ReviewLow muscle mass and strength in pediatrics patients: Why should we care?
Introduction
Adequate skeletal muscle quantity and “quality” are essential for the maintenance of optimal health throughout life [1]. Besides its contractile function, skeletal muscle plays an essential role in whole-body protein metabolism and is an important determinant of glucose and energy homeostasis [2], directly influencing the development of metabolic diseases [3], [4], [5]. During all life stages, several factors have been found that negatively influence skeletal muscle quantity and “quality”, such as inactivity, diseases and malnutrition [6]. These factors can generate a phenotype defined as “sarcopenia”, which is characterized by low muscle mass and strength and poor physical performance [6].
In 1964, Forbes described for the first time a low muscle mass phenotype in children [7]; nonetheless, very little attention has been paid to the mechanical and metabolic implications of low skeletal muscle mass and strength in pediatrics since this initial publication [8]. Similar to its effects in adulthood and senescence, low muscle mass and strength contribute to adverse health outcomes in childhood. Several studies have described an increased risk of developing metabolic dysfunction and cardiovascular diseases in children and adolescents with low skeletal muscle mass and strength [4], [5], [9], [10], [11]. On the other hand, additional research has shown positive associations between muscle mass and bone mineral content [12], [13], and cognition and motor scores early in life [14], [15].
In view of the risks associated with low skeletal muscle mass and strength, the aim of this narrative review is to identify and discuss the factors affecting skeletal muscle development, the impact of low muscle mass and strength on children's health, and to review the latest technology employed in both clinical and research settings to assess muscle mass and strength. For the purpose of this review, we will use the most accurate terminology to describe the body composition measured by the authors (as defined in Table 1), which may vary from the original terminology presented by them.
Section snippets
Methods
An unsystematic literature search was performed in PubMed from its inception until December 2018. The search strategy consisted of key words related to the main topics discussed throughout this narrative review involving only the pediatric population: muscle mass and strength, bone and cognitive development, sarcopenic obesity, and techniques to assess body composition and strength. Moreover, the reference list of selected literature was manually searched for additional relevant articles.
Influences on skeletal muscle development
Skeletal muscle is a tissue capable of modifying its structure and metabolic properties. Despite its plasticity, the number of muscle fibers are partially set before birth during the embryonic and fetal stages of development (between weeks 6–8 and 8–18 of pregnancy, respectively) [16], [17], [18]. After birth, muscle fibers grow mainly in size and to a much lesser degree in number [19]; therefore, defects in muscle development that occurred during pregnancy may be perpetuated throughout adult
Impact of low muscle mass and strength in pediatrics
Previous studies have established that low muscle mass and strength contribute to adverse health outcomes in childhood [4], [5], [9], [10], [11], [12], [13]. Here, we discuss this evidence by highlighting the implications of low muscle mass and strength on metabolic homeostasis, bone health, and neurodevelopment as summarized in Fig. 2.
Sarcopenic obesity in pediatrics
Recent evidence suggests that a body composition phenotype combining both high FM and low muscle mass (also known as sarcopenic obesity in adults) is associated with greater health risks than either compartment alone [153], [154]. To elucidate the relative contribution of these body components to physiological function, the model of metabolic load-capacity has been used in the adult population [155]. Metabolic load was previously defined as the extent of an adverse effect on the organism caused
Tracking muscle mass and strength throughout development
Measurement of muscle mass and strength are fundamental to identify relevant health outcome measures and functional status, establish nutritional recommendations, and monitor the effectiveness of interventions aiming to promote health and prevent diseases [157]. In pediatric patients with chronic diseases, an accurate bedside evaluation of muscle mass and strength provide further support to clinicians in planning ongoing care of patients [24], [158], [159]. These high-risk children usually
Conclusion and perspectives
Growing evidence suggests that several pre- and postnatal factors influence the development of suboptimal muscle mass and strength, fostering the development of a sarcopenic-like phenotype in childhood and adolescence. Inadequate maternal intake along with genetics and hormonal disorders, physical inactivity and obesity, can limit the growth of skeletal muscle as expected for an individual's age, pubertal stage and sex. In addition, current literature confirms that low muscle mass and strength
Funding
This work has been funded by the generous support of the Stollery Children's Hospital Foundation through the Women and Children's Health Research Institute (RES0040520). Camila E Orsso is supported by the Alberta Diabetes Institute and a recipient of the 2018 Alberta SPOR Graduate Studentship in Patient-Oriented Research, which is jointly funded by Alberta Innovates and the Canadian Institutes of Health Research. Jenneffer R B is supported by CNPq through the Graduate Scholarship and a
Conflict of interest
The authors declare no conflict of interest.
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