Sarcopenia and cognitive impairment in elderly women: results from the EPIDOS cohort

BACKGROUND

common pathophysiological pathways are shared between age-related body composition changes and cognitive impairment.

OBJECTIVE

evaluate whether current operative sarcopenia definitions are associated with cognition in community-dwelling older women.

DESIGN

cross-sectional analyses.

SUBJECTS

a total of 3,025 women aged 75 years and older.

MEASUREMENTS

body composition (assessed by dual energy X-ray absorptiometry) and cognition (measured by short portable mental status questionnaire) were obtained in all participants. Multivariate logistic regression models assessed the association of six operative definitions of sarcopenia with cognitive impairment. Gait speed (GS, measured over a 6-meter track at usual pace) and handgrip strength (HG, measured by a hand-held dynamometer) were considered additional factors of interest.

RESULTS

a total of 492 (16.3%) women were cognitively impaired. The prevalence of sarcopenia ranged from 3.3 to 18.8%. No sarcopenia definition was associated with cognitive impairment after controlling for potential confounders. To proof consistency, the analyses were performed using GS and HG, two well-established predictors of cognitive impairment. Low GS [odds ratio (OR) 2.42, 95% confidence interval (CI) 1.72-3.40] and low HG (OR: 1.81, 95% CI: 1.33-2.46) were associated with cognitive impairment.

CONCLUSION

no significant association was evidenced between different operative sarcopenia definitions and cognitive impairment. The study suggests that the association between physical performance and cognitive impairment in not mediated by sarcopenia.

New horizons in the pathogenesis, diagnosis and management of sarcopenia

Sarcopenia is the age-related loss of skeletal muscle mass and function. It is now recognised as a major clinical problem for older people and research in the area is expanding exponentially. One of the most important recent developments has been convergence in the operational definition of sarcopenia combining measures of muscle mass and strength or physical performance. This has been accompanied by considerable progress in understanding of pathogenesis from animal models of sarcopenia. Well-described risk factors include age, gender and levels of physical activity and this knowledge is now being translated into effective management strategies including resistance exercise with recent interest in the additional role of nutritional intervention. Sarcopenia is currently a major focus for drug discovery and development although there remains debate about the best primary outcome measure for trials, and various promising avenues to date have proved unsatisfactory. The concept of 'new tricks for old drugs' is, however, promising, for example, there is some evidence that the angiotensin-converting enzyme inhibitors may improve physical performance. Future directions will include a deeper understanding of the molecular and cellular mechanisms of sarcopenia and the application of a lifecourse approach to understanding aetiology as well as to informing the optimal timing of interventions.

Body size phenotypes and low muscle mass: the Korean sarcopenic obesity study (KSOS)

CONTEXT

Unique subsets of body size phenotypes seem to be more prone or more resistant to the development of obesity-associated metabolic disorders, although the underlying mechanism is not yet clearly understood.

OBJECTIVES

We investigated the prevalence and risk of low muscle mass in subjects who are classified as either metabolically healthy normal weight (MHNW), metabolically abnormal but normal weight (MANW), metabolically healthy obese (MHO), or metabolically abnormal obese (MAO). Subjects were classified based on body mass index and presence of metabolic syndrome.

METHODS

Thigh muscle cross-sectional area was evaluated using computed tomography as an index of muscle mass in 492 apparently healthy adults enrolled in the Korean Sarcopenic Obesity Study (KSOS), an ongoing prospective observational cohort study. Low muscle mass was defined as thigh muscle cross-sectional area divided by weight (percent) of <1 SD below the mean values of young adults in both sexes.

RESULTS

The prevalence rates of low muscle mass in MHNW, MANW, MHO, and MAO subjects were 6.2%, 17.8%, 23.2%, and 33.7%, respectively. In a multiple logistic regression analysis, men with the MANW phenotype showed a remarkably increased risk of low muscle mass (odds ratio = 11.30, 95% confidence interval, 1.73-73.28) compared with those with MHNW. Furthermore, in both men and women, MHO or MAO subjects had higher odds ratios of low muscle mass compared with MHNW subjects.

CONCLUSIONS

The present study suggests that low muscle mass may be associated with different metabolic consequences according to body size phenotype.

Discriminating sarcopenia in community-dwelling older women with high frequency of overweight/obesity: the São Paulo Ageing & Health Study (SPAH)

SUMMARY

The criteria most used for the definition of sarcopenia, those based on the ratio between the appendicular skeletal muscle mass (ASM) and the square of the height (h(2)) underestimate prevalence in overweight/obese people whereas another criteria consider ASM adjusted for total fat mass. We have shown that ASM adjusted for fat seems to be more appropriate for sarcopenia diagnosis.

INTRODUCTION

Since the prevalence of overweight and obesity is a growing public health issue, the aim of this study was to evaluate the prevalence and risk factors associated with sarcopenia, based on these two criteria, among older women.

METHODS

Six hundred eleven community-dwelling women were evaluated by specific questionnaire including clinical data. Body composition and bone mineral density were evaluated by dual X-ray absorptiometry. Logistic regression models were used to identify factors independently related to sarcopenia by ASM/h(2) and ASM adjusted for total fat mass criteria.

RESULTS

The prevalence of overweight/obesity was high (74.3 %). The frequency of sarcopenia was lower using the criteria of ASM/h(2) (3.7 %) than ASM adjusted for fat (19.9 %) (P < 0.0001). We also note that less than 5 %(1/23) of sarcopenic women, according to ASM/h(2), had overweight/obesity, whereas 60 % (74/122) of sarcopenic women by ASM adjusted for fat had this complication. Using ASM/h(2), the associated factors observed in regression models were femoral neck T-score (OR = 1.90; 95 % CI 1.06-3.41; P = 0.03) and current alcohol intake (OR = 4.13, 95 % CI 1.18-14.45, P = 0.03). In contrast, we have identified that creatinine (OR = 0.21; 95 % CI 0.07-0.63; P = 0.005) and the White race (OR = 1.81; 95 % CI 1.15-2.84; P = 0.01) showed a significant association with sarcopenia using ASM adjusted for fat.

CONCLUSIONS

In women with overweight/obesity, ASM adjusted for fat seems to be the more appropriate criteria for sarcopenia diagnosis. This finding has relevant public health implications, considering the high prevalence of overweight/obesity in older women.

Sarcopenia or muscle modifications in neurologic diseases: a lexical or patophysiological difference?

Sarcopenia is a condition characterized by a decrease in muscle mass and function (strength and mobility) that is frequently observed in the elderly. In people with paresis and altered mobility due to central nervous system (CNS) diseases, this definition then may not be applicable. In CNS diseases, mainly stroke and spinal cord injury, different and specific patterns of muscle loss and muscle changes have been described, due to denervation, disuse atrophy, spasticity and myosteatosis. The main observations available about these phenomena in CNS diseases are reviewed, and a broad view on the specific physiopathological mechanisms is also described. Moreover, a description of the potential pharmacological targets and treatment strategies (physical and nutritional) is provided. Since sarcopenia of the elderly and muscle modifications and muscle atrophy in CNS diseases have different mechanisms, it is probable that they do not respond equally to the same treatments.

The association between daily calcium intake and sarcopenia in older, non-obese Korean adults: the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) 2009

Recent data suggest that variations in calcium intake may influence body weight and composition; however, the relationship between daily calcium intake and muscle mass has not been well established. The objective of this study was to assess the relationship between daily calcium intake and sarcopenia. We analyzed data for older adults (over 60 years) from the fourth Korea National Health and Nutrition Examination Survey (KNHANES) conducted in 2009. A total of 1339 Non-Obese (BMI between 18.5 and 25 kg/m²), older adults (592 men and 707 women) were enrolled. Dietary variables were assessed using a nutrition survey that used a 24-hour recall method. Daily calcium intake based on the consumption of each food item was calculated. Sarcopenia was defined as an appendicular skeletal muscle mass divided by body weight less than 2 SD below the sex-specific mean for young adults. We found that daily calcium intake was negatively correlated with total body fat percentage and positively correlated with appendicular skeletal mass (p<0.001). Participants with sarcopenia appear to have significantly lower daily calcium intakes than participants without sarcopenia (p<0.001). The unadjusted prevalence of sarcopenia according to daily calcium intake tertiles were 6.3%, 4.3%, and 2.7% in tertiles 1, 2, and 3, respectively. After adjustment for age, sex, BMI, total energy intake, and lifestyle factors, compared with those in the lowest tertile of daily calcium intake, participants in the highest tertile had an odds ratio for sarcopenia of 0.295 (95% confidence interval, 0.087-0.768; p for trend = 0.014). We found that daily calcium intake, corrected for total energy intake and serum 25(OH)D status, was significantly lower in subjects with sarcopenia than in those without. Our results suggest a strong inverse association between daily calcium intake and sarcopenia in non-obese, older Korean adults.

Dietary patterns and sarcopenia in an urban African American and White population in the United States

The primary objective of this cross-sectional study was to characterize dietary patterns of African Americans and Whites, 30 to 64 years, examined in the Healthy Aging in Neighborhoods of Diversity across the Life Span study. Other objectives of the study were to evaluate micronutrient adequacy of each pattern and to determine the association of diet with sarcopenia. Cluster analysis was used to determine patterns and mean adequacy ratio (MAR) to determine adequacy of 15 micronutrients. Ten clusters were identified: sandwich, sweet drink, pizza, poultry, frozen meal, dessert, alcoholic drink, bread, starchy vegetables, and pasta/rice dish. MAR ranged from 69 for the sweet drink cluster to 82 for the pasta/rice dish cluster. Sarcopenia was present in 6.4% of the sample, ranging from 1.5% in the poultry cluster to 14.1% in the alcoholic drink cluster. This study is the first to report an association between diet and sarcopenia in people younger than 65 years. The identification of presarcopenia has important implications for dietary interventions that might delay age-associated loss of lean mass.

Sarcopenia and its relationship with bone mineral density in middle-aged and elderly European men

The aim of this study was to determine the relationship between reduced muscle mass (sarcopenia) and areal bone mineral density (BMD(a)) in middle-aged and elderly community-dwelling European men. Men with sarcopenia had significantly lower BMD(a) and were more likely to have osteoporosis compared with men without sarcopenia.

INTRODUCTION

In men, the relationship between reduced muscle mass (sarcopenia) and BMD(a) is unclear. This study aimed to determine this relationship in middle-aged and elderly community-dwelling men.

METHODS

Men aged 40-79 years from the Manchester (UK) and Leuven (Belgium) cohorts of the European Male Ageing Study were invited to attend for assessment including dual-energy X-ray absorptiometry, from which appendicular lean mass (aLM), fat mass (FM) and whole-body, spine and hip BMD(a) were determined. Relative appendicular skeletal muscle mass (RASM) was calculated as aLM/height². Muscle strength was assessed in subjects from Leuven. Sarcopenia was defined by RASM at <7.26 kg/m² and by the recent definition of the European Working Group on Sarcopenia in Older People (RASM at <7.26 kg/m(2) plus low muscle function). Linear regression was used to determine the associations between aLM, FM, muscle strength and BMD(a) and logistic regression to determine the association between sarcopenia and osteoporosis.

RESULTS

Six hundred seventy-nine men with a mean age of 59.6 (SD = 10.7), contributed data to the analysis; 11.9 % were sarcopenic by the conventional definition. After adjustment for age and centre, aLM, RASM and FM were positively associated with BMD(a). Men with RASM at <7.26 kg/m² had significantly lower BMD(a) compared with those with RASM at ≥7.26 kg/m(2). In a multivariable model, aLM was most consistently associated with BMD(a). Men with sarcopenia were more likely to have osteoporosis compared with those with normal RASM (odds ratio = 3.0; 95 % CI = 1.6-5.8).

CONCLUSIONS

Sarcopenia is associated with low BMD(a) and osteoporosis in middle-aged and elderly men. Further studies are necessary to assess whether maintaining muscle mass contributes to prevent osteoporosis.

[Sarcopenia: toward its clinical utilisation]

Sarcopenia is a term that was introduced to describe 'low muscle mass'. There is no consensus definition for sarcopenia; a variety of criteria are being used to establish the diagnosis of 'sarcopenia'. Depending on the criteria used, the prevalence of sarcopenia in elderly varies from 7% to over 50%. The presence of sarcopenia often remains unrecognized when the loss of muscle mass is replaced by fat and connective tissue; body weight thus remains stable or even increases. Sarcopenia can be detected by measuring muscle mass with dual-energy X-ray absorptiometry (DEXA) or bioimpedance analysis (BIA). Besides the generation of strength, muscle tissue is an important internal organ involved in protein storage, glucose regulation, hormonal homeostasis and cellular communication. Systemic, cellular, neuromechanical factors and lifestyle are linked to the pathophysiology of sarcopenia. Sarcopenia is associated with higher mortality, dependency in activities of daily living, toxicity of chemotherapy, and disturbed glucose regulation.

The potential of classic and specific bioelectrical impedance vector analysis for the assessment of sarcopenia and sarcopenic obesity

PURPOSE

The aim of this paper is to investigate whether bioelectrical impedance vector analysis (BIVA) can be a suitable technique for the assessment of sarcopenia. We also investigate the potential use of specific BIVA as an indicator of sarcopenic obesity.

SUBJECTS AND METHODS

The sample comprised 207 free-living elderly individuals of both sexes, aged 65 to 93 years. Anthropometric and bioelectrical measurements were taken according to standard criteria. The "classic" and "specific" BIVA procedures, which respectively correct bioelectrical values for body height and body geometry, were used. Dual energy X-ray absorptiometry (DXA) was used as the reference method for identifying sarcopenic and obese sarcopenic individuals. Bioelectrical and DXA values were compared using Student's t-test and Hotelling's T(2) test, as well as Pearson's correlation coefficient.

RESULTS

According to classic BIVA, sarcopenic individuals of both sexes showed higher values of resistance/height (R/H; p < 0.01) and impedance/height (Z/H; p < 0.01), and a lower phase angle (p < 0.01). Similarly, specific BIVA showed significant differences between sarcopenic and nonsarcopenic individuals (men: T(2) = 15.7, p < 0.01; women: T(2) = 10.7, p < 0.01), with the sarcopenic groups showing a lower specific reactance and phase angle. Phase angle was positively correlated with the skeletal muscle mass index (men: r = 0.52, p < 0.01; women: r = 0.31, p < 0.01). Specific BIVA also recognized bioelectrical differences between sarcopenic and sarcopenic obese men (T(2) = 13.4, p < 0.01), mainly due to the higher values of specific R in sarcopenic obese individuals.

CONCLUSION

BIVA detected muscle-mass variations in sarcopenic individuals, and specific BIVA was able to discriminate sarcopenic individuals from sarcopenic obese individuals. These procedures are promising tools for screening for presarcopenia, sarcopenia, and sarcopenic obesity in routine practice.

Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study

PURPOSE

This study aimed to determine the prevalence of sarcopenia and examine whether sarcopenia was associated with overall and breast-cancer-specific mortality in a cohort of women diagnosed with breast cancer (stages I-IIIA).

METHODS

A total of 471 breast cancer patients from western Washington State and New Mexico who participated in the prospective Health, Eating, Activity, and Lifestyle Study were included in this study. Appendicular lean mass was measured using dual X-ray absorptiometry scans at study inception, on average, 12 months after diagnosis. Sarcopenia was defined as two standard deviations below the young healthy adult female mean of appendicular lean mass divided by height squared (<5.45 kg/m(2)). Total and breast-cancer-specific mortality data were obtained from Surveillance Epidemiology and End Results registries. Multivariable Cox proportional hazard models assessed the associations between sarcopenia and mortality.

RESULTS

Median follow-up was 9.2 years; 75 women were classified as sarcopenic, and among 92 deaths, 46 were attributed to breast cancer. In multivariable models that included age, race-ethnicity/study site, treatment type, comorbidities, waist circumference, and total body fat percentage, sarcopenia was independently associated with overall mortality (hazard ratio (HR) = 2.86; 95 % CI, 1.67-4.89). Sarcopenic women had increased risk of breast-cancer-specific mortality, although the association was not statistically significant (HR = 1.95, 95 % CI, 0.87-4.35).

CONCLUSION

Sarcopenia is associated with an increased risk of overall mortality in breast cancer survivors and may be associated with breast-cancer-specific mortality. The development of effective interventions to maintain and/or increase skeletal muscle mass to improve prognosis in breast cancer survivors warrants further study.

IMPLICATIONS FOR CANCER SURVIVORS

Such interventions may help breast cancer patients live longer.

Prevalence and associated factors of sarcopenia in older adults with intellectual disabilities

Sarcopenia is defined as a syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength. It has hardly been studied in older people with intellectual disabilities (ID). In this study 884 persons with borderline to profound ID aged 50 years and over, were investigated to determine the prevalence of sarcopenia in this group. To identify the associations of sarcopenia, logistic regression analyses were performed with patient characteristics, mobility, physical activity, intake of energy and proteins, body mass index (BMI) and levels of CRP, albumin and vitamin D in serum. The prevalence of sarcopenia was 14.3% in the total group. In the age group 50-64 years prevalence was 12.7%. Sarcopenia was positively associated with mobility impairment and inflammation and negatively with BMI. The next thing to do is collecting longitudinal data to study the relation between sarcopenia and negative outcomes in older people with ID.

The impact of insulin resistance and inflammation on the association between sarcopenic obesity and physical functioning

Age associated increases in visceral adiposity and decreases in muscle mass (sarcopenia) have been shown to contribute to disability in late life. Furthermore, there is evidence that obesity-related physiological states, such as insulin resistance and systemic inflammation, may exacerbate physical functioning problems. Both conditions have been shown to prompt hypercatabolism and impair the anabolic effect of muscles, ultimately stimulating protein breakdown and suppressing muscle synthesis. This cross-sectional study investigates whether insulin resistance and inflammation partially account for the associations between decreased physical functioning and sarcopenic obesity. Subjects include 2,287 males and females aged 60 and older without diagnosed diabetes from the National Health and Nutrition Examination Survey (NHANES 1999-2004). Body composition measurements indicating waist circumference and appendicular skeletal muscle mass, measured by dual-energy X-ray absorptiometry (DXA), were used to construct four body composition categories--healthy, sarcopenic nonobese, nonsarcopenic obese, and sarcopenic obese. Physical functioning was measured using self-reports of difficulty performing six activities. The homeostasis model assessment (IR(HOMA)) was used to measure insulin resistance, while inflammatory state was assessed through measurement of serum C-reactive protein (CRP). Modified Poisson regression models were used to examine the association between physical functioning and body composition, and to evaluate whether differences in insulin resistance or inflammation partially explained this relationship. In the analysis, we controlled for possible confounders such as age, education, sex, height, and race/ethnicity. Findings suggest that physical functioning problems are increased in those with sarcopenic obesity, sarcopenic nonobesity and nonsarcopenic obesity. Furthermore, these associations may be influenced by differences in insulin resistance among different body composition phenotypes.

Nutrition in the critically-ill obese patient

People are fatter than they used to be. Although the upward trend has slowed in recent years, more than one third of all adults in the US are obese, and one in six children are overweight or obese. Reflecting this reality, there are a large number of obese patients in the intensive care unit. Some 30-35% of adult ICU patients are obese, and 5% or more are morbidly obese. Patients who are both critically-ill and morbidly obese present unique challenges to care. These range from basic care, such as prevention of bedsores and ambulation, to sophisticated issues, such as medication dosing and ventilator management. It takes a team of caregivers, for example, to help a 400-pound patient in and out of bed. One of the most difficult aspects of the care of such patients is nutrition support, which is the subject of the present review.

Sarcopenic indices in community-dwelling older adults

BACKGROUND

Sarcopenic (SP) indices are used to estimate loss of skeletal lean mass and function and to determine the prevalence of SP in older adults. It is believed that older women and men with lower skeletal lean mass will be weaker and have more functional limitations.

PURPOSE

(1) To classify community-dwelling older adults using 2 common SP indices: appendicular lean mass/height² (ALM/ht²) and skeletal muscle index (SMI), and (2) to determine each indices value as indicators of lower extremity strength and physical function.

METHODS

The sample consisted of 154 community-dwelling older adults (111 women and 43 men; mean age = 82.4, SD = 3.6 years; mean body mass index = 25.8, SD = 4.4 kg/m). Each underwent whole-body dual-energy x-ray absorptiometry to assess lean mass. The 9-item modified Physical Performance Test and self-selected walking speed were used to evaluate function. Lower extremity strength was measured bilaterally using isokinetic dynamometry.

RESULTS

The ALM/ht² index classified 75 participants (49%) as SP and 79 (51%) as nonsarcopenic (NSP). The SMI classified 129 participants (84%) as SP and 25 (16%) as NSP. There were no differences in functional measures between groups by gender using either index after classification. The ALM/ht index was more strongly correlated with peak torque of all lower extremity muscle groups (r = 0.276-0.487) compared with the SMI (r = 0.103-0.344). There was no relationship between SP index and physical function.

DISCUSSION

There were marked differences in how 2 SP indices classified community-dwelling older adults. Lower extremity strength was lower in older women classified as SP than NSP using the ALM/ht index, but LE strength was not different in older men. However, no lower extremity strength differences were observed between SP and NSP men or women using the SMI classification. None of the SP index uniformly identified community-dwelling older adults with functional or strength deficits.

CONCLUSIONS

Detection of strength deficits using SP indices alone may be gender-specific and may not reflect strength or functional decline in community-dwelling men aged 80 years or older. Given associations between lower extremity strength and physical function, strength measures remain a better predictor of physical performance than SP indices for community-dwelling older men and women.

Frailty and sarcopenia: definitions and outcome parameters

An operational definition of musculoskeletal decline in older people is needed to allow development of interventions for prevention or treatment, as was developed for the treatment of osteoporosis. Frailty and sarcopenia are linked, but distinct, correlates of musculoskeletal aging that have many causes, including age-related changes in body composition, inflammation, and hormonal imbalance. With the emergence of a number of exciting candidate therapies to retard the loss of muscle mass with aging, the derivation of a consensual definition of sarcopenia and physical frailty becomes an urgent priority. Although several consensual definitions have been proposed, these require clinical validation. An operational definition, which might provide a threshold for treatment/trial inclusion, should incorporate a loss of muscle mass as well as evidence of a decrease in muscle strength and/or physical activity. Evidence is required for a link between improvements in the measures of muscle strength and/or physical activity and clinical outcomes to allow development of interventions to improve clinical outcomes in frail older patients.

Skeletal muscle mass abnormalities are associated with survival rates of institutionalized elderly nursing home residents

BACKGROUND

Knowledge about the changes in skeletal muscle mass in nursing home residents is very limited. We hypothesized that such patients have different types of skeletal muscle mass abnormalities that may affect mortality rates. Therefore, the objective of this study was to evaluate the prevalence and extent of skeletal muscle mass decline, its different clinical phenotypes (sarcopenia, wasting/atrophy and cachexia) and the mortality rates associated with these abnormalities.

METHODS

A retrospective chart-review study comprising 109 institutionalized nursing home residents. Body mass index, body fat mass, fat free mass, skeletal muscle mass and survival rates were assessed.

RESULTS

Skeletal muscle mass abnormalities were found among 73 out of 109 (67.0%) patients and were more prevalent in males compared with females (97.8% and 43.8%, respectively, p<0.001). Most of these patients had muscle wasting/atrophy (51.4%) or sarcopenia (40.3%), and 9.7% suffered from cachexia. One third of the patients with abnorrmal skeletal muscle mass showed a moderate decline of skeletal muscle mass (34.7%) while the remainder (65.3%) had very low levels of skeletal muscle mass. Each group was characterized by typical medical conditions associated with skeletal muscle mass abnormality. A Kaplan-Meier survival plot of mortality showed only lower one-year survival rates in the group with sarcopenia (60%) and muscle atrophy or cachexia (53%), compared with elderly participants with a normal skeletal muscle mass (73%), (p<0.0001). There were no significant differences in 1-year mortality rates between patients with abnormal skeletal muscle mass (whether sarcopenia, cachexia or wasting).

CONCLUSION

About two thirds of nursing home patients show skeletal muscle mass abnormalities, most within the range of very low skeletal muscle mass rather than moderately low skeletal muscle mass, that are associated with shorter survival rates, compared with normal skeletal muscle mass patients.

Relationship of low plasma klotho with poor grip strength in older community-dwelling adults: the InCHIANTI study

Handgrip strength is a strong indicator of total body muscle strength and is a predictor of poor outcomes in older adults. The aging suppressor gene klotho encodes a single-pass transmembrane protein that is secreted as a circulating hormone. In mice, disruption of klotho expression results in a syndrome that includes sarcopenia, atherosclerosis, osteoporosis, and shortened lifespan, and conversely, overexpression of klotho leads to a greater longevity. The objective was to determine whether plasma klotho levels are related to skeletal muscle strength in humans. We measured plasma klotho in 804 adults, ≥65 years, in the InCHIANTI study, a longitudinal population-based study of aging in Tuscany, Italy. Grip strength was positively correlated with plasma klotho at threshold <681 pg/mL. After adjusting for age, sex, education, smoking, physical activity, cognition, and chronic diseases, plasma klotho (per 1 standard deviation increase) was associated with grip strength (beta = 1.20, standard error = 0.35, P = 0.0009) in adults with plasma klotho <681 pg/mL. These results suggest that older adults with lower plasma klotho have poor skeletal muscle strength.

Prevalence of sarcopenia in healthy community-dwelling elderly in an urban area of Barcelona (Spain)

INTRODUCTION

The purpose of this study was to evaluate the prevalence of sarcopenia in a cohort of healthy community-dwelling elderly in an urban area in Barcelona (Spain) for native benchmarks and compare them with those published in other geographical areas.

MATERIAL AND METHODS

We prospectively evaluated a series of 200 healthy elderly in the community with preserved functional capacity and absence of cognitive impairment. We performed a comprehensive geriatric assessment and determined anthropometric data, muscle mass (MM) and the muscle mass index (MMI). Assessment of muscle mass was performed by bioelectrical impedance analysis (BIA). The cut-off point for defining sarcopenia MMI was established as less than 2 SD of the mean of a reference group comprising 220 healthy volunteers (20-42 years) in the same area. Results were compared with studies undertaken in the USA, France and Taiwan.

RESULTS

The cut-off points obtained were 8.31 Kg/m(2) for men and 6.68 Kg/m2 for women, being similar to those observed in France and Taiwan but different from the USA. The prevalence of sarcopenia observed was 33% for elderly women and 10% for males. On comparison of the prevalence of sarcopenia in the four populations, we observed some differences, particularly in males.

CONCLUSIONS

We have defined reference values for sarcopenia, determined by BIA, in our setting. We also observed a remarkable prevalence of sarcopenia in the healthy elderly community, especially in females, showing some differences from those in other geographical regions.

Impact of a new sarco-osteopenia definition on health-related quality of life in a population-based cohort in Northern Europe

Sarcopenia has been shown to be a marker of falling; therefore, combining osteopenia and sarcopenia could identify a frailer, higher-fracture-risk population. We aimed to define sarco-osteopenia (SOP) in a population-based healthy young sample using both muscle functional and quantitative parameters and assessing the impact of this definition on health-related quality of life. A population sample of 304 patients aged 25-70 yr was analyzed with a Lunar DPX-IQ dual-energy X-ray absorptiometry machine (GE Healthcare, Pollards Wood, UK), and their health-related quality of life was assessed with the Short-Form-36 (SF-36) questionnaire. SOP was defined as bone mineral density (BMD) -1 standard deviation (SD) and height-adjusted appendicular muscle mass -2 SD and/or grip strength -2 SD less than the mean values of 77 young individuals in the population sample (age: 25-39 yr). Our proposed SOP definition identifies 3-9% of the population older than 40 yr as sarco-osteopenic. These individuals also show markedly lower scores in the role-physical (p=0.01), vitality (p=0.03), and role-emotional (p=0.02) subscales of the SF-36 questionnaire. No difference in the quality of life was observed between osteopenic individuals and those with normal BMD. The new definition identifies a population with significant decrements in health-related quality of life.

[Age-related sarcopenia as the risk factor of development of myocardial dysfunction and chronic heart failure in elderly patients with arterial hypertension]

To estimate the expressiveness of involutive sarcopenia and its influences on the development of myocardial dysfunctions 88 patients of 60+ years with arterial hypertension (AH) II stage (middle age 66.9 +/- 0.7 years, 76 women and 12 men) and 32 persons who do not have cardiovascular diseases were surveyed. It is revealed that expressiveness of involutive sarcopenia is non-uniform at senior patients; structural and functional changes of heart in elderly patients with AH clinically shown by myocardial dysfunction, decreased tolerance to physical activity, are more pronounced in the group of patients with a low index of muscular weight. High values of the indicators of oxidative modification of lipids in the blood serum and the insufficiency of mechanisms of antioxidant protection in elderly patients with AH who have low index of muscle mass point to the negative role of oxidative stress in the pathogenesis of involutive sarcopenia.

[Sarcopenia: prevalence, detection, clinical significance]

Population aging is a most important demographic process in the recent decades. The elderly subjects constitute an increasingly greater fraction of the patients staying at multifield hospitals. They are characterized not only by having multiple pathologies but also by age-related changes in peripheral tissues. These physiological changes may considerably aggravate the clinical conditions of the patients. One of the processes accompanying aging is sarcopenia or the loss of muscular mass leading to deterioration of the quality of life and physical independence, disablement and a poor life prognosis. Sarcopenia has been extensively studied in recent decades with reference to it social and economic consequences. At the same time the efficacy of measures designed to control sarcopenia is impaired by concomitant diseases and age-related changes in the muscular tissue. The problem of sarcopenia is insufficiently dealt with in the Russian-language literature despite its clinical significance. This review is intended for a wide circle of clinicians dealing with aged patients in their practical work.

Low testosterone in ageing men: a modifiable risk factor for frailty?

There is substantial interest in the role of testosterone (T) in male ageing. Studies suggest that low T may be a risk factor for frailty, the vulnerable health status that occurs at advanced ages. However, T deficiency is relatively rare in ageing men and, importantly, is linked to modifiable risk factors including body weight and concurrent illnesses. These observations shift the focus away from hormone replacement and towards potential preventative strategies to help maintain T levels in ageing men. Furthermore, the effects of T on physical function remain inconsistent, and studies examining the safety of T treatment in ageing males raise concerns. Further research may usefully focus on novel pro-anabolic pharmaceutical agents, which together with other interventions will allow for optimal management of frailty.

Sarcopenia and obesity

Four body composition phenotypes exist in older adults: normal, sarcopenic, obese, and a combination of sarcopenic and obese. There is no consensus, however, on the definitions and classifications of these phenotypes and their etiology and consequences continue to be debated. The lack of standard definitions, particularly for sarcopenia and sarcopenic obesity, creates challenges for determining prevalence across different populations. The etiology of these phenotypes is multifactorial with complex covariate relationships. This review focuses on the current literature addressing the classification, prevalence, etiology, and correlates of sarcopenia, obesity, and the combination of sarcopenia and obesity, referred to as sarcopenic obesity.

Vitamin D deficiency is associated with sarcopenia in older Koreans, regardless of obesity: the Fourth Korea National Health and Nutrition Examination Surveys (KNHANES IV) 2009

BACKGROUND

An association between vitamin D status and sarcopenia has not been shown in a community-dwelling cohort, despite the well-documented relationship between vitamin D status and falls.

OBJECTIVE

Our objective was to investigate whether vitamin D level is associated with sarcopenia in older Koreans.

DESIGN AND SETTING

The Fourth Korea National Health and Nutrition Examination Survey in the Korean population was conducted in 2009.

PARTICIPANTS

Participants included 1380 men and 1789 women aged 50 yr or older.

MEASUREMENTS

Serum 25-hydroxyvitamin D [25(OH)D] and PTH levels were measured. Sarcopenia was defined as an appendicular skeletal muscle mass divided by body weight that was less than 2 sd below the sex-specific mean for young adults. Obesity was defined as a body mass index (BMI) of 27.5 kg/m(2) or higher.

RESULTS

25(OH)D level correlated negatively with appendicular fat mass and positively with appendicular skeletal mass. The groups with sarcopenic obesity and sarcopenia only had lower 25(OH)D levels than did the nonsarcopenia groups. However, 25(OH)D levels did not differ between the sarcopenic obesity and sarcopenia groups. After adjustment for age, sex, BMI, and lifestyle factors, compared with those in the lowest quartile of 25(OH)D level, participants in the highest quartile had an odds ratio for sarcopenia of 0.47 (95% confidence interval = 0.30-0.73; P for trend = 0.001). There was no association between PTH and sarcopenia after adjustment of BMI.

CONCLUSIONS

Vitamin D levels were significantly lower in subjects with sarcopenia than in those without, regardless of obesity. We found a strong inverse association between 25(OH)D level and sarcopenia in the older Korean population.

Risk of malnutrition among Brazilian institutionalized elderly: a study with the Mini Nutritional Assessment (MNA) questionnaire

BACKGROUND

Brazilian population has passed for a process of demographic transition throughout latest years, characterized for the increase of the elderly population. Malnutrition is a serious problem to frail elderly.

OBJECTIVE

The objective of this study was o evaluate the risk of malnutrition among institutionalized elderly resident in municipal shelters in the city of Rio de Janeiro, Brazil, using the tool Mini Nutritional Assessment (MNA).

DESIGN

344 institutionalized elderly aged over 60 years old were tested in a cross-sectional study using MNA. This tool classifies the nutricional status of the elderly in three groups: malnutrition (score < 17), risk of malnutrition (score 17 - 23,5) and well-nourished (score > = 24). Anthropometric measurements such as calf circumference (CC), mid-arm circumference (MAC) and Body mass index (BMI) were also evaluated. The variables were evaluated using the chi-square or ANOVA test. To correlate it was used Pearson's Correlation Coefficient (r).

RESULTS

Mean age were 75.4 (+- 9.4) years old. Most of the elderly were female gender (59.6%). According to MNA 8.3% were with malnutrition, 55.6% at risk of malnutrition and 36.1% well-nourished. BMI classified 10.0% of the elderly as underweight. CC classified 10.0 % of them as inadequate in muscular mass. MNA was well correlated to BMI (r=0.412 p=0.000), age (r=-0.124 p=0.031), CC (r=0.399 p = 0.000) and MAC (r=0.391 p=0.000).

CONCLUSION

Risk of malnutrition was high among the institutionalized elderly from public shelters in Rio de Janeiro - Brazil. MNA is a useful diagnostic tool for the identification on the frail elderly at risk of malnutrition.

A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach

BACKGROUND

the European Working Group on Sarcopenia in Older People has developed a clinical definition of sarcopenia based on low muscle mass and reduced muscle function (strength or performance). Grip strength is recommended as a good simple measure of muscle strength when 'measured in standard conditions'. However, standard conditions remain to be defined.

METHODS

a literature search was conducted to review articles describing the measurement of grip strength listed in Medline, Web of Science and Cochrane Library databases up to 31 December 2009.

RESULTS

there is wide variability in the choice of equipment and protocol for measuring grip strength. The Jamar hand dynamometer is the most widely used instrument with established test-retest, inter-rater and intra-rater reliability. However, there is considerable variation in how it is used and studies often provide insufficient information on the protocol followed making comparisons difficult. There is evidence that variation in approach can affect the values recorded. Furthermore, reported summary measures of grip strength vary widely including maximum or mean value, from one, two or three attempts, with either hand or the dominant hand alone.

CONCLUSIONS

there is considerable variation in current methods of assessing grip strength which makes comparison between studies difficult. A standardised method would enable more consistent measurement of grip strength and better assessment of sarcopenia. Our approach is described.

The epidemiology of sarcopenia

The term sarcopenia was coined in 1989 and refers to the age-related loss in skeletal muscle mass. Operational definitions of sarcopenia have been used in research studies to identify older persons with healthy muscle mass values (normal) and older adults with unacceptably low muscle mass values (sarcopenic). Despite the enormous research on sarcopenia that has been completed in the past 20 years, sarcopenia currently receives little attention in the clinical setting. To address this issue, the European Working Group on Sarcopenia in Older People recently developed a consensus definition of sarcopenia. The availability of a consensus definition may assist with the integration of sarcopenia into mainstream geriatric assessment.

Body composition phenotypes in systemic lupus erythematosus and rheumatoid arthritis: a comparative study of Caucasian female patients

OBJECTIVES

The amount and distribution of fat and lean mass have important implications for health and systemic inflammation may represent a risk for altered body composition. The aim of this study was to analyse whether changes in body composition are similarly associated with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), two inflammatory conditions of different pathogenesis.

METHODS

Body mass index (BMI), waist circumference, fat mass (FM) and fat-free mass (FFM) were measured in 92 women with SLE, 89 with RA and 107 controls. Results were compared among the 3 groups and correlations of FM percentage were explored within SLE and RA.

RESULTS

Abnormal body composition was more frequent in women with SLE and RA than in non-inflammatory controls, despite having a similar BMI. RA diagnosis was significantly associated with overfat (OR=2.782, 95%CI 1.470-5.264; p=0.002) and central obesity (OR=2.998, 95%CI 1.016-8.841; p=0.04), while sarcopenia was more common among SLE (OR=3.003; 95%CI 1.178-7.676; p=0.01). Sarcopenic obesity, i.e. the coexistence of overfat with sarcopenia, was present in 6.5% of SLE and 5.6% of RA women, but no controls. Independent correlations of FM percentage in women with SLE included smoking, disease activity and CRP. In RA, education, disease activity and cumulative corticosteroid dose were identified as independent predictors of FM percentage.

CONCLUSIONS

Women with SLE or RA diagnosis are more likely to have abnormal body composition phenotype, with some differences existing between these two conditions. Changes in body composition are partly explained by the inflammatory burden of disease and its treatment.

Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia

Sarcopenia, the age-associated loss of skeletal muscle mass and function, has considerable societal consequences for the development of frailty, disability, and health care planning. A group of geriatricians and scientists from academia and industry met in Rome, Italy, on November 18, 2009, to arrive at a consensus definition of sarcopenia. The current consensus definition was approved unanimously by the meeting participants and is as follows: Sarcopenia is defined as the age-associated loss of skeletal muscle mass and function. The causes of sarcopenia are multifactorial and can include disuse, altered endocrine function, chronic diseases, inflammation, insulin resistance, and nutritional deficiencies. Although cachexia may be a component of sarcopenia, the 2 conditions are not the same. The diagnosis of sarcopenia should be considered in all older patients who present with observed declines in physical function, strength, or overall health. Sarcopenia should specifically be considered in patients who are bedridden, cannot independently rise from a chair, or who have a measured gait speed less that 1 m/s(-1). Patients who meet these criteria should further undergo body composition assessment using dual energy x-ray absorptiometry with sarcopenia being defined using currently validated definitions. A diagnosis of sarcopenia is consistent with a gait speed of less than 1 m·s(-1) and an objectively measured low muscle mass (eg, appendicular mass relative to ht(2) that is ≤ 7.23 kg/m(2) in men and ≤ 5.67 kg/m(2) in women). Sarcopenia is a highly prevalent condition in older persons that leads to disability, hospitalization, and death.

Challenges and new opportunities for clinical nutrition interventions in the aged

Nutritional status plays a critical role in the prevention and management of many chronic health conditions that are common in the elderly and are likely to become more prevalent as the population ages. This paper highlights several aspects of nutrition that require additional basic science and clinical application research to improve the health and well-being of older adults. Topics addressed are selected demographic and health indices, the uncertain benefits of energy restriction in aged humans compared with other species, the impact of food insecurity on health, the relationship between dietary protein and sarcopenia, the prevention and management of obesity while maintaining muscle mass and functional status, and controversy regarding high intakes of folic acid. Research needs regarding the safety, efficacy, and application of clinical interventions related to these topics also are discussed.

[Obesity in dialysis and reverse epidemiology: true or false?]

About 50% of patients who undergo dialysis are overweight or obese. Rather than being a disadvantage, the extra weight is associated with improved survival in this patient group. However, the relationship between weight and outcome is complex among dialysis patients. In the general population obesity constitutes a clear cardiovascular risk factor. By contrast, in obese dialysis patients the nutritional status may be better, and obesity thus provides, at least in the short term, some protection against malnutrition and the associated morbidity. On the other hand, some studies suggest that mortality in the long term is directly correlated with excess weight and obesity, which indicates that fat represents a risk factor also in uremia. In the elderly, particularly those affected by end-stage renal disease, endocrine and metabolic effects on the nitrogen balance cause the loss of muscle mass despite an excess of adipose tissue, which is a condition known as sarcopenic obesity. While a good nutritional state is found in some obese dialysis patients, which probably accounts for the improved survival of the obese group as a whole, there is a sizable proportion of sarcopenic obese, which is probably increasing. Sarcopenic obesity is not only characterized by the reduction of muscle mass but also by the accumulation of fat surrounding the abdominal viscera (visceral fat syndrome), which may be associated with a greater degree of metabolic and atherosclerotic disease. Several studies have shown that malnutrition associated with obesity, including sarcopenic obesity, is the risk factor most closely correlated with morbidity and mortality both in dialysis patients and the general population. The timely identification of this condition has therefore become necessary in the dialysis population now dominated by the elderly and very elderly. Body mass index is inadequate as a measure of sarcopenic obesity since it cannot define muscle mass nor indicate the localization of the fat in the visceral compartment. Other indices must be developed and validated in well performed clinical trials to identify fat localization and the presence of sarcopenia.

The association between the ratio of visceral fat to thigh muscle area and metabolic syndrome: the Korean Sarcopenic Obesity Study (KSOS)

OBJECTIVE

A relationship between visceral fat accumulation and metabolic syndrome (MetS) has been established. However, the effect of a relative increase in visceral fat and a decrease in muscle mass on metabolic disorders has not been investigated. The aim of the present study was to examine the association between the ratio of visceral fat to thigh muscle area (VMR) and MetS in Korean adults. STUDY SUBJECT/MEASUREMENTS: A total of 264 age-and gender-matched subjects recruited from the Korean Sarcopenic Obesity Study (KSOS), an ongoing prospective observational cohort study, were categorized into four groups based on their body mass index (BMI) and VMR. We measured visceral fat area and thigh muscle area using computed tomography.

RESULTS

Subjects with MetS showed a significantly higher VMR than those without MetS. In both obese and nonobese groups, the subjects with a higher VMR had a higher prevalence of MetS than those in the lower VMR groups. VMR was significantly related to components of the metabolic syndrome, especially in women, and was positively correlated with a number of MetS components in both men and women. In multiple logistic regression analysis, the odds ratio for MetS was 6·72 (highest vs lowest quartile, 95% confidence interval, 1·60-28·14) after an adjustment of potential confounders, including BMI and waist-to-hip ratio.

CONCLUSION

VMR is significantly increased in subjects with MetS and independently associated with MetS. These results suggest that the VMR may be a potential indicator for MetS risk in Korean adults.

[Sarcopenia: a physical marker of frailty]

Sarcopenia is defined by loss of muscular mass, strength and quality that occur in elderly. Multiple factors underlie this process: low physical activity, low steroids hormones, increase of cytokines, loss of motoneurons, decrease of protein synthesis...However, the role of these factors is not yet well understood and consensual clinical definition and assessment are still needed. It has become an important area of research because of its frequency and the influence in the disability of old people. It is a major component of frailty. So far, no pharmacological treatment has proven definitive evidence to treat or prevent sarcopenia. Nevertheless, it needs a multidimensional approach based on physical activity and prevention of malnutrition.

Prevalence of sarcopenia and its association with functional and nutritional status among male residents in a nursing home in Turkey

The prevalence of sarcopenia differs between different populations, ages, gender and between settings such as the community and nursing homes. Studies on the association of sarcopenia with functional status revealed conflicting results whereas its association with nutritional status is well documented. We aimed at investigating the prevalence of sarcopenia and its association with functional and nutritional status among male residents in a nursing home in Turkey. Fat free mass (FFM) was detected by bioelectric impedance analysis. Functional status was evaluated with Katz activities of daily living (ADL) and Lawton Instrumental activities of daily living (IADL). Nutritional assessment was performed by Mini Nutritional Assessment Test (MNA(R)). One hundred fifty-seven male residents composed the study cohort. Mean age was 73.1 +/- 6.7 years. The prevalence of sarcopenia was 85.4%. No significant correlation was found between sarcopenia and ADL or IADL. There was a weak but significant correlation between IADL score and FFM (r = 0.18; p = 0.02). Sarcopenic residents had lower MNA score than non-sarcopenic residents (18.1 +/- 3.2 vs. 21.8 +/- 0.8, p = 0.02). FFM was significantly lower in the residents with malnutrition compared to well-nourished residents (26.8 +/- 1 kg/body surface area vs. 28.1 +/- 1.8 kg/body surface area, p < 0.05). In conclusion, the prevalence of sarcopenia was very high among male nursing home residents in Turkey. Sarcopenia was associated with low nutritional status but not with functional status.

Subclinical hypothyroidism has little influences on muscle mass or strength in elderly people

Sarcopenia, the age-related decline in muscle mass, affects the muscle strength and muscle quality, and these changes decrease functional capacity. The prevalence of thyroid dysfunction increases with age, and changes in thyroid hormone level lead to neuromuscular deficits. We investigated the effects of subclinical hypothyroidism on the muscle mass, strength or quality in elderly people. One thousand one hundred eighteen subjects aged > or = 65 yr were randomly selected from a local population and classified into a euthyroid (280 men and 358 women), subclinically hypothyroid (61 men and 75 women), or overtly hypothyroid (7 men and 16 women) group. Although women with subclinical hypothyroidism had a higher prevalence of sarcopenia, defined according to the ratio of appendicular skeletal muscle mass to the square of height, muscle mass, strength or quality did not differ in relation to thyroid status in men or in women. Multivariate analysis including age, diabetes, hypertension, acute coronary event, alcohol, smoking, presence of pain, physical activity score, and lipid profile, showed that thyroid-stimulating hormone level was not associated with muscle mass, strength or quality. In conclusion, subclinical hypothyroidism has little influences on muscle mass, strength or quality, and may not be associated with sarcopenia.

[Diabetes mellitus and the syndrome of frailty in the elderly]

Frequently, geriatric syndromes are diagnosed in patients with multiple pathologies; perhaps, the most evident example is Diabetes Mellitus (DM). During the last years, an association between DM and frailty has been described. Theoretically, there are multiple pathways that justify such an association, especially if DM has been diagnosed during adulthood. However, there are data that suggest a relationship, perhaps of another type, between frailty and late onset DM. This article has the purpose of reviewing the evidence around this association.

Sarcopenia exacerbates obesity-associated insulin resistance and dysglycemia: findings from the National Health and Nutrition Examination Survey III

Background

Sarcopenia often co-exists with obesity, and may have additive effects on insulin resistance. Sarcopenic obese individuals could be at increased risk for type 2 diabetes. We performed a study to determine whether sarcopenia is associated with impairment in insulin sensitivity and glucose homeostasis in obese and non-obese individuals.

Methodology

We performed a cross-sectional analysis of National Health and Nutrition Examination Survey III data utilizing subjects of 20 years or older, non-pregnant (N = 14,528). Sarcopenia was identified from bioelectrical impedance measurement of muscle mass. Obesity was identified from body mass index. Outcomes were homeostasis model assessment of insulin resistance (HOMA IR), glycosylated hemoglobin level (HbA1C), and prevalence of pre-diabetes (6.0≤ HbA1C<6.5 and not on medication) and type 2 diabetes. Covariates in multiple regression were age, educational level, ethnicity and sex.

Principal Findings

Sarcopenia was associated with insulin resistance in non-obese (HOMA IR ratio 1.39, 95% confidence interval (CI) 1.26 to 1.52) and obese individuals (HOMA-IR ratio 1.16, 95% CI 1.12 to 1.18). Sarcopenia was associated with dysglycemia in obese individuals (HbA1C ratio 1.021, 95% CI 1.011 to 1.043) but not in non-obese individuals. Associations were stronger in those under 60 years of age. We acknowledge that the cross-sectional study design limits our ability to draw causal inferences.

Conclusions

Sarcopenia, independent of obesity, is associated with adverse glucose metabolism, and the association is strongest in individuals under 60 years of age, which suggests that low muscle mass may be an early predictor of diabetes susceptibility. Given the increasing prevalence of obesity, further research is urgently needed to develop interventions to prevent sarcopenic obesity and its metabolic consequences.

Handgrip strength as a predictor of functional, psychological and social health. A prospective population-based study among the oldest old

BACKGROUND

muscle wasting is associated with a detrimental outcome in older people. Muscle strength measurements could be useful as part of a clinical evaluation of oldest old patients to determine who are most at risk of accelerated decline in the near future.

OBJECTIVE

this study aimed to assess if handgrip strength predicts changes in functional, psychological and social health among oldest old.

DESIGN

the Leiden 85-plus Study is a prospective population-based follow-up study.

SUBJECTS

five-hundred fifty-five, all aged 85 years at baseline, participated in the study.

METHODS

handgrip strength was measured with a handgrip strength dynamometer. Functional, psychological and social health were assessed annually. Baseline data on chronic diseases were obtained from the treating physician, pharmacist, electrocardiogram and blood sample analysis.

RESULTS

at age 85, lower handgrip strength was correlated with poorer scores in functional, psychological and social health domains (all, P < 0.001). Lower baseline handgrip strength predicted an accelerated decline in activities of daily living (ADL) and cognition (both, P <or= 0.001), but not in social health (P > 0.30).

CONCLUSION

poor handgrip strength predicts accelerated dependency in ADL and cognitive decline in oldest old. Measuring handgrip strength could be a useful instrument in geriatric practice to identify those oldest old patients at risk for this accelerated decline.

[Skeletal muscle mass in institutionalized elderly]

Increased longevity raises the proportion of elderly individuals in a population, and thereby, the number of individuals suffering from frailty. Frailty is associated with loss of skeletal muscle mass and function (sarcopenia), which stems from an imbalance between muscle protein synthesis and degradation. Nutrition intake, physical activity (both aerobic and resistance training) and comorbidities are associated with skeletal muscle mass in elderly individuals. In community-dwelling seniors, prevalence estimates for sarcopenia reach 17.5% among very elderly males. Sarcopenia is considerably higher in disabled nursing home residents and differs between men and women. These differences might reflect gender differences in comorbidity rates. Identification of modifiable risk factors for sarcopenia may lead to intervention opportunities. Further research is needed to determine whether improved skeletal muscle mass impacts survival in this frail elderly nursing home residents.

[Changes of skeletal muscle mass among disabled elderly]

BACKGROUND

The reduction of skeletal muscle mass and strength, that occurs with aging (sarcopenia), leads to disability in the elderly population.

OBJECTIVES

To investigate the prevalence of sarcopenia among older disabled nursing home residents and to examine the relationship between skeletal muscle mass (SMM) and routine data of nutritional, functional status and body composition estimations.

PARTICIPANTS

Sixty three men and women aged 63 to 99 years old (mean +/- SD = 84.7 +/- 7.1) suffering from advanced dementia (89.8%), who have undergone evaluations and are considered disabled according to their functional status (FIM = 27-32 +/- 7.2-7.9%).

MEASUREMENTS

The whole SMM and body composition (FFM, FM) were assessed by daily urinary creatinine excretion and the results were compared to routine data on nutritional, functional status, body composition, functional status indexes and muscle strength (MMT).

RESULTS

Prevalence of sarcopenia was 87.5% and 41.0% for men and women, respectively. Significant differences were found in both gender groups in all indexes of body composition and SMM: prevalence of underweight was 15.4% in women vs 33.3% in men. Absolute levels of FFM and SMM in men were significantly higher, but relative to height2 were reduced among men compared to women. No correlation was found between SMM and routine data of nutritional status, but it highly correlates with values of functional status and body composition.

CONCLUSION

Sarcopenia in elderly nursing home residents is one of the important parameters of disability and its prevalence in men is twice as high in comparison to women. The routine nutritional status assessments are limited to estimation of skeletal muscle mass. The method of measuring SMM, based on daily creatinine excretion, is simple but well correlated with body composition and functional status data.

Understanding sarcopenia as a geriatric syndrome

PURPOSE OF REVIEW

Highly prevalent in the population older than 65 years and leading to poor outcomes (functional decline and its related consequences), sarcopenia does not benefit yet either of a clear understanding of its pathophysiology or of precise clinical or biological markers allowing its identification.

RECENT FINDINGS

The new scientific definition of 'geriatric syndromes' challenges the authors to review the current sarcopenia literature, allowing them to affirm that sarcopenia cannot be considered as an age-related disease but as a true 'geriatric syndrome'. More than 50% of the population older than 80 years suffer from this medical condition, which is linked to multiple causations: the ageing process itself, genetic susceptibility, certain life habits, changes in living conditions and a number of chronic diseases. Moreover, sarcopenia favours poor outcomes such as mobility disorders, disability, poor quality of life and death.

SUMMARY

Considering sarcopenia as a geriatric syndrome allows us to request its recognition and assess its multiple risk factors, to implement a clinical and public health approach to the management of sarcopenic patients and population at risk and to disentangle the links among sarcopenia, frailty, disability and mortality.

[Recurrent falling, osteoporosis and sarcopenia, three major problems, an integrated approach]

Falling incidents occur frequently and have many harmful side-effects. Not only is there a risk of injuries, the psychological and financial consequences can also be considerable. If these issues are to be addressed thoroughly attention will have to be paid to a reduction of the risk of falling as well as to that of fractures. The department of Gerontology and Geriatrics of the University of Louvain is actively involved in both areas. This involvement is clarified in this contribution. Firstly there is a description of the establishment of the 'Expert Centre Prevention of Falling Flanders' and its tasks. Then some research projects related to prevention of falling will be dealt with briefly, whilst the final part discusses in greater detail the research programme 'Old age related osteoporosis and sarcopenia'.

Sarcopenic/obesity and physical capacity in older men and women: data from the Nutrition as a Determinant of Successful Aging (NuAge)-the Quebec longitudinal Study

Sarcopenia and obesity have been independently associated with physical capacity impairments. However, few studies have investigated the impact of sarcopenic/obesity on physical capacity in older individuals using objective measures of physical capacity and body composition. This study included 904 older individuals aged between 68 and 82 years old. Body composition (fat mass (FM) and lean body mass (LBM) by dual-energy X-ray absorptiometry (DXA)), physical capacity (timed up and go, chair stands, walking speed at normal and fastest pace, and one leg stand), sum of reported chronic conditions and physical activity level were measured. A global physical capacity score was then calculated giving a maximal score of 20. Finally, four groups were created within genders based on sarcopenia and obesity ((i) nonsarcopenic/nonobese; (ii) sarcopenic/nonobese; (iii) nonsarcopenic/obese; (iv) sarcopenic/obese). The four groups were significantly different for the sit-to-stand test and the one leg stand test (P < 0.05) and only for the one leg stand test in women (P < 0.05). In both genders results for the global physical capacity score revealed that both obese groups (sarcopenic and nonsarcopenic) were similar (P = 0.14 in men and P = 0.19 in women) and had a lower global physical capacity score compared to nonsarcopenic/nonobese individuals (P < 0.05). In addition, sarcopenic women displayed a higher score than both obese nonsarcopenic and obese sarcopenic groups (P < 0.01). Sarcopenic/obese men and women do not display lower physical capacity compared to nonsarcopenic/obese individuals in this cohort of well-functioning older men and women. Obesity per se appears to contribute more to lower physical capacity than sarcopenia.