Influence of nutritional status in the diagnosis of sarcopenia in nursing home residents

Diagnostic and prognostic value of calf circumference for sarcopenia in community-dwelling older adults

BACKGROUND

An age-dependent normative values of calf circumference (CC) has been recently proposed as an accessible proxy for muscle mass. However, its usefulness to estimate sarcopenia has not been assessed. The objectives of the present study were to determine if the substitution of the classical way to assess muscle mass by these values have enough diagnostic accuracy and prognostic value among older adults living in the community.

METHODS

Data from the Toledo Study of Healthy Ageing (TSHA) were used. CC was measured using an anthropometric tape. We used two age-groups CC cut-off points: the TSHA CC median and the one proposed in the Longevity Check-up 7+ (Lookup 7+) project. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People (EWGSOP2), the Foundation for the National Institutes of Health (FNIH), and FNIH criteria standardized for our population (sFNIH). Frailty (according to the Frailty Phenotype and the Frailty Trait Scale-5) and disability (Katz index) were assessed at baseline and follow-up. Mortality and first hospitalization were also recorded. Logistic (incident frailty and worsening disability) and Cox (mortality and hospitalization) regressions were performed. Diagnostic accuracy was assessed through Kappa index, AUCs, positive and negative predictive values. Predictive ability was assessed through AUCs and integrated AUCs (IAUCs).

RESULTS

1531 participants (74.8 ± 5.8 years; 45.6% men) were included in the analysis. Prevalence rates of sarcopenia were 22.7% (sFNIH), 15.0% (FNIH), and 13.9% (EWGSOP2). Using TSHA-based cut-points of CC, the prevalence of sarcopenia was 16.8% (sFNIH), 11.0% (FNIH), and 11.5% (EWGSOP2). According to LC7+-based CC cut-off points, sarcopenia prevalence was 17.6% (sFNIH), 11.9% (FNIH), and 12.4% (EWGSOP2). CC cut-off points showed low-to-moderate agreement (Kappa Index values between 0.49 and 0.69) with appendicular lean mass for the evaluation of sarcopenia. Sarcopenia identified by Lookup 7+ and TSHA CC cut-off points was associated with the adverse events examined, with similar AUCs and IAUCs than original sarcopenia definitions, and were lost after adjustment by baseline frailty, except when the original EWGSOP2 definition was used.

CONCLUSIONS

Using normalized values of CC as a criteria of muscle mass shows moderate agreement with classical criteria for diagnosing sarcopenia and offer similar predictive value in community-dwelling older adults.

Diabetic Sarcopenia. A proposed muscle screening protocol in people with diabetes : Expert document

OBJECTIVES

To propose the grounds for "diabetic sarcopenia" as a new comorbidity of diabetes, and to establish a muscle screening algorithm proposal to facilitate its diagnosis and staging in clinical practice.

METHOD

A qualitative expert opinion study was carried out using the nominal technique. A literature search was performed with the terms "screening" or "diagnostic criteria" and "muscle loss" or "sarcopenia" and "diabetes" that was sent to a multidisciplinary group of 7 experts who, in a face-to-face meeting, discussed various aspects of the screening algorithm.

RESULTS

The hallmark of diabetic sarcopenia (DS) is muscle mass atrophy characteristic of people with diabetes mellitus (DM) in contrast to the histological and physiological normality of muscle mass. The target population to be screened was defined as patients with DM with a SARC-F questionnaire > 4, glycosylated haemoglobin (HbA1C) ≥ 8.0%, more than 5 years since onset of DM, taking sulfonylureas, glinides and sodium/glucose cotransporter inhibitors (SGLT2), as well as presence of chronic complications of diabetes or clinical suspicion of sarcopenia. Diagnosis was based on the presence of criteria of low muscle strength (probable sarcopenia) and low muscle mass (confirmed sarcopenia) using methods available in any clinical consultation room, such as dynamometry, the chair stand test, and Body Mass Index (BMI)-adjusted calf circumference. DS was classified into 4 stages: Stage I corresponds to sarcopenic patients with no other diabetes complication, and Stage II corresponds to patients with some type of involvement. Within Stage II are three sublevels (a, b and c). Stage IIa refers to individuals with sarcopenic diabetes and some diabetes-specific impairment, IIb to sarcopenia with functional impairment, and IIc to sarcopenia with diabetes complications and changes in function measured using standard tests Conclusion: Diabetic sarcopenia has a significant impact on function and quality of life in people with type 2 diabetes mellitus (T2DM), and it is important to give it the same attention as all other traditionally described complications of T2DM. This document aims to establish the foundation for protocolising the screening and diagnosis of diabetic sarcopenia in a manner that is simple and accessible for all levels of healthcare.

Factors Associated with Sarcopenia among Elderly Individuals Residing in Community and Nursing Home Settings: A Systematic Review with a Meta-Analysis

To investigate the factors associated with sarcopenia in elderly individuals residing in nursing homes and community settings, we conducted a systematic search of databases, including MEDLINE, EMBASE, PubMed, Web of Science and Cochrane, up to May 2023. We incorporated a total of 70 studies into our analysis. Our findings revealed that the prevalence of sarcopenia in nursing homes ranged from 25% to 73.7%, while in community settings, it varied from 5.2% to 62.7%. The factors associated with sarcopenia in both nursing homes and community settings included male gender, BMI, malnutrition, and osteoarthritis. In community settings, these factors comprised age, poor nutrition status, small calf circumference, smoking, physical inactivity, cognitive impairment, diabetes, depression and heart disease. Currently, both the European Working Group on Sarcopenia in Older People (EWGSOP) and the Asian Working Group for Sarcopenia (AWGS) standards are widely utilized in nursing homes and community settings, with the EWGSOP standard being more applicable to nursing homes. Identifying factors associated with sarcopenia is of paramount significance, particularly considering that some of them can be modified and managed. Further research is warranted to investigate the impact of preventive measures on these factors in the management of sarcopenia among elderly individuals residing in nursing homes and community settings.

Caloric restriction delays age-related muscle atrophy by inhibiting 11β-HSD1 to promote the differentiation of muscle stem cells

Introduction

Calorie restriction (CR) is an important direction for the delay of sarcopenia in elderly individuals. However, the specific mechanisms of CR against aging are still unclear.

Methods

In this study, we used a CR model of elderly mice with muscle-specific 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1) knockout mice and 11β-HSD1 overexpression mice to confirm that CR can delay muscle aging by inhibiting 11β-HSD1 which can transform inactive GC(cortisone) into active GC(cortisol). The ability of self-proliferation and differentiation into muscle fibers of these mouse muscle stem cells (MuSCs) was observed in vitro. Additionally, the mitochondrial function and mitochondrial ATP production capacity of MuSCs were measured by mitochondrial oxygen consumption.

Results

It was found that the 11β-HSD1 expression level was increased in age-related muscle atrophy. Overexpression of 11β-HSD1 led to muscle atrophy in young mice, and 11β-HSD1 knockout rescued age-related muscle atrophy. Moreover, CR in aged mice reduced the local effective concentration of glucocorticoid (GC) through 11β-HSD1, thereby promoting the mitochondrial function and differentiation ability of MuSCs.

Conclusions

Together, our findings highlight promising sarcopenia protection with 40% CR in older ages. Furthermore, we speculated that targeting an 11β-HSD1-dependent metabolic pathway may represent a novel strategy for developing therapeutics against age-related muscle atrophy.

Loss of Muscle Mass and Vulnerability in Institutionalized Older Adults

This study aimed to evaluate the association between muscle mass and vulnerability in institutionalized older adults. A cross-sectional study was carried out in eight philanthropic Long-Term Care Facilities (LTCF) located in the metropolitan area of Natal, Rio Grande do Norte, Brazil. The participants were individuals aged 60 years or older who were present in the institutions at the time of data collection. To assess muscle mass, the calf circumference was categorized into loss of muscle mass (<31 cm) and preserved muscle mass (≥31 cm). The vulnerability was assessed by The Vulnerable Elders Survey (VES-13). Of the 250 older adults evaluated, 46.1% presented loss of muscle mass, which was associated with the presence of physical limitation, vulnerability, and age group (p < 0.05). The presence of vulnerability was the main factor contributing to loss of muscle mass (R2 = 8.8%; B = 0.781; 95% CI 0.690−0.884; p < 0.001). Loss of muscle mass is associated with disability in institutionalized older adults.

Applying classification and regression tree analysis to identify risks of developing sarcopenia in the older population

BACKGROUND AND OBJECTIVE

Variations in the risk factors for sarcopenia can lead to differences in the likelihood of developing sarcopenia among older adults; however, few studies have explored the interactions among the risk factors. This study examined the interactions among risk factors and identified a discriminative pathway for groups at risk of sarcopenia in community-dwelling older adults.

METHODS

A cross-sectional study was conducted between July and August 2019 to recruit 200 older adults from an outpatient department of a hospital providing care for older people. Data on various risk factors, namely demographics (age, gender, education, comorbidities, and body mass index [BMI]), dietary habits (weekly consumption of milk, coffee, and meat), lifestyle behaviours (vitamin D supplementation, smoking, drinking, and physical activity), and depression symptoms were collected. Sarcopenia was defined according to the Asian Working Group for Sarcopenia criteria. A classification and regression tree (CART) model was used to examine interactions among these factors and identify groups at risk of sarcopenia.

FINDINGS

The prevalence of sarcopenia was 38.5%. The CART model identified two end groups at differential risks of sarcopenia, with a minimum of one and a maximum of three risk factors. In the first group, low BMI (<18.5 kg/m² ) was a predominant risk factor for sarcopenia among older people. In the second group, older adults with a normal BMI, aged ≥68 years, and without a regular walking habit had a higher probability of developing sarcopenia than did their counterparts.

CONCLUSIONS

The interactive effects among older age, BMI, and walking may cause different probabilities of developing sarcopenia in the older population.

IMPLICATIONS FOR PRACTICE

Older adults with a low or normal BMI but without a regular walking habit could be a predominant risk group for sarcopenia. The appropriate maintenance of body weight and regular walking activity is suggested to prevent sarcopenia in community-dwelling older adults.

Sarcopenia in chronic kidney disease: prevalence by different definitions and relationship with adiposity

This was a cross-sectional study with Chronic Kidney Disease (CKD) patients under non-dialysis-dependent (NDD), hemodialysis (HD) and kidney transplant (KTx) treatment aimed to evaluate the prevalence of sarcopenia using the European Working Group on Sarcopenia in Older People (EWGSOP2) and the Foundation of the National Institutes of Health (FNIH) guidelines; also analyze the relationship between sarcopenia and its components with body adiposity. Body composition was assessed by dual energy X-ray absorptiometry (DXA) and anthropometry. Bioelectrical impedance provided data of phase angle and body water. The prevalence of sarcopenia in total sample (n=243; 53% men, 48±10 y) was 7% by FNIH and 5% by EWGSOP2 criteria; and was low in each CKD group independently of the criteria applied (max 11% prevalence). Low muscle mass was present in 39% (FNIH) and 36% (EWGSOP2) and dynapenia in 10% of patients. Sarcopenic patients by EWGSOP2 criteria presented low body adiposity. Conversely, sarcopenic patients by FNIH presented high adiposity. This study suggests that in CKD (i) sarcopenia and low muscle mass prevalence varies according to the diagnostic criteria, (ii) are common conditions, (iii) association with body adiposity depends on the criteria used to define low muscle mass, (iv) FNIH criteria detected high adiposity in individuals with sarcopenia. Novelty bullets: Prevalence of sarcopenia and low muscle mass in CKD varied according to the diagnostic criteria; association of excess adiposity with sarcopenia and low muscle mass depends on muscle mass index applied; FNIH criteria detected higher adiposity in individuals with sarcopenia. NOVELTY BULLETS Prevalence of sarcopenia and low muscle mass in CKD varied according to the diagnostic criteria; Association of excess adiposity with sarcopenia and low muscle mass depends on muscle mass index applied; FNIH criteria detected higher adiposity in individuals with sarcopenia and low muscle mass.

Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review

This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives.

Associations of geriatric nutrition risk index and other nutritional risk-related indexes with sarcopenia presence and their value in sarcopenia diagnosis

Objective

Standard modalities recommended for sarcopenia diagnosis may be unavailable in primary care settings. We aimed to comprehensively evaluate and compare associations of some better popularized nutritional risk-related indexes with sarcopenia presence and their value in sarcopenia diagnosis in community-dwelling middle-aged and elderly adults, including geriatric nutrition risk index (GNRI), albumin (ALB), calf circumference (CC), mid-arm circumference (MAC), triceps skinfold thickness (TST) and body mass index (BMI).

Methods

Based on the West China Health and Aging Trend study, the current study included participants aged 50 or older who were recruited in 2018. Sarcopenia-related assessment and diagnosis were in line with Asian Working Group for Sarcopenia 2019. For each single index, we assessed its association with sarcopenia presence by univariate and multivariate logistic regression analysis; we also computed diagnostic measures including the area under the receiver operating characteristic curve (AUC) and sensitivity, specificity, accuracy at the optimal cut-off value determined according to Youden’s index.

Results

A total of 3829 subjects were included, consisting of 516 and 3313 subjects in the sarcopenia and non-sarcopenia groups, respectively. Regarding the risk for sarcopenia presence, the fully adjusted odds ratios of GNRI, ALB, CC, MAC, TST and BMI per standard deviation decrease were 2.95 (95% CI 2.51–3.47, P < 0.001), 1.01 (95% CI 0.90–1.15, P = 0.816), 4.56 (95% CI 3.82–5.44, P < 0.001), 4.24 (95% CI 3.56–5.05, P < 0.001), 1.67 (95% CI 1.92–1.45, P < 0.001) and 4.09 (95% CI 3.41–4.91, P < 0.001), respectively. Regarding the value in sarcopenia diagnosis in the entire study population, their AUCs could be ordered as MAC (0.85, 95% CI 0.83–0.86) > GNRI (0.80, 95% CI 0.78–0.82), CC (0.83, 95% CI 0.81–0.85), BMI (0.81, 95% CI 0.79–0.83) > TST (0.72, 95% CI 0.70–0.74) > ALB (0.62, 95% CI 0.60–0.65). At the relevant optimal cut-off values, the sensitivity was the highest for CC (0.83, 95% CI 0.80–0.87) and MAC (0.80, 95% CI 0.77–0.84), while GNRI showed the highest specificity (0.79, 95% CI 0.78–0.81) and accuracy (0.78, 95% 0.76–0.79).

Conclusion

Overall diagnostic performance was the best for MAC, followed by GNRI, CC, BMI, and the worst for TST, ALB in distinguishing sarcopenia from non-sarcopenia in middle-aged and elderly adults in community-based settings. CC or MAC might do better in reducing missed diagnosis, while GNRI was superior in reducing misdiagnosis.

Malnutrition–Sarcopenia Syndrome and Self-Management Behaviors in Continuing-Care Retirement Community Residents

Malnutrition–sarcopenia syndrome (MSS) might put older adults at higher risk for disability, frailty, and mortality. This study examined the prevalence and association of the self-management-process factors (i.e., self-efficacy and aging expectations) and behaviors (protein and caloric intake and sedentary and physical-activity behaviors) to MSS among older adults living in continuing care retirement communities (CCRCs). Using a cross-sectional correlational design, data of 96 CCRC residents (82.4 ± 7.4 years) were analyzed. Muscle mass, strength, function, nutritional status, sedentary time, physical activity levels, protein and caloric intake, self-efficacy for physical activity, aging expectations, and physical and mental health-related quality of life were measured. Results show that 36 (37.5%) had sarcopenia, 21 (21.9%) had malnutrition risk, 13 (13.4%) had malnutrition, and 12 (12.5%) had MSS. We also found that high time spent in sedentary behaviors (OR = 1.041; 95% CI: 1.011–1.071) was associated with higher odds of having MSS and high expectations regarding aging (OR = 0.896; 95% CI: 0.806–0.997) were associated with less likelihood of having MSS. Findings suggest that CCRC residents should be screened for MSS. Self-management interventions that consider the self-management-process factors are needed to prevent MSS and mitigate its negative outcomes among CRCC residents.

A poor appetite or ability to eat and its association with physical function amongst community-dwelling older adults: age, gene/environment susceptibility-Reykjavik study

A poor appetite or ability to eat and its association with physical function have not been explored considerably amongst community-dwelling older adults. The current study examined whether having an illness or physical condition affecting one's appetite or ability to eat is associated with body composition, muscle strength, or physical function amongst community-dwelling older adults. This is a secondary analysis of cross-sectional data from the age, gene/environment susceptibility-Reykjavik study (n = 5764). Illnesses or physical conditions affecting one's appetite or ability to eat, activities of daily living, current level of physical activity, and smoking habits were assessed with a questionnaire. Fat mass, fat-free mass, body mass index, knee extension strength, and grip strength were measured, and the 6-m walk test and timed up-and-go test were administered. Individuals who reported illnesses or physical conditions affecting their appetite or ability to eat were considered to have a poor appetite. The associations of appetite or the ability to eat with body composition and physical function were analysed with stepwise linear regression models. A total of 804 (14%) individuals reported having conditions affecting their appetite or ability to eat and had a significantly lower fat-free mass and body mass index, less grip strength, and poorer physical function than did those without any conditions affecting their appetite or ability to eat. Although the factors reported to affect one's appetite or ability to eat are seldom considered severe, their strong associations with physical function suggest that any condition affecting one's appetite or ability to eat requires attention.

Sarcopenia

Objective: To assess the prevalence of sarcopenia and associated factors among older women from the local community and older women living in Long-Term Care (LTC) institutions.Methods: A cross-sectional study conducted with 423 older women aged 60 or more, from the local community and older women aged 60 or more, living in LTC institutions. Sarcopenia was defined, according to the consensus of the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), including three criteria: low muscle strength (LMS) (<16kg); low muscle mass (LMM) (≤6.75kg/m2) assessed by a skeletal muscle mass index, and low physical performance (LPP) (≤0,8m/s) assessed by gait speed test. Older women who only showed LMS were considered to have pre-sarcopenia, those with LMS associated with LMM were diagnosed with sarcopenia and those who met all three criteria, were diagnosed with severe sarcopenia.Results: Among the community-dwelling older women, the prevalence of sarcopenia was 2.0% (from 60 to 69), 8.6% (from 70 to 79) and 12.9% (80 or more) and among the ones living in LTC Institutions, 3.3% (from 60 to 69), 14.8% (from 70 to 79) and 34.2% (80 or more). After multivariate logistic regression, age and low body mass index (BMI) were associated with sarcopenia in both groups.Conclusion: The prevalence of sarcopenia is higher among LTC older women. However, this is not an independent factor. In addition, regardless of residence, low BMI and advanced age are predictive for sarcopenia.

The association between body composition and quality of life among elderly Italians

OBJECTIVE

This study aimed to assess the body composition and quality of life in elderly Italian people and to value the association between these variables.

METHODS

Height, weight, humerus breadth, circumferences, skinfolds, and hand grip strength were measured in 256 older adults (age: M: 81.1 ± 7.3, F: 84.9 ± 8.1 years). Body mass index, waist-hip ratio, waist-height ratio, upper-arm areas, and body composition parameters were calculated. Quality of life (QoL) was measured by WHO Quality of Life-BREF questionnaire (WHOQOL-BREF). Differences between sexes were valued. A multiple regression analysis was carried out to assess the influence of nutritional status and of socio-demographic characteristics on QoL.

RESULTS

The participants were in average overweight. Even if the percentage of overweight/obese subjects was high in both sexes, males presented a more centripetal fat distribution. These characteristics, joined to data regarding lower values of arm-muscle area and hand grip strength, put males at greater risk of cardiometabolic diseases. Regarding quality of life assessments, psychological domain showed the worst scores, and, marital status resulted the main explanatory variable for this domain.

CONCLUSIONS

Social care facilities for the elderly people require planning strategies based on health promotion criteria in order to accentuate active ageing interventions to ameliorate the quality of life of residents.

Sarcopenia, nutritional status and type 2 diabetes mellitus: A cross-sectional study in a group of Mexican women residing in a nursing home

AIM

To evaluate the prevalence of sarcopenia and its association with nutritional status and type 2 diabetes mellitus (T2DM) in older women living in a nursing home.

METHODS

This cross-sectional study assessed nutritional status using the Mini Nutritional Assessment (MNA). Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People; hand grip strength and physical performance were determined by dynamometry and gait speed, respectively. Muscle mass was assessed using calf circumference.

RESULTS

The mean age of the 114 participants was 84.1 ± 7.0 years. The prevalence of sarcopenia and T2DM was 30.7% and 10.5%, respectively. The majority (66.7%) had a normal nutritional status, 29.8% were at risk of malnutrition, and 3.5% were undernourished. The prevalence of sarcopenia in participants at risk of malnutrition and those who were undernourished was higher compared with participants with a normal NS (P < 0.0001). A statistically significant difference was observed in the Barthel Index (BI) between women with and without sarcopenia (P = 0.048). The multivariate logistic regression model, adjusted by age (p = 0.007) showed an association between sarcopenia and nutritional status. Women with a poor nutritional status were more likely to have sarcopenia (OR 4.97, P = 0.003) whilst those with T2DM showed a higher probability of sarcopenia (OR 5.52, P = 0.019) than women without T2DM.

CONCLUSIONS

Sarcopenia was highly prevalent in women with a poor nutritional status and T2DM. It is necessary to implement intervention programs to reduce adverse outcomes.

Prevalence and Diagnosis of Sarcopenia in Residential Facilities: A Systematic Review

Assessing sarcopenia, the age-related loss of muscle mass and function, in institutionalized older adults is a challenging task. Data on its prevalence in residential facilities are scant and highly variable. Our objective was to report the prevalence of sarcopenia in older adults living in residential facilities (nursing/long term-care homes and assisted-living facilities) and review the criteria and methodologies used to diagnose sarcopenia in this setting. Bibliographic searches were carried out in 6 electronic databases (Medline via PubMed, Web of Science, Scopus, CINAHL, LILACS, and Cochrane) with the use of the Medical Subject Heading terms "Sarcopenia" and "Residential Facilities." We included studies that evaluated the prevalence of sarcopenia among older adults (aged ≥60 y) living in residential facilities. Forty-four studies were identified, of which 21 studies were included after applying eligibility criteria. The reported prevalence of sarcopenia ranged widely between 17.7% and 73.3% in long term-care homes and between 22% and 87% in assisted-living facilities. Most studies (n = 14) followed the consensus on sarcopenia diagnosis published by the European Working Group on Sarcopenia in Older People. In the other 7 studies, sarcopenia was diagnosed according to muscle mass, which was measured via 5 different techniques, most frequently bioelectrical impedance analysis, establishing cutoff scores for low muscle mass with the use of 5 different indexes, most frequently the skeletal muscle index. There are major differences in study design, methodology, and the approach to sarcopenia diagnosis in this setting, which would, in part, explain the enormous variability in the reported prevalence data. The lack of consensus on the correct diagnostic approach hampers the implementation of appropriate nutritional interventions.

Prevalence and Associated Factors of Sarcopenia in Nursing Home Residents: A Systematic Review and Meta-analysis

OBJECTIVE

To review the prevalence and associated factors of sarcopenia in nursing homes.

DESIGN

A systematic review and meta-analysis of published studies in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials.

SETTING

Nursing homes.

PARTICIPANTS

Older adults aged ≥60 years.

MEASUREMENTS

Sarcopenia was defined according to various validated diagnostic criteria, such as the European Working Group on Sarcopenia in Older People (EWGSOP) criteria and skeletal muscle index (SMI). We performed meta-analyses with random effects models to calculate the pooled prevalence of sarcopenia. The risk of bias of the included studies was evaluated using a 10-item tool explicitly designed for prevalence studies.

RESULTS

We included 16 studies with a total of 3585 participants from 129 nursing homes. The included studies were of low to moderate risk of bias. The pooled prevalences of EWGSOP-defined sarcopenia and SMI-defined sarcopenia were 41% [95% confidence interval (CI) 32%-51%, 12 studies, 2685 cases] and 59% (95% CI 24%-93%, 3 studies, 643 cases), respectively. The pooled prevalences of EWGSOP-defined sarcopenia in women and men were 46% (8 studies, 1332 cases) and 43% (8 studies, 739 cases), respectively. The pooled data showed that malnutrition was an independent associated factor of EWGSOP-defined sarcopenia (odds ratio [OR] 1.74, 95% CI 1.36-2.24; 3 studies, 718 cases), but malnutrition risk (OR 1.01, 95% CI 0.53-1.94; 2 studies, 379 cases) and female gender were not (OR 1.14, 95% CI 0.11-11.66; 3 studies, 827 cases). The association between age and body mass index with sarcopenia was inconsistent across studies. Limited evidence indicated that smoking might be related to sarcopenia.

CONCLUSIONS/IMPLICATIONS

Sarcopenia is highly prevalent in older nursing home residents. Malnutrition may be an associated factor of sarcopenia. More prospective studies are needed to clarify the association between age, gender, malnutrition, and smoking with sarcopenia.