Date Published: July 24, 2017
Publisher: Springer International Publishing
Author(s): Daniella Welch, Laetitia Sungu Ndanyo, Simon Brown, Sandra Agyapong-Badu, Martin Warner, Maria Stokes, Dinesh Samuel.
Thigh tissue thickness has not been examined in older females living in extended care in UK as an indicator of musculoskeletal health. This study examined the feasibility of using ultrasound imaging to measure the thickness of superficial (fat) and deep layers (muscle) of the thigh in older females living in extended care.
In ten older females in extended care (aged 80–98 years, mean 88 ± 6.8; body mass: 56.5 ± 12.6 kg) images of the anterior thigh (dominant) were taken in supine using B-mode ultrasound imaging. Superficial and deep layers were measured and percentage thickness was calculated. Independent t tests compared data from those in extended care to ten sedentary females living independently (aged 80–90 years, mean 84 ± 3.6; body mass: 61.6 ± 10.0 kg).
Thickness of the superficial layers was not significantly different between the two groups (CI −0.017 to 0.815, p = 0.059). However, those living in extended care had greater (p < 0.001) muscle thickness (mean 2.75 ± 0.48 cm) than those living independently (mean 1.83 ± 0.3 cm), which was similarly significant when normalised for body mass (extended care 0.51 ± 0.16; independent living 0.30 ± 0.06). These novel findings showed it is feasible to use ultrasound to measure muscles in older females in extended care and that muscle thickness was larger than in those living independently. The reason for the difference seen between groups would need to be confirmed by a larger study that also examined factors related to risk of sarcopenia and frailty, such as nutrition and physical activity levels.
The UK population is ageing and the number of people aged 80 and over is projected to rise to 6 million by 2037 [1, 2]. The development of physical disability is considered a significant risk factor in ageing , and changes in body composition are considered important predictors for functional decline [4, 5]. For example, decrease in muscle mass (sarcopenia), and increase in subcutaneous fat, are both linked to age-related changes . Assessment of functional health by examining body composition may help identify the following: health risks related to excessively high or low body fat; the observation of changes in body composition related to certain diseases; as an aid to producing weight loss or weight gain programmes; assessing the effectiveness of nutrition and exercise interventions, and monitoring age-related changes to body composition . Therefore, an accurate method of measuring body composition in the older adult population would be valuable, as it can be used as a potential biomarker for musculoskeletal characteristics and general health status.
The present study has demonstrated that it is feasible to use ultrasound imaging to examine the contributions of fat and fascia (superficial layers) and muscle (deep layers) of the anterior thigh, relative to total thigh thickness in older females living in residential care in the UK. This and the study by Agyapong-Badu et al.  have highlighted the use of ultrasound to provide rapid assessment of the anterior thigh, as a potential biomarker for musculoskeletal health status.
The present study demonstrated that it is feasible to use ultrasound imaging to measure anterior thigh tissue thickness in older females living in extended care in the UK and some challenges to recruitment have been highlighted. These preliminary findings in a small sample are the first to indicate that muscle thickness may be greater in older females in extended care than those living independently. This potential for those living independently to be at risk of sarcopenia and frailty warrants investigation to determine the extent to which this occurs and aid prevention. Further data are needed in large samples and in different population groups to identify musculoskeletal characteristics in terms of age, gender and activity levels, to be able to make definitive conclusions about how measuring tissue thickness can indicate musculoskeletal health status across different groups.