Prevalence of sarcopenia in older Brazilians: A systematic review and meta-analysis

Comparison of Bioelectrical Impedance Analyser (BIA) with Dual-Energy X-ray Absorptiometry (DXA) Scan in Assessing the Body Composition of Adult Individuals with Type 2 Diabetes Mellitus

Introduction

Assessing the body composition is important in adult patients with type 2 diabetes mellitus to prevent and achieve optimum control during treatment. Bioelectrical impedance analysis (BIA), being a more affordable method of assessing the body composition, should therefore be compared with the gold standard dual-energy X-ray absorptiometry (DXA) to look for a correlation between the two and the potential of BIA to be used widely in this population. A cross-sectional observational study was conducted on 60 patients attending the endocrinology outpatient department (OPD) of a tertiary care centre in Kolkata, India.

Methods

Body composition was measured by both BIA and DXA. Intra-class correlation (ICC) values were calculated between the two methods for fat mass and fat-free mass for three body mass index (BMI) groups and overall.

Results

DXA and BIA correlated well for both fat mass and fat-free mass in the entire study population and in the non-overweight non-obese group (BMI <23) and the obese group (BMI ≥25). However, the overweight group (23 ≥BMI <25) did not correlate well with the above-mentioned parameters.

Conclusion

We suggest interchangeable use of the two methods in the non-overweight non-obese (BM I <23) and obese (BMI ≥25) BMI groups of adult subjects with type 2 diabetes mellitus. However, the low correlation for all parameters in the overweight group points towards exercising caution when taking such measurements by BIA and planning a further study with a larger cohort of such individuals to better evaluate the said correlation.

The prevalence of sarcopenia and risk factors in the older adult in China: a systematic review and meta-analysis

Background

Understanding the epidemiological information of a certain disease is the first step in related prevention and control work. This article aims to understand the prevalence and associated risk factors of sarcopenia among the older adult (≥60 years old) in China and to provide an evidence-based basis for early identification, management, and prevention of sarcopenia patients.

Methods

We searched seven databases: CNKI, Wanfang, VIP, PubMed, Web of Science, Embase, and Cochrane Library databases from the establishment of the database until January 31, 2024. The Quality evaluation criteria of cross-sectional studies recommended by the Agency for Healthcare Research and Quality (AHRQ) were used for literature quality evaluation. Stata 18.0 software was used for statistical analysis.

Results

We finally included 45 studies, involving a total of 37,571 cases. After statistical analysis, we found that the prevalence of sarcopenia among the older adult in China was 20.7% [95% CI (18.3, 23.0%)]. The results of subgroup analysis suggest that: ① According to gender, the prevalence rate of sarcopenia in women (21.6%) is higher than that in men (19.2%); ② According to age, the prevalence rate of older adult people aged ≥80 (45.4%) was the highest, followed by 70-79 (27.2%) and 60-69 (15.7%). ③ According to region, the prevalence rate of the older adult in the south (21.7%) is higher than that in the north (19.0%); ④ According to the time of publication, the prevalence of sarcopenia among the older adult in China has increased (from 19.2% in 2014-2018 to 21.4% in 2019-2024); ⑤ According to the diagnostic criteria, the detection rate of AWGS (2019) is higher than that of AWGS (2014) (24.5% vs. 19.3%). Finally, aging, low BMI, low leg circumference, smoking, depression, osteoporosis, malnutrition and malnutrition risk are all risk factors for sarcopenia among the older adult in China.

Conclusion

The prevalence of sarcopenia in the older adult in China was higher (20.7%), which should be paid attention to by relevant health authorities. In addition, aging, low BMI, low calf circumference, smoking, depression, osteoporosis, malnutrition and malnutrition risk are risk factors for the development of sarcopenia in the older adult in China. For these high-risk populations, early identification, prevention, and intervention can be carried out to delay the occurrence and progression of sarcopenia.

Prevalence and factors associated with sarcopenia among Brazilian older adults: An exploratory network analysis

OBJECTIVES

This study aimed to verify the prevalence of sarcopenia and its associations with sociodemographic, clinical and psychological factors in community-dwelling older adults.

STUDY DESIGN

A randomized cross-sectional study was extracted from a probabilistic cluster conducted on individuals aged 65 years or older residing in the community.

METHODS

Sarcopenia was defined according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). Body composition was assessed using dual-energy X-ray absorptiometry (DXA). Associations were analyzed using networks based on mixed graphical models. Predictability indices of the estimated networks were assessed using the proportion of explained variance for numerical variables and the proportion of correct classification for categorical variables.

RESULTS

The study included 278 participants, with a majority being female (61 %). The prevalence of sarcopenia was 39.57 %. Among those with sarcopenia, 67 % were women and 33 % were men. In the network model, age, race, education, family income, bone mass, depression, cardiovascular disease, diabetes, total cholesterol levels and rheumatism were associated with sarcopenia. The covariates demonstrated a high accuracy (62.9 %) in predicting sarcopenia categories.

CONCLUSION

The prevalence of sarcopenia was high, especially in women. In addition, network analysis proved useful in visualizing complex relationships between sociodemographic and clinical factors with sarcopenia. The results suggest early screening of sarcopenia for appropriate treatment of this common geriatric syndrome in older adults in Brazil.

Prevalence of sarcopenia among people living with HIV defined by the revised European working group on sarcopenia in older people

BACKGROUND

Sarcopenia is a progressive and systemic skeletal muscle disorder associated with an increased risk of hospitalization and adverse effects on survival. This study aims to investigate the prevalence and related risk factors of sarcopenia in people living with HIV using the revised European Working Group on Sarcopenia in Older People (EWGSOP2) definition.

METHODS

This cross-sectional study comprising 379 patients with confirmed HIV infection evaluated the appendicular skeletal muscle mass by employing the bioelectrical impedance analysis method. Muscle strength and functional mobility were analyzed using the five-time sit-to-stand test and the timed "Up and Go" test.

RESULTS

The prevalence rates of pre-sarcopenia and sarcopenia among people living with HIV were 3.4 % and 2.1 % according to the revised EWGSOP2 definition. Advanced age (Odds Ratio 1.07, p = .03), lower body mass index (Odds Ratio 0.79, p = .012) and CD4+ T-cell count below 500/μl (Odds Ratio 2.22, p = .007) were identified as significant factors associated with sarcopenia. Sarcopenia was also identified as a significant correlate of frailty (p < .001).

CONCLUSION

This is the first study examining the prevalence of sarcopenia in people living with HIV according to the revised EWGSOP2 clinical algorithm. Advanced age, lower body mass index and a poor immune status are determined as promoting factors of sarcopenia. Sarcopenia significantly correlates with frailty. Standardized clinical algorithms are essential for reliable sarcopenia diagnosis in people living with HIV in order to promote intervention strategies and to prevent adverse health outcomes.

Effect of whole-body vibration stimulation on plasma soluble TNF receptors in elderly with sarcopenia: a randomized controlled trial

Sarcopenia is a pathology resulting from a progressive and severe loss of muscle mass, strength, and function in the course of aging, which has deleterious consequences on quality of life. Among the most widespread studies on the issue are those focused on the effect of different types of physical exercise on patients with sarcopenia. This randomized controlled study aimed to compare the effects of a whole-body vibration exercise (WBV) session on the inflammatory parameters of non-sarcopenic (NSG, n=22) and sarcopenic elderly (SG, n=22). NSG and SG participants were randomly divided into two protocols: intervention (squat with WBV) and control (squat without WBV). After a one-week washout period, participants switched protocols, so that everyone performed both protocols. Body composition was assessed by dual-energy radiological absorptiometry (DXA) and function through the six-minute walk test (6MWD) and Short Physical Performance Battery (SPPB). Plasma soluble tumor necrosis factor receptors (sTNFR) were determined by enzyme-linked immunosorbent assay (ELISA) and measured before and immediately after each protocol. After exercise with WBV, there was an increase in sTNFR2 levels in the NSG (P<0.01; d=-0.69 (-1.30; -0.08) and SG (P<0.01, d=-0.95 (-1.57; -0.32) groups. In conclusion, an acute session of WBV influenced sTNFr2 levels, with sarcopenic individuals showing a greater effect. This suggested that WBV had a more pronounced impact on sTNFr2 in those with loss of muscle strength and/or physical performance. Additionally, WBV is gaining recognition as an efficient strategy for those with persistent health issues.

Skeletal muscle mass obtained by anthropometric equation and presence of sarcopenia in postmenopausal women

Objective

To analyze the amount of muscle and the presence of sarcopenia in postmenopausal women using different methods, verifying the agreement between them as to skeletal muscle mass (SMM).

Methods

This cross-sectional observational study was conducted with postmenopausal women aged ≥ 50 years. SMM was obtained from a predictive equation, Bioelectrical Impedance (BIA), and Dual Energy X-Ray Absorptiometry (DXA). The skeletal muscle mass index (SMI) and the appendicular skeletal muscle mass index (ASMI) were calculated. The cut-off point of SMI was determined for the population itself. The agreement between the SMI obtained using the different methods was verified. Sarcopenia was diagnosed according to the criteria proposed by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). The significance level adopted for all tests was 5.0%.

Results

A total of 112 women were evaluated, with an average age of 66.1 ± 5.65 years. Among them, 51.8% were sufficiently active and 43.8% were overweight and obese. The SMI cut-offs were 6.46 kg/m2 for the predictive equation and 7.66 kg/m2 for BIA, with high sensitivity and specificity. There was an excellent agreement in the identification of SMM by the predictive equation (0.89 [0.824-0.917], p < 0.001) and BIA (0.92 [0.883-0.945], p < 0.001), in reference to DXA. The prevalence of sarcopenia was 0.9%, 1.8%, and 2.7% according to BIA, DXA, and the predictive equation, respectively.

Conclusion

The predictive equation showed the expected agreement in estimating skeletal muscle mass in postmenopausal women, offering a viable and accurate alternative.

Prevalence of osteoporosis, sarcopenia, and high falls risk in healthy community-dwelling Thai older adults: a nationwide cross-sectional study

Thailand has transitioned from an aging society to an aged society, which implies that the prevalence of age-related disorders will increase; however, epidemiological data specific to the prevalence of age-related degenerative musculoskeletal disorders among Thai older adults remain limited. Accordingly, the aim of this study was to investigate the prevalence of age-related musculoskeletal diseases, including osteoporosis, sarcopenia, and high falls risk among healthy community-dwelling Thai older adults. This cross-sectional nationwide study enrolled Thai adults aged ≥60 yr from 2 randomly selected provinces from each of the 6 regions of Thailand via stratified multistage sampling during March 2021 to August 2022. All enrolled participants were evaluated for BMD, skeletal muscle mass, grip strength, and gait speed. Osteoporosis was diagnosed according to the World Health Organization definition, and sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Falls risk was determined using the self-rated Fall Risk Questionnaire. A total of 2991 eligible participants were recruited. The mean age of participants was 69.2 ± 6.5 yr (range: 60-107), and 63.1% were female. The prevalence of osteoporosis, sarcopenia, and high falls risk was 29.7%, 18.1%, and 38.5%, respectively. Approximately one-fifth of subjects (19.1%) had at least 2 of 3 risk factors (ie, osteoporosis, sarcopenia, and high falls risk) for sustaining a fragility fracture, and 3.4% had all 3 risk factors. In conclusion, the results of this study revealed a high and increasing prevalence of osteoporosis, sarcopenia, and high falls risk in healthy community-dwelling Thai older adults. Since these conditions are all major risk factors for fragility fracture, modification of Thailand's national health care policy is urgently needed to address the increasing prevalence of these conditions among healthy community-dwelling older adults living in Thailand.

Geriatric sarcopenia is associated with hypertension: A systematic review and meta-analysis

This meta-analysis aimed to explore the potential relationship between senile sarcopenia and hypertension in older people. A comprehensive search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library, up to November 2022. Ten studies comprising 14 804 participants were enrolled. The odds ratio (OR) and 95% confidence interval (CI) was pooled to evaluate the correlation between sarcopenia and hypertension in older people utilizing a random-effects model. Subgroup and sensitivity analyses were then carried out to explore the potential sources of heterogeneity. The results revealed a substantial correlation between sarcopenia and hypertension among older people (OR = 1.39, 95% CI: 1.15-1.67, p < .01). Further subgroup analysis revealed an association between sarcopenic obesity and hypertension (OR = 1.49, 95% CI: 1.37-1.62, p < .01). In conclusions, our findings highlighted a significant relationship between sarcopenia and hypertension among older people, with sarcopenic obesity amplifying this risk.

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.

Anthropometric equations to estimate appendicular muscle mass from dual-energy X-ray absorptiometry (DXA): A scoping review

BACKGROUND

Appendicular skeletal muscle mass (ASM) obtained from dual-energy x-ray absorptiometry (DXA) is recommended to quantify sarcopenia, but has limited availability in disadvantaged-income countries, moreover in an epidemiological context. Predictive equations are easier and less costly to apply, but a review of all available models is still lacking in the scientific literature. The objective of this work is to map, with a scoping review, the different proposed anthropometric equations to predict ASM measured by DXA.

METHODS

Six databases were searched without restriction on publication date, idiom, and study type. A total of 2,958 studies were found, of which 39 were included. Eligibility criteria involved ASM measured by DXA, and equations proposed to predict ASM.

RESULTS

predictive equations (n = 122) were gathered for 18 countries. The development phase involves sample size, coefficient of determination (r2), and a standard error of estimative (SEE) varying between 15 and 15,239 persons, 0.39 and 0.98, 0.07 and 3.38 kg, respectively. The validation phase involves a sample size, accuracy, and a SEE between 15 and 3,003 persons, 0.61 and 0.98, 0.09 and 3.65 kg, respectively.

CONCLUSIONS

The different proposed predictive anthropometric equations of ASM DXA were mapped, including validated pre-existing equations, offering an easy-to-use referential article for clinical and research applications. It is necessary to propose more equations for other continents (Africa and Antarctica) and specific health-related conditions (e.g., diseases), once the equations can only have sufficient validity and accuracy to predict ASM generally when applied to the same population.

Exploring the correlation between serum fibroblast growth factor-21 levels and Sarcopenia: a systematic review and meta-analysis

BACKGROUND

Fibroblast growth factor 21 (FGF-21) plays an important role in the growth and metabolism of skeletal muscle cells. This study aims to systemically review the evidence regarding the relationship between FGF-21 levels and Sarcopenia, as well as the related influential factors.

METHODS

This review was conducted according to the PRISMA guidelines. We comprehensively searched PubMed, EMBASE, the Web of Science, Scopus, and Chinese Databases (CNKI, Wan Fang, VIP, and CBM) up to 1 May 2023. 3 investigators performed independent literature screening and data extraction of the included literature, and two investigators performed an independent quality assessment of case-control studies using the Joanna Briggs Institute (JBI) tool. Data analysis was performed using Review Manager 5.4 software. For continuous various outcomes, mean difference (MD) or standard mean difference (SMD) with 95% confidence intervals (CIs) was applied for assessment by fixed-effect or random-effect model analysis. The heterogeneity test was performed by the Q-statistic and quantified using I², and publication bias was evaluated using a funnel plot.

RESULTS

Five studies with a total of 625 cases were included in the review. Meta-analysis showed lower BMI in the sarcopenia group [MD= -2.88 (95% CI, -3. 49, -2.27); P < 0.00001; I² = 0%], significantly reduced grip strength in the sarcopenia group compared to the non-sarcopenia group [MD = -7.32(95% CI, -10.42,-4.23); P < 0.00001; I² = 93%]. No statistically significant differences in serum FGF21 levels were found when comparing the two groups of subjects [SMD = 0.31(95% CI, -0.42, 1.04); P = 0.41; I² = 94%], and no strong correlation was found between the onset of sarcopenia and serum FGF21 levels.

CONCLUSION

The diagnosis of sarcopenia is followed by a more significant decrease in muscle mass and strength, but there is a lack of strong evidence to support a direct relationship between elevated organismal FGF21 and sarcopenia, and it is not convincing to use FGF21 as a biological or diagnostic marker for sarcopenia. The currently used diagnostic criteria for sarcopenia and setting of cut-off values for each evaluation parameter no longer seem to match clinical practice.

Inflammatory biomarkers at different stages of Sarcopenia in older women

In recent years, studies have found that Sarcopenia alters inflammatory biomarkers. However, the behavior of inflammatory biomarkers at different stages of Sarcopenia is not well understood. This study aimed to compare a broad panel of inflammatory biomarkers in older women at different stages of Sarcopenia. The study included 71 Brazilian community-dwelling older women. Muscle Strength was assessed by using handgrip strength (Jamar dynamometer). The Short Physical Performance Battery (SPPB) was performed to assess the physical performance, and body composition was assessed by DEXA. Sarcopenia was diagnosed and classified according to the EWGSOP2 criteria. Blood was drawn, and inflammatory biomarkers associated with Sarcopenia (IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, TNF, adiponectin, leptin, resistin, BDNF, sTNFr-1 and sTNFr-2) was analysed. After diagnosis and classification of sarcopenia, 45% of women did not present Sarcopenia (NS, N = 32), 23.9% were diagnosed with Sarcopenia Probable (SP, N = 17), 19,7% with Sarcopenia Confirmed (SC, N = 14), and 11.3% with Severe Sarcopenia (SS, N = 8). The analysis of inflammatory biomarkers revealed that the more advanced the stage of Sarcopenia, the higher the levels of BDNF, IL-8, sTNFr-1, and sTNFr-2. The assessment of BDNF, IL-8, sTNFr-1, and sTNFr-2 levels may be an adjuvant tool in diagnosis and severity classification of Sarcopenia in older Brazilian women.

Sarcopenia and sarcopenic obesity among community-dwelling Peruvian adults: A cross-sectional study

Background

Sarcopenia and sarcopenic obesity (SO) have emerged as significant contributors to negative health outcomes in the past decade. However, there remains a lack of consensus on the criteria and cut-off thresholds for assessing sarcopenia and SO. Moreover, limited data are available on the prevalence of these conditions in Latin American countries. To address this evidence gap, we aimed to estimate the prevalence of probable sarcopenia, sarcopenia, and SO in a community-dwelling population of 1151 adults aged ≥ 55 years in Lima, Peru.

Methods

Data collection for this cross-sectional study was conducted between 2018 and 2020 in two urban low-resource settings in Lima, Peru. Sarcopenia was defined as the presence of low muscle strength (LMS) and low muscle mass (LMM) according to European (EWGSOP2), US (FNIH) and Asian (AWGS) guidelines. We measured muscle strength by maximum handgrip strength; muscle mass using a whole-body single-frequency bioelectrical impedance analyzer, and physical performance using the Short Physical Performance Battery and 4-meter gait speed. SO was defined as a body mass index ≥ 30 kg/m2 and sarcopenia.

Results

The study participants had a mean age of 66.2 years (SD 7.1), of which 621 (53.9%) were men, and 41.7% were classified as obese (BMI ≥ 30.0 kg/m2). The prevalence of probable sarcopenia was estimated to be 22.7% (95%CI: 20.3-25.1) using the EWGSOP2 criteria and 27.8% (95%CI:25.2-30.4) using the AWGS criteria. Sarcopenia prevalence, assessed using skeletal muscle index (SMI), was 5.7% (95%CI: 4.4-7.1) according to EWGSOP2 and 8.3% (95%CI: 6.7-9.9) using AWGS criteria. The prevalence of sarcopenia based on the FNIH criteria was 18.1% (95%CI: 15.8-20.3). The prevalence of SO, considering different sarcopenia definitions, ranged from 0.8% (95%CI: 0.3-1.3) to 5.0% (95%CI: 3.8-6.3).

Conclusions

Our findings reveal substantial variation in the prevalence of sarcopenia and SO when using different guidelines, underscoring the necessity for context-specific cut-off values. Nevertheless, regardless of the chosen guideline, the prevalence of probable sarcopenia and sarcopenia among community-dwelling older adults in Peru remains noteworthy.

Prevalence of sarcopenia in older women and level of agreement between the diagnostic instruments proposed by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2)

BACKGROUND

The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) proposed the use of different diagnostic tools to assess sarcopenia. This study aimed to determine prevalence rates of sarcopenia according to the diagnostic instruments proposed by EWGSOP2 and to assess their level of agreement in older Brazilian women.

METHODS

A cross-sectional study with 161 community-dwelling older Brazilian women. Probable sarcopenia was assessed through Handgrip Strength (HGS) and the 5-times sit-to-stand test (5XSST). In addition to reduced strength, Appendicular Skeletal Muscle Mass (ASM) (obtained by Dual-energy X-ray absorptiometry) and ASM/height² were considered for diagnosis confirmation. Sarcopenia severity was determined by reduced muscle strength and mass and poor functional performance assessed by Gait Speed (GS), Short Physical Performance Battery (SPPB), and Timed Up and Go test (TUG). McNemar's test and Cochran's Q-test were used to compare sarcopenia prevalence. Cohen's Kappa and Fleiss's Kappa tests were used to assess the level of agreement.

RESULTS

The prevalence of probable sarcopenia was significantly different (p < 0.05) when using HGS (12.8%) and 5XSST (40.6%). Regarding confirmed sarcopenia, the prevalence was lower when using ASM/height² than with ASM. Regarding severity, the use of SPPB resulted in a higher prevalence in relation to GS and TUG.

CONCLUSION

There were differences in the prevalence rates of sarcopenia and low agreement between the diagnostic instruments proposed by the EWGSOP2. The findings suggest that these issues must be considered in the discussion on the concept and assessment of sarcopenia, which could ultimately help to better identify patients with this disease in different populations.

Cross-cultural adaptation and validation of Sarcopenia and Quality of Life (SarQoL) in Brazil

BACKGROUND

Sarcopenia is defined as a slow, progressive, and apparently inevitable process of involuntary loss of muscle mass, strength, and quality, which occurs with advancing age. It is widely accepted that sarcopenia can directly affect quality of life.

OBJECTIVE

Translate, adapt and validate the "Sarcopenia and Quality of Life" instrument (SarQoL) to the Brazilian context.

DESIGN AND SETTINGS

Translation, cross-cultural adaptation, and validation study carried out at the Federal University of São Carlos, São Carlos, São Paulo, Brazil.

METHODS

The population consisted of 221 older adult participants. The steps recommended by the guidelines from the authors of the original instrument were followed sequentially: initial translation, synthesis of translations, backward translation, evaluation by a panel of judges, pre-test, and analysis of psychometric properties. The translation and adaptation process was conducted as recommended.

RESULTS

Two hundred and twenty-one participants took part in the step analysis of the psychometric properties of SarQoL, in which 55 presented sarcopenia. Cronbach's alpha coefficient of the total SarQoL questionnaire was 0.976, indicating excellent internal consistency. Excellent agreements between the test and retest with an Interclass Correlation Coefficient (ICC) of 0.983 (95% confidence interval: 0.901-0.996) were observed in the SarQoL domains. The domains of Short-Form 36 and EuroQoL 5-dimension showed significant correlation, from moderate to strong magnitude, with SarQoL total score, indicating convergent validity.

CONCLUSION

The Brazilian version of SarQoL presented evidence of reliability and validity.

Motor Reaction Time, Sarcopenia and Functional Skills in Elderly Women: A Cross-Sectional Study

IMPORTANCE

Aging generates changes over the years. Because of this, the musculoskeletal system is directly degraded and suffer deficits in its performance in elderly patients with Sarcopenia, as this condition is characterized by a decrease in muscle mass and function.

OBJECTIVE

Correlate the motor reaction time and functional skills of non-sarcopenic, pre-sarcopenic and sarcopenic elderly women, and analyze influence on the risk of falls.

DESIGN

Cross-sectional observational analytical study, following the methodological strategies of STROBE (Strengthening the Reporting of Observational Studies in Epidemiology), carried out under the approval of the Research Ethics Committee of the Unievangélica University, no. 3.694.235/2019.

SETTING

Participants were evaluated regarding: cognitive status, level of physical activity, fear of falling, body composition, motor reaction time, static and dynamic balance, gait kinetics, strength and endurance of the lower limbs and finally handgrip strength.

PARTICIPANTS

A total of 59 volunteer elderly women were assessed following the diagnostic criteria for sarcopenia proposed by the European Working Group on Sarcopenia in Older People (EWGSOP).

RESULTS

The results show that there was a greater difference in motor reaction time between the non-sarcopenic and sarcopenic elderly women due to the executing organ being damaged by the presence of sarcopenia, causing motor response to slowdown. Functional deficit, fear of falling and greater risk of falls were observed in the sarcopenic group, under the harmful influence of increased motor reaction time.

CONCLUSION

Sarcopenic elderly women present increased motor reaction time, that is, slowed motor responses due to decreased muscle mass, strength and impaired musculature, which generate functional deficits that contribute to an increased risk of falls.

Definition of an adapted cut-off for determining low lean tissue mass in older women with obesity: a comparison to current cut-offs

The prevalence of sarcopenia in patients with obesity varies according to the definition used. The purpose of our study was to: (i) determine the prevalence of sarcopenia in terms of lean tissue mass in older women with obesity using the current cut-offs, (ii) redefine a specific cut-off for low lean tissue mass (LLTM), and (iii) re-determine the prevalence of LLTM using this new cut-off. Appendicular lean mass (ALM) and the ALM index [ALM/height²: ALMI(h²)] and ALMI/body mass index [ALMI(BMI)] were determined in 791 women with or without obesity. LLMM prevalence was calculated using the current cut-offs: EWGSOP2: ALM < 15 kg and ALMI(h²) < 5.5 kg/m²; FNIH: ALM < 15.02 kg and ALMI(BMI) < 0.51; and IWGS: ALMI(h²) < 5.67 kg/m² and cut-offs newly determined from data provided from young women with obesity. ALM, ALMI(h²) and ALMI(BMI) were lower in older compared to young obese women. Using the current cut-offs, a wide distribution of LLTM prevalence (0 to 29.2%) was observed. When the newly determined cut-offs were applied – i.e., ALM < 18.51 kg; ALMI(h²) < 7.15 kg/m², ALMI(BMI) < 0.483, and T-score: [(ALMI(h²) measured)-(2.08 + 0.183*BMI)]/0.72] − the LLTM mass prevalence was 17.37%; 8.47, 14.8 and 12.71%. respectively. This study showed that the current cut-offs for LLTM as criteria for sarcopenia diagnosis are not adapted to the obese population. Although the new “static” cut-offs appeared to be more adapted, a “dynamic” cut-off for ALMI(h²) that took into account the BMI and thus the obesity severity appeared even more relevant.

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

BACKGROUND

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

METHODS

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

RESULTS

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

IMPLICATIONS

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

The effects of synbiotic and/or vitamin D supplementation on gut-muscle axis in overweight and obese women: a study protocol for a double-blind, randomized, placebo-controlled trial

BACKGROUND

Sarcopenia refers to an age-related loss of skeletal muscle content, strength, and function, leading to a decrease in mobility. Obesity may exacerbate age-related complications such as sarcopenia through inflammatory pathways. In addition, intestinal dysbiosis has been proposed as an emerging contributor to sarcopenia due to the stimulation of the immune system and elevated barrier permeability of the intestine. Targeting microbiome with synbiotic and vitamin D supplementation may modulate the microbiome followed by the enhancement of sarcopenia indices. Thus, the present study aims to evaluate the effect of synbiotic supplementation with or without vitamin D on the intestinal microbiome and its relationship with strength, muscle function, and body composition in middle-aged overweight and obese women.

METHODS

This multi-factorial, double-blind, randomized controlled trial will be conducted on 88 participants in eight weeks. The participants will be allocated into four groups receiving vitamin D placebo (weekly) and synbiotic placebo (daily), vitamin D and synbiotic placebo, vitamin D placebo and symbiotic, and vitamin D and synbiotic. Intestinal microbiome assessment will be done by DNA isolation and real-time polymerase chain reaction (PCR). In addition, anthropometric indices, body composition, muscle strength, and physical performance will be evaluated by standard methods. All measurements will be made at the beginning and end of the study.

DISCUSSION

The previous studies showed that probiotics were involved in reducing inflammation, insulin sensitivity, modulation of atrophy markers such as atherogen-1, and decreasing reactive oxygen indices. In addition, vitamin D was found to improve the intestinal microbiome and facilitate muscle anabolism. The present protocol is novel as it aims to investigate the impact of the co-supplementation of synbiotic and vitamin D on the gut microbiome and sarcopenia indices.

TRIAL REGISTRATION

This trial has been registered in the Iranian Registry of Clinical Trials (IRCT20090822002365N25, date of registration: March 2021).

Low appendicular skeletal muscle mass index is associated with the anthropometric variables of post-menopausal women

BACKGROUND

Skeletal muscle mass is a central component of body composition and its decline is enhanced during aging. We verified the association between the appendicular skeletal muscle mass index (ASMI) with the anthropometric variables, biochemical variables, and lifestyle of postmenopausal women.

METHODS

Cross-sectional observational study conducted with postmenopausal women. Sociodemographic, clinical, lifestyle, physical activity level, biochemical, and anthropometric markers were collected. Body composition was assessed by dual-energy densitometry. Multivariate logistic regression analysis was applied.

RESULTS

One hundred fourteen women aged in average 66.0 ± 5.8 years were evaluated. There was a significant association between ASMI and age (p = 0.004), body mass (p < 0.001), body mass index (BMI) (p < 0.001), adductor pollicis muscle thickness (APMT) (p < 0.001), plasma calcium levels (p = 0.003), calf circumference (CC), and waist circumference (WC) (p < 0.001 for both). Adjusted regression analyses revealed the influence of BMI, CC, and APMT in the 1st tertile of ASMI (p < 0.05), BMI and CC in the 2rd tertile of ASMI.

CONCLUSIONS

ASMI was associated with BMI and muscle mass reserve indicators such as CC and DAPMT. In clinical practice, this indicates that simple, low-cost measures with good applicability can be used to predict and track the risk of depletion of skeletal muscle mass and consequent sarcopenia.

Prevalence of sarcopenia in community dwelling outpatient postmenopausal Hungarian women

Background

Ageing is an inherent feature of life and as per the United Nations, in the year 2020, 985 million women were ≥ 50 years of age worldwide, and the figure is expected to rise to 1.65 billion by 2050. Preservation of health and well-being in the elderly are challenging, and on the same note generalized changes in the musculoskeletal system contribute to this scenario. Musculoskeletal changes with ageing are referred to as sarcopenia. Reduced muscle mass and physical performance are hallmarks of sarcopenia, exclaimed with difficulty in independent activity and poor quality of life. Knowing that there is a hiatus in our knowledge as regards to the prevalence of sarcopenia in Hungary, the aim of this study was to determine the prevalence of sarcopenia in a community dwelling outpatient postmenopausal Hungarian cohort using the EWGSOP2 consensus recommendation.

Methods

In this cross-sectional study, women arriving for routine bone densitometry examination at the Regional Osteoporosis Center, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen were invited to participate in the study. A total of a 100 community-dwelling women were recruited who confirmed to the inclusion criteria of self-reported postmenopausal status, ≥ 50 years of age and gave written informed consent. The study procedures included the self-administered SARC-F questionnaire, followed by assessment of muscle strength, muscle quantity and physical preformance. Muscle strength was determined with the hand grip strength (HGS), appendicular skeletal muscle mass was assessed using dual energy X-ray absorptiometry and physical performance was determined by the gait speed (GS) test.

Results

As per the EWGSOP2 definition, the percentage of study participants with probable sarcopenia (low muscle strength), sarcopenia (low muscle strength and low muscle quantity) and severe sarcopenia (low muscle strength, muscle quantity and low physical performance) was 36, 31 and 8%, respectively. Multiple linear regression analysis revealed that height, weight, HGS and GS were all independent predictors of appendicular skeletal muscle mass.

Conclusion

The 31% prevalence of sarcopenia in the studied post-menopausal women highlights the need for adequate assessment of the condition in the elderly. Our findings most probably bear public health implications and may accelerate formulation of policies promoting healthy ageing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05167-2.

Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta-analysis

BACKGROUND

Sarcopenia is defined as the loss of muscle mass and strength. Despite the seriousness of this disease, a single diagnostic criterion has not yet been established. Few studies have reported the prevalence of sarcopenia globally, and there is a high level of heterogeneity between studies, stemmed from the diagnostic criteria of sarcopenia and the target population. The aims of this systematic review and meta-analysis were (i) to identify and summarize the diagnostic criteria used to define sarcopenia and severe sarcopenia and (ii) to estimate the global and region-specific prevalence of sarcopenia and severe sarcopenia by sociodemographic factors.

METHODS

Embase, MEDLINE, and Web of Science Core Collections were searched using relevant MeSH terms. The inclusion criteria were cross-sectional or cohort studies in individuals aged ≥18 years, published in English, and with muscle mass measured using dual-energy x-ray absorptiometry, bioelectrical impedance, or computed tomography (CT) scan. For the meta-analysis, studies were stratified by diagnostic criteria (classifications), cut-off points, and instruments to assess muscle mass. If at least three studies reported the same classification, cut-off points, and instrument to measure muscle mass, they were considered suitable for meta-analysis. Following this approach, 6 classifications and 23 subgroups were created. Overall pooled estimates with inverse-variance weights obtained from a random-effects model were estimated using the metaprop command in Stata.

RESULTS

Out of 19 320 studies, 263 were eligible for the narrative synthesis and 151 for meta-analysis (total n = 692 056, mean age: 68.5 years). Using different classifications and cut-off points, the prevalence of sarcopenia varied between 10% and 27% in the studies included for meta-analysis. The highest and lowest prevalence were observed in Oceania and Europe using the European Working Group on Sarcopenia in Older People (EWGSOP) and EWGSOP2, respectively. The prevalence ranged from 8% to 36% in individuals <60 years and from 10% to 27% in ≥60 years. Men had a higher prevalence of sarcopenia using the EWGSOP2 (11% vs. 2%) while it was higher in women using the International Working Group on Sarcopenia (17% vs. 12%). Finally, the prevalence of severe sarcopenia ranged from 2% to 9%.

CONCLUSIONS

The prevalence of sarcopenia and severe sarcopenia varied considerably according to the classification and cut-off point used. Considering the lack of a single diagnostic for sarcopenia, future studies should adhere to current guidelines, which would facilitate the comparison of results between studies and populations across the globe.

Baixa reserva muscular em pessoas idosas e fatores associados

Resumo Objetivo Estimar a prevalência de baixa reserva muscular e identificar os fatores associados em pessoas idosas. Método Estudo transversal realizado com 784 idosos (60 anos ou mais) não institucionalizados, residentes em Viçosa, Minas Gerais no ano de 2009. As características de interesse foram sociodemográficas, hábitos de vida, condições de saúde e antropométricas. A baixa reserva muscular (BRM) foi definida como o perímetro da perna (PP) < 33 cm para mulheres e < 34 cm para homens. Realizou-se análise descritiva, análise bivariada e múltipla, por meio da regressão de Poisson com variância robusta, para identificar os fatores independentemente associados ao desfecho de interesse. Resultados Mais da metade da amostra era composta por mulheres (52,9%), maior frequência de idosos mais jovens (60 – 69 anos :49,5%), com no máximo quatro anos de estudo (79,9%). A prevalência de baixa reserva muscular foi de 21,7% (IC 95% 18,9%-24,7%) e os fatores independentemente associados foram a faixa etária de 70 a 79 anos (RP:1,31; IC95%: 0,96-1,795), 80 anos ou mais (RP:1,64; IC95%:1,12-2,70), histórico de internação hospitalar (RP: 1,46; IC95%: 1,02-2,09) e baixo peso (RP: 5,45; IC95%:3,77-7,88). Conclusões A prevalência da BRM na amostra é expressiva, se relaciona com a idade mais avançada, hospitalização e com o baixo peso. O monitoramento do PP mostra-se importante para o rastreamento de alterações relacionadas à baixa reserva muscular na pessoa idosa e os fatores associados devem ser considerados nas avaliações antropométricas destinadas a esta população.

Factors affecting executive function performance of Brazilian elderly in the Stroop test

Aging is related to a decrease in physiological abilities, especially cognitive functions. To unravel further evidence of age-related cognitive decline, we analyzed which physical and functional variables are predictors of cognitive performance in a sample of 498 Brazilian elderly (67.26% women). To do so, we used the Stroop test as a tool to evaluate executive functions and the General functional fitness index (GFFI) to evaluate the functional fitness of the participants. A linear regression analysis revealed that female sex (β=-0.097; t=-2.286; P=0.023), younger age (β=0.205; t=4.606; P<0.0001), more years of education (β=-0.280; t=-6.358; P<0.0001), and higher GFFI (β=-0.101; t=-2.347; P<0.02) were predictors of better cognitive performance. Body mass index (kg/m²) and nutritional status (underweight, eutrophic, overweight, or obese) were not predictors of cognitive performance. Interestingly, among the GFFI tasks, muscle strength influenced the test execution time, both in upper and lower limbs (elbow flexion: β=-0.201; t=-4.672; P<0.0001; sit-to-stand: β=-0.125; t=-2.580; P<0.01). Our findings showed that: 1) women performed the Stroop test faster than men; 2) the older the person, the lower was the cognitive performance; 3) the higher the education, the better the test execution time; and 4) higher scores in the GFFI were associated with a better performance in the Stroop test. Therefore, gender, age, education, and functional fitness and capacity were predictors of cognitive performance in the elderly.

Are sociodemographic and anthropometric variables effective in screening probable and confirmed sarcopenia in community-dwelling older adults? A cross-sectional study

BACKGROUND

Screening for probable and confirmed sarcopenia using sociodemographic and anthropometric indicators can be a practical, cheap, and effective strategy to identify and treat older people susceptible to this condition.

OBJECTIVES

To identify cutoff points for sociodemographic and anthropometric variables in screening probable and confirmed sarcopenia in community-dwelling older adults.

DESIGN AND SETTING

This was a cross-sectional study of community-dwelling older adults in Araranguá, Santa Catarina, Brazil.

METHODS

Sociodemographic (age, education) and anthropometric (weight, height, body mass index [BMI], waist circumference [WC], and dominant calf circumference [DCC]) factors were considered as predictors. The outcomes were probable sarcopenia (reduction in muscle strength assessed by time ≥ 15 s in the five-time sit-to-stand test) and confirmed sarcopenia (reduction in strength and muscle mass). Receiver operating characteristic curve analysis was used to analyze the ability to track sociodemographic and anthropometric variables for sarcopenia.

RESULTS

In 308 older adults, WC > 91 cm in women and age > 69 years in men were useful in screening for probable sarcopenia. The variables age, weight, BMI, WC, and DCC can be used to screen for sarcopenia in older women and men.

CONCLUSION

Sociodemographic and anthropometric variables are simple and accessible tools for sarcopenia screening in older adults.

Low muscle reserve in older adults and associated factors

Abstract Objective To estimate the prevalence of low muscle reserve and identify associated factors in older people. Method Cross-sectional study carried out with 784 non-institutionalized older people (60 years or older), living in Viçosa, Minas Gerais, in 2009. The characteristics of interest were sociodemographic, life habits, health and anthropometric conditions. Low muscle reserve (LMR) was defined as leg circumference (LC) < 33 cm for women and < 34 cm for men. Descriptive analysis, bivariate and multiple analysis were performed, using Poisson regression with robust variance, to identify the factors independently associated with the outcome of interest. Results More than half of the sample consisted of women (52.9%), more frequently younger seniors (60 – 69 years old :49.5%), with a maximum of four years of study (79.9%). The prevalence of low muscle reserve was 21.7% (95%CI 18.9%-24.7%) and the independently associated factors were the age group from 70 to 79 years (PR:1.31; 95%CI: 0.96-1.795), 80 years or older (PR:1.64; 95%CI:1.12-2.70), history of hospitalization (PR: 1.46; 95%CI: 1.02-2.09) and low weight (PR: 5.45; 95%CI: 3.77-7.88). Conclusions The prevalence of LMR in the sample is expressive, it is related to older age, hospitalization and low weight. LC monitoring is important for tracking changes related to low muscle reserve in older people and associated factors should be considered in anthropometric assessments for this population.

Influence of Polymorphism on the NFkB1 Gene (rs28362491) on the Susceptibility to Sarcopenia in the Elderly of the Brazilian Amazon

BACKGROUND

Sarcopenia is a disease characterized by progressive reduction in muscle mass and strength or function. Although it is known that sarcopenia may be associated with environmental factors, studies suggest the identification of genes related to skeletal muscle maintenance that explain the susceptibility to the disease.

OBJECTIVE

To analyze the influence of NFkB1 gene polymorphism on susceptibility to sarcopenia in the elderly.

METHODS

This is a case-control study, which included 219 elderly people, 74 elderly people with sarcopenia, and 145 without sarcopenia. Samples were analyzed for NFkB1 gene polymorphism (rs28362491), genotyped in PCR, and followed by fragment analysis. To avoid misinterpretation due to population substructure, we applied a previously developed set of 61 informative ancestral markers that were genotyped by multiplex PCR. We used logistic regression to identify differences in genotypic frequencies between elderly people with and without sarcopenia.

RESULTS

It was observed that the NFkB1 gene polymorphism presented frequencies of 24%, 50%, and 26% for the genotype DEL/DEL, DEL/INS, and INS/INS, respectively. Furthermore, elderly individuals with the INS/INS genotype had increased chances (p = 0.010; OR:2.943; 95%CI:1.301-6.654) for the development of sarcopenia.

CONCLUSION

The INDEL polymorphism of the NFkB1 gene (rs28362491) may influence the susceptibility to sarcopenia in the elderly in elderly people in the Amazon.

Cut-off points to screening for sarcopenia in community-dwelling older people residents in Brazil

BACKGROUND

At a time when the world's population is aging, one of the most important challenges for the healthcare field is to control the decline of the musculoskeletal system. This decline consists of a reduction in muscle mass and function, which is called sarcopenia and is associated with adverse health outcomes. Although there has been an increase in the number of publications on sarcopenia and its consequences, the reported prevalence varies widely, since these depend on the characteristics of the population studied, the definitions found in the literature and the cut-off points adopted. In this perspective, the heterogeneity in the classification and the different reference values has a critical impact on the epidemiology of sarcopenia, since neither the procedures, the components and the cut-off points are consistent.

OBJECTIVES

To develop cut-off points for the screening of sarcopenia in community-dwelling older people residents in the northeast of Brazil and compare the prevalences between the values defined by the consensus and the values of the population studied.

METHODS

Community-dwelling older men and women living in three cities in the countryside of Rio Grande do Norte were evaluated. Cutoff points were defined for the variables used to screen for sarcopenia (handgrip strength, SMI, gait speed and SPPB) using the 20th percentile of their population distributions.

RESULTS

The sample was composed of 1,290 older people (62.5% female and 37.5% male), with an average of 69.5 (± 6.05) years of age. Regarding the cutoff points, the handgrip values were defined as 25.3 kg and 16 kg for men and women, respectively. Considering the SMM adjusted according to their height, the values of 7.88 kg/m2 were adopted for men and 5.52 kg/m2 for women. When adjusting by BMI we obtained 0.73 kg/BMI for men and 0.41 kg/BMI for women. For gait speed it was defined 0.71 m/s for men and 0.63 m/s for women. In the case of SPPB, the result was the same for both genders (≤8). When applying the values found in the studied population, a variation in prevalence was observed for both men and women, depending on the cut-off points and consensus used.

CONCLUSION

The cutoff values found in our population were lower than those adopted by international consensus (EWGSOP2, IWGS and FNIH), except for HGS in woman and SMI/m2 for men. Therefore, using specific cutoff points for different populations can provide an accurate assessment of the presence of sarcopenia and better target health prevention strategies for the older people living in the community.

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

OBJECTIVE

This meta-analysis was conducted to estimate the overall prevalence of sarcopenia in older Chinese adults.

DESIGN

Systematic review and meta-analysis.

PARTICIPANTS

A literature research was conducted using the PubMed, Web of Science, China National Knowledge Infrastructure, CQVIP and Wanfang databases. The following search terms in the abstract were used: "sarcopenia" in combination with the terms "prevalence," "epidemiology" and "China." All studies published from January 2010 to November 2020 were included. The random-effect model was used to estimate the prevalence of sarcopenia. The sex-specific prevalence of sarcopenia at a 95% CI was also calculated using different criteria for defining sarcopenia.

PRIMARY OUTCOME MEASURES

The overall prevalence of sarcopenia in older Chinese adults.

RESULTS

In total, 23 articles were included in this meta-analysis involving 21 564 participants. On the basis of the Asian Working Group for Sarcopenia criterion, the overall prevalence of sarcopenia among the elderly in China was 14% (95% CI 11% to 18%); the prevalence was higher in Chinese women than in men (15% vs 14%).

CONCLUSIONS

This systematic review is the first estimation of the pooled prevalence of sarcopenia in older Chinese adults. Our results suggest that China has a large number of patients with sarcopenia. These findings would be useful for sarcopenia prevention in China. There is a high degree of heterogeneity, and although there are a large number of cases and could be an emerging public health issue, more research is required to make these claims.

PROSPERO REGISTRATION NUMBER

CRD42020223405.

Fish Consumption: A Review of Its Effects on Metabolic and Hormonal Health

Dietary habits are a major determinant of the risk of chronic disease, particularly metabolic and endocrine disorders. Fish as a food group are a unique source of nutrients with metabolic and hormonal importance including omega-3 fatty acids, iodine, selenium, vitamin D, taurine and carnitine. Fish are also a source of high quality protein and have in general low caloric density. The impact of these nutrients on cardiovascular risk has been extensively reviewed, but the impact of fish on the broader field of endocrine and metabolic health is sometimes not sufficiently appreciated. This article aimed to summarize the impact the effect of regular fish consumption on conditions like the metabolic syndrome, obesity, diabetes, hypothyroidism, polycystic ovary syndrome and the menopausal transition, which are in and of themselves significant causes of morbidity and mortality worldwide. The review revealed that scientific evidence from food science, translational research, epidemiologic studies and interventional trials shows that regular fish consumption has a positive impact on thyroid homeostasis, facilitates maintenance of a healthy body weight, reduces the magnitude of age-associated increases in blood pressure, improves glucose homeostasis helping prevent diabetes and the metabolic syndrome, and has a positive impact on muscle mass preservation among the elderly. These effects are mediated by multiple mechanisms, only some of which have been identified. For most of these effects it holds true that the potential benefits are more substantial when baseline fish consumption is low.

Age- and Gender-Related Changes in Physical Function in Community-Dwelling Brazilian Adults Aged 50 to 102 Years

BACKGROUND AND PURPOSE

Cutoff points for physical function tests are commonly used in clinical practice for the evaluation, monitoring, and treatment of older adults. Previous studies have shown that, while age-related patterns of muscle strength change are similar between ethnic groups, strength values differ significantly independent of age. Whether the same applies to other physical function tests is presently unclear. This study investigated age- and gender-related changes of performance on a battery of physical function tests in Brazilian community dwellers.

METHODS

The study followed a cross-sectional design. Participants were community-dwelling adults. Candidates were considered eligible if they were 18 years or older, lived independently, and possessed sufficient physical and cognitive abilities to perform all of the measurements required by the protocol. Physical function tests included isometric handgrip (IHG), 5 times sit-to-stand (5×STS) test, Timed Up and Go, 1-leg stance, and walking speed (WS) at usual and fast pace.

RESULTS

Two-thousand eight-hundred and four people were enrolled. Mean age was 68.0 (7.0) years (range 50-102 years), and 2262 (80.7%) were women. Men displayed better IHG and balance, while women showed higher performance on the 5×STS and WS tests. A gender-specific pattern of decline in physical performance was observed. Specifically, women showed a linear age-dependent decline in all tests. In men, only in the IHG, 1-leg stance, and WS test at a fast pace was there a linear decline with age. In both genders, the lowest mean values of physical function tests were higher than the proposed cutoffs for sarcopenia.

DISCUSSION AND CONCLUSIONS

Our findings indicate that the performance on different physical function tests decreases with advancing age in Brazilian adults, following a gender-specific pattern. In none of the tests did the lowest mean values reach the cutoffs for sarcopenia. This suggests that region-specific cutoffs might be necessary to identify older people at risk of adverse events.

Fatores associados à fragilidade em idosos acompanhados na Atenção Primária à Saúde

Resumo Objetivo Verificar a associação entre os marcadores de fragilidade e as características sociodemográficas e clínicas em idosos na Atenção Primária à Saúde. Método Pesquisa transversal, realizada com 356 idosos cadastrados em unidades de saúde da família, no Nordeste do Brasil. Os instrumentos de coleta utilizados foram o Índice de Vulnerabilidade Clínico-Funcional e outro de perfil socioeconômico e de saúde. Analisaram-se os dados pela estatística inferencial, utilizando o teste do Qui-quadrado, com nível de significância 0,05. Resultados A média de idade foi de 72,85 anos (±8,965); 63,8% eram do sexo feminino, 39% apresentaram risco de fragilização e 22,5% demonstraram fragilidade. Houve associação entre fragilidade, sexo, faixa etária, estado civil, escolaridade, renda, presença de doença cardíaca e hipertensão. Conclusões e implicações para a prática Os marcadores de fragilidade nos idosos evidenciaram associação entre as características sociodemográficas e clínicas, indicando a necessidade de rastreio precoce no nível primário de atenção à saúde.

Normalizing calf circumference to identify low skeletal muscle mass in older women: a cross-sectional study

Introduction

Introduction: functional limitation is a result of sarcopenia and is associated with loss of skeletal muscle mass (SMM). Cost-effective methods are important for the identification of sarcopenia. Objective: to propose cutoff points for normalized calf circumference (CC) in order to identify low SMM in older women based on their functional limitation. Methods: in this descriptive, cross-sectional study the CC values of a young female sample (n = 78) were used to establish cutoff points (-2 SD) for low SMM in older women (n = 67). Functional limitation was identified by the six-minute walk test (≤ 400 m). CC was normalized by body mass, height, and BMI. The diagnostic accuracy of CC was calculated with a ROC curve, using functional limitation as standard. Results: cutoff points and area under the curve (AUC) were: CC (≤ 28.5; 0.62); CC·body mass-1 (≤ 0.40; 0.63); CC·height-2 (≤ 8.52; 0.55) and CC·BMI-1 (≤ 1.10; 0.73). Only CC·BMI-1 achieved a desirable accuracy (AUC > 0.7) to distinguish functional limitation. Conclusion: the accuracy attained supports the use of CC·BMI-1 to identify low SMM in older women. In the clinical context it is possible to predict the risk of sarcopenia when sophisticated methods for determining SMM are not available.

Sarcopenia - Molecular mechanisms and open questions

Sarcopenia represents a muscle-wasting syndrome characterized by progressive and generalized degenerative loss of skeletal muscle mass, quality, and strength occurring during normal aging. Sarcopenia patients are mainly suffering from the loss in muscle strength and are faced with mobility disorders reducing their quality of life and are, therefore, at higher risk for morbidity (falls, bone fracture, metabolic diseases) and mortality. Several molecular mechanisms have been described as causes for sarcopenia that refer to very different levels of muscle physiology. These mechanisms cover e. g. function of hormones (e. g. IGF-1 and Insulin), muscle fiber composition and neuromuscular drive, myo-satellite cell potential to differentiate and proliferate, inflammatory pathways as well as intracellular mechanisms in the processes of proteostasis and mitochondrial function. In this review, we describe sarcopenia as a muscle-wasting syndrome distinct from other atrophic diseases and summarize the current view on molecular causes of sarcopenia development as well as open questions provoking further research efforts for establishing efficient lifestyle and therapeutic interventions.

Anthropometric indicators as a discriminator of sarcopenia in community-dwelling older adults of the Amazon region: a cross-sectional study

BACKGROUND

Sarcopenia is a geriatric syndrome associated with negative health outcomes and the use of viable alternative screening tools may help in the diagnosis of this condition. This study aimed to analyze the association of sarcopenia with anthropometric indicators among community-dwelling older adults and to identify cut-off points for such indicators as a discriminant criterion for predicting sarcopenia.

METHODS

This was a cross-sectional study conducted on community-dwelling older adults ≥60 years old (n = 411) of both sexes from Macapá, Amapá, Brazil. Socioeconomic, clinical and anthropometric data (arm circumference - AC, waist circumference - WC, calf circumference - CC and body mass index - BMI) were collected using a structured form. Sarcopenia was identified according to the EWGSOP 2 consensus. The association between anthropometric indicators and sarcopenia was performed using logistic regression and cut-off points established from the ROC Curve. Statistical significance was defined as p ≤ 0.05.

RESULTS

Adjusted analysis indicated an independent and inverse association between sarcopenia and the anthropometric indicators: AC (odds ratio, OR: 0.63; 95% confidence interval, 95%CI: 0.53-0.76), CC (OR: 0.73; 95%CI: 0.62-0.85), WC (OR: 0.93; 95%CI: 0.90-0.97) and BMI (OR: 0.64; 95%CI: 0.53-0.76). The following cut-off points for older men and women represented the discriminant criterion for the presence of sarcopenia: WC (≤97 and ≤ 86 cm), CC (≤33 and ≤ 31 cm), AC (≤27 cm) and BMI (≤24.8 kg/m2 and ≤ 24.5 kg/m2) (area under the ROC curve superior to 0.70). BMI and AC were the indicators with the highest ability to discriminate older adults of both sexes with sarcopenia.

CONCLUSIONS

An increase of one unit of the indicators can reduce the probability of occurrence of sarcopenia. All indicators were considered to discriminate the occurrence of sarcopenia, with emphasis on BMI and AC, and could be used to screen for this condition among community-dwelling older adults.

Sarcopenia in Type 2 Diabetes Mellitus: A Cross-Sectional Observational Study

BACKGROUND

The aim of this study was to compare the prevalence of low muscle mass and sarcopenia in patients with type 2 diabetes mellitus (T2DM) versus paired controls (control group, CG) and the association between sarcopenia and chronic diabetes complications.

METHODS

Men and women ≥50 years with T2DM (T2DM group, T2DMG) were recruited during routine outpatient visits. Total body densitometry and handgrip strength (HGS) were evaluated in the T2DMG and CG, while the T2DMG was also evaluated for the physical performance using the gait speed (GS) test. Sarcopenia was diagnosed according to the criteria of the Foundation for the National Institutes of Health Sarcopenia Project (FNIH).

RESULTS

The study included 177 individuals in the T2DMG and 146 in the CG. The mean HGS value was lower in the T2DMG (24.4 ± 10.3 kg) compared with the CG (30.9 ± 9.15 kg), p < 0.001, with low HGS in 46 (25.9%) and 10 (9%) in the T2DMG and CG, respectively (p < 0.001). The prevalence of sarcopenia defined according to the FNIH criteria was higher in the T2DMG 23 (12.9%) compared with the CG 8 (5.4%), p < 0.03. The presence of albuminuria increased the odds of sarcopenia (odds ratio (OR) 2.84, 95% confidence interval (CI) 1.07-7.68, p=0.04) and osteoporosis (OR 3.38, 95% CI 1.12-9.89, p=0.03), even in patients with mild to moderate nephropathy. The body composition analysis showed increased odds of sarcopenia with increased percentage of total fat (%TF) in women (OR 1.18, 95% CI, 1.03-1.43, p=0.03) and men (OR 1.31, 95% CI, 1.10-1.75, p=0.01).

CONCLUSION

Patients with T2DM presenting with albuminuria, osteoporosis, and increased %TF were more likely to have sarcopenia. This finding emphasizes the need for patients with T2DM to be evaluated for sarcopenia to allow for early implementation of measures to prevent or treat this disorder.

Prevalence of sarcopenia in kidney transplants and their association with determinant factors of muscle homeostasis

INTRODUCTION

Sarcopenia is characterized by the involuntary loss of lean body mass associated with a progressive reduction of muscle strength.

OBJECTIVE

To determine the prevalence of sarcopenia in kidney transplant recipients and its association with the determining factors that control muscle homeostasis.

METHODS

We evaluated renal transplant recipients undergoing follow-up at the University Hospital of the Federal University of Maranhão from June 2017 to July 2018 and who met the inclusion criteria. Sarcopenia was defined according to the European criteria. The skeletal muscle mass index was measured by dual-energy radiological absorptiometry; the values <7,26 kg/m2 for men and <5,5 kg/m2 for women were adopted for muscle depletion. For handgrip strength, values of <30 kg for men and <20 kg for women were considered as reduced muscle strength. In both sexes, the cutoff point for walking speed was <0,8 m/s.

RESULTS

We evaluated 83 renal transplant recipients with a mean age of 48.8 ± 12,1 years and predominantly males (57,8%). The prevalence of sarcopenia was 19,3%. Among individuals without sarcopenia, 17,9% had a decrease in handgrip strength and 40,3% has altered gait speed.

DISCUSSION

Individuals submitted to renal transplant may develop sarcopenia while still young and already present altered muscle function and strength even before the depletion of lean body mass.

CONCLUSION

Early diagnosis may allow the prevention of sarcopenia and provide a better quality of life for patients.