Sarcopenia Is Recognized as an Independent Condition by an International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) Code

Evaluation of the Responsiveness of the SarQoL® Questionnaire, a Patient-Reported Outcome Measure Specific to Sarcopenia

INTRODUCTION

The Sarcopenia Quality of Life (SarQoL®) questionnaire was developed to provide a patient-reported outcome measure specific to sarcopenia. Its psychometric properties indicate that it is a valid and reliable instrument. However, until now, its ability to detect change over time has not been examined. Therefore, the objective of this study is to evaluate the responsiveness (also known as sensitivity to change) of the SarQoL® questionnaire in a prospective, longitudinal cohort of community-dwelling, older, sarcopenic subjects.

METHODS

Sarcopenic subjects from the SarcoPhAge (Sarcopenia and Physical impairment with advancing Age) study were included. Responsiveness was evaluated with nine pre-specified hypotheses on the correlation between the evolution of the SarQoL® scores after a 2-year interval and the evolution of the scores on the Short Form-36 (SF-36) and the Euroqol 5-dimension (EQ-5D) questionnaires. This technique considers responsiveness to be a form of longitudinal validity. Additionally, standardized response means were also calculated to compare the quantity of change measured by the different questionnaires.

RESULTS

A total of 42 sarcopenic subjects were included. The median age of the sample was 72.9 (68.9-78.8) years, 59.5% were female, and the mean body mass index was 23.3 (20.4-25.7) kg/m2. A good responsiveness was observed, as evidenced by the confirmation of eight out of nine hypotheses, well above the 75% confirmation threshold. The standardized response mean of the Overall SarQoL® score was significantly higher than those of the SF-36 Physical Component Summary (p = 0.005), the EQ-5D Utility Index (p < 0.001) and the Euroqol visual analogue scale (p = 0.003).

CONCLUSION

The first data available on the ability of the SarQoL® questionnaire to detect change over time indicates that the questionnaire has good responsiveness. This, together with the previously established psychometric properties, confirms that the SarQoL® questionnaire is a relevant instrument for the assessment of quality of life in sarcopenic populations.

Effects of branched-chain amino acids and vitamin D supplementation on physical function, muscle mass and strength, and nutritional status in sarcopenic older adults undergoing hospital-based rehabilitation: A multicenter randomized controlled trial

AIM

To investigate the effects of branched-chain amino acids and vitamin D supplementation on physical function, muscle strength, muscle mass, and nutritional status in sarcopenic older adults undergoing hospital-based rehabilitation.

METHODS

We carried out an 8-week, multicenter, randomized, controlled, blinded outcome, two-cohort parallel group intervention trial of sarcopenic older adults undergoing in-hospital rehabilitation. The eligibility criteria included older adults (aged ≥65 years) with low muscle strength (handgrip strength) and low muscle mass (calf circumference) according to the cut-off values for older Asians. The intervention group received branched-chain amino acids and vitamin D supplementation, whereas the control group did not. Both groups underwent low-intensity resistance training in addition to the post-acute rehabilitation program. The primary outcome of physical function (Functional Independence Measure-motor scores), and the secondary outcomes of muscle strength (handgrip strength), muscle mass (calf circumference) and nutritional status (body mass index) were measured at baseline and at the end of the intervention.

RESULTS

Finally, a total of 68 patients were analyzed (intention-to-treat analysis): 35 in the intervention group and 33 in the control group. Functional Independence Measure-motor scores increased significantly in both groups over time (P < 0.05). However, no treatment-by-time effects were observed (median estimated difference 2.4, 95% confidence interval -1.2 to 7.1). Handgrip strength, calf circumference and body mass index increased significantly in both groups over time (P < 0.05), with significantly greater improvements in the intervention group (P = 0.041, 0.033 and 0.035, respectively).

CONCLUSIONS

We showed that an 8-week intervention of branched-chain amino acids and vitamin D supplementation with low-intensity resistance training improves muscle-related outcomes in sarcopenic older adults undergoing hospital-based rehabilitation (UMIN000006238). Geriatr Gerontol Int 2019; 19: 12-17.

The "BIOmarkers associated with Sarcopenia and PHysical frailty in EldeRly pErsons" (BIOSPHERE) study: Rationale, design and methods

Sarcopenia, the progressive and generalised loss of muscle mass and strength/function, is a major health issue in older adults given its high prevalence and burdensome clinical implications. Over the years, this condition has been endorsed as a marker for discriminating biological from chronological age. However, the absence of a unified operational definition has hampered its full appreciation by healthcare providers, researchers and policy-makers. In addition to this unsolved debate, the complexity of musculoskeletal ageing represents a major challenge to the identification of clinically meaningful biomarkers. Here, we illustrate the advantages of biomarker discovery procedures in muscle ageing based on multivariate methodologies as an alternative approach to traditional single-marker strategies. The rationale, design and methods of the "BIOmarkers associated with Sarcopenia and PHysical frailty in EldeRly pErsons" (BIOSPHERE) study are described as an application of a multi-marker strategy for the development of biomarkers for the newly operationalised Physical Frailty & Sarcopenia condition.

Sarcopenia

Sarcopenia is defined as a combination of low muscle mass with low muscle function. The term was first used to designate the loss of muscle mass and performance associated with aging. Now, recognized causes of sarcopenia also include chronic disease, a physically inactive lifestyle, loss of mobility, and malnutrition. Sarcopenia should be differentiated from cachexia, which is characterized not only by low muscle mass but also by weight loss and anorexia. Sarcopenia results from complex and interdependent pathophysiological mechanisms that include aging, physical inactivity, neuromuscular compromise, resistance to postprandial anabolism, insulin resistance, lipotoxicity, endocrine factors, oxidative stress, mitochondrial dysfunction, and inflammation. The prevalence of sarcopenia ranges from 3% to 24% depending on the diagnostic criteria used and increases with age. Among patients with rheumatoid arthritis 20% to 30% have sarcopenia, which correlates with disease severity. Sarcopenia exacts a heavy toll of functional impairment, metabolic disorders, morbidity, mortality, and healthcare costs. Thus, the consequences of sarcopenia include disability, quality of life impairments, falls, osteoporosis, dyslipidemia, an increased cardiovascular risk, metabolic syndrome, and immunosuppression. The adverse effects of sarcopenia are particularly great in patients with a high fat mass, a condition known as sarcopenic obesity. The diagnosis of sarcopenia rests on muscle mass measurements and on functional tests that evaluate either muscle strength or physical performance (walking, balance). No specific biomarkers have been identified to date. The management of sarcopenia requires a multimodal approach combining a sufficient intake of high-quality protein and fatty acids, physical exercise, and antiinflammatory medications. Selective androgen receptor modulators and anti-myostatin antibodies are being evaluated as potential stimulators of muscle anabolism.

The impact of exercise and nutrition on the regulation of skeletal muscle mass

The maintenance of skeletal muscle mass and strength throughout life is a key determinant of human health and well-being. There is a gradual loss of both skeletal muscle mass and strength with ageing (a process termed sarcopenia) that increases the risk of functional dependence, morbidity and mortality. Understanding the factors that regulate the size of human muscle mass, particularly during the later years of life, has therefore become an area of intense scientific inquiry. The amount of muscle mass is determined by coordinated changes in muscle protein synthesis (MPS) and muscle protein breakdown (MPB). In this review, we assess both classical and contemporary work that has examined how resistance exercise and nutrition impact on MPS and MPB. Special consideration is given to the role of different sources of dietary protein (food vs. supplements) and non-protein nutrients such as omega-3 fatty acids in regulating MPS. We also critically evaluate recent studies that have employed novel 'omic' technologies such as dynamic protein profiling to probe for changes in rates of MPS and MPB at the individual protein level following exercise. Finally, we provide suggestions for future research that we hope will yield important information for the development of exercise and nutritional strategies to counteract muscle loss in a variety of clinical settings.

Current Status of Sarcopenia in Korea: A Focus on Korean Geripausal Women

Sarcopenia is defined as an age-associated decline in muscle mass and function caused by several etiologies and mechanisms. Muscle mass and function do not decrease concurrently, and a loss of muscle function may be more highly associated with adverse health outcomes. Despite the clinical significance of sarcopenia, no universally operational definition of sarcopenia or standardized intervention programs are currently available. Sarcopenia, osteoporosis, and obesity share several pathophysiological mechanisms, and a combination of these entities may lead to an increased risk of musculoskeletal, cardio-metabolic, and psychological morbidities especially in geripause populations. Treatment for sarcopenia is mainly nonpharmacological, however, various drugs are currently being developed. It is conceivable that sarcopenia is the next immediate clinical target in musculoskeletal science.

Prediction of sarcopenia using a combination of multiple serum biomarkers

Sarcopenia is a gradual loss of skeletal muscle mass and function with aging. Given that sarcopenia has been recognized as a disease entity, effective molecular biomarkers for early diagnosis are required. We recruited 46 normal subjects and 50 patients with moderate sarcopenia aged 60 years and older. Sarcopenia was clinically identified on the basis of the appendicular skeletal muscle index by applying cutoff values derived from the Asian Working Group for Sarcopenia. The serum levels of 21 potential biomarkers were analyzed and statistically examined. Interleukin 6, secreted protein acidic and rich in cysteine, macrophage migration inhibitory factor, and insulin-like growth factor 1 levels differed significantly between the normal and sarcopenia groups. However, in each case, the area under the receiver operating characteristics curve (AUC) was <0.7. Subsequent combination of the measurements of these biomarkers into a single risk score based on logistic regression coefficients enhanced the accuracy of diagnosis, yielding an AUC value of 0.763. The best cutoff value of 1.529 had 70.0% sensitivity and 78.3% specificity (95% CI = 2.80–21.69, p < 0.0001). Combined use of the selected biomarkers provides higher diagnostic accuracy than individual biomarkers, and may be effectively utilized for early diagnosis and prognosis of sarcopenia.

Association of sarcopenia and fractures in community-dwelling older adults: a systematic review and meta-analysis of cohort studies

To our knowledge, no comprehensive meta-analysis has examined the association between sarcopenia and the risk of fractures. This systematic review and meta-analysis of prospective cohort studies aims to summarize whether sarcopenia is a risk factor for fractures among community-dwelling older adults. We searched four electronic literature databases (Ovid MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PubMed) for relevant publications from inception to December 2017, using relevant keywords. We conducted a pooled analysis of the association between sarcopenia and the risk of fractures by employing a random-effects model. Subgroup analyses were conducted based on definitions of sarcopenia and gender. In total, nine studies were included in our systematic review and meta-analysis. The prevalence of sarcopenia ranged from 4.3 to 33.1%. The pooled RR of fractures for the sarcopenic versus the nonsarcopenic was 1.34 (95% CI = 1.13-1.58, P = 0.001, I² = 5.5%, P-heterogeneity = 0.391). Subgroup analyses showed that associations between sarcopenia and fractures were significant when using the AWGS definition (combined effect size = 1.78, 95% CI = 1.25-2.54, P = 0.001), and studies in males (combined effect size = 1.39, 95% CI = 1.13-1.71, P = 0.002). In conclusion, we found that compared to nonsarcopenic, the association between sarcopenia and fractures among community-dwelling older people was significant when using the AWGS definition, and only for males. Future studies are needed to establish a possible association between sarcopenia definitions and risk of fractures of different sites.

Determinants of muscle preservation in individuals with cerebral palsy across the lifespan: a narrative review of the literature

In individuals with cerebral palsy (CP), smaller muscle and atrophy are present at young age. Many people with CP also experience a decline in gross motor function as they age, which might be explained by the loss of muscle mass. The clinical observation of muscle wasting has prompted a comparison with sarcopenia in older adults, and the term accelerated musculoskeletal ageing is often used to describe the hallmark phenotype of CP through the lifespan. However, there has been very little research emphasis on the natural history of ageing with CP and even less with respect to the determinants or prevention of muscle loss with CP. Considering the burgeoning interest in the science of muscle preservation, this paper aims to (i) describe the characteristics of accelerated musculoskeletal ageing in people with CP, (ii) describe the pathophysiology of sarcopenia and parallels with CP, and (iii) discuss possible therapeutic approaches, based on established approaches for sarcopenia.

Ingestion of a Multi-Ingredient Supplement Does Not Alter Exercise-Induced Satellite Cell Responses in Older Men

Background

Nutritional supplementation can have beneficial effects on body composition, strength, and function in older adults. However, whether the response of satellite cells can be altered by nutritional supplementation in older adults remains unknown.

Objective

We assessed whether a multi-ingredient protein-based supplement taken over a prolonged period of time could alter the muscle satellite cell response after exercise in older men.

Methods

Twenty-seven older men [mean ± SD age: 73 ± 1 y; mean ± SD body mass index (kg/m2): 28 ± 1] participated in a randomized double-blind experiment. Participants were randomly divided into an experimental (EXP) group (n = 13) who consumed a multi-ingredient protein-based supplement [30 g whey protein, 2.5 g creatine, 500 IU vitamin D, 400 mg Ca, and 1500 mg n-3 (ω-3) polyunsaturated fatty acids] 2 times/d for 7 wk or a control (CON; 22 g maltodextrin) group (n = 14). After 7 wk of supplementation, all participants performed a single resistance exercise session, and muscle biopsy samples were taken from the vastus lateralis before and 24 and 48 h after exercise. Immunohistochemistry was used to assess the change in type I and II muscle fiber satellite cell content and activation status of the cells. In addition, mRNA expression of the myogenic regulatory factors was determined by using reverse transcriptase-polymerase chain reaction.

Results

In response to the single bout of exercise, type I muscle fiber satellite cell content was significantly increased at 24 h (0.132 ± 0.015 and 0.131 ± 0.011 satellite cells/fiber in CON and EXP groups, respectively) and 48 h (0.126 ± 0.010 and 0.120 ± 0.012 satellite cells/fiber in CON and EXP groups, respectively) compared with pre-exercise (0.092 ± 0.007 and 0.118 ± 0.017 satellite cells/fiber in CON and EXP groups, respectively) muscle biopsy samples (P < 0.01), with no difference between the 2 groups. In both groups, we observed no significant changes in type II muscle fiber satellite cell content after exercise.

Conclusion

Ingesting a multi-ingredient protein-based supplement for 7 wk did not alter the type I or II muscle fiber satellite cell response during postexercise recovery in older men. This trial was registered at www.clinicaltrials.gov as NCT02281331.

Hand grip strength measurement in different epidemiologic studies using various methods for diagnosis of sarcopenia: a systematic review

BACKGROUND

The purpose of this systematic review was to compare various methods for measuring hand grip strength to provide data for the development of a standardized protocol for such a measurement based on epidemiologic studies of sarcopenia in older population.

METHODS

Systematic review and meta-analysis were performed using 34 available epidemiologic studies.

RESULTS

The choice of hand dynamometer and measurement protocols for measuring hand grip strength was not consistent among studies. Mean values of hand grip strength in older population were also different by study area (Europe, America, and Asia) and gender.

CONCLUSION

This systematic review demonstrated that various grip strength measurement methods were used in different epidemiologic studies. A standardized method is needed to enable more consistent measurement of grip strength and better assessment of sarcopenia.

Calf Circumference as a Simple Screening Marker for Diagnosing Sarcopenia in Older Korean Adults: the Korean Frailty and Aging Cohort Study (KFACS)

BACKGROUND

The purpose of this study was to explore the optimal cut-off point of calf circumference (CC) as a simple proxy marker of appendicular skeletal muscle mass (ASM) and sarcopenia in the Korean elderly and to test the criterion-related validity of CC by analyzing its relationships with the physical function.

METHODS

The participants were 657 adults aged 70 to 84 years who had completed both dual energy X-ray absorptiometry (DXA) and physical function test in the first baseline year of the Korean Frailty and Aging Cohort Study.

RESULTS

ASM and skeletal muscle mass index (SMI) were correlated positively with CC (male, ASM, r = 0.55 and SMI, r = 0.54; female, ASM, r = 0.55 and SMI, r = 0.42; all P < 0.001). Testing the validity of CC as a proxy marker for low muscle mass, an area under the curve (AUC) of 0.81 for males and 0.72 for females were found and their optimal cut-off values of CC were 35 cm for males and 33 cm for females. In addition, CC-based low muscle groups were correlated with physical functions even after adjusting for age and body mass index. Also, the cut-off value of CC for sarcopenia was 32 cm (AUC; male, 0.82 and female, 0.72).

CONCLUSION

The optimal cut-off values of CC for low MM are 35 cm for males and 33 cm for females. Lower CC based on these cut-off values is related with poor physical function. CC may be also a good indicator of sarcopenia in Korean elderly.

Interventions for Treating Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

BACKGROUND

Much interest has been focused on interventions for treating sarcopenia; however, the effects have gained little evidence.

OBJECTIVE

To analyze the effectiveness of exercise, nutritional, drug, and combinational interventions for treating sarcopenia in older people.

METHOD

We systematically searched MEDLINE via PubMed, the Cochrane Library of Cochrane Reviews and Cochrane Central Register of Controlled Trials, and Ichushi-Web for randomized controlled trials (RCTs) from January 2000 to December 2016. We have assessed the type of intervention, the cohort used, the way sarcopenia was diagnosed, the outcomes, and the quality of evidence. We meta-analyzed the outcomes with the net difference between-group treatment from baseline to the end of the study.

RESULTS

We screened a total of 2668 records and included seven RCTs that investigated the effects of exercise (4 RCTs), nutrition (5 RCTs), drug (1 RCT), and combination (4 RCTs) on muscle mass, strength, and function in older people with sarcopenia. Very low to low-quality evidence suggests that (1) exercise interventions may play a role in improving muscle mass, muscle strength, and walking speed in 3 months of intervention; (2) nutritional interventions may be effective in improving muscle strength in 3 months of intervention; (3) as drug intervention, selective androgen receptor modulator had no clear effect on muscle mass, strength, and physical function; and (4) a combined intervention of exercise and nutrition may have positive effects in improving the walking speed in 3 months of intervention.

CONCLUSION

Our systematic review and meta-analysis showed some positive effects of exercise and nutritional interventions for treating sarcopenia in older people, although the quality of the evidence was low. Future high-quality RCTs should be implemented to strengthen the results.

SARC-F questionnaire identifies physical limitations and predicts post discharge outcomes in elderly patients with cardiovascular disease

Background A simple and inexpensive sarcopenia screening tool would be beneficial in clinical practice. This study was performed to determine whether SARC-F questionnaire can be used to identify physical limitations and poor prognosis in elderly cardiovascular disease (CVD) patients.Methods The study population consisted of 257 Japanese patients ≥65 years old admitted to our hospital for CVD. Prior to discharge from hospital, SARC-F, handgrip strength, usual gait speed, short physical performance battery score, and 6-minute walking distance were measured in all patients. The patients were divided into two groups according to SARC-F score: SARC-F <4 and SARC-F ≥4. The study endpoint was the first occurrence of all-cause emergency readmission or all-cause mortality.Results The prevalence rate of SARC-F ≥4 was 26.8%, and increased with age and number of comorbidities. Even after adjusting for covariates, physical function was significantly poorer and the risks of physical function measurements below the critical cut-off values were higher in the SARC-F ≥4 group compared to the SARC-F <4 group. Sixty (23.3%) patients were readmitted and 17 (6.6%) died over a median follow-up period of 11 months (interquartile range: 6–13 months). SARC-F score was a significant predictor of adverse events after discharge. Patients with SARC-F ≥4 showed higher event risk than those with SARC-F <4 (adjusted hazard ratio: 1.78; 95% confidence interval: 1.03–3.07; P = 0.040).Conclusions SARC-F questionnaire is useful to identify patients at high risk of physical limitations and to predict post-discharge outcomes in elderly CVD patients.

Systematic review and meta-analysis of prevalence of sarcopenia in post acute inpatient rehabilitation

Sarcopenia is associated with poor function and increased risk of falls and disability. This work reports a systematic review and meta-analysis of prevalence of sarcopenia in post acute inpatient rehabilitation. Sarcopenia is found to be present in approximately 50% of rehabilitation patients and its prevalence may vary with admission diagnosis.

PURPOSE

To conduct a systematic review and meta-analysis of reported prevalence of sarcopenia in post acute inpatient rehabilitation.

METHODS

Systematic review conducted according to PRISMA guidelines (PROSPERO registration number CRD42016054135). Databases searched MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register, and CINAHL. Studies considered the following: published January 1988-February 2017. Key terms are as follows: "sarcopenia" AND "inpatient rehabilitation" OR "rehabilitation" AND/OR "prevalence". Abstracts and subsequently full studies reporting sarcopenia prevalence in adults admitted to rehabilitation reviewed irrespective of design, provided sarcopenia diagnosis included at least assessment of muscle mass. Random effect meta-analysis was conducted. Methodological quality assessment: Agency for Healthcare Research and Quality, US Department of Health and Human Services tool (MORE tool); Joanna Briggs Institute Prevalence Critical Appraisal Tool.

RESULTS

Four hundred twenty-six studies identified during initial search, 399 excluded after reviewing titles and abstracts, 21 full text articles reviewed, and six studies met inclusion criteria. Patient populations: after hip fracture (five studies), general deconditioning (one study). Identified sarcopenia prevalence ranged from 0.28 to 0.69. Pooled sarcopenia prevalence obtained with random effect meta-analysis: 0.56 (95% CI 0.46-0.65), heterogeneity I2 = 92.9%. Main quality shortcomings: lack of reporting of inter- and intra-rater reliability, lack of generalizability to other rehabilitation populations.

CONCLUSIONS

Original research examining sarcopenia prevalence in inpatient rehabilitation is scarce. Patient populations studied to date are not representative of general rehabilitation population with regard to both age and admission diagnoses. Sarcopenia may be present in approximately half of rehabilitation patients and its prevalence may vary with admission diagnosis.

Failure to expand the motor unit size to compensate for declining motor unit numbers distinguishes sarcopenic from non-sarcopenic older men

Key points

The age‐related loss of muscle mass is related to the loss of innervating motor neurons and denervation of muscle fibres.

Not all denervated muscle fibres are degraded; some may be reinnervated by an adjacent surviving neuron, which expands the innervating motor unit proportional to the numbers of fibres rescued.

Enlarged motor units have larger motor unit potentials when measured using electrophysiological techniques.

We recorded much larger motor unit potentials in relatively healthy older men compared to young men, but the older men with the smallest muscles (sarcopenia) had smaller motor unit potentials than healthy older men.

These findings suggest that healthy older men reinnervate large numbers of muscle fibres to compensate for declining motor neuron numbers, but a failure to do so contributes to muscle loss in sarcopenic men.

Abstract

Sarcopenia results from the progressive loss of skeletal muscle mass and reduced function in older age. It is likely to be associated with the well‐documented reduction of motor unit numbers innervating limb muscles and the increase in size of surviving motor units via reinnervation of denervated fibres. However, no evidence exists to confirm the extent of motor unit remodelling in sarcopenic individuals. The aim of the present study was to compare motor unit size and number between young (n = 48), non‐sarcopenic old (n = 13), pre‐sarcopenic (n = 53) and sarcopenic (n = 29) men. Motor unit potentials (MUPs) were isolated from intramuscular and surface EMG recordings. The motor unit numbers were reduced in all groups of old compared with young men (all P < 0.001). MUPs were higher in non‐sarcopenic and pre‐sarcopenic men compared with young men (P = 0.039 and 0.001 respectively), but not in the vastus lateralis of sarcopenic old (P = 0.485). The results suggest that extensive motor unit remodelling occurs relatively early during ageing, exceeds the loss of muscle mass and precedes sarcopenia. Reinnervation of denervated muscle fibres probably expands the motor unit size in the non‐sarcopenic and pre‐sarcopenic old, but not in the sarcopenic old. These findings suggest that a failure to expand the motor unit size distinguishes sarcopenic from pre‐sarcopenic muscles.

The age‐related loss of muscle mass is related to the loss of innervating motor neurons and denervation of muscle fibres.

Not all denervated muscle fibres are degraded; some may be reinnervated by an adjacent surviving neuron, which expands the innervating motor unit proportional to the numbers of fibres rescued.

Enlarged motor units have larger motor unit potentials when measured using electrophysiological techniques.

We recorded much larger motor unit potentials in relatively healthy older men compared to young men, but the older men with the smallest muscles (sarcopenia) had smaller motor unit potentials than healthy older men.

These findings suggest that healthy older men reinnervate large numbers of muscle fibres to compensate for declining motor neuron numbers, but a failure to do so contributes to muscle loss in sarcopenic men.

New Skeletal Muscle Mass Index in Diagnosis of Sarcopenia

Background

We sought to develop a novel index based on the skeletal muscle mass that reflects the change of quality of life (QOL), and is the most appropriate index for the body composition of the elderly in Korea. Whether lower extremity skeletal muscle mass index (LESMI) is an appropriate novel new index to diagnose patients with sarcopenia was also evaluated. A cut-off value for each index was reported to facilitate the diagnosis of patients with sarcopenia in a Korean population.

Methods

We used the 5th Korean National Health and Nutrition Examination Survey data from 2010. We analyzed 409 elderly patients, including 231 men and 178 women, aged ≥65 years. Patients were diagnosed by calculating their skeletal muscle index based on the skeletal muscle mass measured using dual energy X-ray absorptiometry. Obesity and osteoporosis were used to screen data and EuroQOL-5 dimension as a health questionnaire.

Results

The prevalence of sarcopenia in each index was obtained based on its cut-off value for diagnosing sarcopenia. There was a significant difference between the obesity rate of elderly patients diagnosed with sarcopenia and those who were not based on each index. There was no significant difference in the prevalence of osteoporosis between the groups. Sarcopenia diagnosis based on the LESMI was significantly correlated with QOL.

Conclusions

LESMI, a novel index based on skeletal muscle mass, reflects changes in QOL and is appropriate for the body composition of elderly people in Korea.

Prevalence and Associated Risk Factors of Sarcopenia in Female Patients with Osteoporotic Fracture

Background

We determined the prevalence of sarcopenia according to fracture site and evaluated the associated risk factors in female patients with osteoporotic fractures.

Methods

A total of 108 patients aged 50 years or older with an osteoporotic fracture (hip, spine, or wrist) were enrolled in this retrospective observational study. A diagnosis of sarcopenia was confirmed using whole-body densitometry for skeletal muscle mass measurement. Logistic regression analysis was used to analyze the risk factors for sarcopenia.

Results

Of 108 female patients treated for osteoporotic fractures between January 2016 and June 2017, sarcopenia was diagnosed in 39 (36.1%). Of these, 41.5% (17/41) had hip fractures, 35% (14/40) had spine fractures, and 29.6% (8/27) had distal radius fractures. Body mass index (BMI; P=0.036) and prevalence of chronic kidney disease (CKD; P=0.046) and rheumatoid arthritis (P=0.051) were significantly different between the groups. In multivariable analysis, BMI (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.55–1.05, P=0.098) and CKD (OR 2.51; 95% CI, 0.38–16.2; P=0.233) were associated with an increased risk of sarcopenia; however, this was not statistically significant.

Conclusions

This study evaluated the prevalence of sarcopenia according to the fracture site and identified associated risk factors in patients with osteoporotic fractures. A longterm, observational study with a larger population is needed to validate our results.

A sarcopenia screening test predicts mortality in hospitalized older adults

The aim of this study is to investigate the validation of a sarcopenia screening test (Ishii’s formula) for predicting long-term mortality among older adult inpatients. A prospective, observational study was conducted in acute geriatric wards at three hospitals in western China. Sarcopenia was estimated using Ishii’s formula. Survival status was assessed at 12, 24, and 36 months after the baseline investigation. Cox proportional-hazard models were applied to calculate the hazard ratio for mortality associated with sarcopenia. Three hundred and eighty participants (100 women) with a mean age of 80.2 ± 7.1 years were included. According to Ishii’s formula, 264 participants (69.5%) were sarcopenic. The prevalence of sarcopenia was similar in men and women (71.1% vs. 65.0%, respectively, P = 0.258). Sixty-seven participants (17.6%) died during the 3-year follow-up period. The all-cause mortality was significantly higher in the sarcopenia group than in the non-sarcopenia group (20.1% vs. 12.1%, respectively, P < 0.05). Multivariate Cox proportional hazards analysis identified sarcopenia as a significant predictor of 3-year all-cause mortality (adjusted hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.02–4.15). In conclusion, sarcopenia, estimated by Ishii’s formula, can predict 3-year all-cause mortality in a study population of hospitalized older adults.

Osteosarcopenia in Patients with Hip Fracture Is Related with High Mortality

BACKGROUND

This study evaluated the prevalence of osteosarcopenia, as well as the relationship between one-year mortality and osteosarcopenia, as defined by criteria of the Asian Working Group on Sarcopenia in patients age 60 or older with hip fracture.

METHODS

A total of 324 patients age 60 years or older with hip fracture were enrolled in this retrospective observational study. The main outcome measure was the prevalence of osteosarcopenia, as well as the relationship between osteosarcopenia and 1-year mortality. The diagnosis of sarcopenia was carried out according to the Asian Working Group on Sarcopenia. Whole body densitometry analysis was used for skeletal muscle mass measurement and muscle strength were evaluated by handgrip testing. Mortality was assessed at the end of 1-year. Cox regression analysis was utilized to analyze the risk factor of osteosarcopenia.

RESULTS

Of 324 patients with hip fracture, 93 (28.7%) were diagnosed with osteosarcopenia. In total, 9.0% died during the one-year follow-up. A one-year mortality of osteosarcopenia (15.1%) was higher than that of other groups (normal: 7.8%, osteoporosis only: 5.1%, sarcopenia only: 10.3%). Osteosarcopenia had a 1.8 times higher mortality rate than non-osteosarcopenia.

CONCLUSION

The present study demonstrates that the prevalence of osteosarcopenia is not rare, and has a higher mortality rate than the non-osteosarcopenia group at the 1-year follow-up period. This is the first study evaluating the relationship between mortality and osteosarcopenia in patients with hip fracture.

Comparisons of predictive values of sarcopenia with different muscle mass indices in Korean rural older adults: a longitudinal analysis of the Aging Study of PyeongChang Rural Area

Purpose

It is important to define lean muscle mass when diagnosing sarcopenia, but there is still controversy on the clinical implication of sarcopenia derived by height, weight, and body mass index (BMI) adjusted muscle mass indices. We aimed to evaluate the longitudinal clinical relevance of 3 sarcopenia definitions in the Korean population.

Patients and methods

We conducted comprehensive geriatric assessments for 1,379 community-dwelling older participants in the Aging Study of PyeongChang Rural Area (ASPRA) cohort and followed them up prospectively for death, institutionalization, and disability every 3 months. Sarcopenia was defined using the Asian Working Group consensus algorithm, combining grip strength, gait speed, and muscle mass.

Results

Among 1,343 participants (mean age: 76 years, 741 women) analyzed, there were 29 deaths and 89 institutionalizations during 22.0 ± 8.3 months follow-up (mean ± SD). All three muscle indices correlated to age and sex. All sarcopenia criteria with muscle mass indices of height, weight, and body mass index (BMI) adjustment significantly predicted death or institutionalization. However, when adjusted for age and sex, only the sarcopenia criteria with muscle mass index of height adjustment were significantly associated with major adverse health outcomes.

Conclusion

Adjusting age and gender, the sarcopenia definition from the quintile-based muscle index of height adjustment could predict death or institutionalization in Korean community-dwelling older adults.

What is the impact of the European Consensus on the diagnosis and prevalence of sarcopenia among institutionalized elderly persons?

Abstract Objective: To verify the impact of the European Consensus on the diagnosis and prevalence of sarcopenia among institutionalized elderly persons in Natal, Rio Grande do Norte, Brazil. Method: 219 elderly persons (≥60 years) of both genders were recruited for the study. Two criteria were initially used to calculate the prevalence of sarcopenia: criterion A, based on the European Consensus, considering only elderly persons with good physical and cognitive conditions and criterion B, considering all elderly individuals, regardless of their physical and/or cognitive condition. The association between sarcopenia and gender, age and body mass index (BMI) in the two groups was investigated using the chi-square test and the Student's t-test, with a significance level of 5%. Result: the diagnosis of sarcopenia according to Criterion A revealed a prevalence of 32% (95% CI: 22.54-43.21), whereas Criterion B identified a prevalence of 63.2% (95% CI: 56; 45-69,13). Despite the difference in the prevalence of sarcopenia using the two criteria employed (p<0.001), no differences were observed in terms of the association with gender (p=0.149, p=0.212), BMI (p<0.001, p<0.001), and age (p=0.904, p=353). Conclusion: including only elderly people with good physical and cognitive abilities to calculate sarcopenia, based on the European Consensus, underestimates the prevalence of this condition among institutionalized elderly. As elderly persons with physical or cognitive limitations are extremely typical in the population of care facilities and increased diagnostic calculation for sarcopenia did not interfere with the distribution of associated factors, it is recommended that these individuals are considered in the basis of calculation for future studies of the diagnosis and prevalence of sarcopenia.

Myopenia and precision (P4) medicine

Precision (P4) medicine represents a new medical paradigm that focuses on Personalized, Predictive, Preventive and Participatory approaches. The P4 paradigm is particularly appropriate for moving the care of persons with myopenia forward. Muscular dystrophies are clearly a set of genetically different diseases where genomics are the basis of diagnosis, and genetic modulation via DNA, oligonucleotides and clustered regularly interspaced short palendronic repeats hold great potential for a cure. The utility of personalized genomics for sarcopenia coupled with utilizing a predictive approach for the diagnosis with early preventive strategies is a key to improving sarcopenic outcomes. The importance of understanding different levels of patient enthusiasm and different responses to exercise should guide the participatory phase of sarcopenic treatment. In the case of cachexia, understanding the effects of the different therapies now available through the P4 approach on muscle wasting is a key to management strategies.

Sarcopenia

Sarcopenia is a condition that is characterized by loss of muscle mass, muscle strength and muscle functional impairment with ageing. The definition of sarcopenia has been through various permutations; however, an enormous recent breakthrough is the inclusion of the condition in the ICD-10 classification of diseases. This chapter covers the background issues regarding definition before describing the epidemiology of the disease according to human and environmental factors. It then provides a practical guide for the assessment of sarcopenia in a clinical setting and finishes with advice on present treatment and the exciting frontiers of future therapies.

Lack of knowledge and availability of diagnostic equipment could hinder the diagnosis of sarcopenia and its management

Objectives

Sarcopenia is an emerging clinical challenge in an ageing population and is associated with serious negative health outcomes. This study aimed to assess the current state of the art regarding the knowledge about the concept of sarcopenia and practice of the diagnostic strategy and management of sarcopenia in a cohort of Dutch healthcare professionals (physicians, physiotherapists, dietitians and others) attending a lecture cycle on sarcopenia.

Material and methods

This longitudinal study included Dutch healthcare professionals (n = 223) who were asked to complete a questionnaire before, directly after and five months after (n = 80) attending a lecture cycle on the pathophysiology of sarcopenia, diagnostic strategy and management of sarcopenia, i.e. interventions and collaboration.

Results

Before attendance, 69.7% of healthcare professionals stated to know the concept of sarcopenia, 21.4% indicated to know how to diagnose sarcopenia and 82.6% had treated patients with suspected sarcopenia. 47.5% used their clinical view as diagnostic strategy. Handgrip strength was the most frequently used objective diagnostic measure (33.9%). Five months after attendance, reported use of diagnostic tests was increased, i.e. handgrip strength up to 67.4%, gait speed up to 72.1% and muscle mass up to 20.9%. Bottlenecks during implementation of the diagnostic strategy were experienced by 67.1%; lack of awareness among other healthcare professionals, acquisition of equipment and time constraints to perform the diagnostic measures were reported most often. Before attendance, 36.4% stated not to consult a physiotherapists or exercise therapists (PT/ET) or dietitian for sarcopenia interventions, 10.5% consulted a PT/ET, 32.7% a dietitian and 20.5% both a PT/ET and dietitian. Five months after attendance, these percentages were 28.3%, 21.7%, 30.0% and 20.0% respectively.

Conclusion

The concept of sarcopenia is familiar to most Dutch healthcare professionals but application in practice is hampered, mostly by lack of knowledge, availability of equipment, time constraints and lack of collaboration.

Molecular mechanisms and therapeutic interventions in sarcopenia

Sarcopenia is the degenerative loss of muscle mass and function with aging. Recently sarcopenia was recognized as a clinical disease by the International Classification of Disease, 10th revision, Clinical Modification. An imbalance between protein synthesis and degradation causes a gradual loss of muscle mass, resulting in a decline of muscle function as a progress of sarcopenia. Many mechanisms involved in the onset of sarcopenia include age-related factors as well as activity-, disease-, and nutrition-related factors. The stage of sarcopenia reflecting the severity of conditions assists clinical management of sarcopenia. It is important that systemic descriptions of the disease conditions include age, sex, and other environmental risk factors as well as levels of physical function. To develop a new therapeutic intervention needed is the detailed understanding of molecular and cellular mechanisms by which apoptosis, autophagy, atrophy, and hypertrophy occur in the muscle stem cells, myotubes, and/or neuromuscular junction. The new strategy to managing sarcopenia will be signal-modulating small molecules, natural compounds, repurposing of old drugs, and muscle-specific microRNAs.

Sarcopenia in patients with hip fracture: A multicenter cross-sectional study

BACKGROUND

Sarcopenia is prevalent in older persons and is a risk factor for falls, fractures, and mortality. The aim of this study was to determine a) the feasibility of determining sarcopenia in patients with acute hip fracture, b) the prevalence of sarcopenia and c) associations of sarcopenia with nutritional status and comorbidities.

METHODS

A multicenter cross-sectional study on sarcopenia in male and female patients with acute hip fracture. Participants were previously ambulatory and living in the community. Sarcopenia was assessed postoperatively with muscle mass estimated by anthropometry using triceps skinfold, arm circumference, height, weight and sex. Grip strength was measured by Jamar dynamometer and pre-fracture mobility was by self-report using the New Mobility Score.

RESULTS

Out of 282 patients, 202 were assessed for sarcopenia of whom 74 (37%) were diagnosed as sarcopenic. Sarcopenia was associated with age, odds ratio (OR) 1.4 per 5 years, 95% confidence interval (CI) [1.1, 1.8], ASA Physical Status Classification System score, OR 2.3 per point, 95% CI [1.3, 4.3] and number of medications at discharge, OR 1.2 per medication, 95% CI [1.0, 1.3] and inversely associated with BMI, OR 0.8, 95% CI [0.7, 0.9] and serum albumin, OR 0.9, 95% CI [0.8,1.0].

CONCLUSIONS

Thirty-seven percent of assessed subjects were diagnosed with sarcopenia. Our data demonstrates that the prevalence of sarcopenia is associated with older age, malnutrition and comorbidities. Determining sarcopenia at the bedside was feasible in postoperative hip fracture patients by using grip strength, estimation of muscle mass by anthropometry and self-reported mobility.

Epidemiology of Sarcopenia: Determinants Throughout the Lifecourse

Sarcopenia is an age-related syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength; it is a major contributor to the risk of physical frailty, functional impairment in older people, poor health-related quality of life and premature death. Many different definitions have been used to describe sarcopenia and have resulted in varying estimates of prevalence of the condition. The most recent attempts of definitions have tried to integrate information on muscle mass, strength and physical function and provide a definition that is useful in both research and clinical settings. This review focuses on the epidemiology of the three distinct physiological components of sarcopenia, and highlights the similarities and differences between their patterns of variation with age, gender, geography and time and the individual risk factors that cluster selectively with muscle mass, strength and physical function. Methods used to measure muscle mass, strength and physical functioning and how differences in these approaches can contribute to the varying prevalence rates will also be described. The evidence for this review was gathered by undertaking a systematic search of the literature. The descriptive characteristics of muscle mass, strength and function described in this review point to the urgent need for a consensual definition of sarcopenia incorporating these parameters.

Validation of the Korean Version of the SARC-F Questionnaire to Assess Sarcopenia: Korean Frailty and Aging Cohort Study

OBJECTIVES

The SARC-F is a simple sarcopenia screening tool comprising 5 assessment items: strength, assistance walking, rising from a chair, climbing stairs, and falls. The present study aimed to examine the validation of the Korean version of SARC-F for elderly individuals residing in communities.

SETTING AND PARTICIPANTS

From the first year baseline data of Korean Frailty and Aging Cohort Study, a total of 1222 elderly individuals (70 years and older) who met the study's selection criteria were included in the analysis.

MEASUREMENTS

The SARC-F was translated into the Korean language in a culturally responsive way. The total score was calculated by adding the scores on the 5 items. The participants were divided into 2 groups according to the total score (SARC-F <4 vs SARC-F ≥4), and its correlations with various factors including walking speed, hand grip, ability to perform everyday activities, and health-related quality of life, were examined by sex. In addition, the tool's validity was analyzed by comparing it with the European, international, and Asian sarcopenia working group diagnostic criteria for sarcopenia.

RESULTS

The prevalence of sarcopenia according to the SARC-F was 4.2% in among men and 15.3% in women. The sensitivity of the SARC-F was low compared with the European, international, and Asian criteria of sarcopenia [male (M): 11%-60%, female (F): 28%-34%]. However, SARC-F showed a high specificity (M: 96.6%-98%, F: 85%-87.7%) and a high negative predictive value (M: 89.2%-99.3%, F: 88.5%-98.4%). The participants in the SARC-F ≥4 group had poorer grip strength, slower walking speed, poorer physical performance, poorer cognitive function, and a lower quality of life (a high EuroQol-5 dimension score) than the participants in the SARC-F <4 group.

CONCLUSIONS

The Korean language version of SARC-F showed a high specificity and high negative predictive value. As such, the tool is useful for briefly ruling out sarcopenia in a clinical setting. In addition, diagnosis of sarcopenia using the SARC-F was found to be associated with physical performance, cognitive function, and the quality of life.

Does nutrition play a role in the prevention and management of sarcopenia?

There is a growing body of evidence that links nutrition to muscle mass, strength and function in older adults, suggesting that it has an important role to play both in the prevention and management of sarcopenia. This review summarises the discussions of a working group [ESCEO working group meeting 8th September 2016] that met to review current evidence and to consider its implications for preventive and treatment strategies. The review points to the importance of 'healthier' dietary patterns that are adequate in quality in older age, to ensure sufficient intakes of protein, vitamin D, antioxidant nutrients and long-chain polyunsaturated fatty acids. In particular, there is substantial evidence to support the roles of dietary protein and physical activity as key anabolic stimuli for muscle protein synthesis. However, much of the evidence is observational and from high-income countries. Further high-quality trials, particularly from more diverse populations, are needed to enable an understanding of dose and duration effects of individual nutrients on function, to elucidate mechanistic links, and to define optimal profiles and patterns of nutrient intake for older adults.

Sarcopenia: Relocating the Forest among the Trees

As life expectancy continues to rise worldwide, health concerns associated with advanced age are increasingly becoming prominent public health concerns. Among these concerns, nearly 30 years of discussion and research have yielded a wealth of information regarding the pathophysiology, biologic etiology, and clinical implications of age-related declines in skeletal muscle mass and function (i.e., sarcopenia). Recent years have yielded several debates surrounding both the definition and terminology of sarcopenia, yet many questions remain regarding interventions to treat the condition. Among major future challenges in the area will be to design and conduct high-quality clinical trials to ultimately provide new therapeutic strategies for the treatment of sarcopenia.

Predictive Accuracy of Calf Circumference Measurements to Detect Decreased Skeletal Muscle Mass and European Society for Clinical Nutrition and Metabolism-Defined Malnutrition in Hospitalized Older Patients

Background/Aims: The ability to readily diagnose sarcopenia and malnutrition in a clinical setting is essential. This study is aimed at clarifying the calf circumference (CC) cut-off values for decreased skeletal muscle mass (SMM), according to the Asian Work Group for Sarcopenia's criteria definition of sarcopenia, and those for European Society for Clinical Nutrition and Metabolism-defined malnutrition, in hospitalized Japanese patients. Methods: The study involved 1,164 patients aged ≥65 years. Predictive CC cut-off values were determined using receiver operating curve (ROC) analyses. The predictive validity of the cut-off values was confirmed against in-hospital mortality. Results: There were 654 females and 510 males (mean age, 83.5 ± 8.2 years). Decreased SMM and malnutrition were observed in 80.4 and 32.8% of all patients, respectively. ROC analyses identified CCs of ≤29 cm (female, area under the curve [AUC] 0.791) and ≤30 cm (male, AUC 0.832) as cut-off values for decreased SMM, and CCs of ≤26 cm (female, AUC 0.798) and ≤28 cm (male, AUC 0.837) for malnutrition. CC cut-off values for SMM and malnutrition were independently correlated with in-hospital mortality. Conclusions: The study determined appropriate cut-off values for CC to identify decreased SMM and malnutrition according to the relevant guidelines.

Increased Myogenic and Protein Turnover Signaling in Skeletal Muscle of Chronic Obstructive Pulmonary Disease Patients With Sarcopenia

BACKGROUND

Sarcopenia was recently recognized as an independent condition by an International Classification of Diseases, Tenth Revision, Clinical Modification code, and is a frequently observed comorbidity in chronic obstructive pulmonary disease (COPD). Muscle mass is primarily dictated by the balance between protein degradation and synthesis, but their relative contribution to sarcopenia is unclear.

OBJECTIVE

We aimed to assess potential differential molecular regulation of protein degradation and synthesis, as well as myogenesis, in the skeletal muscle of COPD patients with and without sarcopenia.

METHODS

Muscle biopsies were obtained from the vastus lateralis muscle. Patients with COPD were clustered based on sarcopenia defined by low appendicular skeletal muscle mass index (nonsarcopenic COPD, n = 53; sarcopenic COPD, n = 39), and compared with healthy nonsarcopenic controls (n = 13). The mRNA and protein expression of regulators and mediators of ubiquitin-proteasome system (UPS), autophagy-lysosome system (autophagy), and protein synthesis were analyzed. Furthermore, mRNA expression of myogenesis markers was assessed.

RESULTS

UPS signaling was unaltered, whereas indices of UPS regulation (eg, FOXO1 protein; p-FOXO3/FOXO3), autophagy signaling (eg, LC3BII/I; p-ULK1[Ser757]/ULK1), and protein synthesis signaling (eg, AKT1; p-GSK3B/GSK3B; p-4E-BP1/4E-BP1) were increased in COPD. These alterations were even more pronounced in COPD patients with sarcopenia (eg, FOXO1 protein; p-FOXO1/FOXO1; LC3BII/I; p-ULK(Ser555); p-AKT1/AKT1; AKT1; p-4E-BP1). Furthermore, myogenic signaling (eg, MYOG) was increased in COPD despite a concomitant increase of myostatin (MSTN) mRNA expression, with no difference between sarcopenic and nonsarcopenic COPD patients.

CONCLUSION

Together with elevated myogenic signaling, the increase in muscle protein turnover signaling in COPD, which is even more prominent in COPD patients with sarcopenia, reflects molecular alterations associated with muscle repair and remodeling.

Epidemiology of sarcopenia and insight into possible therapeutic targets

Musculoskeletal ageing is a major public health concern owing to demographic shifts in the population. Sarcopenia, generally defined as the age-related loss of muscle mass and function, is associated with considerable risk of falls, loss of independence in older adults and hospitalization with poorer health outcomes. This condition is therefore associated with increased morbidity and health care costs. As with bone mass, muscle mass and strength increase during late adolescence and early adulthood, but begin to decline substantially from ∼50 years of age. Sarcopenia is characterized by many features, which include loss of muscle mass, altered muscle composition, infiltration with fat and fibrous tissue and alterations in innervation. A better understanding of these factors might help us to develop strategies that target these effects. To date, however, methodological challenges and controversies regarding how best to define the condition, in addition to uncertainty about what outcome measures to consider, have delayed research into possible therapeutic options. Most pharmacological agents investigated to date are hormonal, although new developments have seen the emergence of agents that target myostatin signalling to increase muscle mass. In this review we consider the current approaching for defining sarcopenia and discuss its epidemiology, pathogenesis, and potential therapeutic opportunities.

Sarcopenia as a predictor of all-cause mortality among community-dwelling older people: A systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to examine the association between sarcopenia and all-cause mortality among community-dwelling older people. A systematic review was performed using three electronic databases (EMBASE, MEDLINE and the Cochrane Library) to identify prospective cohort studies from January 2009 to February 2017 examining sarcopenia as a predictor of all-cause mortality among community-dwelling older people. We conducted a pooled analysis of mortality associated with sarcopenia, and subgroup analyses based on measurements of muscle mass and length of follow-up by employing a random-effects model. Sensitivity analyses were performed evaluate the cause of high heterogeneity. In addition, methodological quality, heterogeneity and publication bias were evaluated. Of 1703 studies identified, 6 studies incorporating 7367 individuals were included in the meta-analysis for all-cause mortality. The pooled hazard ratios (HRs) of all-cause mortality from the combination of included studies suggested participants with sarcopenia had a significantly higher rate of mortality (pooled HR 1.60, 95%CI 1.24-2.06, I²=27.8%, p=0.216) than participants without sarcopenia. The subgroup analysis for length of follow-up suggested studies with a follow-up period of less than 5 years found a higher risk of all-cause mortality (pooled HR 2.09, 95%CI 1.21-3.60) than studies with a follow-up period of 5 years or more (pooled HR 1.52, 95%CI 1.14-2.01). A subgroup of anthropometric measures was found to identify higher mortality risks (pooled HR 2.26, 95%CI 1.30-3.92) than a subgroup of dual-energy x-ray (DXA) absorptiometry (pooled HR 1.82, 95%CI 1.04-3.18) factors or a subgroup of bioelectrical impedance analysis (BIA) factors (pooled HR 1.31, 95%CI 1.15-1.49). Sarcopenia is a predictor of all-cause mortality among community-dwelling older people. Therefore, it is important to diagnose sarcopenia and to intervene, in order to reduce mortality rates in the elderly.

Reference equations for handgrip strength: Normative values in young adult and middle-aged subjects

BACKGROUND & AIMS

Handgrip strength (HS) has been widely used as a functionality parameter of the upper limbs (UL) and general health. The measurement of HS by dynamometry is a low cost, non-invasive method of simple applicability, widely used in pulmonary rehabilitation and in critical care units. However, there are no reports in the literature of reference equations for the Brazilian population involving young and middle-aged adults. The aim of this study was to establish reference equations to predict normal HS for young and middle-aged adults through demographic and anthropometric data.

METHODS

This is a cross-sectional study with a sample of 80 healthy subjects (40 men and 40 women), aged 20-60 years. Inclusion criteria were: 1) BMI between 18.5 and 30 kg/m²; 2) presence of dominant hand; 3) no cardiac, pulmonary, metabolic, or neurologic diseases; 4) lack of musculoskeletal disorders; 5) no history of fractures or trauma of the UL. Anthropometric measurements of the UL were obtained by a tape (hand length and width, forearm circumference and length). The dominance of hands was defined by the Dutch Handedness Questionnaire. HS measures were obtained by a manual hydraulic dynamometer, according to the recommendations of the American Association of Hand Therapists. Data were analyzed with SPSS for Windows, version 17.0, and treated with descriptive and inferential analysis. Normality was evaluated by Kolmogorov-Smirnov. Pearson or Spearman coefficients and multiple regression analysis were also used.

RESULTS

HS was significantly higher for men compared to women, and also higher for the dominant hand (HSD) compared to the non-dominant hand (HSND) (p < 0.05). No significant differences were found for HS between the age groups 20-30, 30-40, 40-50 and 50-60 years (p > 0.05). No correlation was found between HS and age. A weak correlation was found between HS and BMI. A moderate correlation of HS was observed with weight and height. Finally, moderate and high correlations were found between HS and anthropometric variables of UL. The best reference equations with R², adjusted to 0.71 and 0.70, were respectively: HSD_kg = -15.490 + (10.787 × Gender _{male=1; female=0}) + (0.558 × Forearm circumference) + (1.763 × Hand Length); HSND_kg = -9.887 + (12.832 × Gender _{male=1; female=0}) + (2.028 × Hand Length).

CONCLUSION

The variability of HS is largely explained by gender, forearm circumference, and hand length.

[Influence of skeletal muscles on the risk of falling in old age]

Falls in older adults are a major public health problem, affecting 1 in 3 persons aged 65 and over at least once a year. Consequences of falling include death, injuries, fear of falling, and subsequent loss of independence. The age-related loss of muscle mass and function (sarcopenia) as well as muscle strength are markers of the frailty syndrome. In addition, they are associated with physical function and are a risk factor for falling. Older adults should be screened for falls at least annually. If evaluated as at-risk, a comprehensive falls assessment should be conducted to determine an individual's risk profile. Physical exercise with balance and strength training play a key role in the prevention and management of functional decline and fall risk. Multifactorial interventions are indicated in at-risk individuals. In sarcopenic individuals, sufficient intake of protein must be taken into account and supplementation in combination with exercise appears to be useful.

The Future Prevalence of Sarcopenia in Europe: A Claim for Public Health Action

Sarcopenia is a major public health issue. To convince health policy makers of the emergency to invest in the sarcopenia field, it is of critical importance to produce reliable figures of the expected burden of sarcopenia in the coming years. Age- and gender-specific population projections were retrieved until 2045 from the Eurostat online database (28 European countries). Age- and gender-specific prevalences of sarcopenia were interpolated from a study that compared prevalence estimates according to the different diagnostic cutoffs of the EWGSOP proposed definition. The reported prevalence estimates were interpolated between 65 and 100 years. Interpolated age- and gender-specific estimates of sarcopenia prevalence were then applied to population projections until 2045. Using the definition providing the lowest prevalence estimates, the number of individuals with sarcopenia would rise in Europe from 10,869,527 in 2016 to 18,735,173 in 2045 (a 72.4% increase). This corresponds to an overall prevalence of sarcopenia in the elderly rising from 11.1% in 2016 to 12.9% in 2045. With the definition providing the highest prevalence estimates, the number of individuals with sarcopenia would rise from 19,740,527 in 2016 to 32,338,990 in 2045 (a 63.8% increase), corresponding to overall prevalence rates in the elderly of 20.2% and 22.3% for 2016 and 2045, respectively. We showed that the number of sarcopenic patients will dramatically increase in the next 30 years, making consequences of muscle wasting a major public health issue.

Health Outcomes of Sarcopenia: A Systematic Review and Meta-Analysis

OBJECTIVE

The purpose of this study was to perform a systematic review to assess the short-, middle- and long-term consequences of sarcopenia.

METHODS

Prospective studies assessing the consequences of sarcopenia were searched across different electronic databases (MEDLINE, EMBASE, EBM Reviews, Cochrane Database of Systematic Reviews, EBM Reviews ACP Journal Club, EBM Reviews DARE and AMED). Only studies that used the definition of the European Working Group on Sarcopenia in Older People to diagnose sarcopenia were included. Study selection and data extraction were performed by two independent reviewers. For outcomes reported by three or more studies, a meta-analysis was performed. The study results are expressed as odds ratios (OR) with 95% CI.

RESULTS

Of the 772 references identified through the database search, 17 were included in this systematic review. The number of participants in the included studies ranged from 99 to 6658, and the duration of follow-up varied from 3 months to 9.8 years. Eleven out of 12 studies assessed the impact of sarcopenia on mortality. The results showed a higher rate of mortality among sarcopenic subjects (pooled OR of 3.596 (95% CI 2.96-4.37)). The effect was higher in people aged 79 years or older compared with younger subjects (p = 0.02). Sarcopenia is also associated with functional decline (pooled OR of 6 studies 3.03 (95% CI 1.80-5.12)), a higher rate of falls (2/2 studies found a significant association) and a higher incidence of hospitalizations (1/1 study). The impact of sarcopenia on the incidence of fractures and the length of hospital stay was less clear (only 1/2 studies showed an association for both outcomes).

CONCLUSION

Sarcopenia is associated with several harmful outcomes, making this geriatric syndrome a real public health burden.