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Muscle wasting, also known as muscle atrophy, is the decrease in size and wasting of muscle tissue. It is caused by a variety of factors, including physical inactivity, ageing, malnutrition, nerve damage, and underlying medical conditions. In terms of physical inactivity, muscle wasting can occur within 10 days in healthy older adults on bed rest. Astronauts, for example, experience muscle atrophy after a few days of weightlessness. Ageing is a common cause of muscle wasting, with a muscle loss of 1-2% a year typical after the age of 50. In addition, nerve damage or disease can lead to muscle wasting, as can underlying medical conditions such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, multiple sclerosis (MS), and Guillain-Barré syndrome.
| Characteristics | Values |
|---|---|
| Type | Physiologic, Pathologic, Neurogenic |
| Causes | Lack of physical activity, ageing, nerve injuries, malnutrition, underlying medical conditions |
| Underlying medical conditions | Amyotrophic lateral sclerosis (ALS), muscular dystrophy, multiple sclerosis (MS), dermatomyositis, Guillain-Barré syndrome, polio, osteoarthritis, Cushing disease, cancer, chronic inflammatory diseases, neurological disorders, sepsis, organ failure, hyperglycemia, neuromuscular diseases, chronic obstructive pulmonary disease (COPD), kidney disease, diabetes, HIV, rheumatoid arthritis, insulin resistance |
| Treatment | Exercise, physical therapy, ultrasound therapy, surgery, dietary changes, supplements |
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What You'll Learn
Inactivity and immobility
The more time spent sitting or lying down, the more muscle mass and strength are lost. Even if one exercises, spending large portions of the day inactive can contribute to muscle loss and weakness. Older adults are more likely to experience muscle wasting due to inactivity, a poor diet, and chronic disease. Inactivity and a poor diet can also lead to obesity, which is another risk factor for muscle atrophy.
Muscle wasting due to inactivity is often reversible with regular exercise and physical therapy. An exercise program may include swimming to reduce muscle workload or exercises using braces or splints. Physical therapy may involve various techniques, such as focused ultrasound therapy, which stimulates muscle contraction to decrease muscle loss.
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Malnutrition and ageing
Muscle wasting, or atrophy, is the decrease in size and wasting of muscle tissue. It is often caused by a lack of physical activity, which can be due to an injury or an underlying health condition. Physiologic atrophy, or disuse atrophy, occurs when muscles are not used enough, and neurogenic atrophy occurs due to nerve problems or diseases.
Malnutrition is a significant cause of muscle wasting, and this is particularly evident in older people. A 2013 study found that people over the age of 50 typically experience an annual loss of muscle mass of 1-2%. A more recent study found that malnourished older patients experienced an average loss of 9% of thigh muscle mass within 14 days of illness. This is comparable to the average decline of muscle mass during nine years of ageing in older persons. The study also found that malnourished patients had lower muscle mass and strength than those who were not malnourished.
Malnutrition is defined as a significantly inadequate nutritional intake, which can cause muscle loss and wasting. It can be caused by anorexia nervosa, cancer, and persistent nausea. In older people, the risk of malnutrition is increased due to changes in body composition that occur during ageing, which can also influence nutritional status. For example, older people may experience a loss of both fat and muscle tissue.
The effects of malnutrition can be combated through regular exercise and proper nutrition. Doctors may recommend specific exercises depending on the patient's condition, and physical therapy can also be helpful. Surgery may also be an option to correct muscle atrophy caused by malnutrition.
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Muscular dystrophy
Muscle wasting, or atrophy, is usually caused by insufficient physical activity or underlying medical conditions. Muscular dystrophy is one such inherited genetic condition that leads to progressive muscle weakness and wasting. It refers to a group of over 30 types of muscular dystrophy, which vary in their age of onset and specific symptoms. The condition is caused by changes in the genes responsible for making proteins required for healthy muscles.
Duchenne muscular dystrophy (DMD) is the most common form, typically affecting boys, although girls can exhibit milder versions of the disease. Symptoms include delayed development milestones, such as late walking, frequent falls, and trouble with running and jumping. Becker muscular dystrophy (BMD) is the second most common type, usually manifesting milder symptoms in boys, while girls may experience symptoms between the ages of 5 and 60.
Emery-Dreifuss muscular dystrophy (EDMD) primarily affects male children and young adults, causing muscle weakness in the shoulders, upper arms, and shins. It can also lead to heart conditions. Facioscapulohumeral muscular dystrophy (FSHD) is characterised by muscle weakness in the face, shoulders, and upper arms, often affecting one side of the body more than the other. Limb-girdle muscular dystrophy (LGMD) affects the upper arms, upper legs, shoulders, and hips, irrespective of age or gender.
Myotonic dystrophy, the most common adult-onset type, affects both men and women, causing difficulty in relaxing muscles after use. It can also impact the heart, lungs, and endocrine system. Congenital muscular dystrophies (CMD) refer to a group of muscular dystrophies present at or near birth, causing overall muscle weakness and potential joint stiffness or looseness. Distal muscular dystrophy affects the hands, feet, lower arms, and lower legs.
While there is no cure for muscular dystrophy, medicines and treatments can help manage symptoms and slow the progression of the disease. Physical therapy, ultrasound therapy, and surgery are potential treatment options. Proper nutrition and exercise are also crucial in preventing and treating muscle wasting.
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Multiple sclerosis
Muscle wasting, or atrophy, can be caused by a variety of factors and health conditions, one of which is Multiple Sclerosis (MS). MS is an autoimmune disease that affects the central nervous system, and it can have a significant impact on muscle health and function.
In MS, the immune system mistakenly attacks the myelin sheath, a protective covering that surrounds nerve fibers. This damage, or demyelination, interferes with nerve impulses and results in a range of neurological symptoms. Muscle weakness and wasting are common issues for people with MS, and they can occur for several reasons. One of the primary causes is the disruption of signals between the brain and muscles due to nerve damage. This can lead to decreased muscle activation and use, resulting in atrophy over time.
Additionally, people with MS often experience mobility issues and may have difficulty moving around or maintaining their balance. This can lead to a decrease in physical activity and, consequently, muscle disuse and wasting. The specific muscles affected can vary, but MS often causes weakness in the legs, making walking and standing more challenging.
Spasticity is another common symptom of MS, characterized by stiff and tight muscles that can be difficult to move. This increased muscle tone is caused by damage to the nerve pathways and can lead to reduced mobility and muscle atrophy. Managing spasticity is important, as it can also cause pain and interfere with daily activities and sleep.
There are several treatments available to help manage muscle wasting in MS. Physical therapy plays a crucial role, as targeted exercises can help strengthen muscles, improve mobility, and maintain function. Therapists may also recommend the use of assistive devices, such as canes or walkers, to improve safety and encourage physical activity. Additionally, medication can be used to manage spasticity and reduce muscle stiffness.
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Intensive care treatment
Muscle wasting, or atrophy, is the loss of muscle mass and strength, which can occur rapidly during critical illness. Critically ill patients can lose more than 15% of muscle mass in a week, which can have long-term detrimental effects. Muscle wasting is a result of reduced physical activity, increased protein breakdown, and decreased protein synthesis.
Intensive care unit-acquired weakness (ICU-AW) is an umbrella term for a group of neuromuscular disorders that develop due to admission to the intensive care unit and severe illness. ICU-AW is observed in about 40% of mixed ICU patients and is associated with a higher risk of mortality. The pathophysiology of ICU-AW is not yet fully understood, but it appears to be triggered by critical illness and is associated with an inflammatory response, bioenergetic dysfunction, altered protein balance, neuronal axon degeneration, changes in muscle histology, and muscle wasting.
The treatment of muscle wasting can be complex and varies depending on the underlying cause. Physical therapy and exercise are often recommended as treatments for muscle wasting, along with a nutritious and protein-rich diet. Ultrasound is used to assess muscle wasting and can help determine the rate of muscle loss. Bedside ultrasound, for example, is a practical and reliable tool for assessing quadriceps muscle layer thickness.
In the context of intensive care, the focus is on improving muscle mass and strength to prevent further complications and improve patient outcomes. Early mobilization and physical therapy interventions are crucial in preventing muscle wasting and improving patient outcomes. Additionally, nutritional interventions such as enhanced protein provision and specific substrate delivery may be implemented to improve muscle mass and function. However, the potential of dietary protein to attenuate muscle protein catabolism in critically ill patients has not yet been established in clinical trials.
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Frequently asked questions
Muscle wasting, or atrophy, is the decrease in size and wasting of muscle tissue. This is caused by a lack of physical activity or underlying health conditions.
There are several medical conditions that can cause muscle wasting, including muscular dystrophy, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), dermatomyositis, and Guillain-Barré syndrome.
Treatment options for muscle wasting include exercise, proper nutrition, physical therapy, ultrasound therapy, and in some cases, surgery.
