Sarcopenia Prevalence and Risk Factors among Residents in Aged Care

The efficacy of nutritional screening indexes in predicting the incidence of osteosarcopenia and major osteoporotic fracture in the elderly

INTRODUCTION

The effect of nutritional status on osteosarcopenia (OS) and major osteoporotic fracture (MOF) among the elderly is still unclear. So we aimed to compare the efficacy of the Mini-Nutrition Assessment-Short Form (MNA-sf), the Geriatric Nutritional Risk Index (GNRI) and Controlling Nutritional Status (CONUT) for predicting OS and MOF among the elderly.

MATERIALS AND METHODS

A total of 409 participants were enrolled in this prospective study. Blood biochemical indexes, nutritional status, and bone- and muscle-related examinations were assessed at initial visit to the outpatient. Participants were divided into 4 groups: (1) control; (2) osteopenia/osteoporosis; (3) sarcopenia; (4) osteosarcopenia, and then followed for 5 years, recording the occurrence time of MOF.

RESULTS

The frequency values of osteopenia/osteoporosis, sarcopenia, and OS, at baseline, were respectively 13.4, 16.1, and 12% among the study samples. Correlation analysis showed that nutritional status scores were associated with body mass index, handgrip strength, albumin, bone mineral density, and physical functions. According to multivariate models, poor nutritional status was significantly associated with a higher risk of OS and MOF (P < 0.05). Survival analysis showed that the MOF rate in malnutrition group was significantly higher than normal nutrition group (P < 0.05). The receiver operator characteristic curve shows that the value of MNA-sf to diagnose OS and MOF is greater (P < 0.05).

CONCLUSION

The poor nutritional status was associated with a higher risk of both OS and MOF. MNA-sf showed a superior diagnostic power for OS and MOF among the elderly. Early nutrition assessments and interventions may be key strategies to prevent OS and fractures.

Higher systemic immune-inflammation index is associated with sarcopenia in individuals aged 18-59 years: a population-based study

The association between the systemic immune-inflammation index (SII) and the risk of sarcopenia has not yet been revealed. The purpose of this study was to investigate the relationship between the SII and sarcopenia in individuals aged 18-59 years. All data for this study are from the National Health and Nutrition Examination Survey (NHANES) database, including 7258 participants (age range: 18-59 years). We divided SII values by quartiles (quartiles 1-4: 0.3-3.1, 3.2-4.4, 4.4-6.2, and 6.2-58.5). We constructed a multivariate logistic regression model to assess the association between the SII and the risk of sarcopenia, and an interaction test was run to test the stability of the model and identify high-risk individuals with sarcopenia. Compared to nonsarcopenia participants, sarcopenia patients had a significantly higher SII value (weighted average: 6.65 vs. 5.16) (P = 0.002). Multivariate logistic regression results showed a positive linear relationship between the SII and sarcopenia (OR [odds ratio] = 1.12, 95% CI [confidence interval] 1.03-1.21). Compared to the quartile 1 group, the quartile 4 group was associated with a higher risk of sarcopenia (OR = 3.94, 95% CI 1.42-10.94). Compared with the quartile 1 group, the OR value of the quartile 2 to quartile 4 groups showed an upwards trend (Ptrend < 0.001) as the level of SII increased. Subgroup analysis also indicate that the correlation between higher SII values and the risk of sarcopenia was stable. There was a significant positive linear relationship between SII and sarcopenia, indicating that higher SII values can increase the risk of sarcopenia in individuals aged 18-59 in the United States. The findings of this study will be beneficial in promoting the use of SII alone or in combination with other tools for the risk screening of sarcopenia in communities or large populations.

Predicting Slow Walking Speed From a Pooled Cohort Analysis: Sarcopenia Definitions, Agreement, and Prevalence in Australia and New Zealand

BACKGROUND

Recent operational definitions of sarcopenia have not been replicated and compared in Australia and New Zealand (ANZ) populations. We aimed to identify sarcopenia measures that discriminate ANZ adults with slow walking speed (<0.8 m/s) and determine the agreement between the Sarcopenia Definitions and Outcomes Consortium (SDOC) and revised European Working Group for Sarcopenia in Older People (EWGSOP2) operational definitions of sarcopenia.

METHODS

Eight studies comprising 8 100 ANZ community-dwelling adults (mean age ± standard deviation, 62.0 ± 14.4 years) with walking speed, grip strength (GR), and lean mass data were combined. Replicating the SDOC methodology, 15 candidate variables were included in sex-stratified classification and regression tree models and receiver operating characteristic curves on a pooled cohort with complete data to identify variables and cut points discriminating slow walking speed (<0.8 m/s). Agreement and prevalence estimates were compared using Cohen's Kappa (CK).

RESULTS

Receiver operating characteristic curves identified GR as the strongest variable for discriminating slow from normal walking speed in women (GR <20.50 kg, area under curve [AUC] = 0.68) and men (GR <31.05 kg, AUC = 0.64). Near-perfect agreement was found between the derived ANZ cut points and SDOC cut points (CK 0.8-1.0). Sarcopenia prevalence ranged from 1.5% (EWGSOP2) to 37.2% (SDOC) in women and 1.0% (EWGSOP2) to 9.1% (SDOC) in men, with no agreement (CK <0.2) between EWGSOP2 and SDOC.

CONCLUSIONS

Grip strength is the primary discriminating characteristic for slow walking speed in ANZ women and men, consistent with findings from the SDOC. Sarcopenia Definitions and Outcomes Consortium and EWGSOP2 definitions showed no agreement suggesting these proposed definitions measure different characteristics and identify people with sarcopenia differently.

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

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

Sarcopenia in patients following stroke: Prevalence and associated factors

BACKGROUND

This study aimed to investigate the prevalence and associated factors of sarcopenia in patients following stroke during acute hospitalisation.

METHODS

This single-centre prospective observational cohort study assessed skeletal muscle mass using bioelectrical impedance analysis and muscle strength of patients with acute stroke at hospital discharge. Sarcopenia was diagnosed according to the AWGS-2019 criteria. Multiple logistic regression analyses were performed to identify associated factors of post stroke sarcopenia.

RESULTS

A total of 286 participants (32% female; median age, 72 years) were included in this study. The prevalence of post-stroke sarcopenia was 32.5% (n = 93). In multiple logistic regression analysis, age (adjusted odds ratio [aOR]: 1.10; 95% confidence interval [CI]: 1.05-1.05), National Institute of Health Stroke Scale (aOR: 1.15; 95% CI: 1.04-1.27), body mass index (BMI) (aOR: 0.73; 95% CI: 0.64-0.84) and Functional Oral Intake Scale (aOR: 0.67; 95% CI: 0.51-0.89) were independently associated with post-stroke sarcopenia during acute hospitalisation.

CONCLUSION

Approximately one-third of acute stroke patients were diagnosed with sarcopenia at hospital discharge, and older age, severe stroke, low BMI, and poor swallowing function are associated with sarcopenia following stroke during acute hospitalisation.

Prevalence of Sarcopenia in Africa: A Systematic Review

Objective

The world population gradually getting older, age-related sarcopenia is becoming more frequent. Known to be highly prevalent in high income countries, relative data in Africa are still scarce. This review aims to estimate the prevalence of sarcopenia in Africa and its characteristics.

Study Design and Setting

A literature search in PubMed, Web of Science, Google Scholar, and Scopus was conducted in October 2022. All studies reporting the prevalence of sarcopenia in Africa within 15 years were included, and we did an assessment of bias with Hoy et al's risk bias assessment tool. The estimated prevalence of sarcopenia was the outcome and we performed secondary analyses by age, gender, and diagnostic criteria. The random effect model was used for the prevalence estimation. The prevalence of sarcopenia and 95% confidence interval (95% CI) were calculated using the inverse-variance method.

Results

A total of 17 studies met our eligibility criteria, for a study population of 12,690 participants with 44.3% males and 55.7% females. The overall prevalence of sarcopenia was 25% (95% CI: 19-30%). The prevalence of sarcopenia among 50 years old and older was 23% (95% CI: 17-29%). We had a higher prevalence of sarcopenia among males (30%, %95 IC: 20-39%) than females (29%, %95 IC: 21-36%). The prevalence of sarcopenia was different depending on the diagnosis criteria used.

Conclusion

The prevalence of sarcopenia in Africa was relatively high. However, the fact that the majority of included studies were hospital-based studies shows the necessity of further community-based studies in order to have a more accurate representation of the situation in the general population.

Sarcopenia is associated with a greater risk of polypharmacy and number of medications: a systematic review and meta-analysis

Polypharmacy in older adults is associated with multiple negative consequences that may affect muscular function, independently from the presence of medical conditions. The aim of this systematic review and meta-analysis was to investigate the association of sarcopenia with polypharmacy and higher number of medications. A systematic literature search of observational studies using PubMed, Web of Science, Scopus and Cochrane Library databases was conducted from inception until June 2022. To determine if sarcopenia is associated with a higher risk of polypharmacy and increased number of medications, a meta-analysis using a random-effects model was used to calculate the pooled effects (CRD42022337539). Twenty-nine studies were included in the systematic review and meta-analysis. Sarcopenia was associated with a higher prevalence of polypharmacy (odds ratio [OR]: 1.65, 95% confidence interval [CI] [1.23, 2.20], I2  = 84%, P < 0.01) and higher number of medications (mean difference: 1.39, 95% CI [0.59, 2.19], I2  = 95%, P < 0.01) compared with individuals without sarcopenia. Using meta-regression, a high variance was observed due to different populations (i.e., community-dwelling, nursing home residents, inpatients, outpatients) for both outcomes of polypharmacy (r = -0.338, SE = 0.1669, 95% CI [-0.67, -0.01], z = -2.03, P = 0.04) and number of medications (r = 0.589, SE = 0.2615, 95% CI [0.08, 1.10], z = 2.25, P = 0.02). This systematic review and meta-analysis reported a significantly increased risk of polypharmacy and higher number of medications in people with sarcopenia compared with individuals without this condition. Future research should clarify whether the specificity and number of medications is a direct contributor in accelerating the progression of muscle wasting and dysfunction contributing to sarcopenia in older adults.

Prevalence and associated factors of sarcopenia in community-dwelling older adults at risk of malnutrition

BACKGROUND

There is an increasingly strong association between sarcopenia and malnutrition in research findings. We aimed to determine the prevalence and factors associated with sarcopenia in community-dwelling older adults (≥ 65 years) at risk of malnutrition based on Malnutrition Universal Screening Tool (MUST).

METHODS

This was a cross-sectional study of 811 participants. Participants were recruited from the general population, community centers, senior activity centers, polyclinics, and hospital. Community-dwelling older adults at risk of malnutrition participated in the study. Participants' data and measurements were collected at the baseline visit. Data included socio-demographic information, anthropometric measurements, body composition, dietary intakes, and functional assessments. Sarcopenia was defined using the Asian Working Group for Sarcopenia 2019 consensus.

RESULTS

Of the 694 participants with complete datasets, overall prevalence of sarcopenia was 76% (n = 530); 57% (n = 393) had severe sarcopenia. In the overall cohort, compared to participants without sarcopenia, those with sarcopenia were older, had lower physical activity scale for the elderly score, leg strength, handgrip endurance, mid-upper arm circumference, calf circumference, and bone mass, and had lower dietary protein intake and poorer nutritional status (all p ≤ 0.015). After adjusting for confounders, sarcopenia was significantly associated with older age, male gender, higher risk of malnutrition, lower calf circumference, and lower bone mass (all p ≤ 0.044).

CONCLUSIONS

In community-dwelling older adults at risk of malnutrition, there is a high prevalence of sarcopenia and severe sarcopenia. As such, screening positive for either malnutrition risk or sarcopenia in older adults should prompt screening for the other risk factor, to allow early institution of disease modifying interventions to forestall adverse outcomes for both malnutrition and sarcopenia.

TRIAL REGISTRATION

The study was registered at clinicaltrials.gov as NCT03245047 .

Tackling malnutrition with a new compact oral nutrient supplement among residents in aged care: a pilot study

Introduction There is a high prevalence of malnutrition among older adults entering residential aged care (RAC). Aim To determine whether 60 mL of a compact oral nutrition supplement (ONS; daily total: 576 kcal, 35 g protein) consumed four times daily with medication rounds improves malnutrition status, body weight, and body composition measures among older adults in RAC. Methods Residents (n  = 20; mean age: 86.7 ± 6.8 years; 50% female) screened for malnutrition (20% malnourished, 80% at risk of malnutrition) using the Mini Nutritional Assessment-short form were recruited during April-June 2021. Participants received 60 mL of an ONS four times daily using the Medication Pass Nutrition Supplement Programme (Med Pass). The ONS intake and participant compliance were recorded. Body mass index, fat, and muscle mass (bioelectrical impedance), malnutrition risk, depressive symptoms, and quality of life were assessed at baseline and following the 18-week intervention. Results Median overall compliance was 98.6%. An ONS intake did not significantly increase mean ± s.d. any body composition measures or improve health and wellbeing outcomes; however, it resulted in increased body weight and body mass index (BMI; 13/20 (65%) participants), body fat mass and percentage (10/16 (63%) participants) and muscle mass (9/16 (56%) participants). Malnutrition risk scores improved in 65% (13/20) of participants, resulting in 10% being assessed as malnourished, 65% at risk of malnutrition, and 25% with normal nutrition status. Discussion Delivery of a compact oral nutrition supplement with the medication round was accepted by residents. Its efficacy in improving malnutrition risk and body composition among residents warrants further investigation.