Prevalence of sarcopenia in older Chinese adults: a systematic review and meta-analysis

The association of social isolation and loneliness with sarcopenia among the middle-aged and elderly in China

OBJECTIVES

This study examined the relationship of social isolation and loneliness on sarcopenia among Chinese middle-aged and elderly people.

METHODS

Social isolation, loneliness, and sarcopenia were measured at baseline. Follow-up measures of new-onset sarcopenia were obtained 4 years later. Then used logistic regression to evaluate the association between social isolation, loneliness and sarcopenia.

RESULTS

In cross-sectional analysis, social isolation and loneliness are significantly associated with sarcopenia [OR = 1.88 (95% CI = 1.54-2.28)]. In longitudinal analysis, social isolation and loneliness are significantly associated with sarcopenia [OR = 1.09 (95% CI = 0.71-1.69)]. Social isolation and loneliness have a synergistic effect. Among them, individuals over 60 years old [OR = 2.01 (95% CI = 1.37-2.96)] and those without social support [OR = 2.64 (1.61-4.32), P-for interaction < 0.001] are at higher risk.

CONCLUSION

Social isolation and loneliness were significantly associated with sarcopenia, and there was a synergistic effect between social isolation and loneliness.

Prevalence and associated risk factors of sarcopenia in community-dwelling older adults in Pakistan: a cross-sectional study

BACKGROUND

Advancements in medical facilities have led to an increase in global life expectancy, emphasizing the need to address age-related health issues. Sarcopenia, characterized by muscle mass loss, poses significant challenges for older adults. Despite a higher prevalence in Asian populations, there is a remarkable absence of studies addressing sarcopenia among the older adults in Pakistan. This research aims to determine sarcopenia prevalence, identify risk factors, and explore gender- and age-specific patterns among older adults in Pakistan.

METHODS

A cross-sectional study involving 142 participants (65 males, 77 females) aged 60 and above was conducted using DEXA scans. Over a six-month period from January to June 2023, data were collected from the Islamabad Diagnostic Centre. This comprehensive dataset covered anthropometric measurements, body composition details, and health parameters. Statistical analyses, including logistic regression, were employed to examine the associations between sarcopenia and various factors.

RESULTS

Sarcopenia manifested in 47.18% of the older adult population (n = 142), with a distribution of 39 males (60%) and 28 females (36.36%). The investigation unveiled a compelling correlation between underweight status and sarcopenia across genders. Indeed, males exhibited a significant negative correlation between skeletal muscle mass index and age, whereas females did not show a statistically significant association. Males presented higher odds of sarcopenia in comparison to females (Odds Ratio [OR] = 2.63, 95% Confidence Interval [CI]: 1.33-5.18, p = 0.005). Age (OR = 1.12, 95% CI: 1.02-1.22, p = 0.014), lower BMI (OR = 0.35, 95% CI: 0.20-0.60, p < 0.001), and reduced body fat percentage (OR = 1.75, 95% CI: 1.31-2.33, p < 0.001) emerged as significant contributors to sarcopenia. These detailed gender-specific findings emphasize the importance of customizing intervention strategies to address gender disparities in sarcopenia risk factors.

CONCLUSION

This study highlights the significant prevalence of sarcopenia among older adults in Pakistan, with distinct gender and age-related patterns observed. The overall prevalence of sarcopenia was found to be 47.18%, with higher rates among males compared to females. Age emerged as a significant risk factor, with each additional year increasing the odds of sarcopenia. Furthermore, weight, BMI, lean mass, and total body fat demonstrated important associations with sarcopenia prevalence, highlighting the multifaceted nature of this condition. The practical implications of this study emphasize the need for targeted screening programs and personalized interventions to mitigate sarcopenia's impact, informing healthcare policies and public health strategies in Pakistan.

Association of High-Density Lipoprotein Cholesterol with Sarcopenia in Chinese Community-Dwelling Middle-Aged and Older Adults: Evidence from 4-Year Longitudinal Study

INTRODUCTION

There is inconsistent evidence on the associations between high-density lipoprotein cholesterol (HDL-C) and risk of sarcopenia. The aim of the study was to determine the evidence existing between HDL-C and sarcopenia in Chinese middle-aged and older adults.

METHODS

We used a panel study design of the China Health and Retirement Longitudinal Study (CHARLS), with 7,415 participants (mean age 57.5 years) from 2011, 2013, and 2015. HDL-C was measured by colorimetric test of venous serum samples. Sarcopenia was defined as low muscle mass, plus low muscle strength, or low physical performance. Muscle mass was estimated by anthropometric measures. Muscle strength was measured by handgrip strength using dynamometer. Physical performance was measured by 5-time chair stand test, gait speed test, and short physical performance battery.

RESULTS

With 961 (13.0%) sarcopenia cases, each 1-unit increase (1 SD = 15.4 mg/dL) of HDL-C levels was associated with 42% increased odds of incident sarcopenia (OR = 1.42, 95% confidence interval [CI] = 1.28-1.58) at 4-year follow-up. Females with high HDL-C levels (HDL-C >60 mg/dL) had a higher risk of sarcopenia (OR = 2.49, 95% CI = 1.76-3.52). The restricted cubic spline curves showed a J-shaped association between HDL-C and risk of sarcopenia in females. HDL-C was negatively associated with muscle mass (β = -0.23, 95% CI = -0.27 to -0.20) and hand grip strength (β = -0.05, 95% CI = -0.19 to 0.09).

CONCLUSION

High HDL-C levels were associated with higher risk of sarcopenia among middle-aged and older Chinese adults, and appropriate control of its high levels informs the management of sarcopenia.

Abnormal sleep duration is associated with sarcopenia in older Chinese people: A large retrospective cross-sectional study

Aim

Abnormalities in sleep patterns are a common health problem for the older adults. The relationship between sarcopenia and sleep duration in older people is controversial. This research is to examine the association between sleep duration and sarcopenia.

Methods

We drew 21,095 adults from the China Health and Retirement Longitudinal Survey (CHARLS). Not only we explore the relationship between sleep duration and sarcopenia, but also compare sleep duration to three sarcopenia subcomponents. Moreover, the sensitivity analysis was conducted by the gender and residence area to ascertain the discrepancy, separately. Finally, using restricted cubic spline to find the non-linear association between them.

Results

Among 7,342 community older adults engaged by CHARLS in 2015, the incidence of possible sarcopenia and sarcopenia was 23.14 and 11.30%, separately. Sleep duration (≤6 h) [OR(95%CI) = 1.30(1.03-1.65), p < 0.05] and (≥8 h) [OR(95%CI) = 1.33(1.05-1.69), p < 0.05] were significantly linked with possible sarcopenia, while long sleep duration (≥8 h) [OR(95%CI) = 1.41(1.01-2.02), p < 0.05] was correlated strongly with sarcopenia. A non-linear relationship (U-shaped) between sarcopenia risk and sleep duration was found (p for non-linear = 0.009).

Conclusions

Our findings highlight the importance of sleep duration in the onset of sarcopenia and might assist older persons to maintain good sleeping habits.

Relationship between skeletal muscle mass loss and metabolic dysfunction-associated fatty liver disease among Chinese patients with metabolic dysregulation

OBJECTIVE

The aim of this study was to explore the correlation between skeletal muscle content and the presence and severity of metabolic dysfunction-associated fatty liver disease in patients with metabolic dysregulation in China.

METHODS

A cross-sectional study was conducted among patients from the endocrinology outpatient department at Ningbo First Hospital, in Ningbo, China, in April 2021. Adult patients with metabolic dysregulation who accepted FibroScan ultrasound were included in the study. However, those without clinical data on skeletal muscle mass were excluded. FibroScan ultrasound was used to noninvasively evaluate metabolic dysfunction-associated fatty liver disease. The controlled attenuation parameter was used as an evaluation index for the severity of liver steatosis. Bioelectrical impedance analysis was used to measure the skeletal muscle index.

RESULTS

A total of 153 eligible patients with complete data were included in the final analysis. As the grading of liver steatosis intensifies, skeletal muscle index decreases (men: Ptrend<0.001, women: Ptrend=0.001), while body mass index, blood pressure, blood lipid, uric acid, aminotransferase, and homeostatic model assessment of insulin resistance increase (Ptrend<0.01). After adjusting for confounding factors, a negative association between skeletal muscle index and the presence of metabolic dysfunction-associated fatty liver disease was observed in men (OR=0.691, p=0.027) and women (OR=0.614, p=0.022). According to the receiver operating characteristic curve, the best cutoff values of skeletal muscle index for predicting the metabolic dysfunction-associated fatty liver disease presence were 40.37% for men (sensitivity, 87.5%; specificity, 61.5%) and 33.95% for women (sensitivity, 78.6%; specificity, 63.8%).

CONCLUSION

Skeletal muscle mass loss among patients with metabolic dysregulation was positively associated with metabolic dysfunction-associated fatty liver disease severity in both sexes. The skeletal muscle index cutoff value could be used to predict metabolic dysfunction-associated fatty liver disease.

Alterations in the diversity, composition and function of the gut microbiota in Uyghur individuals with sarcopenia

BACKGROUND

Research on the gut microbiota has emerged as a new direction for understanding pathophysiologic changes in diseases associated with aging, such as sarcopenia. Several studies have shown that there are differences in the gut microbiota between individuals with sarcopenia and without sarcopenia. However, these differences are not consistent across regions and ethnic groups, and additional research is needed.

METHODS

In this study, we collected fresh fecal samples from 31 Uyghur individuals with sarcopenia and 31 healthy controls. We used 16S rRNA sequencing to obtain fecal base sequences and analyzed the diversity, composition and function of the gut microbiota.

RESULTS

There was no significant difference in alpha diversity between the sarcopenia group and the healthy control group (P > 0.05). There was a significant difference in beta diversity between the groups (P < 0.05). In the sarcopenia group, the abundances of Alloprevotella, un_f_Prevotellaceae, Anaerovibrio, Prevotellaceae_NK3B31_group, Mitsuokella, Prevotella and Allisonella were lower than those in the heathy control group, and the abundances of Flavobacteriales, Flavobacteriaceae, Catenibacterium, Romboutsia, Erysipelotrichaceae_UCG-003, GCA-900066575, Lachnospiraceae_FCS020_group, and un_f_Flavobacteriaceae were higher than those in the heathy control group. Linear discriminant analysis effect size (LEfSe) revealed that the microbial species in the control group that were significantly different from those in the sarcopenia group were concentrated in the genus Alloprevotella, while the species in the sarcopenia group were concentrated in the genus Catenibacterium. Functional prediction analysis revealed that D-alanine, glycine, serine, and threonine metabolism and transcription machinery, among others, were enriched in the sarcopenia group, which indicated that metabolic pathways related to amino acid metabolism and nutrient transport may be regulated to varying degrees in the pathophysiological context of sarcopenia.

CONCLUSIONS

There were significant differences in the composition and function of the gut microbiota between Xinjiang Uyghur sarcopenia individuals and healthy individuals. These findings might aid in the development of probiotics or microbial-based therapies for sarcopenia in Uyhur individuals.

The accuracy of screening tools for sarcopenia in older Chinese adults: a systematic review and meta-analysis

Objective

This review aimed to analyze and compare the accuracy of eight screening tools for sarcopenia in older Chinese adults according to different diagnostic criteria.

Methods

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang databases were searched between the publication of the first expert consensus on sarcopenia in 2010 and April 2023 using relevant MeSH terms. We evaluated the risk bias of the included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The pooled result of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and plot the summary receiver operating characteristic curve (SROC) were calculated by using a bivariate random-effects model. The accuracies of sensitivity and specificity of the screening tools were compared using the Z-test.

Results

A total of 30 studies (23,193 participants) were included, except for calf circumference (CC), Ishii, and Finger-ring Test; Screening tools for sarcopenia in older Chinese adults have consistently shown low to moderate sensitivity and moderate to high specificity. Regional and sex differences affect the accuracy of the screening tools. In terms of sensitivity and specificity, the CC, Ishii, and Finger-ring Test were superior to the other screening tools.

Conclusion

The Asian Working Group on Sarcopenia (AWGS) 2019 criteria are more appropriate for the diagnosis of sarcopenia in older Chinese adults. According to the AWGS 2019, CC and Ishii are recommended for sarcopenia screening in older Chinese adults.

The prevalence and factors associated with sarcopenia in Thai older adults: A systematic review and meta-analysis

Objective

This systematic review and meta-analysis aimed to assess the prevalence and identify factors associated with sarcopenia in older Thais.

Methods

Research studies were searched in online databases, including PubMed, Embase, Scopus, and Thai-Journal Citation Index. The articles included in this review were limited to being published between January 1, 2013 and January 31, 2023 and observational study designs. The research quality was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tool for prevalence studies. A meta-analysis was performed using the JBI SUMARI software. The review protocol has been registered on PROSPERO with the assigned ID CRD42023420514.

Results

A total of 265 research articles were initially identified, out of which 17 articles were included in this study, including a total of 4,668 participants aged 60 years and over, consisting of 1,380 (29.6%) men and 3,288 (70.4%) women. The overall prevalence of sarcopenia in Thai older adults was 20.7% (95% CI 14.4%-27.8%). Subgroup analysis of the sarcopenia prevalence based on the study areas revealed that the prevalence was 33.4% (95% CI 28.7%-38.3%) in hospitalized individuals, 23.2% (95% CI 12.5%-35.9%) in outpatient clinic settings, and 17.3% (95% CI 9.4%-26.8%) in community-living older adults. Advanced age (OR = 4.60, 95% CI 3.07-6.91), being male (OR = 2.30, 95% CI 1.37-3.85), low body mass index (BMI) (OR = 8.95, 95% CI 6.05-13.25), and malnutrition (OR = 2.78, 95% CI 2.09-3.70) are strong predictors of sarcopenia in older adults in Thailand.

Conclusions

This systematic review represents the first assessment of the overall prevalence and factors associated with sarcopenia in Thai older adults, indicating its significant concern within this population. These findings are of importance for public health management aimed at preventing and managing sarcopenia in the country.

How long were older people expected to live with or without sarcopenia? Multistate modeling of a national cohort study

Objectives

Sarcopenia is well known to be associated with mortality, but there is a lack of evidence on the estimates of life expectancy (LE) for sarcopenia in China. This study aims to estimate total life expectancy (TLE) and sarcopenia-specific LE in community-dwelling older Chinese adults with and without sarcopenia.

Methods

This study included participants aged 60 years and older who enrolled in the cohort in 2011 and 2013 and at least completed one follow-up until 2015 as part of the China Health and Retirement Longitudinal Study (CHARLS). The criteria for defining sarcopenia were based on the guidelines established by the Asian Working Group on Sarcopenia in 2019. TLE and sarcopenia-specific LE were estimated for the total population and subgroups using continuous-time multistate modeling.

Results

A total of 6,029 participants (49.2% women) with an average age of 68.4 (SD: 6.56) years were included in the study. The baseline prevalence of sarcopenia and possible sarcopenia was 19.5 and 44.9%, respectively. We observed that sarcopenia stages naturally deteriorated to worse stages (including death, by 24.4%) and returned to better stages (17.1%) during a median follow-up of 3.92 years (IQR: 2.00 ~ 4.00). The average TLE at the age of 60 was 20.9 [95% CI: 20.2-21.5] years (22.1 [95% CI: 19.6-24.6] for non-sarcopenic older adults, 20.9 [95% CI: 19.5-22.3] for possible sarcopenic, and 18.7 [95% CI: 16.4-21.1] for sarcopenic). Men, former and current smokers, and those living in northwest China had less TLE. Sarcopenic older adults, those with lower education, those who are unmarried, those with agriculture hukou, and those living in rural and northwest China were expected to live fewer years with non-sarcopenia. Sarcopenic older people, men, those with agriculture hukou, and those living in rural and southwest China were expected to live more years with sarcopenia.

Discussion

The results improved our understanding of the relationship between sarcopenia and life expectancy. We suggested that targeted strategies should be considered in high-risk populations and underdeveloped regions to prevent sarcopenia and improve non-sarcopenic life years for the older population.

Sarcopenia in Type 2 Diabetes Mellitus: Study of the Modifiable Risk Factors Involved

(1) Background: Sarcopenia has gained much interest in recent years due to an increase in morbidity. Sarcopenia is associated with type 2 diabetes mellitus (T2DM) and vice versa. There is a paucity of information regarding the prevalence and predictors of sarcopenia among T2DM individuals. The aim of the present study was to determine the prevalence and predictors of sarcopenia among T2DM individuals. (2) Methods: This study included 159 diabetics (cases) and 79 non-diabetics (controls) aged >50 years. The subjects were assessed for demographic and anthropometric parameters. Sarcopenia (according to the Asian Working Group for Sarcopenia 2019 criteria) was assessed using Jammer's hydraulic dynamometer for handgrip strength, dual-energy X-ray absorptiometry for muscle mass, and 6m gait speed. The biochemical investigations included glycated hemoglobin; fasting and prandial glucose; fasting insulin; lipid, renal, liver, and thyroid profiles; serum calcium; phosphorous; vitamin D; and parathyroid hormone (PTH). Appropriate statistical methods were used to determine the significance of each parameter, and a multivariate regression analysis was applied to determine the predictors. (3) Results: The prevalence of sarcopenia was significantly higher among the cases than the controls (22.5% vs. 8.86%, p-0.012). Body mass index (BMI) (OR-0.019, CI-0.001-0.248), physical activity (OR-0.45, CI-0.004-0.475), serum calcium levels (OR-0.155, CI-0.035-0.687), hypertension (OR-8.739, CI-1.913-39.922), and neuropathy (OR-5.57, CI-1.258-24.661) were significantly associated with sarcopenia following multivariate regression analysis. (4) Conclusions: T2DM individuals are prone to sarcopenia, especially those with a low BMI, low physical activity, hypertension, neuropathy, and low serum calcium levels. Hence, by modifying these risk factors among the elderly T2DM, sarcopenia can be prevented.

Prevalence of sarcopenia and its association with clinical outcomes in heart failure: An updated meta-analysis and systematic review

BACKGROUND

Sarcopenia is thought to be strongly associated with heart failure, but meta-analyses with sufficient samples are still lacking to accurately address its clinical situation.

HYPOTHESIS

Sarcopenia has a high prevalence in patients with heart failure and is closely related to adverse clinical outcomes.

METHODS

Relevant databases were systematically searched in October 2021 and updated in July 2022. The data with high heterogeneity were combined with random effects model.

RESULTS

Twenty-one studies with 68,556 HF patients were included. The combined prevalence of sarcopenia in HF patients was 31%. Subgroup analysis found that the prevalence of sarcopenia in HF patients was 35% in Asia, 31% in Europe, 25% in the Americas, 31% in people aged ≥65 years, 25% in people with age <65 years, 28% in HF with reduced ejection fraction (HFrEF) patients and 18% in HF with preserved ejection fraction (HFpEF) patients. In addition, our analysis shows that sarcopenia in patients with HF is associated with an increased risk of poor prognosis, with a combined hazard ratio [HR] of 1.64 (95% confidence interval [CI] = 1.20-5.25), sarcopenia was also associated with poor outcomes in HFrEF patients with pooled HR of 2.77 (95% CI = 1.29-5.95). However, it was not associated with poor outcomes in HFpEF patients with pooled HR of 1.61 (95% CI = 0.82-3.16).

CONCLUSIONS

The prevalence of sarcopenia is high in HF patients, and patients with HF, particularly those with reduced ejection fraction, are at high risk of adverse outcomes from sarcopenia. Therefore, early identification and intervention for sarcopenia were beneficial for improving the prognosis of HF patients.

Association between early life exposure to the great famine and possible sarcopenia in older Chinese adults: a national cross-sectional study

OBJECTIVES

We used data from the China Health and Retirement Longitudinal Study (CHARLS) to investigate how an early life famine exposure affected possible sarcopenia (PS) and to explore the extent to which a sex difference exists in the association among older Chinese adults, as well as whether risk factors modify the association.

DESIGN

Cross-sectional study.

SETTING

28 provinces of China.

PARTICIPANTS

Considering that the Great Chinese Famine lasted from the spring of 1959 to the fall of 1961, 3557 participants were selected and categorised into four subgroups based on their date of birth: unexposed group (1 October 1962 to 30 September 1964), fetal exposed group (1 October 1959 to 30 September 1961), infant exposed group (1 January 1958 to 31 December 1958) and preschool exposed group (1 January 1956 to 31 December 1957).

OUTCOME MEASURE

PS was defined as having low muscle strength or low physical performance.

METHODS

We used multivariable logistic models to analyse the association between early life famine exposure and the risk of PS in elderly life.

RESULTS

The prevalences of PS among individuals in the unexposed, fetal, infant and preschool exposed groups were 15.1%, 14.4%, 23.6% and 21.9%, respectively. Compared with the unexposed group, the infant (OR: 1.55; 95% CI 1.17 to 2.05) and preschool exposed (OR: 1.46; 95% CI 1.17 to 1.82) groups exhibited significantly higher risks of PS. In men, the infant (OR: 2.15; 95% CI 1.40 to 3.31) and preschool exposed (OR: 1.78; 95% CI 1.23 to 2.57) groups were more likely to have PS, but no significant increase was seen in women. In both sexes, prevalence of PS was unrelated to early life famine exposure in the urban, underweight and normal weight subgroups.

CONCLUSIONS

Early life exposure to the Great Chinese Famine was associated with a higher risk of PS in older adults. Keeping normal nutritional status in elderly life might help avoid the risk of PS, whatever the effect of early famine exposure.

Soy Food Consumption Is Inversely Associated with Handgrip Strength: Results from the TCLSIH Cohort Study

Background: Soy foods contain high levels of soy protein or isoflavones, which can stimulate muscle protein synthesis and increase antioxidant capacity, and thus ameliorate muscle strength decline. However, data from epidemiological studies investigating the association of habitual soy food consumption with muscle strength decline among general Chinese adults are limited. Methods: This study included 29,525 participants (mean age: 41.6 years; 16,933 (53.8%) males). Soy food consumption was evaluated using a validated 100-item food frequency questionnaire. Handgrip strength (HGS) was assessed with a hand dynamometer. Analysis of covariance were performed to assess the multivariable-adjusted least square means (LSM) and 95% confidence interval (CI) for HGS. Results: The multiple adjusted LSM (95% CI) of HGS across soy food consumption were 35.5 (34.2, 37.1) kg for <1 time per week, 36.1 (34.6, 37.6) kg for 1 time per week, 36.3 (34.8, 37.8) kg for 2−3 times per week, and 36.6 (35.1, 38.0) kg for ≥4 times per week (p for trend < 0.001). Compared to participants with soy food consumption less than one time per week, the multiple adjusted odds ratio (95% CI) of low HGS was 0.638 (0.485, 0.836) when the weekly consumption was ≥ 4 times (p for trend < 0.01). Conclusions: Higher habitual soy food consumption was positively associated with HGS in general Chinese adults. Consumption of soy foods may have beneficial effects on muscle health.

Association of Different Obesity Phenotypes with Sarcopenia in Han Chinese Middle-Aged and Elderly with Type 2 Diabetes Individuals

PURPOSE

To investigate the relationship between different obesity phenotypes and sarcopenia in hospitalized Chinese patients with type 2 diabetes mellitus (T2DM).

METHODS

This cross-sectional study included 385 men. Anthropometric measurements including applied the determination method of Dual-energy X-ray absorptiometry (DXA) determination of limb skeletal muscle mass index (ASMI) and blood samples were analyzed. The people were divided into four groups according to body mass index (BMI) (≥24kg/m²) and waist circumference (WC) (female ≥85cm, male ≥90cm). Group A (BMI and WC were normal), Group B (BMI was normal and high WC), Group C (high BMI and WC were normal), and Group D (BMI and WC were abnormal).

RESULTS

The prevalence rates of sarcopenia and abdominal obesity were 32.2% and 74.0%, respectively. The detection rate of lower ASMI decreased gradually from Group A to Group D(74.6% vs 68.3% vs 54.5% vs 51.6%, χ 2 =14.243, P=0.003). Logistic analysis showed that the risk of lower ASMI were decreased by 62.4% (95% CI: 0.149-0.950, P = 0.039) in Group C and 68.8% (95% CI: 0.165-0.593, P = 0.000) in Group D compared with Group A, respectively. The risk of lower ASMI were increased 4.153-fold (95% CI: 2.623-6.576, P = 0.000) in male. Male (OR = 4.065, 95% CI: 2.246-7.356, P = 0.000) and WC (OR = 1.053, 95% CI: 1.004-1.104, P = 0.033) were risk factors for lower ASMI, but the risk of lower ASMI was decreased by 32% (95% CI: 0.5744-0.804, P = 0.000) by elevated BMI in the overweight and obese group (Group C and Group D).

CONCLUSION

The prevalence of sarcopenia and abdominal obesity was elevated in han Chinese middle-aged and elderly patients with T2DM. Being overweight or obesity as defined by BMI protect against sarcopenia, while abdominal obesity increases the risk of sarcopenia.

Association between body fat and sarcopenia in older adults with type 2 diabetes mellitus: A cross-sectional study

OBJECTIVES

To investigate the association between body fat (BF%) and sarcopenia in older adults with type 2 diabetes mellitus (T2DM) and potential link with increased levels of inflammatory indicators and insulin resistance.

METHODS

A total of 543 older adults with T2DM were included in this cross-sectional study. Appendicular skeletal muscle (ASM), handgrip strength and gait speed were measured to diagnose sarcopenia according to the updated Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Body composition data were tested using dual-energy X-ray absorptiometry (DEXA). Levels of serum high-sensitive C-reactive protein (hs-CRP), interleukin-6, fasting blood insulin (FINS), hemoglobin A1c (HbA1c), 25-hydroxyvitamin D₃ [25(OH) D₃] were also determined.

RESULTS

The prevalence of sarcopenia in all participants was 8.84%, of which 11.90% were male and 5.84% females. The Pearson's correlation analysis revealed that BF% was negatively correlated with gait speed in men and women (R =-0.195, P=0.001; R = -0.136, P =0.025, respectively). After adjusting for all potential confounders, sarcopenia was positive associated with BF% (male, OR: 1.38, 95% CI: 1.15-1.65, P< 0.001; female, OR: 1.30, 95% CI: 1.07-1.56, P=0.007), and negatively associated with body mass index (BMI) (male, OR: 0.57, 95% CI: 0.44-0.73, P<0.001; female, OR: 0.48, 95% CI: 0.33-0.70, P<0.001). No significant differences were found in hs-CRP, interleukin-6, and insulin resistance between older T2DM adults with and without sarcopenia.

CONCLUSION

Higher BF% was linked to an increased risk of sarcopenia in older adults with T2DM, suggesting the importance of assessing BF% rather than BMI alone to manage sarcopenia.

Associations of Body-Roundness Index and Sarcopenia with Cardiovascular Disease among Middle-Aged and Older Adults: Findings from CHARLS

OBJECTIVES

Sarcopenia and obesity may contribute to chronic disease. However, little is known about the association between sarcopenia, body roundness index (BRI), and cardiovascular disease (CVD). The aim of this study was to investigate the association of sarcopenia and BRI with CVD in middle-aged and older Chinese population.

DESIGN

Cohort study with an 8-year follow-up.

SETTING AND PARTICIPANTS

Data were derived from 4 waves of the China Health and Retirement Longitudinal Study, and 6152 participants aged 45 or above were included in the study.

METHODS

Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. CVD was defined as the presence of physician-diagnosed heart disease, diabetes and/or stroke. The associations of BRI and sarcopenia with CVD risk were explored using Cox proportional hazards regression models.

RESULTS

The mean age of the participants was 58.3 (8.9) years, and 2936 (47.7%) were males. During the 8 years follow-up, 2385 cases (38.8%) with incident CVD were identified. Longitudinal results demonstrated that compared to neither sarcopenia or high BRI, both sarcopenia and high BRI (HR: 1.49, 95%CI: 1.08, 2.07) were associated with higher risk of CVD. In the subgroup analysis, individuals with both sarcopenia and high BRI were more likely to have new onset stroke (HR: 1.93, 95%CI: 1.12, 3.32) and increased risk of multimorbidity (HR: 2.15, 95% CI: 1.14, 4.04).

CONCLUSIONS

Coexistence of sarcopenia and high BRI was associated with higher risk of CVD. Early identification and intervention for sarcopenia and BRI not only allows the implementation of therapeutic strategies, but also provides an opportunity to mitigate the risk of developing CVD.

Associations of Pain and Sarcopenia with Successful Aging among Older People in China: Evidence from CHARLS

OBJECTIVES

Sarcopenia and chronic pain are geriatric syndromes that negatively impact the lives of older people. The aim of this study was to explore the relationship among sarcopenia, pain, and successful aging among older persons participating in the China Health and Retirement Longitudinal Study (CHARLS).

DESIGN

Cohort study with a 2-year follow-up.

SETTING AND PARTICIPANTS

Data were derived from 2 waves of the CHARLS, and 4280 community-dwelling participants aged ≥ 60 years were included in the study.

METHODS

Sarcopenia status was defined according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria. Successful aging was defined following Rowe and Kahn's multidimensional model. Pain was assessed by a self-reported questionnaire. A generalized estimating equation (GEE) was used to examine the associations.

RESULTS

Longitudinal results demonstrated that compared with no sarcopenia, possible sarcopenia [OR (95%CI): 0.600 (0.304~1.188)] was not significantly associated with successful aging. Pain only was strongly associated with successful aging [0.388 (0.251~0.600)], whereas the association between sarcopenia only and successful aging was weaker [0.509 (0.287~0.905)]. The likelihood of being successful aging was substantially lower in the presence of coexisting sarcopenia and pain [0.268 (0.108~0.759)].

CONCLUSIONS

Both pain and sarcopenia are significant predictors for achieving successful aging among community-dwelling older adults. Early identification of sarcopenia and pain permits the implementation of treatment strategies and presents an opportunity to mitigate the risk of being unsuccessful aging.

Calf circumference has a positive correlation with physical performance among community-dwelling middle-aged, older women

Introduction

Sarcopenia and frailty are well-known public health problems in middle-aged and older people. Calf circumference (CC) is a representative anthropometric index that may be useful for screening sarcopenia. Physical performance, assessed by hand grip strength and gait speed, measures sarcopenia and frailty. This community-based, cross-sectional study was conducted in Guishan District, Taoyuan City, between April and October 2017 to investigate the relationship between CC and physical performance among community-dwelling middle-aged, older people in Taiwan and to evaluate potential sex differences. CC tends to be an efficient predictor of physical performance in community health screenings and outpatient clinics for community health examinations, where there is limited time for surveys.

Methods

A total of 1,308 volunteers aged 50-85 were recruited. Volunteers who declined to participate, those with recent cardiovascular disease, and those with an inability to complete an interview, physical performance examinations, and body composition measurements were excluded from the study. A total of 828 participants were enrolled in this study (237 men and 591 women). The statistical methods applied in this study were the Mann-Whitney U-test, independent two-sample t-test, Chi-square test, and multivariate logistic regression models.

Result and discussion

Significant differences were observed in age, waist circumference, appendicular skeletal mass index, calf circumference, hand grip strength, and income between men and women. No significant differences were observed between the men and women regarding body mass index, gait speed, exercise habits, or underlying disorders of diabetes mellitus, hypertension, or hyperlipidemia. Comparing across three different CC tertiles, we discovered significant differences in age, body mass index, waist circumference, appendicular skeletal muscle index, gait speed, and hand grip strength in both men and women. On multivariate logistic regression, after adjusting for age, appendicular skeletal mass index, body mass index, exercise habits, income levels, and CC were positively correlated with physical performance as measured by both gait speed (β = 0.15, p = 0.01) and hand grip strength (β = 0.25, p < 0.001) in women, compared to only hand grip strength (β = 0.41, p < 0.001) in men. Lower calf circumference is an independent risk factor for poor physical performance, especially among women.

Estimation of Appendicular Skeletal Muscle Mass for Women Aged 60-70 Years Using a Machine Learning Approach

OBJECTIVES

This article aimed to develop and validate an anthropometric equation based on the least absolute shrinkage and selection operator (LASSO) regression, a machine learning approach, to predict appendicular skeletal muscle mass (ASM) in 60-70-year-old women.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

Community-dwelling women aged 60-70 years.

METHODS

A total of 1296 community-dwelling women aged 60-70 years were randomly divided into the development or the validation group (1:1 ratio). ASM was evaluated by bioelectrical impedance analysis (BIA) as the reference. Variables including weight, height, body mass index (BMI), sitting height, waist-to-hip ratio (WHR), calf circumference (CC), and 5 summary measures of limb length were incorporated as candidate predictors. LASSO regression was used to select predictors with 10-fold cross-validation, and multiple linear regression was applied to develop the BIA-measured ASM prediction equation. Paired t test and Bland-Altman analysis were used to validate agreement.

RESULTS

Weight, WHR, CC, and sitting height were selected by LASSO regression as independent variables and the equation is ASM = 0.2308 × weight (kg) - 27.5652 × WHR + 8.0179 × CC (m) + 2.3772 × Sitting height (m) + 22.2405 (adjusted R² = 0.848, standard error of the estimate = 0.661 kg, P < .001). Bland-Altman analysis showed a high agreement between BIA-measured ASM and predicted ASM that the mean difference between the 2 methods was -0.041 kg, with the 95% limits of agreement of -1.441 to 1.359 kg.

CONCLUSIONS AND IMPLICATIONS

The equation for 60-70-year-old women could provide an available measurement of ASM for communities that cannot equip with BIA, which promotes the early screening of sarcopenia at the community level. Additionally, sitting height could predict ASM effectively, suggesting that maybe it can be used in further studies of muscle mass.

[Research progress on the correlation between sarcopenia and osteoarthritis]

Objective

To review the research progress on the correlation between sarcopenia and osteoarthritis (OA).

Methods

The basic and clinical studies at home and abroad in recent years on sarcopenia and OA were extensively reviewed. The correlation between sarcopenia and OA was analyzed and summarized from five aspects: epidemiological status, risk factors, pathogenesis, clinical treatments, and the impact on joint arthroplasty.

Results

Sarcopenia and OA are common diseases in the elderly with high prevalence and can increase the ill risk of each other. They share a set of risk factors, and show negative interactive and influence on pathogenesis and clinical treatments, thus participating in each other's disease process and reducing the treatment benefits. Clinical studies show that sarcopenia can affect the rehabilitation effect and increase the risk of postoperative complications after total joint arthroplasty in many ways.

Conclusion

Current research results show that sarcopenia and OA are related and can be mutually affected in the above 5 aspects, but more studies are needed to further clarify the relationship between them, so as to provide more theoretical basis for the understanding, prevention, diagnosis, and treatments of the two diseases.

Beneficial effects of walking-based home program for improving cardio-respiratory performance and physical activity in sarcopenic older people: a randomized controlled trial

BACKGROUND

Sarcopenia is an age-related loss of muscle mass, decline in physical performance, and/or loss of muscle strength. Improving physical activity (PA) is associated with a reduced risk of sarcopenia. Additionally, the World Health Organization 2020 guidelines recommend 150 minutes/week of moderate-intensity or 75 minutes/week of vigorous PA plus resistance exercise twice a week. An increase in walking steps/day also enhances PA.

AIM

The study explored the benefits of a pedometer-based walking program plus a resistance exercise program in older adults with sarcopenia.

DESIGN

A randomized control trial.

SETTING

In community dwelling.

POPULATION

Older individuals with sarcopenia.

METHODS

Screening for sarcopenia was defined according to the Asian Working Group of Sarcopenia criteria in 2019, which is composed of the skeletal muscle mass index (SMI), muscle strength, and physical performance. Bioimpedance analysis, handgrip strength, and gait speed were measured for the SMI, muscle strength, and physical performance, respectively. to explore the effectiveness of a pedometer-based walking program plus TheraBand resistance exercise over 12 weeks. The intervention group was required to wear a pedometer and walk 7 500 steps/day for 5 days/week and perform the TheraBand resistance exercise twice a week, while the control group continued their routine daily activities. Respiratory muscle strength, functional capacity (i.e., 6-minute walk test), and PA were assessed before and after the 12-week program. To evaluate the benefits of the home-based walking program plus resistance exercise, two-way mixed ANOVAs were performed.

RESULTS

Sixty older individuals with sarcopenia aged ≥60 years were enrolled; however, a total of 57 older adults (28 in the invention group and 29 in the control group) completed the study. Inspiratory muscle strength, functional capacity, and PA increased between and within groups after the 12-week program (all P<0.05). Furthermore, muscle strength and physical performance improved in the intervention group after the 12-week program but not in the control group.

CONCLUSIONS

A pedometer-based intervention program with TheraBand resistance exercise could improve cardio-respiratory performance and PA among older Thai individuals with sarcopenia. Further study needs to consider type of exercise and dietary supplements.

CLINICAL REHABILITATION IMPACT

Increasing the number of steps walked per day may reduce the risk of developing sarcopenia in older people.

Gut microbiota as a promising therapeutic target for age-related sarcopenia

Sarcopenia is characterized by a progressive loss of skeletal muscle mass and function with aging. Recently, sarcopenia has been shown to be closely related with gut microbiota. Strategies such as probiotics and fecal microbiota transplantation have shown potential to ameliorate the muscle loss. This review will focus on the age-related sarcopenia, in particular on the relationship between gut microbiota and age-related sarcopenia, how gut microbiota is engaged in sarcopenia, and the potential role of gut microbiota in the treatment of age-related sarcopenia.

Prevalence of sarcopenia in Chinese community-dwelling elderly: a systematic review

BACKGROUND

Sarcopenia is associated with age-related loss of muscle mass and function and is becoming prevalent in the older Chinese population. This systematic review aims to obtain a reliable estimation of the prevalence of sarcopenia among community-dwelling Chinese populations aged 65 years and older and to characterize its epidemiology.

METHODS

A literature search was performed in the Cochrane Library, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, and CQVIP databases up to September 31, 2021. All studies that reported the prevalence of sarcopenia in Chinese community-dwelling older adults were included, and Hoy et al.'s tool was used to assess the risk of bias. The overall prevalence of sarcopenia will be calculated as the primary outcome, and subgroup analyses will be performed by study year, age, sex, muscle mass assessment method, diagnostic criteria and area.

RESULTS

A total of 26 studies were included in this study, which involved 25,921 subjects, and 3597 had sarcopenia. Although significant heterogeneity between studies was reported, no statistically significant publication bias was detected. The overall prevalence of sarcopenia in community-dwelling older adults aged over 65 years in the Chinese population was 17.4% (95% CI: 14.6%-20.2%). Subgroup analysis based on study year, age and sex, muscle mass assessment method, diagnostic criteria, region and area showed that the prevalence of sarcopenia was different in each subgroup.

IMPLICATIONS

The prevalence of sarcopenia in Chinese community-dwelling older adults was higher than that in previous studies. As a multidimensional survey of the prevalence of sarcopenia in older adults, this meta-analysis provides data support for the targeted management of sarcopenia among Chinese older adults.

Diet Quality and Measures of Sarcopenia in Developing Economies: A Systematic Review

Sarcopenia refers to common age-related changes characterised by loss of muscle mass, strength, and physical performance that results in physical disability, poorer health status, and higher mortality in older adults. Diet quality is indicated as a potentially modifiable risk factor for sarcopenia. However, the association between diet quality and sarcopenia in developing economies appears to be conflicting. Hence, we conducted a systematic review of the literature from developing economies examining the relationship between diet quality and at least one of the three components of sarcopenia, including muscle mass, muscle strength, and physical performance, and the overall risk of sarcopenia. No restrictions on age and study design were employed. We identified 15 studies that met review inclusion criteria. There was heterogeneity among the studies in the diet quality metric used and sarcopenia-related outcomes evaluated. Longitudinal evidence and studies relating diet quality to a holistic definition of sarcopenia were lacking. Although limited and predominantly cross-sectional, the evidence consistently showed that diet quality defined by diversity and nutrient adequacy was positively associated with sarcopenia components, such as muscle mass, muscle strength, and physical performance.

Prevalence, Incidence, and Associated Factors of Possible Sarcopenia in Community-Dwelling Chinese Older Adults: A Population-Based Longitudinal Study

Purpose: This study aimed to assess the prevalence, incidence, and associated factors of possible sarcopenia in a nationwide representative sample of the community-dwelling older Chinese population. Methods:This study used the data of participants aged 60 years and over from the China Health and Retirement Longitudinal Study (CHARLS). Data on participants from three waves (2011-2015) of CHARLS were extracted. Possible sarcopenia was defined as low muscle strength or low physical performance, based on the Asian Working Group for Sarcopenia 2019 consensus. We first described baseline prevalence and four-year incidence of possible sarcopenia. Then multiple logistic regression and multivariable parametric proportional hazard model with Weibull distribution were used to examine the association of risk factors with baseline prevalence and four-year incidence of possible sarcopenia, respectively. Results:The prevalence of possible sarcopenia was 46.0%. The four-year incidence of possible sarcopenia was 11.9 per 100 person-years. Multivariable analysis revealed that advanced age and depressive symptoms were associated with increased prevalence of possible sarcopenia, while receiving education and moderate or high physical activity were associated with a lower risk of possible sarcopenia prevalence. For incidence, only advanced age was associated with an increased risk of possible sarcopenia incidence. Conclusion:Our study revealed the substantial burden of possible sarcopenia and related risk factors in community-dwelling settings in China. It highlighted the importance of early detection and intervention in this subclinical group for the prevention of sarcopenia.