Sarcopenia and its determinants among Iranian elderly (SARIR): study protocol

Associations between dietary total antioxidant capacity and sarcopenia: a cross-sectional study

BACKGROUND

No study has investigated the relationship between dietary total antioxidant capacity and sarcopenia so far.

OBJECTIVE

This study aimed to investigate the association between dietary Total Antioxidant Capacity (d-TAC) and sarcopenia in elderly adults.

METHODS

In this cross-sectional study we enrolled 300 elderly people (150 men and 150 women) aged ≥ 55 years using cluster random sampling method. Sarcopenia was defined based on European Working Group on Sarcopenia (EWGSOP) definition. A DXA scanner, a squeeze bulb dynamometer and a 4-Meter walk gait speed test was used to measure Appendicular Skeletal Muscle (ASM), muscle strength and muscle performance respectively. We also used a Block-format 117-item food frequency questionnaire (FFQ) to assess dietary intakes of participants. Multivariable logistic regression models were applied to examine the association between d-TAC and sarcopenia.

RESULTS

Mean ± SD age of study participants and their BMI was 66.8 ± 7.72 year and 27.3 ± 4.2 kg/m2, respectively. People in the highest tertile of d-TAC had the greatest hand grip strength (11.9 ± 3.63 vs. 10.4 ± 3.55 psi, p = 0.009) and had lower odds of sarcopenia compared with those in the lowest tertile, either before (OR = 0.39; 95% CI: 0.17, 0.88) or after adjustment for potential confounders (OR = 0.33; 95% CI: 0.11, 0.95). No other significant association was seen between d-TAC and components of sarcopenia.

CONCLUSION

We found an inverse association between dietary total antioxidant capacity and odds of sarcopenia. No significant association was seen between d-TAC and individual components of sarcopenia. Further studies are needed to confirm our findings.

Relationship between healthy eating index and sarcopenia in elderly people

BACKGROUND

Data on the association of Alternative Healthy Eating Index-2010 (AHEI-2010) with sarcopenia are scarce. We aimed to evaluate the association between adherence to AHEI-2010 and sarcopenia and its components including low muscle mass, low muscle strength, and low muscle performance among elderly people.

METHODS

In this cross-sectional study, which was conducted on 300 older people (150 men and 150 women) aged ≥55 years. Dietary information was done using a valid 117-item food frequency questionnaire (FFQ). To construct AHEI-2010 score, earlier studies were used. Sarcopenia and its components were described based on both former and new European Working Group on Sarcopenia in Older People (EWGSOP) guidelines.

RESULTS

We found no significant association between AHEI-2010 score and odds of EWGSOP2-sarcopenia, either before (OR for the highest vs. lowest tertiles: 0.55; 95% CI: 0.19, 1.55) or after (OR: 0.44; 95% CI: 0.14, 1.34) adjustment for confounders. In gender-stratified analyses, we found a significant protective association between adherence to the AHEI-2010 score and odds of EWGSOP2-sarcopenia among women after controlling for confounders (0.20; 95%CI: 0.04, 0.91).

CONCLUSIONS

In conclusion, healthy eating was inversely associated with odds of sarcopenia among women, but not in men. Further studies with a large sample size and prospective design are needed to examine this association.

Association between dietary intake of branched-chain amino acids and sarcopenia and its components: a cross-sectional study

There is no previous study that investigated the association between dietary intake of total and individual branched-chain amino acids (BCAAs) and odds of sarcopenia. The present study aimed to examine the association between dietary intake of BCAAs and sarcopenia and its components among Iranian adults. The data for this cross-sectional study was collected in 2011 among 300 older people (150 men and 150 female) with aged ≥ 55 years. We used a Block-format 117-item food frequency questionnaire (FFQ) to evaluate usual dietary intakes. BCAAs intake was calculated by summing up the amount of valine, leucine and isoleucine intake from all food items in the FFQ. The European Sarcopenia Working Group (EWGSOP) definition was used to determine sarcopenia and its components. Mean age of study participants was 66.8 years and 51% were female. Average intake of BCAAs was 12.8 ± 5.1 g/day. Prevalence of sarcopenia and its components was not significantly different across tertile categories of total and individual BCAAs intake. We found no significant association between total BCAAs intake and odds of sarcopenia (OR for comparison of extreme tertiles 0.48, 95% CI 0.19–1.19, P-trend = 0.10) and its components (For muscle mass 0.83, 95% CI 0.39–1.77, P-trend = 0.63; for hand grip strength 0.81, 95% CI 0.37–1.75, P-trend: 0.59; for gait speed 1.22, 95% CI 0.58–2.57, P-trend = 0.56). After adjusting for potential confounders, this non-significant relationship did not alter. In addition, we did not find any significant association between individual BCAAs intake and odds of sarcopenia or its components. We found no significant association between dietary intakes of BCAAs and sarcopenia in crude model (OR 0.60; 95% CI 0.29–1.26). After controlling for several potential confounders, the result remained insignificant (OR 0.48; 95% CI 0.19–1.19). In this cross-sectional study, no significant association was observed between dietary intakes of total and individual BCAAs and odds of sarcopenia and its components.

Inflammatory cytokines and sarcopenia in Iranian adults-results from SARIR study

Some studies suggested the effects of inflammatory cytokines in reducing muscle mass and muscle strength and, performance. This study aimed to compare pro-inflammatory cytokines in sarcopenic and non-sarcopenic subjects. 120 men and women were selected out from the cross-sectional study ‘sarcopenia and its determinants among Iranian elders’ (SARIR). Sarcopenia was defined based on the first ‘European Working Group on sarcopenia in older people’ (EWGSOP₁) guidelines. A fasting blood sample was taken from each participant to measure serum high-sensitivity C-reactive protein (hs-CRP), Interleukin 6 (IL-6), and tumor necrosis factor α (TNFα). A total of 120 participants were included in this study. Mean age was 66.7 ± 7.7 years and mean body mass index (BMI) was 27.3 ± 4.2 kg/m². Forty participants had the criteria of EWGSOP₁ sarcopenia. A statistically significant difference was seen between normal and abnormal groups of muscle strength in hs-CRP (P-value = 0.04). Furthermore, we did not observe any remarkable association between inflammatory biomarkers including IL-6 (OR 1.15; 95% CI 0.31–4.28), TNF-α (OR 0.68; 95% CI 0.17–2.77), and hs-CRP (OR 2.39; 95% CI 0.87–6.55) and the presence of sarcopenia even after controlling for plausible confounders. We found that inflammatory biomarkers level was not associated with odds of sarcopenia. The lack of correlation between inflammatory cytokines and sarcopenia could be due to the participants’ age and genetics. Future studies are required to confirm these findings.

Sarcopenia screening strategies in older people: a cost effectiveness analysis in Iran

Background and objectives

Sarcopenia is an important age-related disease which can lead to an increased risk of mortality, falls, fractures, and poor quality of life. So, timely detection can be effective in reducing the burden of disease. The aim of this study was to identify the most cost-effective strategy for sarcopenia screening in Iran.

Materials and methods

We constructed a Markov transition model over a life-time horizon based on natural history. Compared strategies included Sarcopenia scoring assessment models (SarSA-Mod), European working group on sarcopenia in older people (EWGSOP), Mini sarcopenia risk assessment (MSRA) and SARC-F. Parameters values were extracted from primary data and the literature, and the costs and Quality-adjusted life years (QALYs) were calculated for each strategy. Sensitivity analysis of uncertain parameters was also performed to determine the robustness of the model. Analysis was performed using 2020 version of TreeAge Pro software.

Results

All four screening strategies increased life time QALYs. After removing dominated strategy, the incremental cost per QALY gained for sarcopenia screening varied from $1875.67 for EWGSOP to $1898.33 for MSRA. Our base-case analysis showed that the most cost-effective strategy was EWGSOP and 2nd best was SarSA-Mod with $43,414.3 and $42,663.3 net monetary benefits given one GDP per capita ($5520.311) as willingness to pay, respectively. Sensitivity analysis of model parameters also showed robustness of results.

Conclusions

The results of the study, as the first economic evaluation of sarcopenia screening, showed that the EWGSOP strategy is more cost-effective than other strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10511-7.

The Relationship Between Food-Based Pro-inflammatory Diet and Sarcopenia: Findings From a Cross-Sectional Study in Iranian Elderly People

Background: Sarcopenia has rarely been linked to Food-based Inflammatory Potential of the Diet (FIPD) in earlier studies. This study was performed to examine the association of FIPD and sarcopenia and its components. Method: In the cross-sectional research, dietary intakes of 300 randomly-selected elderly adults aged 55 years or older were collected through a validated food frequency questionnaire. We constructed FIPD score based on average consumptions of 28 food items. According to The European Working Group on Sarcopenia definition, sarcopenia and its components such as muscle strength, muscle mass, and gait speed were defined. Result: No significant difference was found between the prevalence of sarcopenia (P = 0.05), low muscle mass (P = 0.27), low handgrip strength (P = 0.72), and lower gait speed (P = 0.14) across tertiles of FIPD score. Moreover, we did not find significant differences among means of handgrip strength (P = 0.65), muscle mass (P = 0.33), and walking speed (P = 0.89) across FIPD categories. However, binary logistic regression analysis indicated a significant positive relationship between FIPD score and odds of sarcopenia; such that subjects in the top vs. those in the bottom FIPD tertile had 155% greater chance of having sarcopenia (OR: 2.55; 95% CI: 1.17-5.55). After controlling for all confounding factors, this association strengthened (OR: 2.67; 95% CI: 1.18-6.01). Conclusion: We found that greater FIPD score, which means a more pro-inflammatory diet, was positively linked with sarcopenia.

Patterns of Nutrient Intake in Relation to Sarcopenia and Its Components

Background: Despite the associations between individual nutrients and sarcopenia, we are aware of no information about the link between patterns of nutrient intake and odds of sarcopenia and its components. The present study aimed to examine the association between nutrient-based dietary patterns and sarcopenia and its components among the Iranian adult population. Methods: In this population-based, cross-sectional study, we enrolled 300 elderly adults (150 men and 150 women) aged ≥55 years by using a cluster random sampling method. Dietary intakes of the study population were assessed using a validated food frequency questionnaire. Principal component analysis was conducted to derive nutrient patterns based on a daily intake of 33 nutrients. Muscle mass, muscle strength, and gait speed were measured according to standard methods. Sarcopenia and its components were defined based on the European Working Group on Sarcopenia. Results: Three major nutrient-based dietary patterns were identified: (1) the "pro-vit pattern" that was high in pantothenic (B5), cobalamin (B12), calcium, protein, phosphor, riboflavin (B2), zinc, cholesterol, saturated fat, folate, niacin (B3), selenium, vitamin D, vitamin K, and vitamin A; (2) the "anti-inflammatory" pattern, which was rich in polyunsaturated fat, monounsaturated fat, copper, vitamin E, omega-3, magnesium, iron, pyridoxine (B6), sodium, and caffeine; and (3) the "carbo-vit" patternm which is characterized by high intake of fructose, glucose, dietary fiber, biotin, potassium, thiamin (B1), vitamin C, and chromium. After adjusting for confounders, subjects in the top tertile of the anti-inflammatory pattern had lower odds of sarcopenia (OR 0.25; 95% CI 0.10-0.63) and low muscle strength (OR: 0.46; 95% CI: 0.22-0.96) than those in the bottom tertile. Greater adherence to the carbo-vit pattern was inversely associated with the odds of low gait speed (OR: 0.46; 95% CI: 0.235-0.93). Conclusion: Major nutrient-based dietary patterns were significantly associated with sarcopenia and its components. Further studies are required to confirm our findings.

Inflammatory potential of the diet and risk of sarcopenia and its components

BACKGROUND

Despite a large body of evidence on the link between dietary inflammatory index (DII) and several chronic conditions, limited data are available about the association of DII and sarcopenia. This study aimed to examine the relationship between inflammatory potential of the diet (as measured by DII) and sarcopenia and its components among community-dwelling elderly population.

METHODS

This population-based cross-sectional study was performed in 2011 among 300 elderly people (150 men and 150 women) aged ≥55 years, who were selected using cluster random sampling method. Dietary assessment was done using a pre-tested food frequency questionnaire. Energy-adjusted DII was calculated based on earlier studies. Sarcopenia and its components were determined based on the European Working Group on Sarcopenia (EWGSOP) definition.

RESULTS

Mean age of study participants was 66.7 ± 7.7 y. Subjects in the highest tertile of DII score (i.e. those with a more pro-inflammatory diet) were more likely to be older (P = 0.02). The prevalence of sarcopenia (P = 0.016) and low muscle mass (P = 0.041) was significantly higher among subjects in the top tertile compared with those in the bottom tertile of DII. After adjustment for potential confounders, those with the highest DII were 2.18 times (95% CI: 1.01-4.74) more likely to have sarcopenia than those with the lowest DII. With regard to components of sarcopenia, subjects in the top tertile of DII had not significantly greater odds of low muscle mass (OR: 1.38; 95% CI: 0.72-2.63), abnormal handgrip strength (OR: 0.97; 95% CI: 0.49-1.89), and abnormal gait speed (OR: 1.61; 95% CI: 0.84-3.08) than those in the bottom tertile.

CONCLUSIONS

In conclusion, a diet with more pro-inflammatory potential was associated with a greater odds of sarcopenia. Further studies are required to confirm these findings.

Association of dietary approaches to stop hypertension eating style and risk of sarcopenia

The association between habitual intake of the “dietary approaches to stop hypertension” (DASH) eating plan and sarcopenia has received limited attention. The present study aimed to investigate the association between adherence to DASH dietary pattern and sarcopenia and its components including muscle mass, muscle strength, and muscle performance among community-dwelling older adults population. This population-based cross-sectional study was performed in 2011 among 300 older people (150 men and 150 women) aged ≥ 55 years, who were selected using cluster random sampling method. Dietary intake of study participants were examined by the use of a Block-format 117-item food frequency questionnaire (FFQ). The DASH score was constructed based on eight main foods and nutrients emphasized or minimized in the DASH diet. All components of sarcopenia was measured using standard protocols and sarcopenia was defined based on both former and new European Working Group on Sarcopenia in Older People (EWGSOP) guidelines. Mean age and BMI of study participants were 66.7 ± 7.7 years and 27.3 ± 4.2 kg/m², respectively. Totally, 31 individuals meet the criteria of EWGSOP2-sarcopenia. We found no significant association between adherence to the DASH diet and EWGSOP2-sarcopenia either before (OR 1.08; 95% CI 0.45–2.54) or after adjustment for potential confounders (OR 1.04; 95% CI 0.39–2.75). The same findings were obtained in the gender-stratified analyses (men: OR 2.29; 95% CI 0.39–13.29 and women: 0.75; 95% CI 0.23–2.45). In conclusion, we found that adherence to the DASH-style diet was not significantly associated with odds of sarcopenia. Future prospective studies are required to confirm these findings.

Sarcopenia disease in Iran: an overview

BACKGROUND

Sarcopenia is a geriatric disease with adverse clinical outcomes, high rate of mortality and a major challenge to healthy elderly. This study aimed to undertake a survey to identify gaps and highlight strengths in sarcopenia research in order to progress research in this area for the next years in Iran.

METHODS

This study included all studies published from the beginning until the first of 2019 in national and international journals by Iranian authors conducted in the field of sarcopenia. The databases including MEDLINE (via PubMed), Web of Science and SCOPUS were used as the sources of information. All relevant available academic studies, including review articles, original articles, case reports, conference abstracts, and letters were included in the analysis.

FINDINGS

A total of 48 articles obtained and then categorized into six groups. These groups were; about Pathophysiology, Epidemiology of sarcopenia, Screening of sarcopenia, Nutrition, Physical activity and Association of Sarcopenia and Other Diseases that briefly findings of each study had been described. These findings showed that the prevalence of sarcopenia was 16.5% to 32.5%, using different definitions. A study developed and validated a screening model for identifying people with sarcopenia. Lifestyle changes such as diet can be appropriate strategies for the prevention of sarcopenia and also, physical activity is considered to be one of the few effective strategies to improve sarcopenia and prevent its outcomes, especially if in combination with appropriate nutritional supplementation. Sarcopenia is associated with adverse outcomes and other serious areas such as metabolic disorders, cancers, cardiovascular diseases, nephrology, gastroenterology, psychiatry, other geriatric diseases (such as osteoporosis, etc) and death. Some studies about these areas have been done in Iran.

CONCLUSIONS

By this study, we found that studies on sarcopenia, the gaps of sarcopenia research in Iran, and highlighted the research priorities for future works. The outcome of the present research is to ultimately improve the health, quality of life and well-being of sarcopenic people.

Prevalence of dynapenic obesity and sarcopenic obesity and their associations with cardiovascular disease risk factors in peritoneal dialysis patients

Background

Dynapenic obesity and sarcopenic obesity increase cardiovascular disease (CVD) and mortality in nonuremic patients. The present study was designed to determine the prevalence of dynapenic obesity and sarcopenic obesity and their associations with CVD risk factors in peritoneal dialysis (PD) patients.

Methods

All eligible PD patients in Tehran peritoneal dialysis centers were included in this cross-sectional study. Skeletal muscle mass and fat mass were assessed using bioelectrical impedance analysis. Muscle strength and physical performance were determined using hand grip strength and a 4-meter walk gait speed test, respectively. In addition, a 5-mL blood sample was obtained from each patient.

Results

The prevalence of dynapenic obesity and sarcopenic obesity were 11.4% and 3.8% in PD patients, respectively. Serum high-sensitive C-reactive protein (hs-CRP), soluble intercellular adhesion molecule type 1, triglyceride, total cholesterol, and low-density lipoprotein cholesterol were significantly higher in PD patients with dynapenic obesity than in dynapenic nonobese and nondynapenic nonobese patients. Similarly, serum concentrations of CVD risk factors in PD patients with sarcopenic obesity were higher than in nonsarcopenic nonobese patients, but these differences were statistically significant only for serum hs-CRP and triglyceride. In addition, muscle strength and skeletal muscle mass percentage were negatively associated with markers of inflammation and dyslipidemia, whereas body fat percentage was positively associated with these CVD risk factors.

Conclusion

This study indicates that although the prevalence of dynapenic obesity and sarcopenic obesity are relatively low in PD patients, these disorders may be associated with CVD risk factors.

Appendicular Skeletal Muscle Mass Reference Values and the Peak Muscle Mass to Identify Sarcopenia among Iranian Healthy Population

Background:

Sacopenia is a common problem in elderly with the adverse outcomes. The objective of this study was to estimate the peak appendicular skeletal muscle mass (ASM) and age of its attainment by sex among the Iranian population.

Methods:

A total of 691 men and women aged 18–94 years participated in this cross-sectional, population-based study in Bushehr, Iran. ASM was measured by dual X-ray absorptiometry. Cutoff points for men and women were established considering two standard deviations (SDs) below the mean values of the skeletal muscle index (SMI) for young reference groups. The relationship between ASM and age was described by the second-degree regression models. Two SDs below the mean SMIs of reference groups were as cutoff values of low muscle mass in Iranian population.

Results:

The peak ASM values were 21.35 ± 0.12 Kg and 13.68 ± 0.10 Kg, and the age at peak ASM were 26 (24–28) years and 34 (33–35) years for men and women, respectively. Mean and SD of SMI in those ages were 7.01 ± 0.02 Kg/m² and 5.44 ± 0.02 Kg/m² among men and women, respectively. Calculated cutoff values of low muscle mass among the Iranian population were 7.0 Kg/m² and 5.4 Kg/m² among men and women, respectively.

Conclusions:

Iranian reference values of SMI for both genders were similar to Asia Working Group for Sarcopenia recommendation and lower than the United States and European values. Further studies from different nations and the Middle East countries are needed to obtain reference values for populations, enabling the researchers for comparison and also more valid reports on sarcopenia prevalence.

Muscle wasting in young patients with dilated cardiomyopathy

BACKGROUND

Muscle wasting can be accelerated by chronic diseases such as heart failure and is one of the major causes of disability, morbidity, and mortality in this population. We aimed to investigate the incidence of muscle wasting and its associated factors in dilated cardiomyopathy patients younger than 55 years of age.

METHODS

Between April 2014 and December 2015, all symptomatic patients with a diagnosis of non-ischaemic dilated cardiomyopathy who were referred to heart failure clinic were included in our study. Dual energy X-ray absorptiometry was used to evaluate body composition and identify muscle wasting. Muscle mass was calculated as the ratio of an individual's total lean mass of legs and arms (also called appendicular skeletal muscle) to their squared height (kg/m² ). The muscle mass values of less than 5.45 kg/m² for women and 7.26 kg/m² for men were considered low.

RESULTS

A total of 55 patients (32 male) were included. The mean (standard deviation) of age was 37.3 (10.1) years, and the mean of left ventricular ejection fraction was 21.4%. Most of the patients were in the New York Heart Association classes of II and II-III. Twenty-six patients (47.3%) met criteria for muscle wasting. Patients with muscle wasting had lower left ventricular ejection fraction, lower 6-min walk distance, and higher New York Heart Association function class and hospitalization rate.

CONCLUSIONS

We concluded that muscle wasting might be present in younger patients with heart failure, particularly in those who are in worse clinical condition.

Diet and its relationship to sarcopenia in community dwelling Iranian elderly: a cross sectional study

OBJECTIVES

Sarcopenia is associated with frailty and disability among the elderly and imposes significant costs on health care systems. We tested whether adherence to a particular dietary pattern was associated with sarcopenia among the elderly in a district of Tehran, Iran.

METHODS

We used a semiquantitative Food Frequency Questionnaire to assess the dietary intake of 300 randomly-selected elderly men and women (at least 55 y old) living in the sixth district of Tehran; and the dietary patterns of the subjects were obtained using principal component analysis. We performed a logistic regression to measure the effect of adherence to each dietary pattern on the odds of sarcopenia.

RESULTS

Subjects in the highest tertile of the Mediterranean dietary pattern, characterized by a higher consumption of olive oil, fruits, vegetables, fish, and nuts, had a lower odds ratio for sarcopenia than those in the lowest tertile (OR = 0.42; 95% CI = 0.18-0.97; P for trend = 0.04). In contrast, adherence to the Western dietary pattern, characterized by a high consumption of sugar, soy, and fast foods, was not associated with sarcopenia (OR = 0.51; 95% CI = 0.21-1.24; P for trend = 0.13). Similarly, adherence to the Mixed dietary pattern, characterized by a high consumption of animal proteins, potatoes, and refined grains, did not affect the odds of sarcopenia (OR = 1.45; 95% CI = 0.66-3.19; P for trend = 0.95).

CONCLUSIONS

This study suggests that adherence to the Mediterranean diet is associated with lower odds of sarcopenia among the Iranian elderly.