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.