Sarcopenia in Korea: Prevalence and Clinical Aspects

Sarcopenia assessed with DXA and CT increases the risk of perioperative complications in patients with gastrectomy

OBJECTIVES

We investigated sarcopenia prevalence using various diagnostic criteria based on dual-energy X-ray absorptiometry (DXA) and computed tomography (CT) in gastric cancer patients who underwent gastrectomy, and evaluated the association between sarcopenia and perioperative complications.

METHODS

This retrospective study included consecutive patients with gastric cancer who underwent gastrectomy, and preoperative DXA and CT from January 2013 to November 2020. Body composition was measured using DXA and CT. Height-adjusted DXA-based Appendicular Skeletal Muscle Mass Index (ASMI) and CT-based skeletal muscle cross-sectional area at the L3 level (SMI) were measured. Sarcopenia and sarcopenic obesity were defined using reported cutoff values. The chi-square test and univariate analysis were performed to determine risk factors for significant and severe perioperative complications (Clavien-Dindo Grades ≥ 2 and ≥ 3, respectively).

RESULTS

In total, 77 males and 43 females aged 61.4 ± 11.0 years were included. ASMI and SMI were correlated (r = 0.819), but sarcopenia prevalence varied (20.0-63.3%), depending on the criteria applied. Univariate analysis revealed sarcopenia defined using the Asian Working Group on Sarcopenia (AWGS) criteria and sarcopenic obesity as risk factors for significant (odds ratio [OR] 2.76, p = 0.030 vs. OR 4.31, p = 0.002) and severe perioperative complications (OR 3.77, p = 0.036 vs. OR 4.78, p = 0.010). In subgroup analyses, sarcopenia and sarcopenic obesity were significantly associated with perioperative complications only in males.

CONCLUSION

Perioperative complication risk can be predicted from sarcopenia defined using the AWGS criteria and sarcopenic obesity measured using DXA and CT, particularly in males.

KEY POINTS

• The prevalence of sarcopenia varies due to definition differences. • Sarcopenia and sarcopenic obesity are risk factors for significant and severe perioperative complications, particularly in males. • Our results suggest that physicians need to pay attention to perioperative complications after surgical treatment of male patients with sarcopenia and sarcopenic obesity.

Subjective voice change was associated with appendicular skeletal muscle mass in elderly men, but not in women: A cross-sectional study

OBJECTIVES

To investigate the relationship between subjective voice changes and appendicular skeletal muscle in the elderly in Korea.

DESIGN

Retrospective cross-sectional study.

SETTING

Population-based survey data were collected by the Korean National Health and Nutrition Examination Survey between January 2009 and December 2011.

PARTICIPANTS

A total of 2611 participants (1081 men and 1530 women) aged 65 to 80 years were enrolled in the Korean National Health and Nutrition Examination Survey from 2009 to 2011. A 70-degree laryngeal endoscopy was performed to check for abnormalities in the larynx, while dual-energy x-ray absorptiometry was utilised to measure appendicular skeletal muscle mass. The correlation between subjective voice change and appendicular skeletal muscle index (ASMI) was analysed using a linear-by-linear association test and logistic regression analysis.

RESULTS

When comparing ASMI according to the presence or absence of subjective voice change, elderly men showed significantly lower ASMI values when subjective voice change was present (p = .021). However, in women, the ASMI was not significantly lower in the presence of subjective voice changes (p = .365). We confirmed that subjective voice change was significantly lower in the highest quintile of ASMI compared to lowest quintile of ASMI in the men using logistic regression analysis (B 0.281, 95% confident interval 0.082-0.964, p < .044).

CONCLUSIONS

This study has shown that in Korean men aged >65 years, subjective voice abnormality significantly increased as skeletal muscle mass decreased. Further longitudinal studies are needed to determine whether a correlation exists between objective voice test results and ASMI.

Geriatrics Fact Sheet in Korea 2021

South Korea became an aged society in 2017 and is predicted to become a super-aged society by 2025. Therefore, knowing the trends among older adults and identifying the geriatric burden are crucial for both healthcare professionals and policymakers. We previously summarized the general health and socioeconomic profiles of Korean older adults from the 2017 National Survey of Living Conditions and Welfare Needs of Older Koreans. In this update, we briefly summarized the results of the 2020 National Survey of Living Conditions and Welfare Needs of Older Koreans by categorizing them according to their general aging profile, socioeconomic status, lifestyle, and health status. In addition, we reviewed recent updates in the field of frailty and sarcopenia from population-based community cohorts in Korea. We hope this study will serve as a current reference for nationwide statistical data on common clinical and social parameters used in geriatrics and gerontology.

Association between sarcopenia and fall characteristics in older adults with fragility hip fracture

INTRODUCTION

Sarcopenia is known as a risk factor for falls and hip fracture, and understanding fall characteristics is important for the fall-prevention programs. The aim of this study is to investigate whether sarcopenia is associated with fall characteristics in older adults with fragility hip fracture.

METHODS

A cross-sectional study was conducted in 147 patients over 65 years of age who had undergone a two-week postoperative rehabilitation for hip fracture. Fall characteristics included the fall type, direction and location. Fall types were categorized into two groups: fragile falls, leg weakness during walking, changing positions or standing; non-fragile falls, slipping or tripping while walking. Correlations between sarcopenia and fall characteristics, and of fall type with sarcopenia and fall characteristics were analyzed. Logistic regression analyzes were used to identify independent risk factors for fragile falls.

RESULTS

Sarcopenia was significantly correlated with fragile falls (r = .222, p = .007) and was more prevalent in the fragile fall group than the non-fragile fall group (53.5% vs. 32.9%). Sarcopenia (OR = 2.354, 95% CI 1.177-4.709, p = .016), moderate comorbidities (OR = 3.572, 95% CI 1.109-11.501, p = .033) and severe comorbidities (OR = 5.396, 95% CI 1.476-19.729, p = .011) by the Charlson Comorbidity Index were significant independent risk factors for fragile falls.

CONCLUSIONS

Sarcopenia was correlated with fragile falls; moreover, it was a risk factor for all of these fall types in older adults with fragility hip fracture. Based on these associations, targeted fall-prevention programs for older adults with sarcopenia, a high risk factor of falls and fractures, could help reduce the incidence rates of falls and fragility hip fracture.

Geriatrics Fact Sheet in Korea 2018 From National Statistics

South Korea is the fastest aging country in the world, having become an aged society in 2017, with over 14% of its population aged 65 years or older. This Korean Geriatrics Fact Sheet 2018 aimed to overview and clarify the current geriatric burden and its trends in South Korea. Using nationwide surveys and public reports from government or related organizations, especially the 2017 Survey of the Living Conditions and Welfare Needs of Korean Older Persons from the Korea Institute for Health and Social Affairs, our committee has summarized the profile, socioeconomic status, health-related lifestyles, geriatric syndromes with major comorbidities, and use of healthcare services in the aging population. We hope that this review will publicize the social burden and seriousness of the aging problem in Korea.

Palliative and end of life care of people with diabetes: Issues, challenges and strategies

Palliative and end of life care are essential, but largely overlooked, aspects of comprehensive, personalised diabetes care. Life expectancy is lower in people with diabetes than in the general population due to complications and comorbidities, especially those associated with obesity such as cardiovascular disease, frailty and cancer. This paper makes the case for early initiation of palliative care and proactive planning for end of life. Early use of palliative care improves symptom management, comfort and quality of life, and often improves function. Significantly, it reduces disease burden and unnecessary treatment. Prognostication is challenging, but tools such as the Gold Standard Framework and diabetes-related indicators of reduced life expectancy can help identify those at high risk one year mortality. Skilled conversations, underpinned by an evidence-based framework, are a critical component in helping people with diabetes, and their families, discuss these complex issues and make appropriate advance care plans based on their values and preferences.

How to Diagnose Sarcopenia in Korean Older Adults?

In 2017, Korea became an aged society, with the percentage of the population aged ≥65 years accounting for 14% of the total Korean population. The increasing number of older adults and the current health status of Korean older adults had led to increased medical expenditure and social problems. Sarcopenia, defined as the progressive decrease in skeletal muscle mass and strength, develops as a consequence of aging. Sarcopenia is also associated with a risk of adverse health outcomes such as frailty, physical disability, poor quality of life, and death. Thus, sarcopenia is a serious clinical problem among older adults. The International Classification of Diseases, Tenth Revision, Clinical Modification code for sarcopenia, M62.84, became available on October 1, 2016, in the United States. The diagnosis and treatment of sarcopenia urgently requires the establishment of an operational definition for sarcopenia in Korean older adults. In this article, I suggest a screening strategy and diagnostic criteria for sarcopenia in this population.

Validation of the Korean Version of the SARC-F Questionnaire to Assess Sarcopenia: Korean Frailty and Aging Cohort Study

OBJECTIVES

The SARC-F is a simple sarcopenia screening tool comprising 5 assessment items: strength, assistance walking, rising from a chair, climbing stairs, and falls. The present study aimed to examine the validation of the Korean version of SARC-F for elderly individuals residing in communities.

SETTING AND PARTICIPANTS

From the first year baseline data of Korean Frailty and Aging Cohort Study, a total of 1222 elderly individuals (70 years and older) who met the study's selection criteria were included in the analysis.

MEASUREMENTS

The SARC-F was translated into the Korean language in a culturally responsive way. The total score was calculated by adding the scores on the 5 items. The participants were divided into 2 groups according to the total score (SARC-F <4 vs SARC-F ≥4), and its correlations with various factors including walking speed, hand grip, ability to perform everyday activities, and health-related quality of life, were examined by sex. In addition, the tool's validity was analyzed by comparing it with the European, international, and Asian sarcopenia working group diagnostic criteria for sarcopenia.

RESULTS

The prevalence of sarcopenia according to the SARC-F was 4.2% in among men and 15.3% in women. The sensitivity of the SARC-F was low compared with the European, international, and Asian criteria of sarcopenia [male (M): 11%-60%, female (F): 28%-34%]. However, SARC-F showed a high specificity (M: 96.6%-98%, F: 85%-87.7%) and a high negative predictive value (M: 89.2%-99.3%, F: 88.5%-98.4%). The participants in the SARC-F ≥4 group had poorer grip strength, slower walking speed, poorer physical performance, poorer cognitive function, and a lower quality of life (a high EuroQol-5 dimension score) than the participants in the SARC-F <4 group.

CONCLUSIONS

The Korean language version of SARC-F showed a high specificity and high negative predictive value. As such, the tool is useful for briefly ruling out sarcopenia in a clinical setting. In addition, diagnosis of sarcopenia using the SARC-F was found to be associated with physical performance, cognitive function, and the quality of life.

Comprehensive Approach for Managing the Older Person with Diabetes Mellitus

Care of the elderly population with diabetes may not be restricted to the management of hyperglycemia, associated risk factors, and specific diabetic complications. An integrated approach should also include the assessment and management of gerontological problems. Both diabetes mellitus and aging interact toward the direction of the increased incidence of geriatric syndromes. Education is a common element of both diabetes control and geriatric syndrome care. However, it has been perceived that conventional education programs for diabetics are not as effective for the elderly. We have designed geriatric reinforced education (GRE) for application in older diabetics with geriatric syndromes. We observed that the application of GRE improved the glucose control and the status of geriatric syndromes in older adults with diabetes. In summary, in terms of integrating the care of coexisting diabetes and geriatric problems, GRE may be a beneficial tool for the management of older adults with diabetes.

Association of Coffee Consumption with Sarcopenia in Korean Elderly Men: Analysis Using the Korea National Health and Nutrition Examination Survey, 2008-2011

Background

Sarcopenia is an age-related loss of muscle mass and strength. Coffee has antioxidant and anti-inflammatory properties that have been shown to be inversely related to the mechanism of sarcopenia. While there have been some studies on the effect of coffee on sarcopenia in animals, studies on the topic in humans are rare. Therefore, we investigated this relationship in elderly Korean men.

Methods

The cross-sectional data were derived from the 2008–2011 Korea National Health and Nutrition Examination Survey. After applying the exclusion criteria, the study sample consisted of 1,781 men who were at least 60 years of age. Study participants were identified as having sarcopenia if their appendicular skeletal muscle mass divided by height squared was less than two standard deviations below the gender-specific mean of this value for young adults. Daily coffee consumption amounts were categorized as <1 cup, 1 cup, 2 cups, and ≥3 cups.

Results

Compared to the group of individuals who drank less than one cup of coffee a day, people who consumed at least 3 cups (adjusted odds ratio, 0.43; 95% confidence interval, 0.20 to 0.94) showed significantly decreased sarcopenia; however, the decrease was not significant when the daily coffee consumption was 1 or 2 cups. In multivariate logistic regression models, significant associations were observed between sarcopenia and coffee consumption (P for trend=0.039).

Conclusion

The results of this study suggest that consuming at least 3 cups of coffee per day was associated with a lower prevalence of sarcopenia in elderly Korean elderly men.

Sarcopenia, Frailty, and Diabetes in Older Adults

Populations are aging and the prevalence of diabetes mellitus is increasing tremendously. The number of older people with diabetes is increasing unexpectedly. Aging and diabetes are both risk factors for functional disability. Thus, increasing numbers of frail or disabled older patients with diabetes will increase both direct and indirect health-related costs. Diabetes has been reported as an important risk factor of developing physical disability in older adults. Older people with diabetes have lower muscle mass and weaker muscle strength. In addition, muscle quality is poorer in diabetic patients. Sarcopenia and frailty have a common soil and may share a similar pathway for multiple pathologic processes in older people. Sarcopenia is thought to be an intermediate step in the development of frailty in patients with diabetes. Thus, early detection of sarcopenia and frailty in older adults with diabetes should be routine clinical practice to prevent frailty or to intervene earlier in frail patients.