleterious effects of sarcopenia targeting also middle-age individuals.

•To investigate the role of sarcopenia in establishing the onset of metabolic diseases such as type 2 diabetics (lean but fat patients)



Actual Forms of Interplay

Assessment----------Exercise training-----------Nutrition



Enhancing Synergies

•This kind of research requires the integration ofmulti-disciplinary teams. (Clinician, Sport scientist,Nutritionist, Epidemiologist, Psychologist)•This, ideally, should culminate in the generation of an international funded research project.• Another initiative should be in relation to an international Postgraduate programme in the field of physical activity and health.• This is the only way to reach the power sufficient for establishing the scientific evidence whichcould then form the base for the pubblication ofwidely accepted public health guidelines in this area.

Documents

Sarcopenia its Assessement and How it's Correlates with Functional