ASSESSMENT TOOLS
After obtaining written informed consent, the participants’demographic details were noted and were screened for the following risk factors of sarcopenia: history of smoking, quality of life using Short Form-36 (SF-36) (9), malnutrition using Mini-Nutritional Assessment (MNA-SF) (10), physical inactivity using the International Assessment Questionnaire Short Form (IPAQ-SF) (11), history of depression using The Center for Epidemiologic Studies Depression Scale (CES-D scale) (12) and the timed ‘Up & Go’ test using which scale were used to assess functional performance (13).
Complete blood count, renal function tests, electrolytes, total protein, albumin, 25 (OH) vitamin D, serum leptin, serum adiponectin, PTH, TSH and vitamin B12 values were recorded. Anthropometric measurements such as waist, hip, upper-middle arm (MAC), calf circumference (CC) and thigh and subcutaneous fat measurements from 3 regions (triceps, biceps, thigh) were measured with the caliper and recorded. Quadriceps-hamstring Peak Torque (PT) values and the ratio of PT values to body weight (PT / VA) (at 60 and 180 ° / sec speeds) were evaluated with an isokinetic dynamometer. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used in the evaluation of knee Osteoarthritis (14). The radiological staging was evaluated with the Kellgren Lawrence (KL) scale (15).
Sarcopenia was diagnosed according to the sarcopenia diagnosis criteria published by EWSGOP using walking speed, hand grip strength, anthropometric measurements and body composition parameters which were determined by DEXA method. The muscle masses of the patients were evaluated by measuring the fat mass (Fat Mass-FM), fat mass index (FMI), lean body mass (LBM) and skeletal muscle index (SMI) calculated by DEXA. Appendicular muscle mass (ASM) is calculated by summing the lean soft tissue of the two upper limbs and the two lower limbs. Skeletal muscle mass index is calculated by dividing the appendicular lean mass by the square of the neck height [SMI = ASM / height2 (kg / m2)]. Those with both low muscle mass and muscle strength were considered sarcopenic. All ultrasonographic examinations were performed by a single physiatrist experienced in musculoskeletal sonography. All ultrasonographic measurements were taken by the same physician experienced in musculoskeletal sonography in order to avoid interindividual variability. Ultrasound measurements was performed in B-mode using 5-12 MHz linear multifrequent transducer (Logic e portable; GE Healthcare, China). The transducer was placed perpendicularly to the long axis of the muscles with adequate use of contact gel and minimal pressure to avoid excessive compression of the muscles. Each examination was performed bilaterally while patients were in supine and prone position. Rectus femoris muscle thickness was assessed on the bilateral side of the patient, in a supine position with both knees extended and relaxed and toes pointing to the ceiling, at the halfway point between epicondylus lateralis and trochanter major of the femur. For the evaluation of the rectus abdominal muscle the probe was positioned longitudinally to the muscle, brain-caudal direction. Two images were placed, one to two centimeters to the right and one to two centimeters to the left of the umbilicus. Gastrocnemius medialis (GM) muscle thickness was assessed at the medial part of the GM muscle belly: half of the distance from the popliteal crease to the center of the medial malleolus. All A set of three consecutive measurements was performed, and the average value was reported as muscles thickness. Data were reported in centimeters (cm) as means ± standard deviation. The thicknesses of subcutaneous were measured in the axial view at the same point. Additionally, fascicle length and pennation angle were measured between the two parallel aponeuroses of the gastrocnemius muscle (bulkiest part of medial head) in the longitudinal view when subjects were in prone position with their ankles at 90°. Comprehensive evaluation tests, anthropometric measurements and laboratory parameters, initially measured muscle ultrasound parameters, were compared in patients with and without sarcopenia. All measurements and blood samples for the control group were measured in the same way.