Differences in sarcopenia prevalence between upper-body and lower-body based EWGSOP2 muscle strength criteria: the Tromsø study 2015-2016

Sarcopenic obesity and weight loss-induced muscle mass loss

PURPOSE OF REVIEW

Sarcopenic obesity is a clinical condition characterized by the coexistence of excess adiposity and impaired muscle function, associated with heightened cardiometabolic risk and frailty. The emergence of new incretin-based obesity management medications (OMMs), which allow unprecedented weight loss, has raised concerns regarding weight loss-induced fat-free mass (FFM) reduction, including skeletal muscle mass (SMM). This review examines recent findings on the prevalence, diagnosis, and implications of sarcopenic obesity, explores the effects of weight-loss interventions on body composition and their impact on health, and discusses strategies to preserve muscle mass.

RECENT FINDINGS

Weight loss induced by incretin-based OMMs results in a variable but significant reduction in FFM. The extent to which this loss affects SMM and function remains uncertain. Nutritional strategies, particularly adequate protein intake, and structured exercise interventions, especially resistance training, play a key role in mitigating FFM loss. Digital health interventions and telemedicine-based exercise programs offer promising approaches for maintaining muscle health during weight loss.

SUMMARY

The clinical significance of FFM loss during weight reduction remains debated. Future research should refine sarcopenic obesity diagnostic criteria, assess the long-term impact of FFM/SMM reduction during intentional weight loss, and evaluate interventions that optimize body composition while preserving functional health.

Handgrip strength is not correlated with the five-times sit-to-stand test in kidney transplant patients

INTRODUCTION

Low muscle strength is the primary criterion proposed by the European Working Group on Sarcopenia in Older People (EWGSOP2) for diagnosing sarcopenia, a prevalent condition in the kidney transplant population. The EWGSOP2 recommends either handgrip strength (HGS) or the five-times sit-to-stand test (5TST) to evaluate muscle strength. However, it remains unclear whether these tests are equivalent for assessing muscle strength in kidney transplant patients (KTPs).

AIM

This study aimed to evaluate the correlation between HGS and the 5TST in KTPs.

METHODS

A cross-sectional study was conducted with 127 KTPs. Muscle strength was assessed using HGS and 5TST. HGS was measured using a dynamometer on the dominant hand, with the highest recorded value used for analysis. The 5TST was conducted by instructing participants to sit and stand from a chair five times as quickly as possible without using their hands. Pearson's correlation was conducted to assess the relationship between HGS and 5TST. In addition, odds ratio analyses were performed to evaluate the likelihood of inadequate 5TST in relation to inadequate HGS. Cohen's kappa (κ) test was also performed to determine the level of agreement between HGS and 5TST.

RESULTS

No correlation was observed between HGS and 5TST (r = 0.093; p = 0.295). After adjusting for BMI, sex, age and glomerular filtration rate, the results remained uncorrelated (r = 0.025; p = 0.777). Individuals with inadequate 5TST did not have a higher likelihood of inadequate HGS (OR = 1.391 [0.254-7.596]). A slight agreement between HGS and 5TST was observed (k = 0.0370).

CONCLUSION

HGS is not correlated with 5TST in KTPs. These results suggest that HGS and 5TST are not equivalent measures of muscle strength in this population.

Malnutrition and sarcopenia in inpatient rehabilitation: prevalence and associations with changes in bodyweight, muscle strength, and functional independence

OBJECTIVE

To investigate the prevalence of malnutrition and sarcopenia in different disciplines of inpatient rehabilitation and the course of nutritional status parameters.

DESIGN

Multi-centre cross-sectional prevalence study and longitudinal observational study.

SUBJECTS/PATIENTS

Inpatients (> 18 years) in geriatric, pulmonary, cardiovascular, internal medicine/oncological, musculoskeletal, or neurological rehabilitation in 5 rehabilitation centres were included.

METHODS

Malnutrition was assessed according to the Global Leadership Initiative on Malnutrition criteria. Sarcopenia was assessed according to the European Working Group on Sarcopenia in Older People criteria. Bodyweight, hand grip strength (HGS), and functional independence measure (FIM) were assessed within 3 days of admission and after 21 days of rehabilitation and analysed using linear mixed models with time*diagnosis interaction.

RESULTS

The study included 558 patients (51.8% male, median age 73.0 years). The overall prevalence of malnutrition and sarcopenia was 35.5% (95% CI 31.5, 39.6%) and 32.7% (95% CI 28.8, 36.8%), respectively. Patients with risk of malnutrition lost on average 1.14 kg (95% CI -1.64, -0.63) during rehabilitation. Patients slightly increased their HGS and FIM, irrespective of risk or diagnosis of malnutrition or sarcopenia. However, at the end of the rehabilitation, malnourished or sarcopenic patients had still a significantly lower bodyweight, HGS, and FIM than patients without (p < 0.01). Some 37.3% of patients at risk of and 35.4% with diagnosed -malnutrition did not receive group or individual nutritional -counselling.

CONCLUSION

Malnutrition and sarcopenia are highly prevalent during inpatient rehabilitation. Nevertheless, dietitians are often not involved in the therapy. While nutritional parameters and functional independence improve, patients with malnutrition and sarcopenia remain on a lower level after 3 weeks of rehabilitation. Long-term follow-up after rehabilitation is recommended to prevent nutritional and muscular decline and related negative health outcomes.

Sarcopenia in older people with multiple sclerosis: A cross-sectional study

BACKGROUND

Older people with multiple sclerosis (pwMS) make up over one-third of the MS population. Ageing increases the risk of sarcopenia, characterised by reduced muscle mass, strength, and function. MS symptoms likely exacerbate sarcopenia, but its impact on older pwMS remains largely unexplored OBJECTIVES: The primary aim of this study was to investigate how the diagnosis of sarcopenia using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) diagnostic tool in older pwMS is influenced by using upper extremity-based or lower extremity-based tests.

METHODS

The present cross-sectional study analysed baseline data from the PoTOMS trial. A total of n = 41 older pwMS and n = 27 healthy controls (HC) were included. Participants were assessed for sarcopenia using the EWGSOP2 diagnostic tools and a lower extremity muscle strength test.

RESULTS

Older pwMS had a preferentially lower muscle mass and strength in the lower extremities compared to HC. According to EWGSOP2 criteria, 5 % of older pwMS had reduced upper extremity strength, 7 % had reduced lower extremity strength, and 15 % had sarcopenic muscle mass. However, only 5 % were diagnosed with sarcopenia despite these reductions.

CONCLUSION

The present study shows that the sarcopenia diagnosis in older pwMS is more sensitive when using a lower extremity test, underlined by the preferentially lower muscle mass and strength in older pwMS compared to HC. Hence, when evaluating sarcopenia in older pwMS the diagnostics test should rely on the lower extremity test.

Association of Muscle Strength With All-Cause Mortality in the Oldest Old: Prospective Cohort Study From 28 Countries

BACKGROUND

Ageing is associated with a gradual loss of muscle strength, which in the end may have consequences for survival. Whether muscle strength and mortality risk associate in a gradual or threshold-specific manner remains unclear. This study investigates the prospective association of muscle strength with all-cause mortality in the oldest old.

METHODS

We included 1890 adults aged ≥ 90 years (61.6% women, mean age 91.0 ± 1.5 years) from 27 European countries and Israel participating in the Survey of Health, Ageing and Retirement in Europe (SHARE) study. Muscle strength was assessed using handgrip dynamometry (unit: kilogram). Using time-varying Cox regression with restricted cubic splines, we determined the prospective association of muscle strength with mortality, controlling for age, sex, smoking, BMI, marital status, education, geographical region and self-perceived health.

RESULTS

Over a mean follow-up of 4.2 ± 2.4 years, more than half of the participants died (n = 971, 51.4%). The mean handgrip strength was 20.4 ± 8.0 kg for all participants, with men (26.7 ± 7.5 kg) showing significantly higher strength than women (16.4 ± 5.4 kg) (p < 0.001). Using the median level of muscle strength as reference (18 kg), lower and higher levels were associated in a gradual and curvilinear fashion with higher and lower mortality risk, respectively. The 10th percentile of muscle strength (10 kg) showed a hazard ratio (HR) of 1.27 (95% CI 1.13-1.43, p < 0.001). The 90th percentile (31 kg) showed an HR of 0.69 (95% CI 0.58-0.82, p < 0.001). Stratified for sex, the median levels of muscle strength were 26 kg for men and 16 kg for women. The 10th percentile of muscle strength showed HRs of 1.33 (95% CI 1.10-1.61, p < 0.001) at 15 kg for men and 1.19 (95% CI 1.05-1.35, p < 0.01) at 10 kg for women. The 90th percentile of muscle strength showed HRs of 0.75 (95% CI 0.59-0.95, p < 0.01) at 35 kg for men and 0.75 (95% CI 0.62-0.90, p < 0.001) at 23 kg for women. Sensitivity analyses, which excluded individuals who died within the first 2 years of follow-up, confirmed the main findings.

CONCLUSION

Rather than a specific threshold, muscle strength is gradually and inversely associated with mortality risk in the oldest old. As muscle strength at all ages is highly adaptive to resistance training, these findings highlight the importance of improving muscle strength in both men and women among the oldest old.

Performance of the SARC-F, SARC-CalF, and calf circumference for sarcopenia case finding in community-dwelling older adults

PURPOSE

We compared the performance of SARC-F, SARC-CalF, calf circumference (CC), and body mass index (BMI)-adjusted CC for sarcopenia case-finding in community-dwelling older adults.

METHODS

Data of Finnish participants (women/men n = 192/36, mean age (SD) of 76.9 (4.8) years) recruited in the SPRINTT trial (NCT02582138) were used. Sarcopenia was determined as a combination of low muscle function (chair-stand-test) and low appendicular lean mass (ALM) detected by whole-body dual-energy X-ray absorptiometry. Associations of case-finding tools with sarcopenia were analysed using ROC curves and logistic regression.

RESULTS

The rates of probable and confirmed sarcopenia were 95% and 18% in women and 94% and 36% in men, respectively. Performance of CC for sarcopenia (women AUC 0.85 [95% CI 0.78-0.92]/ men 0.85 [95% CI 0.71-1.0]) was superior to that of other tools; (AUC in women/men for SARC-F was 0.57/0.50, for SARC-CalF 0.76/0.79, and for BMI-adjusted CC 0.68/0.66). The best performance was found for a CC cut-off point of ≤ 34 cm in women with sensitivity/specificity 82.4/75.3% and ≤ 36 cm in men with sensitivity/specificity 76.9/87.0%. For each cm decrease in CC, adjusted for age and BMI, there was a 30% increase in the odds of sarcopenia in women (OR 1.30, 95% CI 1.09─1.56). Although there was a similar pattern in men, the results did not reach statistical significance (OR 1.34, 95% CI 0.84- 2.14).

CONCLUSIONS

CC was superior to other tools for sarcopenia case-finding. The best performance was found for a CC cut-off point of ≤ 34 cm in women and ≤ 36 cm in men.

Prevalence and Diagnostic Agreement of Sarcopenia Based on Handgrip Strength and 5-Time Chair-Stand Test Among Chinese Community-Dwelling Older Adults

INTRODUCTION

Handgrip strength and the 5-time chair-stand test are the two important muscle strength measures run through the whole sarcopenia diagnosis algorithm. There is a lack of evidence to confirm which muscle strength measures have a higher detection rate of sarcopenia among Chinese older adults, which is a challenge for community workers to choose the muscle strength measures and to identify more sarcopenia in clinical practice.

OBJECTIVE

We aimed to investigate the prevalence and diagnostic agreement of sarcopenia based on handgrip strength and the 5-time chair-stand test among Chinese community-dwelling older adults.

METHODS

This cross-sectional study sampled 1027 community-dwelling older adults from Hunan, China. We used handgrip strength and the 5-time chair-stand test to assess participants' muscle strength and used gait speed and bioimpedance analysis (BIA) to assess physical performance and skeletal muscle mass, respectively. The kappa values of the agreement test were used to evaluate the agreement of handgrip strength and 5-time chair-stand tests in the assessment of sarcopenia.

RESULTS

A total of 1027 participants were included in this analysis including 337 males and 690 females with an average age of 70.35 ± 7.24 years. The prevalence of possible sarcopenia, confirmed sarcopenia and severe sarcopenia based on handgrip strength was 50.8%, 20.3% and 14.5% respectively, while the corresponding prevalence for using the 5-time chair-stand test was 27.6%, 10.8% and 10.9%. The kappa value of the consistency test between handgrip strength and 5-time chair-stand test in the assessment of possible sarcopenia, confirmed and severe sarcopenia was 0.26, 0.51 and 0.62, respectively (p < 0.001 for all).

CONCLUSIONS

The prevalence of possible sarcopenia, confirmed sarcopenia and severe sarcopenia based on handgrip strength was significantly higher than that of the 5-time chair-stand test. We recommend handgrip strength as the preferred method of muscle strength measurement for Chinese community-dwelling older adults and use 5-time chair-stand tests when handgrip strength is not available.

IMPLICATIONS FOR PRACTICE

The findings provide information and suggestions to healthcare providers for choosing the muscle strength measures to detect more sarcopenia in clinical practice. Compared with the 5-time chair-stand test, handgrip strength has a better performance to identify sarcopenia in Chinese community-dwelling older adults.

Comparing Sarcopenia Definitions and Muscle Power Reduction: Associations with Health Outcomes in Spanish Community-Dwelling Older Adults

Objectives: To analyze the associations between the different operational definitions of sarcopenia published in the last decade and reduced muscle power with a set of adverse health-related outcomes, such as comorbidities, depression, polypharmacy, self-perceived health, educational attainment, socioeconomic status, falls, and hospitalizations in Spanish community-dwelling older adults. Methods: A total of 686 community-dwelling older adults (median age: 72; women: 59.2%; physically active: 84%) were included in this cross-sectional analysis (ClinicalTrials.gov: NCT05148351). Sarcopenia was assessed using the FNIH, EWGSOP2, AWGS, and SDOC algorithms. Reduced muscle power was defined as the lowest sex-specific tertile and measured during the rising phase of the sit-to-stand test using a validated mobile application. Unadjusted and adjusted logistic regressions by potential confounders were performed to identify the association between sarcopenia and reduced muscle power with health-related outcomes. Results: Sarcopenia prevalence was 3.4%, 3.8%, 12.4%, and 21.3% according to the SDOC, FNIH, EWGSOP2, and AWGS, respectively. Among these definitions, moderate and large associations with health-related outcomes were observed for EWGSOP2 and SDOC, respectively, but few associations were found for FNIH and AWGS criteria. Reduced muscle power was associated more frequently and moderately with health-related outcomes compared to sarcopenia definitions. These associations remained constant after adjusting for confounders. Conclusions: The prevalence and impact of sarcopenia varied depending on the definitions used. Among the sarcopenia definitions, the SDOC exhibited the strongest associations, while reduced muscle power was the variable most frequently associated with health-related outcomes compared to any of the four sarcopenia definitions in well-functioning and physically active community-dwelling older adults.

Risk of secondary sarcopenia in Europeans with fibromyalgia according to the EWGSOP2 guidelines: systematic review and meta-analysis

INTRODUCTION

Fibromyalgia is characterized by chronic widespread pain accompanied by reduced levels of physical activity and associated comorbidities such as overweight and obesity which have been associated to sarcopenia development. The aim of this systematic review is to ascertain whether Europeans with fibromyalgia show a reduction in sarcopenia determinants compared to apparently-healthy controls and to determine the risk of sarcopenia and its possible risk factors (PROSPERO: CRD42023439839).

EVIDENCE ACQUISITION

Systematic searches were conducted on six databases (Academic-Search-Ultimate, CENTRAL, PubMed, SciELO, WOS-Core Collection, and ClinicalTrials.gov last-search February-2024) looking for original studies developed in European countries which assessed any of the sarcopenia determinants proposed by the EWGSOP2-guidelines (handgrip strength, five sit-to-stand, appendicular skeletal mass [ASM], skeletal muscle index [SMI]) and included fibromyalgia and healthy-control individuals. Studies mixing fibromyalgia with other diagnoses were excluded. Random-effects meta-analyses and meta-regressions were used to analyze possible differences and associated risk factors. The risk of bias was assessed using the Cochrane-Rob tool and the Quality Assessment Tool for Observational Studies, and the certainty of the evidence using GRADE-approach.

EVIDENCE SYNTHESIS

A total of 25 studies (6393 individuals; 97% women; 20-65 years) were included. Fibromyalgia individuals showed reduced muscle strength ([handgrip] SMD: -1.16 [-1.29, -1.03]; high-certainty; [five sit-to-stand] not-assessed) and muscle quantity ([ASM] mean-difference: -0.83 kg [-1.41, -0.37]; [SMI] mean-difference: -0.26 kg/m2 [-0.41, -0.10]; both low-certainty) compared to healthy-controls. Fibromyalgia individuals had nine-times greater risk for probable sarcopenia (OR: 9.23 [6.85, 12.45]; high-certainty), but not for confirmed sarcopenia ([ASM] OR: 0.91 [0.49, 1.67]; [SMI] OR: 0.67 [0.19, 2.33]; both low-certainty) according to the EWGSOP2 cut-off points. Reduced muscle strength was strongly associated to fibromyalgia-severity (β=-0.953 [-0.069, -0.038]). Studies were rated as high-risk of bias overall because did not account for some potential confounders (physical activity, sedentary time, Body Mass Index) which could influence the estimated effect.

CONCLUSIONS

Europeans with fibromyalgia have a large reduction in muscle strength and may have a reduction in muscle quantity. The risk of probable sarcopenia according to the EWGSOP2 cut-off points was nine-times higher, but may have no difference in risk of reduced muscle quantity relative to healthy-controls. Muscle strength was strongly associated to disease severity.

Associations of upper- and lower-limb muscle strength, mass, and quality with health-related quality of life in community-dwelling older adults

AIM

This study aimed to investigate the associations between upper- and lower-limb muscle strength, mass, and quality and health-related quality of life (HRQoL) among community-dwelling older adults.

METHODS

A cross-sectional study was conducted with 428 Brazilian community-dwelling older adults aged 60 to 80 years. Upper- and lower-limb muscle strength were evaluated through the handgrip strength (HGS) test and the 30-s chair stand test, respectively. Muscle mass was assessed by dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA). Muscle quality was evaluated using the muscle quality index (MQI). HRQoL was assessed using the World Health Organization Quality of Life Brief Version questionnaire.

RESULTS

Lower-limb, but not upper-limb, muscle strength and quality were independently associated with HRQoL, particularly within the domains of physical capacity, environment, and overall HRQoL for both males and females (P < 0.05). DXA- and BIA-derived analyses provided similar results in relation to muscle mass and muscle quality.

CONCLUSIONS

Lower-limb, but not upper-limb, muscle strength and quality were independently associated with HRQoL among community-dwelling older adults. Moreover, the results obtained from both BIA and DXA were similar, highlighting that BIA can serve as a viable surrogate method for estimating body composition in resource-limited clinical settings. Geriatr Gerontol Int 2024; 24: 683-692.

The association between HIV infection, disability and lifestyle activity among middle-aged and older adults: an analytical cross-sectional study in Ivory Coast (the VIRAGE study)

INTRODUCTION

People living with HIV (PLWH) live longer and face new health challenges resulting from the confluence of chronic HIV infection and the natural effect of aging and comorbidities. However, there is a dearth of information on the long-term impact of HIV infection on the health and wellbeing of PLWH in sub-Saharan Africa. This research aimed to fill this gap by reporting on physical, functional and social outcomes among PLWH treated at a referral center in Abidjan, Ivory Coast, and comparing them with those of a control group.

METHODS

Body composition, functional capacity, sarcopenia, limitations in daily activities and social participation were assessed among 300 PLWH (aged ≥ 30 years) and 200 uninfected adults of similar age and sex. The associations between these outcomes and participants' socioeconomic characteristics, HIV history and physical activity level were assessed using generalized additive models adjusted for age and sex.

RESULTS

The median age was 51 years, and the median antiretroviral therapy duration was 15 years. Compared to controls, PLWH reported higher levels of physical activity (p < 0.0001). They had a lower muscle index (adjusted p < 0.0001) and grip strength (adjusted p < 0.0001) but achieved similar performance on the 6-min walk test (6MWT, p = 0.2). Among PLWH, physical activity level was positively associated with better performance in the 6MWT (p = 0.006) and greater hand grip strength (p = 0.04). The difference in physical performance according to the level of physical activity appeared mainly after the age of 60. PLWH reported similar rates of activity limitations (p = 0.8), lower depression levels and greater scores for social functioning (p = 0.02).

CONCLUSION

In this study, PLWH achieved high levels of physical activity, which may explain why they maintained good physical performance and social functioning despite having a higher risk of sarcopenia. These results have important implications for resource-limited health systems and show avenues for chronic care models.

TRIAL REGISTRATION

This study was registered on the ClinicalTrials.gov website (NCT05199831, first registration the 20/01/2022).

Quadriceps femoris muscle ultrasound in sarcoidosis: an observational case-control study

BACKGROUND

Although loss of muscle mass may be associated with general weakness, intolerance to physical activity and fatigue, it is underestimated and poorly understood in patients with sarcoidosis.

AIM

To compare the quadriceps femoris muscle (QFM) thickness measured by ultrasonography (US) between the female patients with sarcoidosis and controls, secondly to assess the correlation between the muscle strength, fatigue and QFM thickness.

DESIGN

Observational, case-control study.

SETTING

Physical Medicine and Rehabilitation Department of a University Hospital.

POPULATION

Thirty-one women with sarcoidosis and 27 healthy volunteers were included in the study.

METHODS

The participants were evaluated for the following outcomes: 1) handgrip strength; 2) QFM thickness measured using US; and 3) sonographic thigh adjustment ratio (STAR). The sarcoidosis group was also evaluated with the 30-second chair stand test (30s-CST) and Fatigue Severity Scale (FSS).

RESULTS

The QFM thickness and STAR values of the patients with sarcoidosis were significantly lower than those of the controls (P=0.0001). However, no statistically significant difference was observed between the handgrip strengths of the groups (P=0.581). There was no statistically significant correlation between the STAR values and handgrip strength in the sarcoidosis group; however, there was a significant positive correlation between the STAR values and 30s-CST (r=0.467, P=0.008).

CONCLUSIONS

Loss of muscle mass is one of the musculoskeletal conditions in patients with sarcoidosis that may be associated with nonspecific symptoms, such as general debility, intolerance to physical activity, and fatigue. In the present study, no difference was observed in hand grip strength between the groups, while we found that QFM thickness was affected in patients with sarcoidosis when compared to the controls. The ultrasonographic QFM evaluation seems to be an innovative tool which may be used at all stages of sarcoidosis patient follow-up.

CLINICAL REHABILITATION IMPACT

The grip strength is a commonly used test to detect muscle weakness, but onset of a decrease in muscle mass in the lower extremities may occur earlier. Considering the increased burden of musculoskeletal problems in this population, performing 30s-CST and sonographic QFM thickness is practical methods to identify risky patients.

Sarcopenia prevalence using handgrip strength or chair stand performance in adults living with type 2 diabetes mellitus

BACKGROUND

The updated European Working Group on Sarcopenia in Older People (EWGSOP2) recommends handgrip strength (HGS) and the chair stand test (CST) to assess muscle strength, with the CST being a convenient proxy for lower limb strength. However, adiposity may differentially influence these strength criteria and produce discrepant sarcopenia prevalence.

OBJECTIVE

To determine the prevalence of sarcopenia using HGS or the CST, and to investigate the associations between these strength criteria and adiposity in adults with type 2 diabetes mellitus.

METHODS

The EWGSOP2 definition was used to assess the prevalence of probable (low muscle strength), confirmed (plus low muscle mass) and severe (plus poor physical performance) sarcopenia. Linear regression models were used to study the association between different measures of muscle strength and adiposity.

RESULTS

We used data from 732 adults with type 2 diabetes mellitus (35.7% female, aged 64 ± 8 years, body mass index 30.7 ± 5.0 kg/m2). Using the CST compared with HGS produced a higher prevalence of probable (31.7% vs. 7.1%), confirmed (5.6% vs. 1.6%) and severe (1.0% vs. 0.3%) sarcopenia, with poor agreement between strength criteria to identify probable sarcopenia. CST performance, but not HGS, was significantly associated with all measures of adiposity in unadjusted and adjusted models.

CONCLUSIONS

Higher levels of adiposity may impact CST performance, but not HGS, resulting in a higher prevalence of sarcopenia in adults with type 2 diabetes mellitus. Consideration should be paid to the most appropriate measure of muscle function in this population.

Can motor decline be a modifiable marker of clinical progression in subjective cognitive decline? A national prospective cohort study

OBJECTIVES

Subjective cognitive decline represents a critical stage for preventing mild cognitive impairment and dementia, but the links between clinical progression in the subjective cognitive decline stage and various motor functions remain inconclusive. This cohort study aimed to elucidate the independent and joint associations between the clinical progression of subjective cognitive decline and motor functions.

METHODS

We enrolled 4880 community-dwelling elderly participants from a national cohort and used Cox proportional hazard regression model and restricted cubic spline models to explore the longitudinal associations between motor functions (gait, strength, balance, and endurance) and the clinical progression of subjective cognitive decline.

RESULTS

During 5-years follow-up, 1239 participants experienced clinical progression. After adjusting for demographics, vascular burden, body components, and polypharmacy, gait speed [hazard ratios (HRs)= 0.96, 95% confidence interval (CI) 0.94-0.99], chair stand test (HRs=1.02, 95%CI 1.01-1.03), and endurance limitation in jogging 1 kilometer (HRs=1.18, 95%CI 1.04-1.34) were significantly associated with clinical progression. Among all participants, individuals characterized by poor upper- and lower-body strength, as well as those with slow pace and reduced endurance, faced the highest risk of cognitive impairment.

CONCLUSIONS

This study emphasizes the potential of gait speed, muscle strength, and endurance as non-cognitive indicators of clinical progression in subjective cognitive decline. Understanding their combined effectiveness may reveal primary physiological mechanisms contributing to the dual decline of motor and cognition.

Association between nocturnal sleep duration and midday napping and the incidence of sarcopenia in middle-aged and older adults: a 4-year longitudinal study

BACKGROUND

Identifying treatment targets for sarcopenia is a public health concern. This study aimed to examine the association of nocturnal sleep duration and midday napping with the presence of sarcopenia in middle-aged and older adults, utilizing data from the China Health and Retirement Longitudinal Study in 2011 and 2015.

METHODS

A sum of 7,926 individuals (≥40 years) took part in this study. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia. A self-reported questionnaire was used to collect data on nocturnal sleep duration and midday napping. Nocturnal sleep duration was categorized into three groups: short sleepers (<6 h), normal sleepers (6-8 h), and long sleepers (>8 h). Midday napping was coded as a dichotomous outcome (yes/no).

RESULTS

The incidence of sarcopenia was 5.3% during the 4-year follow-up. Short sleep duration (<6 h) was substantially linked to an increased incidence of sarcopenia (OR: 1.50, 95% CI: 1.21-1.87) as compared to nocturnal sleep length (6-8 h). Adults with midday napping had a lower risk of developing sarcopenia than non-nappers (OR: 0.78, 95% CI: 0.63-0.95). We further found that short sleepers with midday napping did not have a significantly higher risk of subsequent diagnosis of sarcopenia compared to normal sleepers without midday napping.

CONCLUSION

These findings imply that short sleep duration in middle-aged and older persons is related to an increased incidence of sarcopenia. However, the adverse effect of short sleep duration on sarcopenia can be compensated by midday napping.

Sit-to-Stand Video Analysis-Based App for Diagnosing Sarcopenia and Its Relationship With Health-Related Risk Factors and Frailty in Community-Dwelling Older Adults: Diagnostic Accuracy Study

BACKGROUND

Probable sarcopenia is determined by a reduction in muscle strength assessed with the handgrip strength test or 5 times sit-to-stand test, and it is confirmed with a reduction in muscle quantity determined by dual-energy X-ray absorptiometry or bioelectrical impedance analysis. However, these parameters are not implemented in clinical practice mainly due to a lack of equipment and time constraints. Nowadays, the technical innovations incorporated in most smartphone devices, such as high-speed video cameras, provide the opportunity to develop specific smartphone apps for measuring kinematic parameters related with sarcopenia during a simple sit-to-stand transition.

OBJECTIVE

We aimed to create and validate a sit-to-stand video analysis-based app for diagnosing sarcopenia in community-dwelling older adults and to analyze its construct validity with health-related risk factors and frailty.

METHODS

A total of 686 community-dwelling older adults (median age: 72 years; 59.2% [406/686] female) were recruited from elderly social centers. The index test was a sit-to-stand video analysis-based app using muscle power and calf circumference as proxies of muscle strength and muscle quantity, respectively. The reference standard was obtained by different combinations of muscle strength (handgrip strength or 5 times sit-to-stand test result) and muscle quantity (appendicular skeletal mass or skeletal muscle index) as recommended by the European Working Group on Sarcopenia in Older People-2 (EWGSOP2). Sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) of the receiver operating characteristic curve were calculated to determine the diagnostic accuracy of the app. Construct validity was evaluated using logistic regression to identify the risks associated with health-related outcomes and frailty (Fried phenotype) among those individuals who were classified as having sarcopenia by the index test.

RESULTS

Sarcopenia prevalence varied from 2% to 11% according to the different combinations proposed by the EWGSOP2 guideline. Sensitivity, specificity, and AUC were 70%-83.3%, 77%-94.9%, and 80.5%-87.1%, respectively, depending on the diagnostic criteria used. Likewise, positive and negative predictive values were 10.6%-43.6% and 92.2%-99.4%, respectively. These results proved that the app was reliable to rule out the disease. Moreover, those individuals who were diagnosed with sarcopenia according to the index test showed more odds of having health-related adverse outcomes and frailty compared to their respective counterparts, regardless of the definition proposed by the EWGSOP2.

CONCLUSIONS

The app showed good diagnostic performance for detecting sarcopenia in well-functioning Spanish community-dwelling older adults. Individuals with sarcopenia diagnosed by the app showed more odds of having health-related risk factors and frailty compared to their respective counterparts. These results highlight the potential use of this app in clinical settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05148351; https://clinicaltrials.gov/study/NCT05148351.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.3390/s22166010.

Muscular strength, mobility in daily life and mental wellbeing among older adult Inuit in Greenland. The Greenland population health survey 2018

The purpose was to analyse the association of muscular strength, muscle pain and reduced mobility in daily life with mental wellbeing among older Inuit men and women in Greenland. Data (N = 846) was collected as part of a countrywide cross-sectional health survey in 2018. Hand grip strength and 30-seconds chair stand test were measured according to established protocols. Mobility in daily life was assessed by five questions about the ability to perform specific activities of daily living. Mental wellbeing was assessed by questions about self-rated health, life satisfaction and Goldberg's General Health Questionnaire. In binary multivariate logistic regression models adjusted for age and social position, muscular strength (OR 0.87-0.94) and muscle pain (OR 1.53-1.79) were associated with reduced mobility. In fully adjusted models, muscle pain (OR 0.68-0.83) and reduced mobility (OR 0.51-0.55) but were associated with mental wellbeing. Chair stand score was associated with life satisfaction (OR 1.05). With an increasingly sedentary lifestyle, increasing prevalence of obesity and increasing life expectancy the health consequences of musculoskeletal dysfunction are expected to grow. Prevention and clinical handling of poor mental health among older adults need to consider reduced muscle strength, muscle pain and reduced mobility as important determinants.

Comparing associations of handgrip strength and chair stand performance with all-cause mortality-implications for defining probable sarcopenia: the Tromsø Study 2015-2020

BACKGROUND

Widely adopted criteria suggest using either low handgrip strength or poor chair stand performance to identify probable sarcopenia. However, there are limited direct comparisons of these measures in relation to important clinical endpoints. We aimed to compare associations between these two measures of probable sarcopenia and all-cause mortality.

METHODS

Analyses included 7838 community-dwelling participants (55% women) aged 40-84 years from the seventh survey of the Tromsø Study (2015-2016), with handgrip strength assessed using a Jamar + Digital Dynamometer and a five-repetition chair stand test (5-CST) also undertaken. We generated sex-specific T-scores and categorised these as "not low", "low", and "very low" handgrip strength or 5-CST performance. Cox Proportional Hazard regression models were used to investigate associations between these two categorised performance scores and time to death (up to November 2020 ascertained from the Norwegian Cause of Death registry), adjusted for potential confounders including lifestyle factors and specific diseases.

RESULTS

A total of 233 deaths occurred (median follow-up 4.7 years) with 1- and 5-year mortality rates at 3.1 (95% confidence interval [CI] 2.1, 4.6) and 6.3 (95% CI 5.5, 7.2) per 1000 person-years, respectively. There was poor agreement between the handgrip strength and 5-CST categories for men (Cohen's kappa [κ] = 0.19) or women (κ = 0.20). Fully adjusted models including handgrip strength and 5-CST performance mutually adjusted for each other, showed higher mortality rates among participants with low (hazard ratio [HR] 1.22, 95% CI 0.87, 1.71) and very low (HR 1.68, 95% CI 1.02, 2.75) handgrip strength compared with the not low category. Similar associations, although stronger, were seen for low (HR 1.88, 95% CI 1.38, 2.56) and very low (HR 2.64, 95% CI 1.73, 4.03) 5-CST performance compared with the not low category.

CONCLUSIONS

We found poor agreement between T-score categories for handgrip strength and 5-CST performance and independent associations with mortality. Our findings suggest that these tests identify different people at risk when case-finding probable sarcopenia. As discussions on an international consensus for sarcopenia definitions proceed, testing both handgrip strength and chair stand performance should be recommended rather than viewing these as interchangeable assessments.

Are sit-to-stand and isometric handgrip tests comparable assessment tools to identify dynapenia in sarcopenic people?

Sarcopenia is a neuromuscular disease characterized by the simultaneous existence of reduced muscle strength and muscle atrophy. The current recommendations for the diagnosis of sarcopenia suggest dynapenia be operationalized using either isometric handgrip strength (IHG) or sit-to-stand (STS) tests. However, specific associations between each of these assessment tools and sarcopenia-related parameters have been observed. In addition, important neuromuscular and biomechanical aspects differ between IHG and STS. This scenario has important clinical implications and calls for detailed studies to refine the current recommendations for sarcopenia identification. The present communication presents evidence to foster a constructive debate on the matter.

Independent and joint associations of cardiorespiratory fitness and lower-limb muscle strength with cardiometabolic risk in older adults

The aim of this study was to investigate the independent and joint associations of low cardiorespiratory fitness and lower-limb muscle strength with cardiometabolic risk in older adults. A total of 360 community-dwelling older adults aged 60-80 years participated in this cross-sectional study. Cardiometabolic risk was based on the diagnosis of Metabolic Syndrome and poor Ideal Cardiovascular Health according to the American Heart Association guidelines. Cardiorespiratory fitness and lower-limb muscle strength were estimated using the six-minute walk and the 30-second chair stand tests, respectively. Participants in the 20th percentile were defined as having low cardiorespiratory fitness and lower-limb muscle strength. Poisson's regression was used to determine the prevalence ratio (PR) and 95% confidence intervals (CI) of Metabolic Syndrome and poor Ideal Cardiovascular Health. Participants with low cardiorespiratory fitness alone and combined with low lower-limb muscle strength were similarly associated with a higher risk for Metabolic Syndrome (PR 1.27, 95% CI 1.09-1.48, and PR 1.32, 95% CI 1.10-1.58, respectively), and poor Ideal Cardiovascular Health (PR 1.76, 95% CI 1.25-2.47, and PR 1.65, 95% CI 1.19-2.28, respectively). Low lower-limb muscle strength alone was not associated with a higher risk for either Metabolic Syndrome or poor Ideal Cardiovascular Health (PR 1.23, 95% CI 0.81-1.87, and PR 1.11, 95% CI 0.89-1.37, respectively). Low cardiorespiratory fitness alone or combined with low lower-limb muscle strength, but not low lower-limb muscle strength alone, was associated with a higher cardiometabolic risk in older adults. The assessment of physical fitness may be a "window of opportunity" to identify youngest-old adults with a high cardiovascular disease risk.

Acute Changes in Body Muscle Mass and Fat Depletion in Hospitalized Young Trauma Patients: A Descriptive Retrospective Study

Background: Loss of muscle mass, and its strength, is associated with adverse outcomes in many medical and surgical conditions. Trauma patients may get malnourished during their hospital course due to many interrelated contributing factors. However, there is insufficient knowledge on the acute muscle and fat changes in young trauma patients in the early days post-admission. Objective: to explore the diagnosis, feeding status, and outcome of muscle mass loss among young abdominal polytrauma patients. Methods: It was a retrospective study including hospitalized abdominal trauma patients who underwent an abdominal computerized tomographic (CT) examination initially and a follow-up one week later. CT scan-based automatic and manual analysis of the muscles and fat of the abdominal region was calculated and compared. Also, we evaluated the feeding and nutritional values to explore the adequacy of the provided calories and proteins and the potential influence of enteral feeding on the CT-based parameters for muscle loss and fat depletion. Results: There were 138 eligible subjects with a mean age of 32.8 ± 13.5 years; of them, 92% were males. Operative interventions were performed on two-thirds of the patients, including abdominal surgery (43%), orthopedic surgeries (34%), and neurosurgical procedures (8.1%). On admission, 56% received oral feeding, and this rate slightly increased to 58.4% after the first week. Enteral feed was prescribed for the remaining, except for two patients. The percentage of change in the total psoas muscle area was significantly reduced after one week of admission in patients on enteral feed as compared to those in the oral feeding group (p = 0.001). There were no statistically significant differences in the percentages of changes in the CT scan findings except for the total psoas muscle area (p = 0.001) and para-spinal muscle area (p = 0.02), which reduced significantly in the those who underwent laparotomy as compared to those who did not need laparotomy. Trauma patients who underwent emergency abdominal surgery lost muscle and fat over time. Conclusions: Loss of muscle mass and body fat is not uncommon among young trauma patients. Patients who underwent laparotomy are more likely to be affected. Further larger studies are needed to assess the specific features in the younger trauma population and how far this can be influenced by the nutrition status and its impact on the clinical outcomes. It could be early or impending stages of sarcopenia linked to trauma patients, or just acute changes in the muscle and fat, that need further investigation and follow-up after hospital discharge.

Differential Associations Between Two Markers of Probable Sarcopenia and Continuous Orthostatic Hemodynamics in The Irish Longitudinal Study on Ageing

BACKGROUND

Sarcopenia and orthostatic hypotension are growing age-related health burdens associated with adverse outcomes, including falls. Despite a possible pathophysiological link, the association between the 2 disorders is not well elucidated. We sought to investigate this relationship in The Irish Longitudinal Study on Ageing (TILDA).

METHODS

Data from 2 858 participants at wave 3 of TILDA were analyzed. Probable sarcopenia was defined as per the European Working Group on Sarcopenia in Older People revised definition cutoffs (hand grip strength [HGS] <27 kg in men, <16 kg in women, and/or 5-chair stand test [5CST] time >15 seconds). Participants underwent an active stand orthostatic test with continuous blood pressure (BP) monitoring. Multilevel mixed-effects models, controlling for possible confounders, were used to assess the effect of probable sarcopenia by HGS and 5CST criteria on the change in BP after standing.

RESULTS

HGS- and 5CST-defined probable sarcopenia were independently associated with an attenuated BP recovery at 10-20 seconds poststand (systolic BP: β -0.54, p < .001; β -0.25, p < .001). On average, those meeting HGS probable sarcopenia criteria had a significantly lower BP at 20, 30, and 40 seconds (differences in systolic BP: -5.01 mmHg, -3.68 mmHg, -2.32 mmHg, p < .05 for all). Those meeting 5CST probable sarcopenia criteria had a significant difference in systolic BP at 20 seconds (-1.94 mmHg, p = .002) but not at 30 or 40 seconds.

CONCLUSION

Probable sarcopenia had a significant association with delayed orthostatic BP recovery, with HGS-defined probable sarcopenia having a stronger association than 5CST-defined probable sarcopenia. Results support a modest but significant pathophysiological link between probable sarcopenia and orthostatic hypotension.

Prevalence and determinants of sarcopenia in community-dwelling older adults in Ireland

BACKGROUND

Data on the prevalence of sarcopenia among older adults in Ireland are lacking.

AIMS

To assess the prevalence and determinants of sarcopenia among community-dwelling older adults in Ireland.

METHODS

This cross-sectional analysis involved n = 308 community-dwelling adults aged ≥ 65 y living in Ireland. Participants were recruited via recreational clubs and primary healthcare services. Sarcopenia was defined according to the 2019 European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. Skeletal muscle mass was estimated using bioelectrical impedance analysis, strength was measured via handgrip dynamometry, and physical performance was assessed using the Short Physical Performance Battery. Detailed information was collected on demographics, health, and lifestyle. Dietary macronutrient intake was measured via a single 24 h recall. Binary logistic regression was used to examine potential demographic, health, lifestyle, and dietary determinants of sarcopenia (where both probable and confirmed sarcopenia were combined).

RESULTS

The prevalence of EWGSOP2-defined probable sarcopenia was 20.8% and confirmed sarcopenia was 8.1% (5.8% had severe sarcopenia). Polypharmacy (OR 2.60, 95% confidence interval [CI] 1.3, 5.23), height (OR 0.95, 95% CI 0.91, 0.98), and Instrumental Activities Of Daily Living (IADL) score (OR 0.71, 95% CI 0.59, 0.86) were independently associated with sarcopenia (probable and confirmed combined). There were no independent associations between energy-adjusted macronutrient intakes, as determined by 24 h recall, and sarcopenia.

CONCLUSION

Sarcopenia prevalence within this sample of community-dwelling older adults in Ireland is broadly similar to other European cohorts. Polypharmacy, lower height, and lower IADL score were independently associated with EWGSOP2-defined sarcopenia.

Anthropometric and Body Circumference Determinants for Hand Grip Strength: A Population-Based Mon-Timeline Study

Background

Hand grip strength (HGS) is a tool for diagnosing sarcopenia. In this study, we examined some anthropometric and body circumference measurements as determinants for HGS.

Methods

This cross-sectional study was conducted with participants (Mongolians, n = 1080, aged 18-70, mean age of 41.2 ± 13.9 years, 33.7% of men) from the "Mon-Timeline" cohort study. To measure HGS, a digital grip strength dynamometer was used.

Results

Mean HGS in men was 40.1 ± 10.4 kg and in women was 24.5 ± 5.6 kg. Correlation analysis showed that the strongest correlation with HGS was height (r = 0.712, p < 0.001). Moreover, HGS was inversely correlated with age (r = -0.239, p < 0.001) and thigh circumference (r = -0.070, p < 0.01), while it was positively correlated with body weight (r = 0.309, p < 0.001), neck circumference (r = 0.427, p < 0.001), upper arm circumference (r = 0.108, p < 0.0001), lower arm circumference (r = 0.413, p < 0.0001), and calf circumference (r = 0.117, p < 0.0001). In the multivariate linear regression analysis (unstandardized B coefficient, 95% CI), age (-0.159, -0.188; -0.129), sex (-9.262, -10.459; -8.064), height (0.417, 0.357; 0.478), lower arm circumference (1.003, 0.736; 1.270), and calf circumference (-0.162, -0.309; -0.015) were significantly associated with HGS.

Conclusions

When detecting sarcopenia using HGS, it is important to take into account variables such as body height and body circumference.

Muscle Quality in Older Adults: A Scoping Review

OBJECTIVE

This scoping review aimed to map out currently available definitions and assessment methods of muscle quality in older adults.

DESIGN

Scoping review.

SETTING AND PARTICIPANTS

All available studies.

METHODS

Four databases (PubMed, EMBASE, Web of Science, and Cochrane Library) were searched from inception to May 2022. Title, abstract, and full-text screening were undertaken by 2 reviewers independently. Observational and experimental studies were eligible for inclusion if there was a clear description of muscle quality assessment in individuals aged 60+ years.

RESULTS

A total of 96 articles were included. Several definitions and assessment methods of muscle quality were identified and divided into 2 main domains: (1) functional domain, and (2) morphological domain. A total of 70% and 30% of the included studies assessed muscle quality in the functional and morphological domains, respectively. In the functional domain, most studies defined muscle quality as the ratio of knee extension strength by leg lean mass (45.9%). In the morphological domain, most studies defined muscle quality as the echo intensity of quadriceps femoris by ultrasound (50.0%).

CONCLUSIONS AND IMPLICATIONS

There is a substantial heterogeneity of definitions and assessment methods of muscle quality in older adults. Herein, we propose a standardized definition of muscle quality to include terminology, domain, and assessment methods (tests, tools, and body sites). Such standardization may help researchers, clinicians, and decision makers use muscle quality as a potential marker of "skeletal muscle health" in older adults.

Associations between Body Mass Index and Probable Sarcopenia in Community-Dwelling Older Adults

(1) Background/Objectives: The relationship between body mass index (BMI) and probable sarcopenia, a precursor to sarcopenia diagnosis, is unclear. While low BMI has been associated with sarcopenia risk, some evidence suggests that obesity may confer protection. We aimed to investigate the association between probable sarcopenia and BMI and, furthermore, to explore associations with waist circumference (WC). (2) Methods: This cross-sectional study included 5783 community-dwelling adults (mean age 70.4 ± 7.5 years) from Wave 6 of the English Longitudinal Study of Ageing (ELSA). Probable sarcopenia was defined using the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria for low hand grip strength and/or slow chair rise. Associations between BMI and probable sarcopenia were examined using multivariable regression analysis and were similarly performed for WC. (3) Results: Our overall findings show that an underweight BMI was significantly associated with an increased likelihood of probable sarcopenia [OR (CI) 2.25 (1.17, 4.33), p = 0.015]. For higher BMI categories, the findings were conflicting. Overweight and obesity were associated with an increased likelihood of probable sarcopenia when defined by lower limb strength alone, [OR (CI), 2.32 (1.15, 4.70), p = 0.019; 1.23 (1.02, 1.49), p = 0.35, and 1.49 (1.21, 1.83), p < 0.001, respectively]. In contrast, overweight and obesity appeared protective when probable sarcopenia was assessed by low hand grip strength alone [OR (CI) 0.72 (0.60, 0.88), p = 0.001, and 0.64 (0.52, 0.79), p < 0.001, respectively]. WC was not significantly associated with probable sarcopenia on multivariable regression analysis. (4) Conclusion: This study supports the evidence that low BMI is associated with an increased likelihood of probable sarcopenia, highlighting an important at-risk group. The findings for overweight and obesity were inconsistent and may be measurement dependent. It seems prudent that all older adults at risk of probable sarcopenia, including those with overweight/obesity, are assessed to prevent underdetection of probable sarcopenia alone or with the double burden of obesity.

Consequences of applying the different criteria of the EWGSOP2 guideline for sarcopenia case-finding in Spanish community-dwelling older adults

INTRODUCTION

Sarcopenia prevalence varies according to differences in diagnostic criteria used. In order to overcome this issue, the European Working Group on Sarcopenia in Older People-2 (EWGSOP2) published a consensus to increase harmonization for sarcopenia diagnosis. This study aimed to determine the prevalence and risk factors across the different sarcopenia diagnosis criteria recommended by EWGSOP2 and to analyze its agreement.

METHODS

A total of 699 community-dwelling older adults (median-age: 72, 60% female) were recruited in this cross-sectional study. Sarcopenia prevalence was obtained by different combinations of muscle strength (handgrip strength or 5-times sit-to-stand) and muscle quantity (appendicular skeletal mass or skeletal muscle index) as recommended by the EWGSOP2. Cohen's Kappa coefficient was calculated to analyze agreement among the four sarcopenia diagnostic criteria and logistic regressions were performed to identify risks associated to health-related outcomes for each diagnostic criterion.

RESULTS

Sarcopenia prevalence varied from 2.1% to 11.6%, depending on the diagnostic criteria used. Weak-to-moderate agreements (κ-range: 0.13-0.66) were observed among the four sarcopenia diagnosis criteria. There was scarce overlap in sarcopenic people when different diagnostic criteria were used leading to up to 10.4% of underdiagnosis. Sarcopenia defined by 5-times sit-to-stand was more associated with health-related outcomes compared to handgrip strength.

CONCLUSIONS

Sarcopenia prevalence rates vary considerably depending on the diagnostic criteria used. These criteria should not be used in an interchangeable way due to their weak agreement. Sarcopenia diagnosis criteria defined by 5-times sit-to-stand could be more suitable in Spanish community-dwelling older adults due their associations with health-related outcomes.

Relationship between physical activity and depressive symptoms in older Korean adults: moderation analysis of muscular strength

BACKGROUND

This population-based cross-sectional study examined the associations between physical activity (PA) and lower body muscle strength (LBMS) with late-life depression in a representative sample of older Korean adults aged 65 years and older.

METHODS

The data used in the current study (n = 10,097/60% women) were extracted from the 2020 Korea Longitudinal Study on Aging, which is a nationwide population-based survey conducted in Korea. Depressive symptoms were assessed with the Geriatric Depression Scale Short-Form. PA and LBMS were evaluated with a self-reported questionnaire and the 5 times sit-to-stand test, respectively. Covariates include age, gender, body mass index, education level, smoking status, alcohol intake, and comorbidity.

RESULTS

Insufficient PA had higher odds of depression (odds ratio [OR] = 1.201, 95% confidence interval [CI] = 1.035-1.393, p = 0.016), even after adjustments for all covariates, compared to sufficient PA. Poor LBMS had higher odds of depression (OR = 2.173, 95% CI = 1.821-2.593, p < 0.001), even after adjustments for all covariates, compared to good LBMS. Particularly, a significant moderation effect of LBMS on the relationship between PA and depressive symptoms was observed (β = 0.3514 and 95% CI = 0.1294 ~ 0.5733, p < 0.001). Individuals with poor LBMS had a greater odd of depression associated with physical inactivity compared to their counterparts with good LBMS.

CONCLUSIONS

The results of this study support the importance of promoting muscular strength through regular exercise as a preventive strategy against late-life depression in Korean adults.

Handgrip strength rather than chair stand test should be used to diagnose sarcopenia in geriatric rehabilitation inpatients: REStORing health of acutely unwell adulTs (RESORT)

BACKGROUND

according to the revised sarcopenia definition proposed by the European Working Group on Sarcopenia in Older People (EWGSOP2) and revised definition of the Asian Working Group for Sarcopenia (AWGS2019), handgrip strength (HGS) and chair stand test (CST) can be used interchangeably as initial diagnostic measures.

OBJECTIVE

to assess the agreement between sarcopenia prevalence, using either HGS or CST, and their association with adverse outcomes in geriatric rehabilitation inpatients.

METHODS

REStORing health of acutely unwell adulTs is an observational, longitudinal cohort of geriatric rehabilitation inpatients. Cohen's kappa (κ) was used to assess the agreement between sarcopenia prevalence (no, probable and confirmed and severe sarcopenia) according to EWGSOP2 and AWGS2019 using either HGS or CST. Associations between HGS and CST and readmission, institutionalisation and mortality were assessed by binomial regression.

RESULTS

patients (n = 1,250, 57% females) had a median age of 83.1 years (interquartile range: [77.5-88.3]). There was no agreement between probable sarcopenia prevalence using HGS or CST for EWGSOP2 and AWGS2019, respectively (HGS: 70.9% and 76.2%; CST: 95.5% and 98.4%; κ = 0.08 and 0.02). Agreement between confirmed and severe sarcopenia prevalence using either HGS or CST was strong to almost perfect. HGS was associated with 3-month institutionalisation and 3-month and 1-year mortality, whereas CST was not associated.

CONCLUSIONS

HGS and CST cannot be used interchangeably as diagnostic measures for probable sarcopenia in geriatric rehabilitation inpatients. CST is not useful to predict adverse outcomes in geriatric rehabilitation inpatients.

Macular Layer Thickness and Effect of BMI, Body Fat, and Traditional Cardiovascular Risk Factors: The Tromsø Study

Purpose

The purpose of this study was to investigate associations between cardiovascular risk factors and the thickness of retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GCIPL), and outer retina layers (ORL).

Methods

In this population-based study, we included participants from the Tromsø Study: Tromsø6 (2007 to 2008) and Tromsø7 (2015 to 2016). Persons with diabetes and/or diagnosed glaucoma were excluded from this study. Retinal thickness was measured on optical coherence tomography (Cirrus HD-OCT) macula-scans, segmented on RNFL, GCIPL, and ORL and associations were analyzed cross-sectionally (N = 8288) and longitudinally (N = 2595). We used directed acyclic graphs (DAGs) for model selection, and linear regression to adjust for confounders and mediators in models assessing direct effects. Factors examined were age, sex, blood pressure, daily smoking, serum lipids, glycated hemoglobin, body mass index (BMI), total body fat percentage (BFP), and the adjustment variables refraction and height.

Results

The explained variance of cardiovascular risk factors was highest in GCIPL (0.126). GCIPL had a strong negative association with age. Women had thicker GCIPL than men at higher age and thinner ORL at all ages (P < 0.001). Systolic blood pressure was negatively associated with RNFL/GCIPL (P = 0.001/0.004), with indication of a U-shaped relationship with GCIPL in women. The negative association with BMI was strongest in men, with significant effect for RNFL/GCIPL/ORL (P = 0.001/<0.001/0.019) and in women for GCIPL/ORL (P = 0.030/0.037). BFP was negatively associated with GCIPL (P = 0.01). Higher baseline BMI was associated with a reduction in GCIPL over 8 years (P = 0.03).

Conclusions

Cardiovascular risk factors explained 12.6% of the variance in GCIPL, with weight and blood pressure the most important modifiable factors.

Exploring the association between handgrip, lower limb muscle strength, and physical function in older adults: A narrative review

Widely used in daily practice, handgrip strength (HGS) is a low cost, easy-to-use, and portable test to assess overall muscle and physical function. It can be used as a stand-alone or a first-line tool for evaluating muscle weakness, though controversy surrounds its use for assessing global or lower limb muscle function. Lower limb mobility and physical activity are reduced with advancing age. This decline is difficult to quantify with isokinetic or isometric devices in routine settings (hospital and nursing home). For this narrative review we explored and summarized the findings of studies that investigated the association between HGS, lower limb muscle strength, and physical performance in older adults. The review also provides directions for future research. We noted contrasting findings for an association between HGS, lower limb strength, and physical performance. We found insufficient evidence for endorsing the handgrip dynamometer as a definitive tool for measuring overall muscle strength and physical function. More evidence is needed from comparable studies involving larger samples of men and women and investigating other areas such as lifestyle, daily physical activity levels, and health-related disorders.

The Relationship between Late-Life Depression and Cognitive Function in Older Korean Adults: A Moderation Analysis of Physical Activity Combined with Lower-Body Muscle Strength

Background: This study examined the relationship of physical activity (PA) combined with lower-body muscle strength to late-life depression and cognitive impairment in 10,097 participants (6062 females) ≥ 65 years of age. Methods: Exposures were PA, sit-to-stand test (STST), and depressive symptoms. Outcome was cognitive performance. Results: Depressed individuals had an increased risk of mild cognitive impairment (MCI; odds ratio (OR), adjusted OR = 1.845 and 95% confidence interval (CI) = 1.580−2.154, p < 0.001) compared with non-depressed individuals. Individuals who had insufficient PA and a poor STST and either insufficient PA or a poor STST had an increased risk of MCI (adjusted OR = 1.329 and 95% CI = 1.209−1.46, p < 0.001 and adjusted OR = 2.822 and 95% CI = 2.488−3.200, p < 0001, respectively) compared with individuals who had sufficient PA and a good STST. A significant moderation effect of PA combined with lower-body muscle strength on the relationship between depression and cognitive function was observed (β = −1.3923; 95% CI = −2.1505 to −0.6341, p < 0.003). Conclusions: The negative effect of late-life depression on cognitive function was incremental in the order of sufficient PA and a good STST, insufficient PA or a poor STST, and insufficient PA and a poor STST.

Acute Effects of Sedentary Behavior on Ankle Torque Assessed with a Custom-Made Electronic Dynamometer

Inactivity negatively influences general health, and sedentary behaviour is known to impact the musculoskeletal system. The aim of the study was to assess the impact of time spent in active and sedentary behaviour on foot muscle strength. In this observational study, we compared the acute effects of one day of prolonged sitting and one day of low-to-moderate level of activity on ankle torque in one group of eight healthy participants. Peak ankle torque was measured using a portable custom-made electronic dynamometer. Three consecutive maximal voluntary isometric contractions for bilateral plantar flexor and dorsiflexor muscles were captured at different moments in time. The average peak torque significant statistically decreased at 6 h (p = 0.019) in both static and active behaviours, with a higher average peak torque in the active behaviour (p < 0.001). Age, gender, body mass index and average steps did not have any significant influence on the average value of maximal voluntary isometric contraction. The more time participants maintained either static or active behaviour, the less force was observed during ankle torque testation. The static behaviour represented by the sitting position was associated with a higher reduction in the average peak ankle torque during a maximal voluntary isometric contraction when compared to the active behaviour.

Association of Physical Performance, Muscle Strength and Body Composition with Self-Assessed Quality of Life in Hemodialyzed Patients: A Cross-Sectional Study

(1) Patients on chronic hemodialysis (HD) experience impaired quality of life (QoL). We analyzed HD’s relationship with physical performance, body composition, and muscle strength; (2) QoL was assessed with the Short Form-36, composed of physical (PCS) and mental (MCS) health dimensions. Physical performance was assessed with the Short Physical Performance Battery (SPPB), body composition (lean tissue mass% (LTM%), fat tissue mass% (FTM%), and skeletal muscle mass% (SMM%)) was assessed with bioelectrical impedance, and lower extremity strength was assessed with a handheld dynamometer; and (3) we enrolled 76 patients (27 F, 49 M), age 62.26 ± 12.81 years, HD vintage 28.45 (8.65−77.49) months. Their QoL score was 53.57 (41.07−70.64); their PCS and MCS scores were 52.14 (38.69−65.95) and 63.39 (44.64−76.79) and strongly correlated (p < 0.0001, R = 0.738). QoL correlated positively with SPPB (R = 0.35, p ≤ 0.001), muscle strength (R from 0.21 to 0.41, p < 0.05), and LTM% (R = 0.38, p < 0.001) and negatively with FTM% (R = −0.32, p = 0.006). PCS correlated positively with SPPB (R = 0.42 p < 0.001), muscle strength (R 0.25−0.44, p < 0.05), and LTM% (R = 0.32, p = 0.006) and negatively with FTM% (R = −0.25, p = 0.031). MCS correlated positively with SPPB (R = 0.23, p = 0.047), SMM% (R = 0.25; p = 0.003), and LTM% (R = 0.39, p < 0.001) and negatively with FTM% (R = −0.34; p = 0.003). QoL was unrelated to sex (p = 0.213), age (p = 0.157), HD vintage (p = 0.156), and BMI (p = 0.202); (4) Better physical performance, leaner body composition, and higher muscle strength are associated with better mental and physical QoL in HD.

A Custom-Made Electronic Dynamometer for Evaluation of Peak Ankle Torque after COVID-19

The negative effects of SARS-CoV-2 infection on the musculoskeletal system include symptoms of fatigue and sarcopenia. The aim of this study is to assess the impact of COVID-19 on foot muscle strength and evaluate the reproducibility of peak ankle torque measurements in time by using a custom-made electronic dynamometer. In this observational cohort study, we compare two groups of four participants, one exposed to COVID-19 throughout measurements and one unexposed. Peak ankle torque was measured using a portable custom-made electronic dynamometer. Ankle plantar flexor and dorsiflexor muscle strength was captured for both feet at different ankle angles prior and post COVID-19. Average peak torque demonstrated no significant statistical differences between initial and final moment for both groups (p = 0.945). An increase of 4.8%, p = 0.746 was obtained in the group with COVID-19 and a decrease of 1.3%, p = 0.953 was obtained in the group without COVID-19. Multivariate analysis demonstrated no significant differences between the two groups (p = 0.797). There was a very good test−retest reproducibility between the measurements in initial and final moments (ICC = 0.78, p < 0.001). In conclusion, peak torque variability is similar in both COVID-19 and non-COVID-19 groups and the custom-made electronic dynamometer is a reproducible method for repetitive ankle peak torque measurements.

Agreement between upper and lower limb measures to identify older adults with low skeletal muscle strength, muscle mass and muscle quality

BACKGROUND

Identifying low skeletal muscle strength (SMS), skeletal muscle mass (SMM) and skeletal muscle quality (SMQ) is pivotal for diagnosing sarcopenia cases. Age-related declines in SMS, SMM, and SMQ are dissimilar between the upper (UL) and lower limbs (LL). Despite this, both UL and LL measures have been used to assess SMS, SMM and SMQ in older adults. However, it is not clear whether there is agreement between UL and LL measures to identify older adults with low SMS, SMM and SMQ.

OBJECTIVE

To investigate the agreement between UL and LL measures to identify older adults with low SMS, SMM and SMQ.

METHODS

Participants (n = 385; 66.1 ± 5.1 years; 75,4% females) performed the handgrip strength test (HGS) and the 30-s chair stand test (CST) to assess UL- and LL-SMS, respectively. The SMM was assessed by dual-energy X-ray absorptiometry (DXA). The UL-SMQ was determined as: handgrip strength (kgf) ÷ arm SMM (kg). LL-SMQ was determined as: 30-s CST performance (repetitions) ÷ leg SMM (kg). Results below the 25th percentile stratified by sex and age group (60-69 and 70-80 years) were used to determine low SMS, SMM and SMQ. Cohen's kappa coefficient (κ) was used for the agreement analyses.

RESULTS

There was a slight and non-significant agreement between UL and LL measures to identify older adults with low SMS (κ = 0.046; 95% CI 0.093-0.185; p = 0.352). There was a moderate agreement to identify low SMM (κ = 0.473; 95% CI 0.371-0.574; p = 0.001) and a fair agreement to identify low SMQ (κ = 0.206; 95% CI 0.082 to 0.330; p = 0.005).

CONCLUSION

The agreement between UL and LL measures to identify older adults with low SMS, SMM and SMQ is limited, which might generate different clinical interpretations for diagnosing sarcopenia cases.

Should knee extension strength testing be implemented as a screening test for identifying probable and confirmed sarcopenia in older T2DM patients?

Background

The accelerated loss of muscle strength and mass observed in older type 2 diabetes mellitus (T2DM) patients due to the combined effects of diabetes and obesity, greatly increases their risk for sarcopenia. Early detection and treatment of probable and confirmed sarcopenia is paramount to delay mobility disability. Using low handgrip strength cut-off points for the initial identification of sarcopenia according to the new European Working Group on Sarcopenia in Older People (EWGSOP2) guidelines may mask the presence of sarcopenia. Relative knee extension strength cut-off points using a simple hand-held dynamometer can assist clinicians in the diagnosis of probable and confirmed sarcopenia by possibly reducing false negative results.

Methods

A cohort of one hundred T2DM older patients (60% women) (mean age 74.5 years) mostly obese community dwelling older adults were evaluated for body composition by Bioelectrical impedance analysis (BIA), yielding appendicular skeletal mass index (ASMI) results. Patients underwent handgrip strength (HGS) and knee extension strength (KES) tests as well as functional ability tests. Prevalence of probable and confirmed sarcopenia using HGS and KES cut-off points were calculated. Pearson correlations were performed to evaluate the relationship between ASMI and limbs strength. A regression analysis was conducted to examine which variables best predict ASMI values. A multivariate analysis of covariance was performed to assess the effect of independent variables on KES and HGS.

Results

Using cutoff points for low KES identified 24 patients with probable sarcopenia and two with confirmed sarcopenia. Conversely, using the EWGSOP2 cut off points for low HGS, identified only one patient with probable sarcopenia and none of the patients with confirmed sarcopenia.

Conclusion

KES cut-off points using a simple hand-held dynamometer can assist in the identification of probable and confirmed sarcopenia using EWGSOP2 cut off points for low muscle mass in a population of older T2DM patients for further analysis and early treatment. This is notably true in patients possessing high body mass index (BMI) alongside normal ASMI and HGS, potentially reducing false positive sarcopenia screening results.

Trial registration

ClinicalTrials.gov PRS: NCT03560375. Last registration date (last update): 06/06/2018. The trial was a-priori registered before actual recruitment of subjects.

Sex- and Age-Specific Centile Curves and Downloadable Calculator for Clinical Muscle Strength Tests to Identify Probable Sarcopenia

OBJECTIVE

Identifying muscle weakness and probable sarcopenia using strength tests requires reference data. This study aimed to provide age- and sex-specific normative data for grip strength and common variations of the Sit-to-Stand (STS) test: time to complete 5 stands (5x-STS) and number of stands completed in 30 seconds (30s-STS). Predictors of test performance were also explored.

METHODS

Dominant hand grip strength was assessed in adults (age = 18-80 years) using a digital dynamometer, and 5x-STS and 30s-STS performance were assessed synchronously during a single 30-second test. Sex-specific centile curves were generated using the lambda-mu-sigma method.

RESULTS

Data from 2301 participants (female = 1682, male = 619) were included. Peak median grip strength occurred in female participants at 33.9 years of age (27.9 kg) and in male participants at 37.6 years of age (47.2 kg). 5x-STS and 30s-STS performance peaked at the youngest age (18.0 years) in both female participants (8.16 seconds and 17.2 repetitions) and male participants (8.02 seconds and 17.7 repetitions). Test performances were lowest for all tests at the oldest age in the database. Predictors of better test performance included lower age and higher self-reported physical functioning and appendicular skeletal muscle mass, to name a few. White participants had better performance than Black participants on the STS tests.

CONCLUSION

The generated centile curves reveal the pattern of change in muscle strength for tests recommended to identify probable sarcopenia. The curves can be used in rehabilitation to assess an individual's performance relative to sex- and age-specific norms. To aid use of the data, a downloadable Excel-based calculator is provided to compute participant-specific percentiles, z scores, and t scores for each outcome and plot performance on the centile curves.

IMPACT

Physical therapists have an important role in identifying and treating individuals with sarcopenia and other causes of muscle weakness. The reference data provided for common clinical muscle strength tests provide therapists an ability to assess an individual's relative performance.

LAY SUMMARY

Knowing the normal or expected strength for an individual's age and sex is essential to identifying muscle weakness. This study provides age- and sex-specific normal values for hand grip strength and sit-to-stand tests in adults aged 18 to 80 years.

Impact of Different Operational Definitions of Sarcopenia on Prevalence in a Population-Based Sample: The Salus in Apulia Study

Background: In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP1) issued its first operational definition to diagnose sarcopenia. This was updated in 2019 with a revised sequence of muscle mass and muscle strength (EWGSOP2). The aim of the study was to investigate the impact of these different operational definitions on sarcopenia prevalence in a representative population-based sample. Methods: For each algorithm, the prevalence of sarcopenia-related categories was calculated and related to sociodemographic and lifestyle variables, anthropometric parameters, and laboratory biomarkers. The present analysis used data from the Salus in Apulia Study (Italy, 740 subjects, mean age 75.5 ± 5.9 years, 54% women). Results: The application of the EWGSOP1 adapted algorithm resulted in 85% [95% confidence intervals (CI): 82–88%] non-sarcopenic subjects, 10% (95% CI: 8–12%) pre-sarcopenic subjects, and 5% (95% CI: 3–7%) sarcopenic/severe sarcopenic subjects. The sarcopenia-related categories were inversely related to weight and body mass index (BMI), particularly in overweight/obese subjects, and these categories showed favorable metabolic biomarkers. The EWGSOP2 algorithm yielded 73% (95% CI: 69–76%) non-sarcopenic subjects, 24% (95% CI: 21–27%) probably sarcopenic subjects, and 4% (95% CI: 2–5%) sarcopenic subjects. Conclusions: The present study identified BMI as a potential confounder of the prevalence estimates of sarcopenia-related categories in population-based settings with different EWGSOP operational definitions.

Hand grip strength and chair stand test amongst Greenlandic Inuit: reference values and international comparisons

Muscle strength is an important predictor for function and mortality among older adults. We measured hand grip strength among 1442 participants aged 15+ years and carried out a 30 second chair stand test among 786 participants aged 55+ years. Neither test has been carried out among the Inuit before. We present reference values for men and women as means with standard deviations and medians with 10^th, 25^th, 75^th and 90^th percentiles. Hand grip strength was higher among men than among women (means 45.2 kg and 25.8 kg; p < 0.0001), in linear regression analyses it increased with height (β_men = 0.69; β_women = 0.46), weight (β_men = 0.24; β_women = 0.08) and body mass index (β_men = 0.56; β_women = 0.24), and decreased with age (β_men = −0.49; β_women = −0.29) and Inuit genetic ancestry (β_men = −0.96; β_women = −0.59). Chair stand score showed similar associations with sex (mean score for men and women 13.8 and 11.5; p < 0.0001), age (β_men = −0.22; β_women = −0.20) and Inuit genetic ancestry (β_men = −0.38; β_women = −0.41). The hand grip strength of the Inuit was at the same level as in European and North American populations whereas chair stand score was lower than that of a mostly white US population.

Moderate-to-vigorous physical activity modifies the relationship between sedentary time and sarcopenia: the Tromsø Study 2015-2016

BACKGROUND

Sarcopenia is an age-related muscle disease primarily characterized by reductions in muscle strength that increases the risk of falls, fractures, cognitive impairment, and mortality. Exercise is currently preferred in prevention and treatment, but it is unknown how different habitual physical activity and sedentary behaviour patterns associate with sarcopenia status. The purpose of the present study was to compare associations of these patterns with probable sarcopenia in older adults.

METHODS

In 3653 community-dwelling participants (51% women) aged 60-84 years from the seventh survey of the Tromsø Study, we assessed objective physical activity and sedentary behaviour collected over 8 days (ActiGraph wGT3X-BT Accelerometer), grip strength (Jamar+ Digital Dynamometer), five-repetition chair stands, and self-reported disease. We combined tertiles of sedentary (SED) time and moderate-to-vigorous physical activity (MVPA) to create nine different activity profiles (SED_HIGH , SED_MOD , and SED_LOW combined with MVPA_HIGH , MVPA_MOD , or MVPA_LOW ). Multiple logistic regression models were used to examine how these profiles associated with probable sarcopenia, defined by low handgrip strength and/or slow chair stands time according to the revised European Working Group on Sarcopenia in Older People criteria.

RESULTS

Probable sarcopenia was present in 227 (6.2%) participants. Men with probable sarcopenia had on average 35.3 min more SED time and 20 min less MVPA compared with participants without sarcopenia (P < 0.01 for all), while women with probable sarcopenia only had 18 min less MVPA (P < 0.001). Compared with the SED_HIGH -MVPA_LOW reference activity profile (714.2 min SED/day and 10.4 min MVPA/day), the SED_HIGH -MVPA_MOD profile (697.1 min SED/day and 31.5 min MVPA/day) had significantly lower odds ratio (OR) for probable sarcopenia (OR 0.17, 95% confidence interval [CI] 0.08-0.35), while the SED_LOW -MVPA_LOW profile (482.9 min SED/day and 11.0 min MVPA/day) did not (OR 0.72, 95% CI 0.47-1.11). These findings were not influenced by age, sex, smoking, or self-reported diseases, and higher levels of MVPA did not further decrease ORs for probable sarcopenia.

CONCLUSIONS

Older adults who achieve moderate amounts of MVPA have reduced odds for probable sarcopenia, even when they have high sedentary time. Those with low sedentary time did not have reduced odds for probable sarcopenia when they also had low amounts of MVPA. These findings need confirmation in longitudinal studies but suggest that interventions for preventing sarcopenia should prioritize increasing MVPA over reducing sedentary behaviour.

Feasibility of a Geriatric Assessment to Detect and Quantify Sarcopenia and Physical Functioning in German Nursing Home Residents-A Pilot Study

Background: Entering into a nursing home leads to increased immobility and further reductions in physical and cognitive functioning. As a result, there is a risk of sarcopenia, which is characterized by loss of muscle strength, muscle mass and physical functioning. To our knowledge, the feasibility of sarcopenia screening has not yet been performed in the German nursing home setting. Methods: For sarcopenia screening, the specifications of EWGSOP2 were applied. The quantification of sarcopenia was performed according to the corresponding cut-off values. The collection of anthropometric data and the morbidity status were recorded. SARC-F, mini-mental state examination, Barthel Index, Short Physical Performance Battery and Timed Up and Go tests were implemented. Results: In one participant, severe sarcopenia could be identified. The quantification was not possible for four participants. A suspicion of sarcopenia was not confirmed in five participants. Only one person was able to perform all assessments. Conclusions: Sarcopenia screening according to EWGSOP2 presented satisfactory feasibility by nursing home residents. However, further tests to assess the physical functioning of the participants often could not be performed. Moreover, inconsistencies in individual assessments became apparent, leading to inconclusive analyses. The recording of sarcopenia prevalence in German nursing homes should be the goal of further research.

Association between malnutrition and stages of sarcopenia in geriatric rehabilitation inpatients: RESORT

BACKGROUND & AIMS

Malnutrition and sarcopenia coexist in older adults, yet they remain largely undiagnosed and untreated, despite available interventions. This study aimed to assess the prevalence, the coexistence of, and the association between malnutrition and sarcopenia in geriatric rehabilitation inpatients.

METHODS

REStORing health of acutely unwell adulTs (RESORT) is an observational, longitudinal cohort of geriatric rehabilitation inpatients. The association between malnutrition, diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and sarcopenia according to the revised definition of the European Working Group on Sarcopenia in Older People (EWGSOP2) (no sarcopenia, probable sarcopenia, confirmed sarcopenia and severe sarcopenia) was determined using multinomial logistic regression analyses, adjusted for age, sex, comorbidities and cognitive impairment.

RESULTS

Out of 506 geriatric rehabilitation inpatients, 51% were malnourished, 49% had probable sarcopenia, 0.4% had confirmed sarcopenia (non-severe) and 19% had severe sarcopenia. Malnutrition and probable sarcopenia and malnutrition and confirmed/severe sarcopenia coexisted in 23% and 13% of the 506 patients respectively. Malnutrition was not associated with probable sarcopenia (OR = 0.91, 95% CI = 0.58-1.42, p = 0.674) but with severe sarcopenia (OR = 2.07, 95% CI = 1.13-3.81, p = 0.019).

CONCLUSION

The prevalence, coexistence of, and the association between malnutrition and severe sarcopenia in geriatric rehabilitation inpatients warrant diagnosis at admission. Further research into feasible and effective interventions to counteract both conditions to improve geriatric rehabilitation outcomes is needed.