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Kandayah T, Safian N, Azhar Shah S, Abdul Manaf MR. Challenges in the Management of Sarcopenia in the Primary Care Setting: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5179. [PMID: 36982085 PMCID: PMC10049082 DOI: 10.3390/ijerph20065179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Sarcopenia is a disease associated with the loss of muscle mass, strength, and function. It affects the elderly in various ways, such as reduced mobility, compromising their daily activities, and even deteriorating metabolic health. Primary care serves as the first point of contact for patients and plays an important role in health promotion and disease prevention. Hence, this review is conducted to identify the challenges in the management of sarcopenia in the primary care setting. METHOD In December 2022, a scoping review was conducted using PubMed, SCOPUS, Web of Science, and a manual search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. We used articles that have been written in English, and relevant articles were then screened, duplicates were removed, eligibility criteria were applied, and studies that met the criteria were reviewed. The keywords challenges, management, sarcopenia, and primary care were included. RESULT The initial search generated 280 publications, and 11 articles were included after inclusion and exclusion criteria for this review. In this review, challenges in the management of sarcopenia in a primary care setting are reviewed based on the screening and diagnosis. CONCLUSIONS With an increasing aging population, it is important to understand the challenges in the management of sarcopenia in a primary care setting. Identification of elderly at risk of sarcopenia, followed by referring the affected elderly for confirmation of the diagnosis, is essential to preventing the adverse health effects. The initiation of treatment that comprises resistance exercise training and nutrition should not be delayed, as they are salient in the management of sarcopenia.
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Swan L, Martin N, Horgan NF, Warters A, O’Sullivan M. Assessing Sarcopenia, Frailty, and Malnutrition in Community-Dwelling Dependant Older Adults-An Exploratory Home-Based Study of an Underserved Group in Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16133. [PMID: 36498213 PMCID: PMC9736424 DOI: 10.3390/ijerph192316133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Adults of advanced age, with functional dependency, socioeconomic disadvantage, or a need for home care, are expected to be at high risk of sarcopenia, frailty and malnutrition, yet are likely to be underrepresented in research. We aimed to explore the assessment of sarcopenia, frailty, and malnutrition in-home, and to describe the practicality of performing these assessments. METHODS Home-based health assessments and post-study feedback surveys were conducted among community-dwelling older adults ≥65 years in receipt of state-funded home care (n = 31). Assessments included probable sarcopenia [hand-grip strength (HGS), chair rise-test, and SARC-F case-finding tool], the Mini Nutritional Assessment (MNA), and the Clinical Frailty Scale (CFS). RESULTS The study group was of mean age 83.2 ± 8.2 years, 74% were female and 23% lived in socioeconomically disadvantaged areas. Almost all met the criteria for probable sarcopenia (94%, n = 29/31), were frail or vulnerable by the CFS (97%, n = 30/31), and over a quarter were at risk of malnutrition (26%, n = 8). Participants had low physical activity (71.0%, n = 22/31), with a mean daytime average of 11.4 ± 1.6 h spent sitting. It was possible to assess probable sarcopenia (by HGS and SARC-F, but not the chair rise test), malnutrition (MNA), and frailty (CFS). Home-based research was a complex environment, and unearthed significant unmet need, prompting referrals to health services (36%, n = 11), in addition to technology assistance. The majority of participants (93%) reported a willingness to partake in future research. CONCLUSIONS Most community-dwelling older people in receipt of home support, assessed in this exploratory study, were at risk of probable sarcopenia, frailty, and low physical activity, with over a quarter were at risk of malnutrition. Our initial findings provide practical data for large scale studies and may inform the development of intervention studies aiming to support ageing in place.
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Affiliation(s)
- Lauren Swan
- Department of Clinical Medicine, Trinity College, D02 PN40 Dublin, Ireland
| | - Niamh Martin
- Older Person Services CHO9, Health Service Executive (HSE), D09 C8P5 Dublin, Ireland
| | - N Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland
| | - Austin Warters
- Older Person Services CHO9, Health Service Executive (HSE), D09 C8P5 Dublin, Ireland
| | - Maria O’Sullivan
- Department of Clinical Medicine, Trinity College, D02 PN40 Dublin, Ireland
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Rennie KJ, Witham M, Bradley P, Clegg A, Connolly S, Hancock HC, Hiu S, Marsay L, McDonald C, Robertson L, Simms L, Steel AJ, Steves CJ, Storey B, Wason J, Wilson N, von Zglinicki T, Sayer AAP. MET-PREVENT: metformin to improve physical performance in older people with sarcopenia and physical prefrailty/frailty - protocol for a double-blind, randomised controlled proof-of-concept trial. BMJ Open 2022; 12:e061823. [PMID: 35851031 PMCID: PMC9297211 DOI: 10.1136/bmjopen-2022-061823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/19/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Skeletal muscle dysfunction is central to both sarcopenia and physical frailty, which are associated with a wide range of adverse outcomes including falls and fractures, longer hospital stays, dependency and the need for care. Resistance training may prevent and treat sarcopenia and physical frailty, but not everyone can or wants to exercise. Finding alternatives is critical to alleviate the burden of adverse outcomes associated with sarcopenia and physical frailty. This trial will provide proof-of-concept evidence as to whether metformin can improve physical performance in older people with sarcopenia and physical prefrailty or frailty. METHODS AND ANALYSIS MET-PREVENT is a parallel group, double-blind, placebo-controlled proof-of-concept trial. Trial participants can participate from their own homes, including completing informed consent and screening assessments. Eligible participants with low grip strength or prolonged sit-to-stand time together with slow walk speed will be randomised to either oral metformin hydrochloride 500 mg tablets or matched placebo, taken three times a day for 4 months. The recruitment target is 80 participants from two secondary care hospitals in Newcastle and Gateshead, UK. Local primary care practices will act as participant identification centres. Randomisation will be performed using a web-based minimisation system with a random element, balancing on sex and baseline walk speed. Participants will be followed up for 4 months post-randomisation, with outcomes collected at baseline and 4 months. The primary outcome measure is the four metre walk speed at the 4-month follow-up visit. ETHICS AND DISSEMINATION The trial has been approved by the Liverpool NHS Research Ethics Committee (20/NW/0470), the Medicines and Healthcare Regulatory Authority (EudraCT 2020-004023-16) and the UK Health Research Authority (IRAS 275219). Results will be made available to participants, their families, patients with sarcopenia, the public, regional and national clinical teams, and the international scientific community. TRIAL REGISTRATION NUMBER ISRCTN29932357.
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Affiliation(s)
- Katherine J Rennie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Miles Witham
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Penny Bradley
- Pharmacy Directorate, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | - Andrew Clegg
- Academic Unit of Elderly Care & Rehabilitation, University of Leeds, Bradford, UK
| | - Stephen Connolly
- Patient and Public Involvement Representative, Newcastle upon Tyne, UK
| | - Helen C Hancock
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Shaun Hiu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Leanne Marsay
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | | | - Laura Robertson
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Simms
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Alison J Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | | | - Bryony Storey
- Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - James Wason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Avan A P Sayer
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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4
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Witham MD, Heslop P, Dodds RM, Clegg AP, Hope SV, McDonald C, Smithard D, Storey B, Tan AL, Thornhill A, Sayer AA. Performance of the SarQoL quality of life tool in a UK population of older people with probable sarcopenia and implications for use in clinical trials: findings from the SarcNet registry. BMC Geriatr 2022; 22:368. [PMID: 35477354 PMCID: PMC9043890 DOI: 10.1186/s12877-022-03077-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Sarcopenia Quality of Life (SarQoL) questionnaire is a disease-specific sarcopenia quality of life tool. We aimed to independently assess SarQoL with a particular focus on its suitability as a clinical trial outcome measure. Methods We analysed data from the UK Sarcopenia Network and Registry. Measures of physical performance and lean mass were collected at baseline. SarQoL and the Strength, Assistance, Rise, Climb - Falls (SARC-F) questionnaire (to assess functional ability) were collected at both baseline and six-month follow-up. Global changes in fitness and quality of life at 6 months were elicited on seven-point Likert scales. Internal consistency was assessed using Cronbach’s alpha. Responsiveness (Cohen’s d and Guyatt coefficients) and minimum clinically important differences were calculated for participants reporting slight improvement or worsening in their global scores. Concurrent validity was assessed by correlating baseline SarQoL scores with measures of physical performance and functional ability. Results We analysed data from 147 participants, 125 of whom underwent follow up assessment; mean age 78 years; 72 (49%) were women. Internal consistency was good; Cronbach’s alpha was 0.944 at baseline and 0.732 at telephone follow-up. Correlation between baseline and follow-up SarQoL was weak (r = 0.27; p = 0.03). The minimum clinically important improvement ranged from 5 to 21 points giving trial sample size estimates of 25–100 participants. SarQoL scores were moderately correlated with handgrip (r = 0.37; p < 0.001), SARC-F (r = − 0.45; p < 0.001), short physical performance battery (r = 0.48; p < 0.001) and 4-m walk speed (r = 0.48; p < 0.001). Conclusions SarQoL has acceptable performance in older UK participants with probable sarcopenia and is sufficiently responsive for use in clinical trials for sarcopenia.
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Affiliation(s)
- Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
| | - Philip Heslop
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Richard M Dodds
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Andrew P Clegg
- Academic Unit for Ageing and Stroke Research, University of Leeds, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Suzy V Hope
- College of Medicine and Health, University of Exeter, and Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Claire McDonald
- Department of Geriatrics, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - David Smithard
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust and University of Greenwich, London, UK
| | - Bryony Storey
- Department of Geriatrics, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Anna Thornhill
- Academy of Research and Improvement, Solent NHS Trust, Portsmouth, UK
| | - Avan A Sayer
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
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Dodds RM, Heslop P, Jaffar J, Davies K, Noble JM, Shaw FE, Witham MD, Sayer AA. The assessment of sarcopenia and the frailty phenotype in the outpatient care of older people: implementation and typical values obtained from the Newcastle SarcScreen project. Eur Geriatr Med 2022; 13:763-769. [PMID: 35404041 PMCID: PMC8995690 DOI: 10.1007/s41999-022-00641-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/23/2022] [Indexed: 12/17/2022]
Abstract
Aim Is it possible to implement the Newcastle SarcScreen, an assessment of sarcopenia and physical frailty, as part of the outpatient care of older people? Findings Grip strength measurement was possible in 98.2% and gait speed in 82.1%, with the latter typically not measured due to mobility impairment. We found a high prevalence of probable sarcopenia and the frailty phenotype across all age groups studied. Message We successfully implemented the Newcastle SarcScreen. The proforma is available to download as part of this article. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00641-5. Purpose Sarcopenia and the frailty phenotype both indicate older adults at risk of adverse health outcomes and yet are not widely assessed in practice. We developed the Newcastle SarcScreen to enable assessment of these two ageing syndromes during clinical care. In the setting of our Older People’s Medicine Day Unit, our aims were to describe the implementation of the SarcScreen and to examine the typical values obtained. Methods The SarcScreen comprised height, weight, questions (three on the Fried frailty phenotype and five on the SARC-F questionnaire), grip strength and gait speed. We analysed data from 552 patients completing the SarcScreen. We expressed grip strength as Z-scores (number of standard deviations above the mean expected for a patient’s age and sex). Results It was possible to implement the SarcScreen. In 552 patients (65.9% females) with mean age 80.1 (7.7) years, grip strength was feasible in 98.2% and gait speed in 82.1%. Gait speed was typically not assessed due to mobility impairment. Most patients had weak grip strength (present in 83.8%), slow gait speed (88.8%) and the frailty phenotype (66.2%). We found a high prevalence of probable sarcopenia and the frailty phenotype across all age groups studied. This was reflected by low grip strength Z-scores, especially at younger ages: those aged 60–69 had grip strength 2.7 standard deviations (95% CI 2.5–2.9) below that expected. Conclusion It is possible to implement an assessment of sarcopenia and the frailty phenotype as part of the routine outpatient care of older people. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00641-5.
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Affiliation(s)
- R M Dodds
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research, Newcastle, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle Upon Tyne NHS Foundation Trust, 3rd Floor Biomedical Research Building, Campus for Ageing and Vitality, Newcastle, NE4 5PL, UK
- Department of Older People's Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - P Heslop
- School of Design, Northumbria University, Newcastle, UK
| | - J Jaffar
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research, Newcastle, UK
| | - K Davies
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research, Newcastle, UK
| | - J M Noble
- Department of Older People's Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - F E Shaw
- Department of Older People's Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - M D Witham
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research, Newcastle, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle Upon Tyne NHS Foundation Trust, 3rd Floor Biomedical Research Building, Campus for Ageing and Vitality, Newcastle, NE4 5PL, UK
- Department of Older People's Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - A A Sayer
- AGE Research Group, Newcastle University Institute for Translational and Clinical Research, Newcastle, UK.
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle Upon Tyne NHS Foundation Trust, 3rd Floor Biomedical Research Building, Campus for Ageing and Vitality, Newcastle, NE4 5PL, UK.
- Department of Older People's Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.
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Laskou F, Bevilacqua G, Westbury LD, Bloom I, Aggarwal P, Cooper C, Patel HP, Dennison E. A study of diet in older community-dwelling adults in the UK during the COVID-19 pandemic: Findings from the Southampton Longitudinal Study of Ageing (SaLSA). Front Nutr 2022; 9:988575. [PMID: 36712533 PMCID: PMC9880198 DOI: 10.3389/fnut.2022.988575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction Adequate nutrition is important for health in later life. Older adults are especially vulnerable to adverse outcomes following infection by COVID-19 and have commonly spent a disproportionate time within their own homes to reduce risk of infection. There are concerns that advice to shield may have led to malnutrition as older adults may modify daily routines including usual shopping habits. The aims of this study were to report self-reported pandemic-related changes in diet and examine lifestyle and medical correlates of these changes in older UK community-dwelling adults. Methods We recruited 491 participants from the city of Southampton, UK. Participants completed a postal questionnaire in summer/autumn 2021, over a year after the first UK national lockdown was announced. The questionnaire ascertained demographic and lifestyle factors, in addition to number of comorbidities, nutrition risk scores, and presence of frailty. Associations between these participant characteristics in relation to self-reported changes in diet quality (lower, similar or higher when compared to before the first lockdown) were examined using ordinal logistic regression. Results Median (lower quartile, upper quartile) age was 79.8 (77.0, 83.7) years. Overall, 11 (4.9%) men and 25 (9.4%) women had poorer diet quality compared to before the first UK lockdown. The following participant characteristics were associated with increased risk of being in a worse category for change in diet quality after adjustment for sex: lower educational attainment (p = 0.009); higher BMI (p < 0.001); higher DETERMINE (a malnutrition assessment) score (p = 0.004); higher SARC-F score (p = 0.013); and self-reported exhaustion in the previous week on at least 3 days (p = 0.002). Conclusions Individuals at higher nutritional risk were identified as reporting increased risk of deterioration in diet quality during the pandemic. Further investigation of the factors leading to these changes, and an understanding of whether they are reversible will be important, especially for future pandemic management.
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Affiliation(s)
- Faidra Laskou
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Gregorio Bevilacqua
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Leo D Westbury
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Ilse Bloom
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Harnish P Patel
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Medicine for Older People, University Hospital Southampton, Southampton, United Kingdom
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
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Yin L, Song C, Cui J, Wang N, Fan Y, Lin X, Zhang L, Zhang M, Wang C, Liang T, Ji W, Liu X, Li W, Shi H, Xu H. Low fat mass index outperforms handgrip weakness and GLIM-defined malnutrition in predicting cancer survival: Derivation of cutoff values and joint analysis in an observational cohort. Clin Nutr 2021; 41:153-164. [PMID: 34883304 DOI: 10.1016/j.clnu.2021.11.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS The optimal thresholds to define a survival-related low fat mass index (FMI) in Asian oncology populations remains largely unknown. This study sought to derive the sex-specific FMI cutoffs and analyze the independent and joint associations of a low FMI, handgrip weakness, and the Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition with cancer survival. METHODS We performed a multicenter cohort study including 2376 patients with cancer. The FMI was measured by bioelectrical impedance analysis and the best thresholds were determined using an optimal stratification (OS) method. Low handgrip strength (HGS) and malnutrition were defined based on the Asian Working Group for Sarcopenia 2019 framework and the GLIM, respectively. The associations of a low FMI, handgrip weakness and malnutrition with survival were estimated independently and jointly by calculating multivariable-adjusted hazard ratios (HRs). RESULTS The study enrolled 1303 women and 1073 men with a mean age of 57.7 years and a median follow-up of 1267 days. The OS-defined FMI cutoffs were <5 kg/m2 in women and <7.7 kg/m2 in men. A low FMI, low HGS and malnutrition were identified in 1188 (50%), 1106 (46.5%) and 910 (38.3%) patients, respectively. A low FMI was adversely associated with the nutritional status, physical performance, quality of life and hospitalization costs. A low FMI (HR = 1.50, 95%CI = 1.16 to 1.92) and malnutrition (HR = 1.31, 95%CI = 1.08 to 1.59) were independently associated with mortality. Overall, the FMI plus GLIM-defined malnutrition showed the maximal joint prognostic impact, and patients with a combined low FMI and malnutrition had the worst survival (HR = 1.93, 95%CI = 1.48 to 2.52). CONCLUSIONS Low FMI-indicated fat depletion outperforms and strengthens the prognostic value of handgrip weakness and GLIM-defined malnutrition for cancer survival. These findings indicate the importance of including fat mass assessment during routine cancer care to help guide strategies to optimize survival outcomes.
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Affiliation(s)
- Liangyu Yin
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China; Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Chunhua Song
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China
| | - Jiuwei Cui
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Nanya Wang
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Yang Fan
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China
| | - Xin Lin
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China
| | - Ling Zhang
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China
| | - Mengyuan Zhang
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China
| | - Chang Wang
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Tingting Liang
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Wei Ji
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Xiangliang Liu
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Wei Li
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin, 130021, China.
| | - Hanping Shi
- Department of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
| | - Hongxia Xu
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China.
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Hurst C, Murray JC, Granic A, Hillman SJ, Cooper R, Sayer AA, Robinson SM, Dodds RM. Long-term conditions, multimorbidity, lifestyle factors and change in grip strength over 9 years of follow-up: Findings from 44,315 UK biobank participants. Age Ageing 2021; 50:2222-2229. [PMID: 34657960 PMCID: PMC8581389 DOI: 10.1093/ageing/afab195] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/06/2021] [Indexed: 01/28/2023] Open
Abstract
Background Weak grip strength is associated with a range of adverse health outcomes and an accelerated decline in grip strength confers an even greater risk. The factors associated with change in grip strength in mid-life remain to be fully determined. Methods We used data from 44,315 UK Biobank participants who had grip strength measured at baseline (2006-10) and a subsequent visit approximately nine years later. At baseline, participants’ long-term conditions (LTCs) were categorised against a hierarchy, with multimorbidity characterised by the number of LTC categories. Lifestyle factors were assessed. Change in grip strength was grouped into four patterns: decline, stable low, stable high or reference (no change or increase) and used as the outcome in multinomial logistic regression. Results Most LTC categories were associated with adverse patterns of change in grip strength (stable low and/or decline): for example, musculoskeletal/trauma conditions were associated with an increased risk of the stable low pattern (Relative Risk Ratio [RRR] = 1.63; 95% confidence interval [CI]: 1.49-1.79). Multimorbidity and lifestyle factors had independent associations with grip strength change. Those with 3+ categories of LTCs were more likely to experience decline in grip strength (RRR = 1.18; 95% CI: 1.08-1.28) compared to those with none. Low physical activity was associated with adverse patterns of grip strength, while raised body mass index (BMI) had divergent associations. Conclusions Individuals living with multimorbidity and those with lifestyle risk factors such as low physical activity are at increased risk of low muscle strength and the loss of strength over time.
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Affiliation(s)
- Christopher Hurst
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE4 5PL, UK
| | - James C Murray
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE4 5PL, UK
| | - Antoneta Granic
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE4 5PL, UK
| | - Susan J Hillman
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE4 5PL, UK
| | - Rachel Cooper
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester M1 5GD, UK
| | - Avan Aihie Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE4 5PL, UK
| | - Sian M Robinson
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE4 5PL, UK
| | - Richard M Dodds
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne NE4 5PL, UK
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