Evaluation of Dynapenia in Patients with Subclinical Hypothyroidism Ersin Akıncı, Rıdvan Sivritepe, Gözde Özsoy Şen, Sema Basat Uçak Bratislava Medical Journal, 2026 Background Dynapenia is defined as a decline in muscle strength without a corresponding loss of muscle mass, representing a condition different from sarcopenia. Hypothyroidism can negatively affect musculoskeletal function; similarly, subclinical hypothyroidism, although generally asymptomatic, may have almost the same effects. This study aimed to evaluate muscle strength in individuals with subclinical hypothyroidism and to investigate the relationship between subclinical hypothyroidism and dynapenia. Materials and Methods In this cross-sectional study, 172 participants were included—86 patients diagnosed with subclinical hypothyroidism and 86 euthyroid controls—who were admitted to the Internal Medicine Outpatient Clinic of University of Health Sciences Umraniye Training and Research Hospital between February and June 2024. Thyroid function tests (TSH and fT4) were recorded, muscle strength was assessed using a hand dynamometer, and muscle mass was evaluated using bioelectrical impedance analysis. Muscle strength values and the prevalence of dynapenia were compared between the two groups. Statistical analyses were performed using independent t-test, Mann–Whitney U test, and chi-square test as appropriate. Results The mean age of the participants was 42.3 ± 11.3 years, with a similar sex distribution between groups (female: 79%, male: 21% each group). The mean BMI was 26.3 ± 3.4 kg/m 2 . The subclinical hypothyroidism group had higher TSH levels (6.0 ± 1.1 vs. 2.3 ± 0.9 mIU/L) and lower fT4 levels (1.1 ± 0.1 vs. 1.3 ± 0.2 ng/dL) compared to controls (p < 0.001). Mean handgrip strength was significantly lower in the subclinical hypothyroidism group (19.5 ± 5.6 kg vs. 24.5 ± 4.8 kg) (p < 0.001). The prevalence of dynapenia was 82.7% in the subclinical hypothyroidism group and 17.3% in the control group (p < 0.001). Conclusion Subclinical hypothyroidism is significantly associated with the development of dynapenia. This association may be related to the regulatory effects of thyroid hormones on muscle metabolism and muscle fiber synthesis.
The Relationship Between Dynapenia and Insulin Resistance in Non-diabetic Women over 65 Years of Age: A Cross-Sectional Study Gözde Özsoy Şen, Rıdvan Sivritepe, Sema Basat Uçak Bratislava Medical Journal, 2025 Recent studies suggest a link between hyperglycemia and dynapenia, but it is unclear whether this occurs before overt diabetes. This study aimed to evaluate the relationship between dynapenia and insulin resistance in non-diabetic women over 65 years of age. A total of 179 women over 65 were included and divided into dynapenic (n = 94) and non-dynapenic (n = 85) groups. Physical examinations, anthropometric measurements, and handgrip strength assessments were performed. Muscle mass was measured using bioelectrical impedance analysis, and the Timed Up and Go (TUG) test was conducted. The dynapenic group had significantly lower muscle mass, handgrip strength, serum albumin, and calf circumference ( p < 0.05), and higher AST levels ( p = 0.042). Patients with insulin resistance had significantly greater upper arm and calf circumferences ( p = 0.001; p = 0.003). Handgrip strength varied significantly by TUG test category ( p = 0.004). Dynapenia increased the risk of insulin resistance by 2.385 times. Additionally, each unit increase in glucose, insulin, and upper arm circumference raised insulin resistance risk (OR = 1.048, 1.133, and 1.175, respectively). Dynapenia, glucose, insulin, and upper arm circumference were independent risk factors for HOMA-IR. A significant association was found between HOMA-IR and dynapenia in non-diabetic women over 65. Findings suggest that dynapenia may emerge in the prediabetic stage due to insulin resistance. Early identification and management of insulin resistance may help prevent the onset of dynapenia.
Could Urinary Amino Acids be as New Biomarkers for Detection of Sarcopenia? Rıdvan Sivritepe, Sema Uçak Basat, Neslihan Gökmen, Aydın Duygu, Özge Kıran Siyer, Serhat Mert Tiril Bratislava Medical Journal, 2025 Background Sarcopenia is a syndrome that cause falls, fractures, and morbidity in geriatric patients. Early diagnosis of sarcopenia is important as it is known that muscle functions can improve with early intervention. We aimed to investigate whether urinary amino acid levels could serve as biomarkers of sarcopenia. Methods The study included ninety-one patients aged 45–65 who visited to our outpatient clinic. The patients underwent physical examinations, blood tests and sixteen distinct urinary amino acid levels were analyzed. Anthropometric measurements were performed. Physical performances were evaluated. Muscle strengths were measured. Muscle masses were analyzed. Patients were divided into 4 groups: pre-sarcopenic, sarcopenic, severe sarcopenic and non-sarcopenic. Statistical significance level was determined as p < 0.05. Results A total of ninety-one patients, 53 females and 38 males, were included in the study. Three patients had pre-sarcopenia, eleven had sarcopenia, and two met the criteria for severe sarcopenia, while seventy-five patients were non sarcopenic. A significant difference was found between the sarcopenia and non-sarcopenia groups in terms of glutamine and valine levels (p < 0.001 for both). In the ROC analysis, the cut-off value of glutamine and valine levels in detecting sarcopenia was determined as 492 µmol/L and 209 µmol/L (AUC: 0.875 and 0.968). Correlation analysis revealed a negative relationship between urinary leucine levels and both muscle strength and muscle mass Conclusions We found that patients with sarcopenia had high urinary glutamine and valine levels and that urinary leucine levels were associated with both muscle strength and muscle mass.
Do we know about dynapenia? Ridvan Sivritepe Northern Clinics of Istanbul, 2024 Dynapenia is a condition characterized by decreased muscle strength and function in older adults that is not due to a specific underlying disease or medical condition. Dynapenia is common among older adults and has significant health effects, including functional impairment, disability, increased risk of falls, hospitalization, and death. Oxidative stress, mitochondrial dysfunction and chronic inflammation are involved in the etiopathophysiology of dynapenia. Diagnosis of dynapenia is based on the evaluation of muscle strength and function using methods such as hand grip strength, timed up and go test and short physical performance battery. Management of dynapenia involves a multifaceted approach that includes exercise, nutrition, pharmacological interventions, management of underlying medical conditions, and fall prevention strategies. With appropriate interventions, older adults with dynapenia can improve muscle strength and function, reduce the risk of falls and disability, and maintain their independence and quality of life.
Pancreatic and Hepatic Steatosis in Women with Type 2 Diabetes after Pancreatitis: A Retrospective Cross-Sectional Study Firuze Yalçın, Rıdvan Sivritepe, Fatma Kulalı, Aynur Gül, Esra Bora, et al. Clinical Diabetology, 2024 OBJECTIVE: This study aimed to compare the incidence of pancreatic steatosis and hepatic steatosis between patients with/without diabetes suffering from pancreatitis. MATERIALS AND METHODS: 120 patients between the ages of 18 and 65 years who were hospitalized with pancreatitis were included in the study. The patients were divided into 2 groups: patients with diabetes with pancreatitis (n = 60, Group 1) and patients without diabetes with pancreatitis (n = 60, Group 2). Biochemical blood tests of the patients were analyzed. HU attenuation measurement results on pancreatic abdominal computed tomography (CT) were evaluated retrospectively. The pancreatic-hepatic steatosis status of the patients was recorded. All parameters were compared between the 2 groups. RESULTS: The study was conducted on a total of 120 female patients with pancreatitis. The average age of the patients was 52.3 years, the mean body mass index (BMI) was 27.3 kg/m2, the mean HbA1c was 7.4%, and the mean diabetes duration was 4.6 years. The incidence of pancreatic steatosis was found to be statistically significantly higher in Group 1 (p < 0.05). While 35.0% (n = 21) of pancreatic steatosis was detected in Group 2, 56.7% (n = 34) of Group 1 were found to have pancreatic steatosis. The mean Hounsfield unit (HU) attenuation differences in the pancreas, corpus, and tail in Group 1 and Group 2 were determined to be statistically significant. (p = 0.030, 0.25, and 0.18, respectively). In the correlation analysis, a statistically significant and weak relationship was found between HbA1c and tail and pancreas/spleen values (p < 0.05). It was determined that there was a statistically significant and weak relationship between glucose and corpus, tail, pancreas, and pancreas/spleen values (p < 0.05). CONCLUSIONS: In our study, pancreatic steatosis was found to be more common in Group 1. However, no significant difference was detected between Group 1 and Group 2 in terms of hepatosteatosis.
The Association between Non-Alcoholic Fatty Liver Disease and Dynapenia in Men Diagnosed with Type 2 Diabetes Mellitus Atilla Bulur, Rıdvan Sivritepe Healthcare Switzerland, 2023 Background: Dynapenia and non-alcoholic fatty liver disease (NAFLD) are common, especially in the middle and advanced-age diabetic male population. We aimed to examine the clinical features, NAFLD severity, and parameters associated with the presence of dynapenia in type 2 diabetes mellitus (T2DM) cases. Material and Methods: One hundred thirty-five male patients diagnosed with T2DM between 45 and 65 years of age were included. Patients were staged by ultrasonography according to NAFLD status. Results: There were significant differences in muscle strength, upper arm circumference, calf circumference, and up-and-go test scores between the mild-moderate-severe and non-NAFLD groups (p < 0.001 for all). The frequency of dynapenia was lower, and arm and calf circumferences were higher in patients without NAFLD. The muscle strength, upper arm circumference, calf circumference, and up-and-go test scores were significantly lower in the dynapenic group compared to the non-dynapenic group (p < 0.005 for all). The prevalence of dynapenia increased along with the increase in NAFLD stages (p < 0.001). Conclusions: We detected a significant association between NAFLD and dynapenia in middle-aged men with T2DM. As muscle strength decreases, the amount of fat in the liver increases, and as the fat in the liver increases, muscle strength decreases.
The effect of interleukin-6 level at the time of hospitalisation on erectile functions in hospitalised patients with COVID-19 Rıdvan Sivritepe, Sema Uçak Basat, Arzu Baygul, Eyüp Veli Küçük Andrologia, 2022 We evaluated the relationship between erectile dysfunction (ED) and IL‐6 levels in males with COVID‐19. The study included 80 male patients aged 30–45 years who were hospitalised due to COVID‐19. The International Index of Erectile Function (IIEF‐5) questionnaire was used to assess erectile function. The IIEF‐5 questionnaire was re‐administered at a 3‐month control visit after discharge, and the change score from baseline was recorded. The patients were divided into three groups according to the IIEF‐5 score at 3 months as Group 1 (severe ED), Group 2 (moderate ED) and Group 3 (no ED), and into two groups according to IL‐6 level at the time of admission as Group A (IL‐6 ≤ 50 ng/ml) and Group B (IL‐6 > 50 ng/ml). The change in the IIEF‐5 score (p < .001) was significantly greater in Group B than in Group A. There was also significant difference in IL‐6 between Group 1 and Group 2 (p = .008). The correlation analysis revealed a moderate correlation between IL‐6 level and the change in IIEF‐5 score and D‐dimer level (r:0.529, p < .001) and a weak correlation between IL‐6 level and FSH (r:0.309, p = .005). The present study suggests that elevated IL‐6 levels in male patients hospitalised due to COVID‐19 might be related to the risk of developing ED.
The relationship between dynapenia and vitamin D level in geriatric women with type 2 diabetes mellitus Ridvan Sivritepe Northern Clinics of Istanbul, 2022 Objective: In this study, we examined the possible relationship between dynapenia and vitamin D (VD) levels in geriatric women with type 2 diabetes mellitus (T2DM). Methods: One hundred and twenty-two geriatric female patients aged 65–80 years with a diagnosis of T2DM were included in this prospective study. Physical examinations of the patients were performed, and biochemical tests were analyzed. The muscle strength of the patients was measured with a hand dynamometer. Dynapenia was defined as low grip strength with normal skeletal muscle mass index. In muscle strength measurements, for female patients, over 20 kg was accepted as normal and below 20 kg as decreased muscle strength. Patients were separated into three groups as <10 ng/ml, 10–30 ng/ml, and >30 ng/ml according to VD levels; according to the status of dynapenia, they were divided into two groups as dynapenic and non-dynapenic. By comparing all these parameters between these groups, the relationship between VD level and dynapenia was evaluated. In statistical analysis, significance was accepted as p<0.05. Results: While 54 of the patients (44.3%) met the dynapenia criterion, 68 patients (55.7%) were non-dynapenic. Patients were first compared according to their dynapenia status. VD level was significantly lower in the dynapenic group (p<0.05). In the correlation analysis, a moderate positive correlation was found between muscle strength and VD (p=0.033, r: 0.23). The patients were then compared according to the VD groups. In the VD insufficient group, muscle strength (p=0.015), body mass index (p=0.025), systolic blood pressure (p<0.01), and glucose (p<0.01) were statistically significantly higher. Conclusion: In the present study, we found a considerable relationship between VD levels and dynapenia in geriatric women with T2DM.
Serum amino acid levels and mortality in patients undergoing percutaneous endoscopic gastrostomy R. Sivritepe, S. Basat, Neslihan Gokmen Journal of the College of Physicians and Surgeons Pakistan, 2021 OBJECTIVE To evaluate the effect of feeding via percutaneous endoscopic gastrostomy tube (PEG) on serum amino acid levels and mortality. STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey, from January 2016 to February 2019. METHODOLOGY Patients over 18 years of age, who were indicated for PEG due to loss of swallowing reflex, were included in the study. The follow-up period of the study was one year. The patients were reevaluated on the 3rd, 6th, and 12th months after inclusion. Anthropometric measurements, and nutritional status were evaluated at each visit, and quantitative amino acid levels were analysed. Statistical significance was accepted as p <0.05. RESULTS The study was carried out with a total of 53 cases (23 men and 30 women) ranging in the age from 18 to 91 years. While 13 patients were still alive, 40 patients died before completing one year. The levels of glutamine, leucine, taurine, and threonine were significantly different between surviving patients and dead. A statistically significant difference was found between the levels of citrulline (p <0.001), ornithine (p = 0.036) and tyrosine (p = 0.011) during the four different visits of patients who survived. In patients who died, a significant difference was found between the levels of threonine, ornithine, and aspartic acid (p <0.043 for all) between visits. Citrulline and tyrosine levels were found to be significantly increased in surviving patients. CONCLUSION The amino acid profiles of malnourished patients vary considerably. Increase in citrulline, ornithine and tyrosine levels are noted in surviving patients. Key Words: Amino acid, Percutaneous endoscopic gastrostomy, Malnutrition, Mortality.
