Sarcopenia according to the european working group on sarcopenia in older people (EWGSOP) versus Dynapenia as a risk factor for disability in the elderly

Proposal and validation of an equation to identify sarcopenia using bioelectrical impedance analysis-derived parameters

OBJECTIVE

This study aimed to develop a simpler approach for diagnosing sarcopenia by using only bioelectrical impedance vector analysis parameters.

METHODS

The study design was a cross-sectional study. The research was conducted based on the Itabashi Longitudinal Study on Aging, a community-based cohort study, with data collected from the 2022 and 2023 surveys in Itabashi Ward, Tokyo, Japan. The development cohort consisted of 1146 participants from the 2022 survey, and the validation cohort included 656 participants from the 2023 survey. Both cohorts were comprised of community-dwelling older adults with similar inclusion criteria. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. The logistic model utilized height divided by impedance at 50 kHz and phase angle to establish a new regression equation to identify sarcopenia. Regression equations were generated for the development cohort and validated for the validation cohort. Discriminatory ability was assessed using the area under the receiver operating characteristic curve (AUC) for men and women.

RESULTS

The prevalence of sarcopenia was 20.7% and 14.8% in the development and validation cohort, respectively. The AUC (95% confidence interval) of the logistic model in discriminating sarcopenia was 0.92 (0.88, 0.95) for men and 0.82 (0.78, 0.86) for women in the development cohort and 0.85 (0.78, 0.91) for men and 0.90 (0.86, 0.95) for women in the validation cohort.

CONCLUSION

The study demonstrated that a simple formula using bioelectrical parameters at 50 kHz proved useful in identifying sarcopenia in the older adult population.

Factors associated with sarcopenic obesity in Brazilian adults and older people: Systematic review and meta-analysis of observational studies

AIM

Sarcopenic obesity (SO) is characterized by the coexistence of the loss of muscle mass and function with excess adipose tissue. Its prevalence has increased concomitantly with population aging, becoming one of the most significant challenges for public health, threatening the quality of life and the physical and mental health of the elderly population.

METHODS

This study estimated the prevalence and factors associated with SO among adults and the elderly in Brazil's macro-regions, utilizing MEDLINE, Embase, Web of Science, and the Virtual Health Library databases. Primary outcomes included SO prevalence overall and by subgroups, with secondary outcomes identifying associated factors.

RESULTS

A systematic review of 33 studies with 10 266 participants up to July 2023 showed a 17% prevalence of SO (95% confidence interval: 13-21%), using a random effects meta-analysis. The Central-West region had the highest occurrence (27%). Dual-energy X-ray absorptiometry (26%) and bioimpedance (6%) were the top diagnostic methods. Protective factors were chronic kidney disease and healthy lifestyles; risk factors included socioeconomic status, functionality, lifestyle, biochemical parameters, and comorbidities such as osteoarthritis and apnea.

CONCLUSIONS

The prevalence of SO in Brazil is significant, emerging as a critical public health problem. It is essential to direct attention to changes in prevalence rates in the coming years, given the rising obesity trends and the absolute increase in the elderly population. Geriatr Gerontol Int 2024; 24: 661-674.

Associations between Sarcopenia and trajectories of activities of daily living disability: a nationwide longitudinal study of middle-aged and older adults in China from 2011 to 2018

BACKGROUND

Sarcopenia is an age-related clinical syndrome, which is associated with numerous adverse outcomes among older adults. The relationship between sarcopenia and activities of daily living (ADL) disability has been studied in China, but these findings usually focused on a single time point. The patterns of ADL can change over time and vary among individuals. Therefore, it is necessary to explore the association between sarcopenia and trajectories of ADL disability.

METHODS

According to Asian Working Group for Sarcopenia (AWGS) 2019 criteria, muscle mass, muscle strength, and physical performance measurements were measured to diagnose sarcopenia. A six-item ADL score was used to measure ADL disability, and trajectories of ADL disability were identified by the latent class trajectory modelling (LCTM). Multiple logistic regression models were performed to examine the association between sarcopenia and trajectories of ADL disability.

RESULTS

Among 9113 middle-aged and older adults, three trajectories of ADL disability were determined according to changes in ADL score during follow-up, including a mild-high trajectory (n = 648, 7.11%), followed by the low-mild trajectory (n = 3120, 34.24%) and low-low trajectory (n = 5345, 58.65%). After adjustment for covariates, severe sarcopenia was significantly associated with higher risks of being in the mild-high trajectory group (OR = 3.31, 95%CI: 2.10-5.22) and the low-mild trajectory group (OR = 1.44, 95%CI: 1.05-1.98), compared with the low-low trajectory group. This association was still observed when stratified by age and gender. In addition, participants with sarcopenic obesity were associated with a higher risk of ADL disability (OR = 3.99; 95% CI: 2.50-6.09).

CONCLUSIONS

Among the middle-aged and older Chinese adults, sarcopenia and sarcopenic obesity were both associated with persistent higher trajectories of ADL disability. It suggested that early interventions to sarcopenia and sarcopenic obesity among the middle-aged and older adults may reduce the progression of ADL disability.

Agreement and diagnostic differences among three definitions of sarcopenia in patients with chronic hepatitis C

BACKGROUND

There is neither a gold standard definition nor a universal consensus to diagnose sarcopenia in patients with chronic hepatitis C. Thus, we aimed to compare the prevalence of sarcopenia and the agreement and discrepancies between European Working Group on Sarcopenia in Older People (EWGSOP1), EWGSOP2, and Foundation for the National Institutes of Health Biomarkers Consortium Sarcopenia Project (FNIH) definitions in chronic hepatitis C.

METHODS

Dual-energy x-ray absorptiometry was used to assess muscle mass by quantifying appendicular lean mass (ALM) adjusted for squared height (ALM/ht2) or for body mass index (ALMBMI). Muscle function was evaluated by handgrip strength. Subjective Global Assessment was used to assess the nutrition status.

RESULTS

This cross-sectional study included 103 outpatients (mean age, 50.6 ± 11.3 years; 33.0% with compensated cirrhosis). Sarcopenia prevalence was 8.7%, 9.7%, and 9.7%, according to EWGSOP1, EWGSOP2, and FNIH definitions, respectively. There was neither a sex- nor a liver disease severity-specific difference in the prevalence of sarcopenia between the criteria applied. Sixteen (15.5%) patients fulfilled at least one of these criteria, and 3 out of 16 (18.8%) simultaneously had sarcopenia by consensus of the three criteria. Sarcopenic obesity was identified in 9 out of 16 (56.3%) patients, and 6 out of 9 (66.7%) of these only met FNIH consensus.

CONCLUSIONS

In patients without cirrhosis or with compensated cirrhosis, and with chronic hepatitis C, the agreement between EWGSOP1 and EWGSOP2 classifications was substantial for sarcopenia diagnosis. Concerning EWGSOP and FNIH criteria, a fair agreement and limited overlap were found in these patients.

The association between sarcopenia, defined by a simplified screening tool, and long-term outcomes

BACKGROUND

Sarcopenia and frailty are frequently observed in older adult patients and linked to unfavorable postoperative outcomes. Identifying low muscle mass and function is primary for diagnosing sarcopenia. The simpler screening, which excludes muscle mass measurement, exhibited strong predictive capabilities in identifying sarcopenia. This research explored the association between sarcopenia, as defined by the C3 formula, and long-term outcomes in older adult cancer patients who underwent surgery.

METHODS

Surgical cancer patients aged 60 and older were enrolled. Sarcopenia was identified using the C3 formula, assessing muscle strength through handgrip strength, physical performance via a 6-m walk test, and nutrition status via the Mini Nutritional Assessment-Short Form. Long-term outcomes were evaluated with the Barthel Index for activities of daily living (B-ADL) at 3 months, as well as 1-year mortality rates.

RESULTS

The study enrolled 251 patients, with 130 classified as sarcopenic according to the C3 formula. Compared with nonsarcopenic patients, patients with sarcopenia exhibited a higher frequency of moderate to severe disability (B-ADL ≤70) 3 months postdischarge (19.5% vs 5.2%; P = 0.001) and elevated 1-year mortality rates (29.5% vs 14.9%; P = 0.006). No significant differences were observed in infection rates, hospital stay duration, or in-hospital mortality. Distant organ metastasis (HR = 3.99; 95% CI = 2.25-7.07) and sarcopenia defined by the C3 formula (HR = 1.78; 95% CI = 1.01-3.15) were identified as independent risk factors for 1-year mortality.

CONCLUSION

The simplified sarcopenia screening tool was associated with increased rates of moderate to severe disability 3 months postdischarge and higher 1-year mortality rates compared with nonsarcopenic patients.

The longitudinal associations of sarcopenia definitions with functional deterioration: a comparative study

OBJECTIVE

Probable sarcopenia is a predictor of functional limitation in older adults. However, whether standard thresholds recommended by guides, or population-specific thresholds better predict impairment in functionality is an issue that needs to be enlightened. We aimed to study the associations of probable sarcopenia identified by the use of EWGSOP2 and population-specific thresholds with deterioration in functionality at follow-up and give prevalences of probable sarcopenia with different thresholds in older outpatients admitted to a tertiary health center.

METHODS

In this retrospective, longitudinal follow-up study, we assessed handgrip strength (HGS) at the admission with a Jamar hand-dynamometer and diagnosed probable sarcopenia with standard and population-specific thresholds, i.e., 27 kg/16 kg, and 35 kg/20 kg in males/females, respectively. We evaluated activities of daily living (ADL) and instrumental ADL (IADL), with Katz and Lawton scales, at the admission and follow-up. To study whether probable sarcopenia was a predictor of impaired functionality, we defined two models for Cox regression analysis. We performed adjustments for age, sex, and nutritional status (assessed by Mini-Nutritional Assessment-Short Form) in Model 1 and defined Model 2 by adding low gait speed and frailty to the variables in Model 1.

RESULTS

Among a total of 1970 patients, 195 had follow-up of median 560 days. The mean age was 75.5 ± 5.5, and 142 (72.8%) were female. In the basal evaluation, the prevalences of probable sarcopenia defined by the standard cut-offs and by population-specific cut-offs were 8.7% and 35.4%, respectively. In univariate analyses (Kaplan-Meier log-rank test), probable sarcopenia by population-specific cut-offs, but not EWGSOP2-cut-offs, was associated with deteriorations in both ADL (p = 0.04) and IADL (p < 0.001). In multivariate analyses, only the probable sarcopenia identified by population-specific cut-offs was independently associated with impairment in IADL in both models [HR (95%CI) = 1.88 (1.07-3.30), and 1.9 (1.04-3.6); for Model 1 and Model 2, respectively)].

CONCLUSION

Our findings suggested that the definition of probable sarcopenia identified by not standard, but population-specific thresholds more reliably predicted longitudinal deterioration of functionality in older outpatients. This finding might be considered as evidence supporting the use of population-specific cut-offs when the concern is sarcopenia diagnosis.

Assessment of regional body composition, physical function and sarcopenia among peruvian women aging with HIV: A cross-sectional study

Management of chronic conditions and optimization of overall health has become a primary global health concern in the care of people living with HIV in the era of highly active antiretroviral therapy (ART), particularly in lower-and-middle income countries where infrastructure for chronic disease management may be fragmented. Alterations in body composition can reflect important changes in musculoskeletal health, particularly among populations at risk for developing fat and muscle redistribution syndromes, such as women with HIV on ART. Given the lack of data on this topic in Latin America and the Caribbean, we designed an exploratory study to measure these outcomes in a population of women aging with HIV in Peru. We conducted a cross-sectional study among Peruvian women with and without HIV aged ≥40 years. Dual X-ray absorptiometry was used to measure trunk and limb lean mass (LM) and fat mass (FM). Physical performance was assessed with the Short Physical Performance Battery (SPPB) and physical strength with a dynamometer. Sarcopenia was assessed based upon EWGSOP criteria. We used linear regression to model associations between body composition, sarcopenia and physical performance scores. 104 women with HIV and 212 women without HIV were enrolled (mean age 52.4±8.2 vs. 56.4±8.8 years, p≤0.001). Among women with HIV, mean years since diagnosis was 11.8±6 and all were on ART. Mean SPPB score was 9.9 vs 10.8 (p<0.001) between both groups. Sarcopenia spectrum was found in 25.9% and 23.1%, respectively. In the multivariable regression analysis, trunk FM and older age were negatively correlated with physical performance among women with HIV. Severe sarcopenia was found among a greater proportion of those with HIV (3.8% vs. 0.9%, p = 0.84), however this finding was not statistically significant. Women with HIV had significantly lower SPPB scores compared to women without HIV, and trunk FM and upper limb LM were independent predictors for the SPPB and Grip Strength tests, respectively. Larger, prospective studies are needed in Latin America & the Caribbean to identify individuals at high risk for sarcopenia and declines in physical function, and to inform prevention guidelines.

Dynapenia in all-cause mortality and its relationship with sedentary behavior in community-dwelling older adults

The aim of the present study was to investigate the relationship of dynapenia combined with sedentary behavior (SB) on the risk of mortality in older adults living in a Brazilian community. A total of 322 participants aged ≥ 60 years from the ELSIA (Longitudinal Study of Elderly Health in Alcobaça) prospective cohort were included. Dynapenia was diagnosed when the handgrip strength was < 27 ​kg for men and < 16 ​kg for women. The exposure time to SB was assessed considering the total time spent sitting during one day in the week and one day on the weekend. When combined with dynapenia, we derived the construction of four groups: best behavior (absence of dynapenia and low SB), intermediate behavior (absence of dynapenia and high SB; presence of dynapenia and low SB) and worst behavior (presence of dynapenia and high SB). Mortality was assessed by the follow-up time until death and/or censorship. During the 5-year follow-up of the study, 55 participants progressed to death. In the adjusted models, the dynapenia and the time spent exposed to SB were analyzed in a combined way, the older adults with worse behavior (high SB and dynapenia) had higher risk ratios for mortality (hazard ratio 2.46; 95% confidence interval 1.01-5.97) than the best behavior group. Older adults with dynapenia are at greater risk for all-cause mortality, which is aggravated by the addition of longer exposure to SB.

The Relationship between Sarcopenia and Injury Events: A Systematic Review and Meta-Analysis of 98,754 Older Adults

The main purpose of this study was to investigate the relationship between sarcopenia and injury events (falls, fractures, hospitalization, disability, and death). This study systemically searched the literature from Embase, PubMed, MEDLINE, CINAHL, and Cochrane Library and analyzed the collected literature using the random effects model to demonstrate the relationship between sarcopenia and injury events. This study followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and collected a total of 38 prospective studies, and the results showed that, when compared to robust individuals, the risk of injury events for older individuals with sarcopenia was significantly higher for fractures (HR = 9.66, CI: 5.07-18.38), hospital admissions (HR = 11.80, CI: 4.86-28.65), and death (HR = 9.57, CI: 3.17-28.94). In consideration of the negative impact of sarcopenia on the subsequent health of older adults, professional nursing personnel should assess older adults for sarcopenia as early as possible and propose relevant care policies to further reduce negative health impacts.

Development of Nomograms for Predicting Prognosis of Pancreatic Cancer after Pancreatectomy: A Multicenter Study

Surgical resection is the only curative treatment for pancreatic ductal adenocarcinoma (PDAC). Currently, the TNM classification system is considered the standard for predicting prognosis after surgery. However, the prognostic accuracy of the system remains limited. This study aimed to develop new predictive nomograms for resected PDAC. The clinicopathological data of patients who underwent surgery for PDAC between 2006 and 2015 at five major institutions were retrospectively reviewed; 885 patients were included in the analysis. Cox regression analysis was performed to investigate prognostic factors for recurrence and survival, and statistically significant factors were used for creating nomograms. The nomogram for predicting recurrence-free survival included nine factors: sarcopenic obesity, elevated carbohydrate antigen 19–9, platelet-to-lymphocyte ratio, preoperatively-identified arterial abutment, estimated blood loss (EBL), tumor differentiation, size, lymph node ratio, and tumor necrosis. The nomogram for predicting overall survival included 10 variables: age, underlying liver disease, chronic kidney disease, preoperatively found portal vein invasion, portal vein resection, EBL, tumor differentiation, size, lymph node metastasis, and tumor necrosis. The time-dependent area under the receiver operating characteristic curve for both nomograms exceeded 0.70. Nomograms were developed for predicting survival after resection of PDAC, and the platforms showed fair predictive performance. These new comprehensive nomograms provide information on disease status and are useful for determining further treatment for PDAC patients.

Prognostic Impact of Postoperative Loss of Skeletal Muscle Mass in Patients Aged 70 Years or Older with Esophageal Cancer

BACKGROUND

The number of patients with esophageal cancer aged ≥ 70 years with a poor prognosis is increasing. In general patients with esophageal cancer, postoperative loss of skeletal muscle mass (SMM) is a prognostic factor. This study was designed to investigate the prognostic impact of postoperative loss of SMM in patients aged ≥ 70 years with esophageal cancer.

METHODS

This study was a single-center, retrospective cohort study. Patients with esophageal cancer who underwent R0 esophagectomy between 2016 and 2020 were included. The percentage postoperative loss of skeletal muscle mass index (SMI%) was calculated using computed tomography images before and at 4 ± 2 months after surgery.

RESULTS

The number of subjects in the ≥ 70-year and < 70-year age groups was 166 and 218, respectively. The median SMI% was 5% in all patients; thus, 5% was defined as the cutoff point to define major loss of SMI. Major loss of SMI impacted 3-year overall survival (OS) in the ≥ 70-year age group, independent of age, sex, clinical stage, pathological T and N factors, Charlson comorbidity index, and length of hospital stay (adjusted hazard ratio [HR]: 4.400; 95% confidence interval: 1.202-16.105; P = 0.025). The adjusted HR of major loss of SMI in the ≥ 70-year age group was higher than in the < 70-year age group (adjusted HR: 4.400 vs. 2.388, respectively).

CONCLUSIONS

Postoperative loss of SMI in patients with esophageal cancer aged ≥ 70 years more strongly impacted 3-year OS than in patients aged < 70 years.

Vertical Jump Tests: A Safe Instrument to Improve the Accuracy of the Functional Capacity Assessment in Robust Older Women

Age-related decreases in muscle function lead to disabilities and are associated with negative health outcomes in older people. Although several physical tests can be used to assess physical performance, muscle strength, and power, their interpretation can be hampered by the ceiling effect of some of them. The aim of this study was to assess whether vertical jump tests are safe in terms of physical integrity and whether they are useful in assessing physical performance in forty-one robust older women. The investigation entailed an assessment of anthropometric characteristics, physical functioning tests (Short Physical Performance Battery (SPPB), sit-to-up 5 times and sit-to-up 30 s, gait speed, time-up-to-go test (TUGT)), and tests evaluating muscle strength and power (handgrip, lower limb isokinetic tests, and vertical jumping tests). Significant negative correlations were found between vertical jumping tests and BMI, body fat percentage, sit-to-up 5 times and TUGT. In addition, significant positive correlations were observed between vertical jumping tests and SPPB, gait speed, handgrip, and concentric isokinetic tests of knee muscles. No adverse events in volunteers’ physical integrity were reported during and after the performance of all physical tests. Thus, the study results showed that vertical jumping tests are safe and accurate for assessing physical performance and are useful for monitoring age-related loss of muscle performance in robust older women.

Sarcopenia in Chronic Kidney Disease: A Scoping Review of Prevalence, Risk Factors, Association with Outcomes, and Treatment

Sarcopenia, a condition characterized by loss of skeletal muscle mass and function, has important clinical ramifications. We aimed to map the existing literature about prevalence, risk factors, associated adverse outcomes, and treatment of sarcopenia in individuals with chronic kidney disease (CKD). A scoping review of the literature was conducted to identify relevant articles published from databases' inception to September 2019. Individuals with CKD, regardless of their disease stage and their comorbidities, were included. Only studies with sarcopenia diagnosed using both muscle mass and function, based on published consensus definitions, were included. For studies on treatment, only randomized controlled trials with at least one sarcopenia parameter as an outcome were included. Our search yielded 1318 articles, of which 60 from were eligible for this review. The prevalence of sarcopenia ranged from 4 to 42% according to the definition used, population studied, and the disease stage. Several risk factors for sarcopenia were identified including age, male gender, low BMI, malnutrition, and high inflammatory status. Sarcopenia was found to be associated with several adverse outcomes, including disabilities, hospitalizations, and mortality. In CKD subjects, several therapeutic interventions have been assessed in randomized controlled trial with a muscle mass, strength, or function endpoint, however, studies focusing on sarcopenic CKD individuals are lacking. The key interventions in the prevention and treatment of sarcopenia in CKD seem to be aerobic and resistance exercises along with nutritional interventions. Whether these interventions are effective to treat sarcopenia and prevent clinical consequences in this population remains to be fully determined.

Effect Size of Dietary Supplementation and Physical Exercise Interventions for Sarcopenia in Middle-Aged Women

The purpose of this meta-analysis was to comprehensively analyze the relationship between intervention (di-etary supplementation and physical exercise), body composition, and physical activity capacity in middle-aged women with sarcopenia. A total of 19 studies published in the last ten years were selected. The overall effect size was small (0.29; 95% confidence interval: 0.195∼0.385). The Q value was 100.214 and the Higgin’s I² value was 82.038. Each study was found to be heterogeneous and there was no publication bias. The effect size was increased when the number of study partici-pants increased from 50 to 100 and when dietary vitamin D supplementation was combined with resistance exercise. Fur-thermore, the effect on physical activity capacity was higher than that on body composition. In conclusion, dietary vitamin D supplementation combined with resistance training had a positive impact on middle-aged women with sarcopenia.

Difference in sarcopenia characteristics associated with physical activity and disability incidences in older adults

BACKGROUND

Deteriorated skeletal muscle condition, including sarcopenia, is a risk factor for disability in older adults. Promoting physical activity is a useful treatment for sarcopenia. However, optimal intensity of physical activity according to sarcopenia characteristics is unclear.

METHODS

This longitudinal cohort study enrolled 2149 community-dwelling older adults (women 55.7%, mean age: 75.5 ± 4.0 years). Five-year disability incidence defined by Japanese long-term care insurance certification and accelerometer-measured physical activities (light-intensity physical activity [LPA] and moderate-to-vigorous intensity physical activity [MVPA]), which were adjusted for potential confounders, was analysed using cox-proportional hazard model stratified by sarcopenia characteristics based on the diagnostic algorithm by the Asian working group for sarcopenia (robust, low physical function, low muscle mass, and sarcopenia). The sarcopenia group was defined as low muscle mass and low physical function (weakness and/or slowness). The low muscle mass and low physical function groups were each defined by these characteristics alone. Muscle mass was analysed via bioelectrical impedance analysis. Each intensity of physical activity times was divided by median values.

RESULTS

The disability incidence rate was 15.4%, excluding those who could not be followed up. Mean LPA times were 43.8 ± 18.0, 45.6 ± 17.5, 45.4 ± 16.6, 40.8 ± 18.6, and 41.4 ± 18.5 min/day and MVPA times were 24.6 ± 17.6, 26.3 ± 18.3, 27.2 ± 17.3, 21.6 ± 16.3, and 21.5 ± 16.4 min/day in all participants, the robust, low muscle mass, low physical function, and sarcopenia groups, respectively. For all participants, higher MVPA was associated with disability incidence [hazard ratios (HR), 0.63; 95% confidence interval (95% CI), 0.49-0.81; P < 0.001], whereas higher LPA showed no association (HR, 0.86; 95% CI, 0.68-1.10; P = 0.22). Higher LPA was associated in the sarcopenia group (HR, 0.35; 95% CI, 0.15-0.85; P = 0.019), and MVPA was associated in the robust (HR, 0.58; 95% CI, 0.39-0.87; P = 0.008) and low physical function (HR, 0.66; 95% CI, 0.45-0.98; P = 0.040) groups. Both LPA and MVPA showed no association in the low muscle mass group. The P values for interactions between sarcopenia characteristics and physical activity were 0.017 for LPA and 0.014 for MVPA.

CONCLUSIONS

The LPA was associated with a lower risk of disability in older adults with sarcopenia, whereas MVPA was associated in subjects with robust and low physical function. Our findings indicate a need for individualized approaches to prevent disability based on muscle condition.

Global prevalence of sarcopenic obesity in older adults: A systematic review and meta-analysis

BACKGROUND & AIMS

Sarcopenic obesity (SO), which refers to the coexistence of sarcopenia and obesity. It can lead to physical disability, morbidity, and even mortality. This systematic review and meta-analysis aimed to estimate the global prevalence of SO in older adults.

METHODS

We searched PubMed, Embase, and Web of Science for studies reporting the prevalence of SO from inception to December 2020. Two researchers independently screened the literature, evaluated study quality, and extracted data. A random-effects model was used to pool the estimates for the prevalence of SO. Subgroup analysis, sensitivity analysis, and meta-regression analysis were conducted. Publication bias was assessed using a funnel plot and the Egger test. All statistical analyses were performed using Stata 15.0 software.

RESULTS

This review included 50 studies, we found that the global prevalence of SO in older adults was 11%. Subgroup analyses showed that the prevalence of SO was higher among studies using diagnostic criteria of muscle mass alone (15%) to diagnose sarcopenia, using dual-energy X-ray absorptiometry (15%) to assess muscle mass, and those focused on age ≥ 75 years old (23%), hospitalized (16%), South Americans (21%) and North Americans (19%). There were no significant differences in the prevalence of SO among studies using body fat percentage (10%), body mass index (13%), waist circumference (16%) to diagnose obesity and in female (14%), male (10%) patients. Sensitivity analysis showed that none of the studies affected the overall pooled results. Meta-regression analysis found that publication year, geographical region, study setting, and the diagnostic criteria of sarcopenia were sources of heterogeneity.

CONCLUSION

This meta-analysis indicated SO affects more than one in ten older adults globally. Therefore, we should attach importance to the screening and early diagnosis of SO in older adults, then selecting appropriate interventions to reduce the occurrence of it and various adverse outcomes in this demographic.

Can physical activity levels and relationships with energy expenditure change the clinical aspects of sarcopenia and perceptions of falls among elderly women? Observational cross-sectional study

BACKGROUND

Physical activity (PA) is an effective strategy for managing sarcopenia in the elderly, but few studies have addressed PA levels regarding age-related changes.

OBJECTIVE

To ascertain the effects of elderly women's PA levels on sarcopenia, physical performance, handgrip strength and perception of the risk of falling, and their relationship with energy expenditure.

DESIGN AND SETTING

Observational cross-sectional study conducted in the southern region of the city of São Paulo, Brazil.

METHODS

Forty-seven elderly women were evaluated and divided into three groups: low PA (n = 13); moderate PA (n = 16); and high PA (n = 18). Their PA levels were investigated through the International Physical Activity Questionnaire (IPAQ); sarcopenia index, through dual-energy radiological absorptiometry; physical performance through the Timed Up & Go test; handgrip strength, using a digital dynamometer; and perception of the risk of falling, through the Fall Risk Awareness Questionnaire.

RESULTS

High PA level indicated higher skeletal muscle mass index, physical performance and IPAQ score, compared with low and moderate PA levels. Multiple linear regression analysis showed that higher IPAQ energy expenditure at high and moderate PA levels was a good predictor of higher physical performance and increased perception of the risk of falling.

CONCLUSION

Elderly women classified as having high PA level showed improvements in sarcopenia, handgrip strength, physical performance and perception of the risk of falling. The IPAQ energy expenditure of the elderly women with high and moderate PA levels was a good predictor of physical performance and improved perception of the risk of falling.

Prevalence of Sarcopenia in Community-Dwelling Older Adults in Valencia, Spain

This study is an observational and cross-sectional study on the prevalence of sarcopenic disease in 202 autonomous older adults; 18.8 and 81.2% were men and women, respectively, living in their own homes in Valencia, Spain. Sarcopenia was diagnosed using the criteria and cutting points for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), using the tests: SARC-F, grip strength, sit-to-stand, gait speed, appendicular skeletal muscle mass and short physical performance battery. According to the EWGSOP2 criteria, probable sarcopenia was present in 21.1% and 18.3% of men and women, respectively, and the sum of confirmed and severe sarcopenia was 7.9% and 7.3% in men and in women, respectively. A relationship was shown between the prevalence of the disease and the age of the participants, but no significant differences were found between the sum of confirmed and severe sarcopenia between the sexes, nor a relationship between the amount of muscle mass and the strength of grip. The SARC-F questionnaire diagnosed 40% of the sarcopenia cases present in the study. More thorough research is needed to continue using the EWGSOP2 criteria in different populations to establish a correct prevalence of sarcopenic disease in different populations of the world.

The correlation between serum thyroid hormone levels and hand grip among elderly male Chinese inpatients

INTRODUCTION

Thyroid dysfunction is closely associated with skeletal muscle weakness. However, data on the optimal serum range of thyroid hormones for maintaining muscle strength in the elderly is lacking.

METHODS

We conducted a cross-sectional analysis in male elderly inpatients from the Geriatric Department of Zhongshan Hospital (affiliated to Fudan University, Shanghai, China). Serum biochemical parameters and thyroid hormones were detected for each participant. Hand grip (HG) was measured, with low hand grip defined as HG <26 kg according to the standard of the Asian Working Group for Sarcopenia. Logistic regression was used to evaluate the effects of different serum thyroid hormone levels on HG.

RESULTS

The majority of the subjects were euthyroid. The prevalence of low hand grip was 48.5%. Stratified by the free thyroxine (FT4) quartiles, the results showed HG was the highest in the third quartile. Multiple logistic regression analysis showed that compared with those in the first quartile, subjects in the third quartile of FT4 had a significantly lower risk of low hand grip (OR = 0.133, 95%CI: 0.020-0.610, p = .009), after adjusting potential confounding factors.

CONCLUSION

In elderly male inpatients, maintaining a narrower serum range of thyroid hormone might be needed to protect skeletal muscle strength.

Prevalence of sarcopenia and its components in community-dwelling outpatient older adults and their relation with functionality

AIM

Sarcopenia is recognized with its adverse functional outcomes. We aimed to report the prevalence of European Working Group on Sarcopenia in Older People (EWGSOP) defined sarcopenia and its individual components in community dwelling outpatient older adults and study the correlations of EWGSOP defined sarcopenia, muscle mass, muscle strength, and physical performance with functional status.

MATERIAL AND METHODS

The subjects were prospectively recruited from the geriatrics outpatient clinics of our university hospital. Body composition was assessed with bioimpedance analysis. Muscle strength was assessed by measurement of hand grip strength with hydraulic hand dynamometer, physical performance was assessed by 4 meter usual gait speed (UGS). Impaired muscle function was defined as presence of low muscle strength and or slow gait speed. As a measure of functionality, modified version of Katz activities of daily living (ADL) and Lawton instrumental activities of daily living (IADL) were assessed.

RESULTS

A total of 242 community dwelling outpatients with mean age of 79.4 ± 5.7 years were enrolled. 31.8% were male. Prevalence of low muscle mass was 2.1% and impaired muscle function was 71.1%. Prevalence of EWGSOP defined sarcopenia was 0.8% (1.3% in men and 0.6% in women). Most correlated parameter with ADL and IADL was the usual gait speed (r = 0.49, r = 0.63; p < .001, respectively). Grip strength was also correlated with ADL and IADL (r = 0.28, r = 0.35; p < .001). However, the skeletal muscle mass index (SMMI) was not correlated with ADL, IADL (p = .22, p = .22, respectively). In regression analysis, both ADL score and IADL scores were most related to UGS (beta = 0.5 and 0.6, p < .001), age (beta = -0.25 and -0.2, p < .001) and then sarcopenia (beta = 0.1 and 0.1, p < .05) but was not related to hand grip strength or SMMI.

CONCLUSIONS

The prevalence of sarcopenia was low as 0.8% albeit the presence of impaired muscle function in more than 2/3 of the cases. We have found that EWGSOP defined sarcopenia had association with ADL and IADL. The gait speed component of sarcopenia had the strongest associations with functional measures but SMMI component did not have any relation. We suggest that although low muscle mass may be a parameter related to worse functionality, it should not be regarded prerequisite for presence of sarcopenia analogous to low bone mineral density for osteoporosis.

Prevalence and Mortality of Sarcopenia in a Community-dwelling Older Japanese Population: The Hisayama Study

BACKGROUND

The prevalence of sarcopenia defined using the Asian Working Group for Sarcopenia (AWGS) criteria in Asian communities has not been fully addressed. Moreover, few studies have addressed the influence of sarcopenia on mortality.

METHODS

A total of 1,371 and 1,597 residents aged 65 years or older participated in health surveys in 2012 and 2017. Sarcopenia was determined using the AWGS definition. Factors associated with the presence of sarcopenia were assessed using a logistic regression model in participants in the 2012 survey. Subjects in the 2012 survey were followed-up prospectively for a median of 4.3 years. Mortality risk for subjects with sarcopenia was examined using the Cox proportional hazards model.

RESULTS

The crude prevalence of sarcopenia was 7.4% and 6.6% in participants at the 2012 and 2017 surveys, respectively; there was no significant difference between surveys (P = 0.44). The prevalence of sarcopenia increased significantly with age in both sexes (both P for trend <0.001). Subjects with sarcopenia were more likely to exercise less regularly, to intake less total energy, and to exhibit a disability in activity of daily living than those without. The multivariable-adjusted hazard ratio for all-cause mortality was 2.20 (95% confidence interval, 1.25-3.85) in subjects with sarcopenia, compared to those without.

CONCLUSIONS

Approximately 7% of older subjects had sarcopenia in a community-dwelling older Japanese population. Moreover, subjects with sarcopenia had an increased mortality risk. Our findings suggest that a public health strategy for sarcopenia is needed to extend healthy life expectancy.

Barthel Index, but not Lawton and Brody instrumental activities of daily living scale associated with Sarcopenia among older men in a veterans' home in southern Taiwan

BACKGROUND

Older adults are more likely to experience the disorder of skeletal muscles.

OBJECTIVE

This study aimed to examine the prevalence of sarcopenia using the diagnostic procedures of sarcopenia recommended by the Asian Working Group for Sarcopenia in 2019. The association of sarcopenia with physical activity and other factors was also explored.

METHODS

A cross-sectional study was designed. The sample came from a veterans' home in southern Taiwan during the months of July-September 2018. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) criteria in 2019. Skeletal muscle mass and grip strength were determined using bioelectrical impedance analysis and a digital dynamometer, respectively. The walking speed for a 6-m distance was also measured. Furthermore, the Barthel Index (BI), Lawton and Brody Instrumental Activities of Daily Living scales (IADL), mini-mental state examination (MMSE), and body mass index (BMI) were also collected.

RESULTS

Overall, 139 men with a mean age of 84.3 years (± 10.3 years) were analyzed. According to the recommendation of the AWGS in 2019, the prevalence of sarcopenia was 66.9% (n = 93), whereas 55.4% (n = 77) of men were determined to have severe sarcopenia. After adjusting for age, BMI (OR 0.63, 95% CI 0.53-0.75, p < 0.001] and BI scale score [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.93-0.99, p = 0.011) were significantly associated with sarcopenia, but the mini-mental state examination and Lawton and Brody IADL scales scores not.

CONCLUSION

A high prevalence of sarcopenia was evident in this study sample. The impaired score of the BMI and BI were risk factors of sarcopenia. Health providers should pay more attention to residents who have these risk factors, so possible stratagem or intervention can be figured out to improve their health status.

The high prevalence of sarcopenia and its associated outcomes following hip surgery in Taiwanese geriatric patients with a hip fracture

BACKGROUND

Sarcopenia, which is a common risk factor for falls and fractures, affects the functional outcome and mortality in geriatric populations. However, the prevalence of sarcopenia among geriatric Taiwanese patients with a hip fracture is unknown, nor is the effect of sarcopenia on the outcome of hip surgery.

METHODS

From December 2017 to February 2019, geriatric patients who underwent surgery for a hip fracture were prospectively enrolled. Basic demographic data, responses to questionnaires for dementia screening and quality of life (QoL) and daily living activities (ADL) before the injury were analyzed to identify any association with sarcopenia. The QoL and ADL were monitored at six months after the operation to determine the difference between hip fracture patients with or without sarcopenia.

RESULTS

Of 139 hip fracture patients, 70 (50.36%) were diagnosed with sarcopenia. Accounting for all confounding factors in the multivariate logistic regression, lower body mass index (BMI), male gender and a weaker handgrip are the risk factors that are most strongly associated with a diagnosis of sarcopenia in geriatric patients with a hip fracture. Hip fracture patients with sarcopenia also have poor ADL and a lower QoL than patients without sarcopenia before the injury and six months after the operation.

CONCLUSION

A high prevalence of sarcopenia among geriatric hip fracture patients is associated with a poor mid-term outcome following hip surgery. Clinicians must recognize the risk of sarcopenia, especially for male hip fracture patients with a lower BMI and a weaker handgrip.

Association of sarcopenia with phase angle and body mass index in kidney transplant recipients

Malnutrition is an important risk factor for the development of sarcopenia. Recently, phase angle (PhA) obtained from the bioelectrical impedance analysis is increasingly becoming known as a nutritional status marker and may be considered a good indicator to identify elderly patients at risk of sarcopenia. In this study, we investigated the prevalence of sarcopenia and the relationship between sarcopenia and PhA or body mass index (BMI) as nutritional factors, and evaluated the discrimination performance of these nutritional factors for sarcopenia in 210 kidney transplant recipients. The median age was 55 years and 11.1% had sarcopenia. This prevalence of sarcopenia was lower than previous reports in kidney transplant recipients, maybe because of the differences in sarcopenia definitions and population demographics such as age, sex, race, and comorbidities. Both PhA and BMI were negatively correlated with sarcopenia after adjusting for age, sex, dialysis vintage, time after transplant, presence of diabetes mellitus, hemoglobin, estimated glomerular filtration rate, and the other nutritional factor. The discrimination performance for PhA and BMI had enough power to detect sarcopenia. These results suggest that PhA and BMI can be used in clinical practice to predict sarcopenia in kidney transplant patients.

Increased protein intake affects pro-opiomelanocortin (POMC) processing, immune function and IGF signaling in peripheral blood mononuclear cells of home-dwelling old subjects using a genome-wide gene expression approach

Background

Adequate protein intake among older adults is associated with better health outcomes such as immune function and metabolic regulation of skeletal muscle, but conflicting results make it difficult to define the optimal intake. To further understand the impact of protein intake on metabolic processes, the aim of the study was to explore genome-wide gene expression changes in peripheral blood mononuclear cells (PBMCs) in home-dwelling old subjects after increased protein intake for 12 weeks.

Method

In a parallel double-blind randomized controlled intervention study, subjects (≥ 70 years) received a protein-enriched milk (2 × 20 g protein/day, n = 14, mean (±SD) age 76.9 ± 4.9 years) or an isocaloric carbohydrate drink (n = 17, mean (±SD) age 77.7 ± 4.8 years) for breakfast and evening meal for 12 weeks. PBMCs were isolated before and after the intervention. Microarray analysis was performed using Illumina technology. Serum levels of gut peptides and insulin growth factor (IGF)-1 were also measured.

Results

In total 758 gene transcripts were regulated after increased protein intake, and 649 gene transcripts were regulated after intake of carbohydrates (p < 0.05). Forty-two of these genes were overlapping. After adjusting for multiple testing, 27 of the 758 gene transcripts were regulated (FDR, q-value < 0.25) after protein intake. Of these 25 were upregulated and two downregulated. In particular, genes and signaling pathways involved in pro-opiomelanocortin (POMC) processing, immune function, and IGF signaling were significantly altered.

Conclusions

PBMCs can be used to study gene expression changes after long-term protein intake, as many signaling pathways were regulated after increased protein intake. The functional significance of these findings needs to be further investigated.

Trial registration

ClinicalTrials.gov, ID no. NCT02218333. The study was registered on August 18, 2014.

Sarcopenia as a predictor of activities of daily living capability in stroke patients undergoing rehabilitation

AIM

The aim of the present study was to clarify the relationship between sarcopenia, as defined by the European Working Group on Sarcopenia in Older People, and the recovery of the capability to carry out activities of daily living in convalescent stroke patients who completed a rehabilitation program.

METHODS

This retrospective study included consecutive stroke patients admitted to convalescent rehabilitation wards. To determine which patients had sarcopenia, we used the European Working Group on Sarcopenia in Older People criteria. At admission, participants were classified by either the presence or absence of sarcopenia. Baseline characteristics, including the Functional Independence Measure-motor domain score (FIM-M), were retrospectively analyzed. The primary outcome to be explained was the FIM-M at discharge. A multiple linear regression analysis was used to examine how well a sarcopenia diagnosis and various baseline characteristics could predict the FIM-M score at discharge.

RESULTS

In total, 267 participants (117 women) were included in this study. Of these, 129 (48.3%) were classified as definitely having sarcopenia. Participants with sarcopenia showed lower FIM-M at discharge than those without this condition (median 72 vs 89, P < 0.001). Multiple linear regression analyses exploring determinants of the FIM-M scores showed that a diagnosis of sarcopenia independently predicted them at discharge for men (B -4.957, 95% confidence interval -9.902--0.012), but not for women.

CONCLUSIONS

Stroke-related sarcopenia appears to be a predictor of how well male patients can engage in activities of daily living after rehabilitation. Geriatr Gerontol Int 2019; 19: 1124-1128.

Sarcopenia as a mortality predictor in community-dwelling older adults: a comparison of the diagnostic criteria of the European Working Group on Sarcopenia in Older People

BACKGROUND/OBJECTIVES

The definition of sarcopenia remains a matter of discussion and there is no globally accepted consensus for its diagnosis. The aim of this study was to assess the effect of sarcopenia diagnostic components on mortality, as well as to compare the associations between sarcopenia diagnosed via the 2010 and 2018 Consensuses of the European Working Group on Sarcopenia in Older People (EWGSOP) and mortality.

METHODS

Prospective cohort study involving noninstitutionalized older adults aged ≥ 60 years. For the diagnosis of sarcopenia, the definitions proposed by the 2010 (EWGSOP) and 2018 (EWGSOP2) Consensuses were used. The diagnostic components corresponded to muscle mass, muscular strength, and physical performance. The associations of sarcopenia and its components with mortality were investigated using Cox proportional hazard regression models.

RESULTS

The sample consisted of 1291 older adults. After an average of 2.6 years of follow-up, 88 (6.8%) participants had died. The diagnosis of severe sarcopenia by both Consensuses was associated with an increased risk of mortality. Severe sarcopenia was associated with an increased risk of death compared with that in people without sarcopenia when using EWGSOP (hazard ratio (HR) 3.15, 95% confidence interval (CI) 1.44-6.90) and EWGSOP2 (HR 4.11, 95% CI 1.88-9.00). Older adults with decreased gait speed had a 76% higher risk of dying (p = 0.033). There was no statistically significant association between the other sarcopenia components and mortality risk.

CONCLUSIONS

Older adults with severe sarcopenia and those with changes in physical performance had an increased risk of death in the short term.

Physical activity is associated with functional capacity of older women with osteosarcopenic obesity: 24-month prospective study

BACKGROUND/OBJECTIVES

Physical activity (PA) could be effective in the prevention of functional disability in older women, especially for those with body composition abnormalities. The aim this study was to analyze the association of total PA and in different domains with physical function and functional capacity in older women with or without osteosarcopenic obesity (OSO), as well as to assess the risk of functional disability in osteosarcopenic obesity older women insufficiently active.

SUBJECTS/METHODS

The study included 152 Brazilian older women, aged 60 years and older. Body composition was measured by dual energy X-ray absorptiometry (DXA) and physical function by physical tests. Functional capacity and PA were self-reported.

RESULTS

In older women without OSO, the practice of leisure-time exercise (β:-0.23; 95%CI -0.40 to -0.06) and total PA (β:-0.40; 95%CI -0.57 to -0.23) is inversely associated with dependence in ADL. In older women with OSO, the practice of leisure-time exercise was inversely associated with physical function (β:0.88; 95%CI 0.31-1.46) and functional capacity (β:-1.05; 95%CI 1.64 to -0.45), while total PA (β:-1.03; 95%CI -1.93 to -0.13) was inversely associated with functional capacity, independent of control variables. In addition, older women with OSO who remained insufficiently active in leisure-time exercise (HR:2.28; 95%CI 1.04-4.99) and locomotion (HR:2.62; 95%CI 1.28-5.36) domains presented risk for functional disability.

CONCLUSIONS

PA is inversely associated with physical function and functional capacity in older women with or without OSO, and older women with OSO who are insufficiently active in leisure-time exercise and locomotion domains presented a higher risk for functional disability.

Instrumentos de avaliação cognitiva utilizados nos últimos cinco anos em idosos brasileiros

Resumo A detecção e o monitoramento do déficit cognitivo em idosos são necessários já que podem causar impacto em sua funcionalidade. O objetivo dessa revisão integrativa é analisar a produção científica sobre uso de instrumentos de avaliação cognitiva em idosos brasileiros por meio de artigos publicados nos últimos cinco anos, indexados nas bases de dados Web of Science, PubMed, Scopus e Bireme. Os critérios de inclusão foram: artigos originais publicados em inglês e português, de 2012 a 2016, com critério de idade definido para ser considerado idoso, e escore maior que 6 no CASP adaptado. O critério de exclusão foi: ser resumo de congresso. A amostra final foi composta por 100 artigos. Foram apresentados os 61 instrumentos de avaliação cognitiva utilizados nos estudos, com destaque para o Mini Exame do Estado Mental. Essa revisão apresenta o uso de instrumentos cognitivos na pesquisa brasileira, suas diferentes versões e quais domínios são avaliados. O número de instrumentos presentes na literatura foi amplo. Os mais utilizados foram o MEEM (versão de Brucki e colaboradores), o Teste de Fluência Verbal (categoria animais) e o Teste Span de dígitos (ordem direta e inversa). Os achados apresentados nessa revisão são relevantes não apenas para área da pesquisa observacional e experimental, mas também para a prática clínica.

Prevalence and associated factors of sarcopenia, dynapenia, and sarcodynapenia in community-dwelling elderly in São Paulo - SABE Study

OBJECTIVES

To estimate the prevalence of sarcopenia, dynapenia, and sarcodynapenia and associated factors in older adults in the city of São Paulo, Brazil.

METHODS

A population-based, cross-sectional study was conducted with 1,168 older adults who participated in the third wave of the Health, Well-being, and Aging study in 2010 (SABE study). Men and women with skeletal muscle mass ≤ 8.90 and ≤ 6.37 kg/m2, respectively, were considered sarcopenic. Men and women with grip strength < 30 and < 20 kg, respectively, were considered dynapenic. Those with both conditions were considered sarcodynapenic. Sociodemographic, behavioral, clinical, nutritional, and biochemical characteristics were investigated as factors associated with each of the three conditions using multinomial logistic regression.

RESULTS

Theprevalence of sarcopenia, dynapenia, and sarcodynapenia was 4.8% (95%CI 3.6 - 6.3), 30.9% (95%CI 27.5 - 34.6) and 9.0% (95%CI 7.2-11.3), respectively. An increase in age and malnutrition was associated with all the three conditions. Cognitive impairment was associated with both dynapenia and sarcodynapenia. Schooling, current smoking habit, and not having a marital life were associated with sarcopenia. Osteoarthritis, schooling, being an ex-smoker, and low hemoglobin were associated with dynapenia. Smoking habit and the risk of malnutrition were associated with sarcodynapenia.

CONCLUSION

Dynapenia is more prevalent among older adults, followed by sarcodynapenia, and sarcopenia. With the exception of age, schooling, and malnutrition, the factors associated with sarcopenia and dynapenia are different. However, there are similarities in some associations regarding the presence of sarcodynapenia.

Evaluation of dynapenia in the elderly in São Caetano do Sul, São Paulo, Brazil

Abstract Introduction: Aging is characterized by psychological, social, nutritional and biological changes, among which dynapenia stands out. Objective: To analyze the presence of dynapenia and associated factors in elderly people living in the city of São Caetano do Sul. Method: A cross-sectional study was carried out with 295 elderly individuals aged 60 years or older, who were users of public health units in the city of São Caetano do Sul. Dynapenia was assessed by handgrip strength, and its associations were investigated using multivariate logistic regression, according to sociodemographic variables, nutritional status, protein consumption, presence of diseases, and physical activity. Statistical analysis was performed using the IBM-SPSS (Statistical Package for Social Science) software. The adopted level of significance was p < 0.05. Results: Most of the participants were female (n = 251), with mean age of 70.6 years (± 7.0). The presence of dynapenia was observed in 24.07% (n = 71), among which 47 were women (18.73%) and 24 were men (54.55%). Observed associations concerned older age, male sex, lower circumference of the arm and calf, and lower triceps skinfold (p < 0.05). Conclusion: Approximately one-fourth of the elderly studied presented dynapenia, which represents a higher risk of morbidity and mortality. The inclusion of PPF alongside other anthropometric measures for assessing nutritional status is recommended. It is important for public policies to be directed towards health promotion and risk prevention in this age group.

Prevalence and factors associated with sarcopenia and dynapenia in elderly people

Objectives

There is little information about the risk factors for sarcopenia and dynapenia. This study aimed to assess the prevalence of sarcopenia and dynapenia and to verify which risk factors are associated with the elderly population.

Methods

A total of 387 elderly people were evaluated. We used a questionnaire to identify socio-demographic and behavioral aspects. For physical performance, we used the Short Physical Performance Battery. Using the European Working Group of Sarcopenia in Older People consensus, we defined sarcopenia that includes the occurrence of low muscle mass, added to low muscle strength or low physical performance. Dynapenia was defined using handgrip strength.

Results

Sarcopenia and dynapenia were identified in 15.3% and 38.2% of the elderly people, respectively; 15.8% of women and 14.2% of men had sarcopenia, and 52.4% of women and 13.5% of men had dynapenia. Sarcopenia was associated with the increase in aging, white race, smoking, and risk of malnutrition. Dynapenia is more likely to occur in women and hospitalized patients.

Conclusion

Sarcopenia had a greater association with the risk factors evaluated here, mainly with smoking and nutritional status. On the other hand, dynapenia was different, having a greater association with hospital intervention.

Get a grip: individual variations in grip strength are a marker of brain health

Demonstrations that grip strength has predictive power in relation to a range of health conditions-even when these are assessed decades later-has motivated claims that hand-grip dynamometry has the potential to serve as a "vital sign" for middle-aged and older adults. Central to this belief has been the assumption that grip strength is a simple measure of physical performance that provides a marker of muscle status in general, and sarcopenia in particular. It is now evident that while differences in grip strength between individuals are influenced by musculoskeletal factors, "lifespan" changes in grip strength within individuals are exquisitely sensitive to integrity of neural systems that mediate the control of coordinated movement. The close and pervasive relationships between age-related declines in maximum grip strength and expressions of cognitive dysfunction can therefore be understood in terms of the convergent functional and structural mediation of cognitive and motor processes by the human brain. In the context of aging, maximum grip strength is a discriminating measure of neurological function and brain health.

Combined Effect of Dynapenia (Muscle Weakness) and Low Vitamin D Status on Incident Disability

BACKGROUND AND OBJECTIVE

There is little epidemiologic evidence considering the combined effect of dynapenia and low 25-hydroxyvitamin D [25 (OH) D] on incident disability. Our aim was to investigate whether the combination of dynapenia and low 25 (OH) D serum levels increases the risk of activities of daily living (ADL) incident disability.

DESIGN

Prospective cohort study.

SETTINGS

English Longitudinal Study of Aging.

PARTICIPANTS

A total of 4630 community-dwelling adults aged 50 years and older without ADL disability at baseline.

MEASUREMENTS

The baseline sample was categorized into 4 groups (ie, nondynapenic/normal 25 (OH) D, low 25 (OH) D only, dynapenic only, and dynapenic/low 25 (OH) D according to their handgrip strength (<26 kg for men and <16 kg for women) and 25 (OH) D (≤50 nmol/L). The outcome was the presence of any ADL disability 2 years after baseline according to the modified Katz Index. Incidence rate ratios (IRRs) adjusted by sociodemographic, behavioral, and clinical characteristics were estimated using Poisson regression.

RESULTS

The fully adjusted model showed that older adults with dynapenia only and those with lower serum levels of 25 (OH) D combined with dynapenia had higher incident ADL disability risk compared with nondynapenic and those with normal serum levels of 25 (OH) D. The IRRs for lower 25 (OH) D serum levels combined with dynapenia were higher than for dynapenia only, however, the confidence intervals (CIs) showed similar effect for these 2 groups. The IRRs were 1.31 for low 25(OH) D only (95% CI 0.99-1.74), 1.77 for dynapenia only (95% CI 1.08-2.88), and 1.94 for combined dynapenia and low 25(OH)D (95% CI 1.28-2.94).

CONCLUSIONS

Dynapenia only and dynapenia combined with low 25 (OH) D serum levels were important risk factors for ADL disability in middle-aged individuals and older adults in 2 years of follow-up.

Association between pre-sarcopenia, sarcopenia, and bone mineral density in patients with chronic hepatitis C

BACKGROUND

Preserved skeletal muscle is essential for the maintenance of healthy bone. Loss of bone mineral density (BMD) and muscle strength, considered a predictor of BMD, have been demonstrated in patients with cirrhosis, but they are poorly studied in chronic hepatitis C (CHC) without cirrhosis. Thus, we aimed to evaluate the prevalence of low BMD and its association with body composition, muscle strength, and nutritional status in CHC.

METHODS

One hundred and four subjects [mean age, 50.5 ± 11.3 years; 75.0% males; 67.3% non-cirrhotic; and 32.7% with compensated cirrhosis] with CHC, prospectively, underwent scanning of the lean tissue, appendicular skeletal muscle mass (ASM), fat mass, lumbar spine, hip, femoral neck, and whole-body BMD by dual-energy X-ray absorptiometry. Muscle strength was assessed by dynamometry. Sarcopenia was defined by the presence of both low, ASM/height2 (ASMI) and low muscle strength according to the European Working Group on Sarcopenia in Older People criteria. The cut-off points for low ASMI and low muscle strength, for women and men, were < 5.45 and < 7.26 kg/m2 and < 20 and < 30 kg, respectively. According to the adopted World Health Organization criteria in men aged > 50 years, the T-score of osteopenia is between -1.0 and -2.49 standard deviation (SD) below the young average value and of osteoporosis is ≥-2.5 SD below the young normal mean for men, and the Z-score of low bone mass is ≤-2.0 SD below the expected range in men aged < 50 years and women in the menacme. Nutritional status evaluation was based on the Controlling Nutritional Status score.

RESULTS

Low BMD, low muscle strength, pre-sarcopenia, sarcopenia, and sarcopenic obesity were observed in 34.6% (36/104), 27.9% (29/104), 14.4% (15/104), 8.7% (9/104), and 3.8% (4/104) of the patients, respectively. ASMI was an independent predictor of BMD (P < 0.001). Sarcopenia was independently associated with bone mineral content (P = 0.02) and malnutrition (P = 0.01). In 88.9% of the sarcopenic patients and in all with sarcopenic obesity, BMI was normal. The mid-arm muscle circumference was positively correlated with ASMI (r = 0.88; P < 0.001).

CONCLUSIONS

This is the first study to demonstrate that ASM is an independent predictor of BMD in CHC. Mid-arm muscle circumference coupled with handgrip strength testing should be incorporated into routine clinical practice to detect low muscle mass, which may be underdiagnosed when only BMI is used. These findings may influence clinical decision-making and contribute to the development of effective strategies to screen the musculoskeletal abnormalities in CHC patients, independently of the stage of the liver disease.

Dynapenia and Sarcopenia as a Risk Factor for Disability in a Falls and Fractures Clinic in Older Persons

BACKGROUND:

The role of sarcopenia and dynapenia in disability in older persons from falls and bone health clinics remain unknown.

AIM:

This study aims to compare the association of sarcopenia and dynapenia with physical and instrumental disability in a population of older persons attending a falls and fractures clinic.

METHODS:

This is a cross-sectional study in Manizales, Andes Mountains, Colombia. A cohort of 534 subjects (mean age = 74, 75% female) Sarcopenia was measured according to the European Working Group on Sarcopenia in Older People (EWGSOP) including an index of skeletal mass, muscle strength, and gait speed. Dynapenia was defined as a handgrip force ≤ 30 kg for men and ≤ 20 kg for women.

RESULTS:

Dynapenia and sarcopenia were present in 84.6% and 71.2% respectively. Both were more prevalent in older subjects and women than men. While sarcopenia was associated with body mass index and hypertension, dynapenia was associated with hypothyroidism and visual impairment. After controlling for all covariates, sarcopenia was associated with low IADL and mobility disability.

CONCLUSIONS:

Sarcopenia was associated with mobility, ADL and IADL disability. Dynapenia was not associated with disability in this high - risk population. Systematic assessment of sarcopenia should be implemented in falls and fractures clinics to identify sarcopenia and develop interventions to prevent functional decline among elderly individuals.

Protein leucine content is a determinant of shorter- and longer-term muscle protein synthetic responses at rest and following resistance exercise in healthy older women: a randomized, controlled trial

Background

Older women may not be consuming enough protein to maintain muscle mass. Augmentation of protein intake with leucine may enhance the muscle protein synthetic response in older women to aid in maintaining muscle mass.

Objective

We measured the acute (hourly) and integrated (daily) myofibrillar protein synthesis (myoPS) response to consumption of a high-quality mixed protein beverage compared with an isonitrogenous protein beverage with added leucine.

Design

In a parallel design, free-living, healthy older women (aged 65-75 y, n = 11/group) consumed a fixed, weight-maintaining diet with protein at 1.0 g · kg-1 · d-1 and were randomly assigned to twice-daily consumption of either 15 g milk protein beverage containing 4.2 g leucine (LEU) or 15 g mixed protein (milk and soy) beverage containing 1.3 g leucine (CON). Unilateral leg resistance exercise allowed a determination of acute ([13C6]-phenylalanine infusion, hourly rate) and integrated (deuterated water ingestion, daily rate) exercised and rested myoPS responses.

Results

Acute myoPS increased in response to feeding in the rested (CON: 13% ± 4%; LEU: 53% ± 5%) and exercised (CON: 30% ± 4%; LEU: 87% ± 7%) leg in both groups, but the increase was greater in LEU (P < 0.001). Integrated myoPS increased during the supplementation period in both legs (rested: 9% ±1%; exercised: 17% ± 2%; P < 0.001) in LEU, but in the exercised leg only (7% ± 2%; P < 0.001) in CON.

Conclusions

A 15-g protein-containing beverage with ∼4 g leucine induced greater increases in acute and integrated myoPS than did an isonitrogenous, isoenergetic mixed-protein beverage. Declines in muscle mass in older women may be attenuated with habitual twice-daily consumption of a protein beverage providing 15 g protein and higher (4.2 g/serving) amounts of leucine. This trial was registered at clinicaltrials.gov as NCT02282566.

Muscle Weakness and Physical Disability in Older Americans: Longitudinal Findings from the U.S. Health and Retirement Study

IMPORTANCE

Muscle weakness is an important indicator of disability, chronic disease and mortality. While we recently proposed sex/race specific grip strength cutpoints for clinical muscle weakness in a diverse, nationally representative sample of older Americans, the extent to which these cutpoints predict physical disability remains unknown.

OBJECTIVE

To examine whether sex/race specific muscle weakness cutpoints predict physical disability status in a nationally representative sample of Americans age 65+.

DESIGN

We used data from the 2006-2010 Health and Retirement Study. Fully-adjusted, weighted multinomial logistic regression models were used to quantify the odds of experiencing the onset, progression or persistence of disability in activities of daily living (ADL) among weak versus non-weak individuals over a 2-year period.

SETTING

General community, nationally representative sample of older Americans.

PARTICIPANTS

Population-based, community dwelling sample of older American adults aged 65-years+; 57 percent were women, 91% were White and the mean age was 75 years. Main Outcome(s) and Measure(s): The primary outcome of interest was disability dynamics, defined by changes in ADL status across at 2- year period. The primary exposure was clinical muscle weakness as defined by previously identified cutpoints. Hypotheses were formulated before analyses were conducted.

RESULTS

In this nationally representative sample (n= 8,725), 44% of individuals were classified as weak at baseline. At follow-up, 55% remained independent with no change in their ADL status, 11% had an onset of disability and 4% progressed in their disability status. The odds of experiencing an onset of ADL disability was 54% higher among weak individuals compared those who were not weak at baseline (OR= 1.54, 95% CI= 1.54, 1.5, p<.0001); the odds of experiencing a progression in physical disability status was 2.16 times higher among those who were weak at baseline compared to non-weak individuals (OR= 2.16, 95% CI= 2.15, 2.16, p<.0001).

CONCLUSIONS

This is the first study to use grip strength weakness cut-points to identify those who may be at greatest risk for experiencing physical disability in later life. Results underscore the importance of using population-specific cutpoints for clinical weakness in order to identify individuals at greatest risk for adverse health outcomes.

Obesity, sarcopenia, sarcopenic obesity and reduced mobility in Brazilian older people aged 80 years and over

Objective

To analyze which abnormalities in body composition (obesity, sarcopenia or sarcopenic obesity) are related to reduced mobility in older people aged 80 years and older.

Methods

The sample included 116 subjects aged 80 years and older. The body composition was measured using dual-energy X-ray absorptiometry (DXA) and mobility was assessed by motor tests. The χ² test was used to analyze the proportion of older people with sarcopenia, obesity and sarcopenic obesity based on sex as well as to indicate an association between obesity, sarcopenia, sarcopenic obesity and mobility. Binary logistic regression, adjusted for the variables (sex and osteoarticular diseases), was used to express the magnitude of these associations. One-way analysis of variance was used to compare the mobility of four groups (Normal, Obesity, Sarcopenia and Sarcopenic Obesity).

Results

The Sarcopenia Group had lower performance in the lower limbs strength test and in sum of two tests compared with Obesity and Normal Groups. Older people with sarcopenia had higher chance of reduced mobility (OR: 3.44; 95%CI: 1.12-10.52).

Conclusion

Older people aged 80 years and older with sarcopenia have more chance for reduction in mobility.

Factors associated with protein consumption in elderly

ABSTRACT Objective We evaluated factors associated with protein consumption by the elderly. Methods We performed a cross-sectional study in a sample of 295 elderly consumers of health facilities in São Caetano do Sul, São Paulo, Brazil. Protein consumption data (g and g/kg) were obtained through 24-hour dietary recalls, which was reapplied in a 30% sub-sample to estimate habitual consumption, with an interval of two weeks. The association between protein consumption and sociodemographic, economic, health, and dietary variables was tested using multiple linear regression. Results There was a positive association between protein consumption (g and g/kg) and better Brazilian Healthy Eating Index-Revised, between protein consumption (g) and male sex, and a negative association between protein consumption (g/kg) and greater calf circumference. Higher average protein consumption (g or g/kg) was observed among married elderly, individuals with higher income and schooling, who were economically active, eutrophic, without dyslipidemia and symptoms of dysphagia, who consumed three main meals and an intermediate snack. Conclusion The results showed that protein consumption was associated with diet quality, sex, and calf circumference. The identification of elderly groups prone to protein inadequacy may direct individual and collective interventions to prevent muscle mass reduction and its implications, such as sarcopenia and other adverse outcomes.

The combination of dynapenia and abdominal obesity as a risk factor for worse trajectories of IADL disability among older adults

Background/Objectives

The concept of dynapenic obesity has been gaining great attention recently. However, there is little epidemiological evidence demonstrating that dynapenic abdominal obese individuals have worse trajectories of disability than those with dynapenia and abdominal obesity alone. Our aim was to investigate whether dynapenia combined with abdominal obesity can result in worse trajectories of instrumental activities of daily living (IADL) among English and Brazilian older adults over eight and ten years of follow-up, respectively.

Methods

We used longitudinal data from 3374 participants from the English Longitudinal Study of Ageing (ELSA) and 1040 participants from the Brazilian Health, Well-being and Aging Study (SABE) who were free from disability as assessed by IADL at baseline. IADL disability was defined herein as a difficulty to perform the following: preparing meals, managing money, using transportation, shopping, using the telephone, house cleaning, washing clothes, and taking medications according to the Lawton IADL modified scale. The study population in each country was categorized into non-dynapenic/non-abdominal obese (reference group), abdominal obese, dynapenic and dynapenic abdominal obese according to their handgrip strength (<26 kg for men and <16 kg for women) and waist circumference (>102 cm for men and >88 cm for women). We used generalized linear mixed models with IADL as the outcome.

Results

The estimated change over time in IADL disability was significantly higher for participants with dynapenic abdominal obesity compared to those with neither condition in both cohorts (ELSA: 0.023, 95% CI = 0.012–0.034, p < 0.001; SABE: +0.065, 95% CI = 0.038–0.091, p < 0.001). Abdominal+obesity was also associated with changes over time in IADL disability (ELSA: +0.009, 95% CI = 0.002–0.015, p < 0.05; SABE: +0.021, 95% CI = 0.002–0.041, p < 0.05), which was not observed for dynapenia.

Conclusions

Abdominal obesity is an important risk factor for IADL decline but participants with dynapenic abdominal obesity had the highest rates of IADL decline over time among English and Brazilian older adults.

Gait Speed rather than Dynapenia Is a Simple Indicator for Complex Care Needs: A Cross-sectional Study Using Minimum Data Set

The impact of dynapenia on the complexity of care for residents of long-term care facilities (LTCF) remains unclear. The present study evaluated associations between dynapenia, care problems and care complexity in 504 residents of Veterans Care Homes (VCHs) in Taiwan. Subjects with dynapenia, defined as low muscle strength (handgrip strength <26 kg), were older adults with lower body mass index (BMI), slow gait speed, and higher numbers of Resident Assessment Protocol (RAP) triggers. After adjusting for age, education, BMI, and Charlson’s comorbidity index (CCI), only age, education, BMI and gait speed were independently associated with higher numbers of RAP triggers, but not dynapenia or handgrip strength (kg). Dividing subjects into groups based on quartiles of gait speed, those with gait speed ≤0.803 m/s were significantly associated with higher complexity of care needs (defined as ≥4 RAP triggers) compared to the reference group (gait speed >1 m/s). Significantly slow gait speed was associated with RAP triggers, including cognitive loss, poor communication ability, rehabilitation needs, urinary incontinence, depressed mood, falls, pressure ulcers, and use of psychotropic drugs. In conclusion, slow gait speed rather than dynapenia is a simple indicator for higher complexity of care needs of older male LTCF residents.

Anthropometric indicators as a screening tool for sarcopenia in older adults from Florianópolis, Santa Catarina: EpiFloripa Ageing study

ABSTRACT Objective This cross-sectional population-based study aimed to determine the cutoff points of anthropometric indicators to screen for sarcopenia and the association between sarcopenia and these indicators. Methods The sample consisted of 601 older adults. Sarcopenia was detected by appendicular skeletal muscle index. The receiver operating characteristic curve identified the cutoff points for body mass index, waist-to-height ratio, waist circumference, and handgrip strength to screen for sarcopenia. Based on the cut-off points, principal component analysis determined which indicators had a better fit as discriminants to compose an indicator. Finally, logistic regression analysis was performed with this indicator as the main independent variable. Results The results showed that all anthropometric indicators and handgrip strength were capable of discriminating sarcopenia; however, body mass index, waist circumference, and waist-to-height ratio were the best discriminants in principal components analysis, composing the new indicator. Adjusted logistic regression analysis showed that sarcopenia was associated with the indicator in both sexes. Conclusion The concomitant presence of low body mass index, low waist circumference, and low waist-to-height ratio may help to discriminate sarcopenia.