Differences in Characteristics between Older Adults Meeting Criteria for Sarcopenia and Possible Sarcopenia: From Research to Primary Care

Physical activity intensity, frequency, duration, volume and the risk of possible sarcopenia in middle-aged and older adults

This study explored the association of physical activity (PA) from different dimensions including intensity, frequency, duration, and volume with possible sarcopenia (PSA), and established the PA cut-off value to identify PSA in middle-aged and older adults. The data in this study were from the China Health and Retirement Longitudinal Study in 2015. There were 7,957 adults aged over 45 years in the analysis. PA was assessed using a modified version of the International Physical Activity Questionnaire Short Form. Muscle strength and physical performance were measured to define PSA. Results showed that men spending at least 3 days each week, more than 10 min each time on vigorous-intensity PA, or a minimum of 933 Mets on total PA each week had a lower risk of PSA. In women, spending at least 3 days each week, more than 30 min each time on moderate-intensity PA, or taking at least 6 days each week, more than 120 min each time on low-intensity PA, or a minimum of 933 Mets on total PA each week was associated with a lower risk of PSA. In older adults (≥ 65 years), spending at least one day each week, more than 30 min each time on vigorous-intensity PA, or taking a minimum of 933 Mets on total PA each week was linked with a decreased risk of PSA. However, no significant associations were found between any PA dimensions and PSA in middle-aged adults (45-64 years). A receiver operating characteristic analysis showed that the PA cut-off value was 695 and 693 Mets each week for predicting PSA for men and women. The findings suggested that the intensity, frequency, duration, and weekly volume of PA is associated with the risk of PSA in middle-aged and older adults, and the association largely depends on sex and age. The PA cut-off value may be an early indication for a higher risk of sarcopenia.

Association between sleep duration and possible sarcopenia in middle-aged and elderly Chinese individuals: evidence from the China health and retirement longitudinal study

BACKGROUND

Sarcopenia is a common cause of disability in the aging population, and managing sarcopenia is an important step in building intrinsic capacity and promoting healthy aging. A growing body of evidence suggests that sleep deprivation may be a mediator of the development of sarcopenia. The purpose of this study was to explore the longitudinal association between sleep duration and possible sarcopenia using data from a national sample.

METHODS

Two waves of data from the CHARLS database for 2011 and 2015 were used in this study. All possible sarcopenia participants met the Asia Working Group for Sarcopenia 2019 (AWGS 2019) diagnostic criteria. Sleep duration was assessed using a self-report questionnaire, and sleep duration was categorized as short (≤ 6 h), medium (6-8 h), or long (> 8 h) based on previous studies. Longitudinal associations between sleep duration and possible sarcopenia will be calculated by univariate and multifactorial logistic regression analyses and expressed as odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

A total of 5654 individuals participated in the follow-up study, with a prevalence of possible sarcopenia of 53.72% (578) in the short sleep duration group, 38.29% (412) in the medium sleep duration group, and 7.99% (86) in the long sleep duration group. According to the crude model of the second-wave follow-up study, short sleep durations were significantly more strongly associated with possible sarcopenia than were medium and long sleep durations (OR: 1.35, 95% CI: 1.17-1.55, P = 0.000). The association between short sleep duration and possible sarcopenia was maintained even after adjustment for covariates such as age, gender, residence, education level, BMI, smoking status, alcohol consumption and comorbidities (OR: 1.18, 95% CI: 1.02-1.36, P = 0.029). In the subgroup analysis, short sleep duration was associated with low grip strength (OR: 1.20, 95% CI: 1.02-1.41, P = 0.031).

CONCLUSIONS

Sleep deprivation may be closely associated with the development of possible sarcopenia in middle-aged and elderly people, which provides new insights and ideas for sarcopenia intervention, and further studies are needed to reveal the underlying mechanisms involved.

Dynapenia and sarcopenia identify walking speed decline in women but not in men

OBJECTIVE

To determine the best indicator of mobility decline between dynapenia, low skeletal muscle mass index (SMMI), and sarcopenia defined by the EWGSOP2 using different cutoff points for grip strength.

METHODS

A longitudinal study was conducted with a follow-up of eight years, involving 2,680 individuals aged 60 and older who participated in the ELSA study with a walking speed greater than 0.8 m/s at baseline. Dynapenia was defined using different cutoff points for grip strength. SMMI was defined by the 20th percentile of the entire ELSA sample distribution and sarcopenia was defined based on the EWGSOP2, using different cutoff points for grip strength. Mobility was analysed using the walking speed test.

RESULTS

Over time, the greatest decline in walking speed occurred in dynapenic women with grip strength < 17 kg (-0.005 m/s per year; 95 % CI: -0.01 to -0.001) and < 20 kg (-0.007 m/s per year; 95 % CI: -0.01 to -0.001). With regards to sarcopenia, the greatest walking speed decline occurred in women with probable sarcopenia when defined by grip strength < 17 kg [(-0.006 m/s per year; 95 % CI: -0.01 to -0.001) or grip strength < 20 kg (-0.007 m/s per year; 95 % CI: -0.01 to -0.001)]. Dynapenia in men as well as low SMMI and sarcopenia in men and women did not enable identifying the risk of mobility decline.

CONCLUSION

Dynapenia and probable sarcopenia defined by grip strength < 17 kg and < 20 kg enabled identifying walking speed decline over time only in women.

Discriminant analysis of ecological factors influencing sarcopenia in older people in South Korea

This study aimed to investigate the ecological system factors that influence discrimination of sarcopenia among older individuals living in contemporary society. Data analysis included information from 618 older adults individuals aged 65 years or older residing in South Korea. To assess variations in ecological system factors related to SARC-F scores, we conducted correlation analysis and t-tests. Discriminant analysis was used to identify factors contributing to group discrimination. The key findings are summarized as follows. First, significant differences at the p < 0.001 level were observed between the SARC-F score groups in various aspects, including attitudes toward life, wisdom in life, health management, social support, media availability, sports environment, collectivist values, and values associated with death. Further, service environment differences were significant at p < 0.01 level, while social belonging and social activities exhibited significance at p < 0.05. Second, factors influencing group discrimination based on the SARC-F scores were ranked in the following order: health management, attitudes toward life, fear of own death, wisdom in life, physical environment, sports environment, media availability, social support, fear of the own dying, collectivist values, service environment, social activities, and social belonging. Notably, the SARC-F tool, which is used for sarcopenia discrimination, primarily concentrates on physical functioning and demonstrates relatively low sensitivity. Therefore, to enhance the precision of sarcopenia discrimination within a score-based group discrimination process, it is imperative to incorporate ecological system factors that exert a significant influence. These modifications aimed to enhance the clarity and precision of the text in an academic context.

Different Diagnostic Criteria for Determining the Prevalence of Sarcopenia in Older Adults: A Systematic Review

Background: Sarcopenia is defined as a loss of muscle mass, strength, and physical function associated with aging. It is due to a combination of genetic, environmental, and physiological factors. It is also associated with an increased risk of health problems. Since there are many different researchers in the field, with their own algorithms and cut-off points, there is no single criterion for diagnosis. This review aims to compare the prevalence of sarcopenia according to these different diagnostic criteria in older adult populations by age group and sex. Methods: Different databases were searched: Web of Science, Pubmed, Dialnet, Scopus, and Cochrane. The keywords used were "sarcopenia", "diagnosis", "prevalence", "assessment", "aged", "aging" and "older". Studies conducted in a population aged ≥65 assessing the prevalence of sarcopenia were selected. Results: Nineteen articles met the inclusion criteria, with a total of 33,515 subjects, 38.08% female and 61.42% male, at a mean age of 74.52. The diagnostic algorithms used were 52.63% AWGS2, 21.05% EWGSOP2, 10.53% AWGS1 and EWGS1, and 5.26% FNIH. Prevalence ranged from 1.7% to 37.47%, but was higher in males and increased with age. Conclusions: The prevalence of sarcopenia varies depending on the diagnostic algorithm used, but it increases with age and is higher in men. The EWGSOP2 and AWGS2 are the most used diagnostic criteria and measure the same variables but have different cut-off points. Of these two diagnostic algorithms, the one with the highest prevalence of sarcopenia and severe sarcopenia is the AWGS2. These differences may be due to the use of different tools and cut-off points. Therefore, a universal diagnostic criterion should be developed to allow early diagnosis of sarcopenia.

Risk of sarcopenia and mobility of older adults during the COVID-19 pandemic: the longitudinal data from the REMOBILIZE study

BACKGROUND

We assessed whether clinical, functional and behavioral factors were associated with the decrease in mobility trajectories reported in older people at risk of sarcopenia (RS) and without risk of sarcopenia (NRS) during COVID-19 pandemic.

METHODS

We prospectively analyzed mobility trajectories reported in older adults with RS and NRS over 16-month follow-up (Remobilize study). The self-perceived risk of sarcopenia and mobility were assessed using the SARC-F and the Life-Space Assessment (LSA) tools, respectively. Gender, age, comorbidities, pain, functional limitation, physical activity (time spent in walking; min/week), and sitting time (ST; hours/day) were assessed. We used a multilevel model to determine changes in mobility between groups and over time.

RESULTS

Mobility was lower in RS than in NRS. Older people at RS, who were women, aged 70-79 years and 80 years or older, inactive, and with moderate to severe functional limitation experienced reduced mobility trajectories reported over the pandemic. For older people at NRS, trajectories with reduce mobility reported were experienced by women with comorbidities, for those with insufficient walking time and aged 70-79 years; aged 70-79 years and with ST between 5 and 7 hours/day; for those with insufficient walking time and increased ST; and for those with pain and increased ST.

CONCLUSION

Mobility trajectories reported in older people at risk of sarcopenia were negatively influenced by insufficient level of physical inactivity and pre-existing moderate to severe functional limitation. Health and social interventions should be target to avoid mobility limitation during and after the COVID-19 pandemic.

Association between sarcopenia and multimorbidity among middle-aged and older adults in China: Findings from the China Health and Retirement Longitudinal Study

BACKGROUND

Little is known about the association between sarcopenia and multimorbidity among middle-aged and older adults. This study investigated whether sarcopenia is associated with multimorbidity in middle-aged and older Chinese individuals.

MATERIALS AND METHODS

A total of 12,760 participants from China Health and Retirement Longitudinal Study (CHARLS) 2015, with data on 14 specified chronic diseases and sarcopenia status were included in the cross-sectional analysis. A total of 7345 participants without multimorbidity from the CHARLS 2015 were included and followed up in 2018 in the longitudinal analysis. Logistic regression models were used in a cross-sectional investigation to assess the association between sarcopenia status and multimorbidity. In a longitudinal analysis, the relationships between sarcopenia status and multimorbidity were investigated using Cox proportional hazards models.

RESULTS

Multimorbidity was prevalent in the no sarcopenia, possible sarcopenia, and sarcopenia groups at 38.8 % (3765/9713), 56.6 % (1199/2118), and 48.5 % (451/929), respectively. Multivariable regression revealed that both possible sarcopenia (β = 0.088, P<0.001) and sarcopenia (β = 0.028, P = 0.009), contributed to the number of chronic diseases. Logistic regression revealed that possible sarcopenia (OR: 1.56, 95 % CI: 1.39-1.76) was associated with multimorbidity. In the longitudinal analysis, participants in the possible sarcopenia group (HR: 1.19, 95 % CI:1.03-1.38) were more prone to experience new onset multimorbidity than did participants in the no sarcopenia group.

CONCLUSIONS

Possible sarcopenia is associated with the development of multimorbidity in middle-aged and older Chinese populations. Health screening of populations with possible sarcopenia can facilitate early detection of multimorbidity.

Association of possible sarcopenia with major chronic diseases and multimorbidity among middle-aged and older adults: Findings from a national cross-sectional study in China

AIM

This study investigated the prevalence of possible sarcopenia (PSA) in a large sample of middle-aged and older adults, and determined the association between PSA, major chronic diseases and the number of chronic diseases.

METHODS

A total of 14 917 adults aged ≥40 years were included in the analysis. The handgrip strength and the five-time chair stand test were used to assess PSA. The participants' major chronic diseases were divided into 14 categories. Four categories were created based on the participants' number of chronic illnesses: 0, 1, 2 and ≥3.

RESULTS

The present study found an overall prevalence of PSA of 23.6% among Chinese middle-aged and older adults aged ≥40 years, with the risk increasing with advancing age. PSA was significantly associated with most categories of chronic diseases and multimorbidity. The closely independent associations were obtained for stroke; emotional, nervous or psychiatric problems; chronic lung disease, asthma, heart disease, hypertension and arthritis or rheumatism. Compared with participants with 0 chronic disease, those with two or more chronic diseases had higher odds for PSA. However, the association between PSA and the number of chronic diseases varied in different sex and age groups.

CONCLUSIONS

The findings suggest that PSA is associated with major chronic diseases among middle-aged and older adults. People with two or more chronic diseases have a greater likelihood of PSA compared with those without chronic diseases, and the association between PSA and the number of chronic diseases largely depended on sex and age. Geriatr Gerontol Int 2023; 23: 925-931.

Effectiveness of elastic band training and group-based dance on physical-functional performance in older women with sarcopenia: a pilot study

BACKGROUND

Sarcopenia is a syndrome associated with aging that causes progressive loss of skeletal muscle mass and muscle function. In this pilot study, we compared the effectiveness of elastic band training regarding group-based dance on fat mass, fat-free mass, handgrip strength (HGS; dominant and non-dominant hand), leg strength, timed up-and-go (TUG) and walking speed in older women with sarcopenia.

METHODS

This is a randomized controlled trial, single-blind, repeated measures of parallel groups (elastic band group: EBG, n = 21; group-based dance: GBD, n = 19), and a quantitative methodology. Three 60-minute sessions per week for 12 weeks were dedicated to the interventions with pre- and post-assessments. A two-factor mixed analysis of variance (ANOVA) model with repeated measures was performed to measure the group×time effect.

RESULTS

A significant interaction revealed for fat-free mass (F1,16= 18.91; p < 0.001; EBG + 10.9% vs. GBD - 1.97%), HGS dominant hand (F1,16= 7.44; p = 0.014; EBG + 10.9% vs. GBD + 0.59%), HGS non-dominant hand (F1,16= 6.41; p = 0.022; EBG + 10.21% vs. GBD + 3.80%), leg strength (F1,16= 17.98; p < 0.001; EBG + 9.1% vs. GBD + 3.83%), TUG (F1,16= 7.52; p = 0.014; EBG - 14.7% vs. GBD - 1.0%) and walking speed (F1,16 = 6.40; p = 0.019; EBG - 7.6% vs. GBD - 4.35%) in favor of EBG.

CONCLUSION

Elastic band training produces significantly greater responses on physical-functional performance regarding group-based dance in older women with sarcopenia. On the other hand, the EBG revealed a significant improvement in fat-free mass and upper and lower limb muscle strength, as well as a significant decrease time in TUG, and walking speed. Elastic band exercise is a safe, easy, affordable, and effective physical activity strategy, according to the findings.

Management of Sarcopenia in Primary Care Settings

With aging, loss of skeletal muscle mass and muscle function increases, resulting in an increased risk of falls, fractures, long-term institutional care, cardiovascular and metabolic diseases, and even death. Sarcopenia, which is derived from the Greek words "sarx" or flesh+"penia" or loss, is defined as a condition characterized by low muscle mass and low muscle strength and performance. In 2019, the Asian Working Group for Sarcopenia (AWGS) published a consensus paper on the diagnosis and treatment of sarcopenia. The AWGS 2019 guideline, specifically, presented strategies for case-finding and assessment to help diagnose "possible sarcopenia" in primary care settings. For case finding, the AWGS 2019 guideline proposed an algorithm that recommends calf circumference measurement (cut-off <34 cm in men, <33 cm in women) or the SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls) questionnaire (cut-off ≥4). If this case finding is confirmed, handgrip strength (cutoff <28 kg in men, <18 kg in women) or the 5-time chair stand test (≥12 seconds) should be performed to diagnose "possible sarcopenia." If an individual is diagnosed as "possible sarcopenia," AWGS 2019 recommends that the individual should start lifestyle interventions and related health education for primary healthcare users. Because no medication is available to treat sarcopenia, exercise and nutrition is essential for sarcopenia management. Many guidelines, recommend physical activity, with a focus on progressive resistance (strength) training, as a first-line therapy for the management of sarcopenia. It is essential to educate older adults with sarcopenia on the need to increase protein intake. Many guidelines recommended that older people should consume at least 1.2 g of proteins/kg/d. This minimum threshold can be increased in the presence of catabolic or muscle wasting. Previous studies reported that leucine, a branched-chain amino acid, is essential for protein synthesis in muscle, and a stimulator for skeletal muscle synthesis. A guideline conditionally recommends that diet or nutritional supplements should be combined with exercise intervention for older adults with sarcopenia.

Patterns of Muscle-Related Risk Factors for Sarcopenia in Older Mexican Women

Early detriment in the muscle mass quantity, quality, and functionality, determined by calf circumference (CC), phase angle (PA), gait time (GT), and grip strength (GSt), may be considered a risk factor for sarcopenia. Patterns derived from these parameters could timely identify an early stage of this disease. Thus, the present work aims to identify those patterns of muscle-related parameters and their association with sarcopenia in a cohort of older Mexican women with neural network analysis. Methods: Information from the functional decline patterns at the end of life, related factors, and associated costs study was used. A self-organizing map was used to analyze the information. A SOM is an unsupervised machine learning technique that projects input variables on a low-dimensional hexagonal grid that can be effectively utilized to visualize and explore properties of the data allowing to cluster individuals with similar age, GT, GSt, CC, and PA. An unadjusted logistic regression model assessed the probability of having sarcopenia given a particular cluster. Results: 250 women were evaluated. Mean age was 68.54 ± 5.99, sarcopenia was present in 31 (12.4%). Clusters 1 and 2 had similar GT, GSt, and CC values. Moreover, in cluster 1, women were older with higher PA values (p < 0.001). From cluster 3 upward, there is a trend of worse scores for every variable. Moreover, 100% of the participants in cluster 6 have sarcopenia (p < 0.001). Women in clusters 4 and 5 were 19.29 and 90 respectively, times more likely to develop sarcopenia than those from cluster 2 (p < 0.01). Conclusions: The joint use of age, GSt, GT, CC, and PA is strongly associated with the probability women have of presenting sarcopenia.