Prevalence of sarcopenia in community-dwelling older people in the UK using the European Working Group on Sarcopenia in Older People (EWGSOP) definition: findings from the Hertfordshire Cohort Study (HCS)
TL;DR: The EWGSOP consensus definition was of practical use for sarcopenia case finding and the next step is to use this consensus definition in other ageing cohorts and among older people in a range of health-care settings.
Abstract: Introduction: sarcopenia is associated with adverse health outcomes. The aim of this study was to describe the prevalence of sarcopenia in community-dwelling older people in the UK using the European Working Group on Sarcopenia in Older People (EWGSOP) consensus definition.
Methods: we applied the EWGSOP definition to 103 community-dwelling men participating in the Hertfordshire Sarcopenia Study (HSS) using both the lowest third of dual-energy X-ray absorptiometry (DXA) lean mass (LM) and the lowest third of skin-fold-based fat-free mass (FFM) as markers of low muscle mass. We also used the FFM approach among 765 male and 1,022 female participants in the Hertfordshire Cohort Study (HCS). Body size, physical performance and self-reported health were compared in participants with and without sarcopenia.
Results: the prevalence of sarcopenia in HSS men (mean age 73 years) was 6.8% and 7.8% when using the lowest third of DXA LM and FFM, respectively. DXA LM and FFM were highly correlated (0.91, P < 0.001). The prevalence of sarcopenia among the HCS men and women (mean age 67 years) was 4.6% and 7.9%, respectively. HSS and HCS participants with sarcopenia were shorter, weighed less and had worse physical performance. HCS men and women with sarcopenia had poorer self-reported general health and physical functioning scores.
Conclusions: this is one of the first studies to describe the prevalence of sarcopenia in UK community-dwelling older people. The EWGSOP consensus definition was of practical use for sarcopenia case finding. The next step is to use this consensus definition in other ageing cohorts and among older people in a range of health-care settings.
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Catholic University of the Sacred Heart1, University of Nice Sophia Antipolis2, Autonomous University of Baja California3, Kyoto University4, Institut national de la recherche agronomique5, Taipei Veterans General Hospital6, Tufts University7, Guy's and St Thomas' NHS Foundation Trust8, University of Central Florida9, University of Pittsburgh10, French Institute of Health and Medical Research11, The Chinese University of Hong Kong12, University of Verona13, Uppsala University14
TL;DR: Prevalence of sarcopenia is substantial in most geriatric settings, and well-designed, standardised studies evaluating exercise or nutrition interventions are needed before treatment guidelines can be developed.
Abstract: OBJECTIVE: to examine the clinical evidence reporting the prevalence of sarcopenia and the effect of nutrition and exercise interventions from studies using the consensus definition of sarcopenia proposed by the European Working Group on Sarcopenia in Older People (EWGSOP).METHODS: PubMed and Dialog databases were searched (January 2000-October 2013) using pre-defined search terms. Prevalence studies and intervention studies investigating muscle mass plus strength or function outcome measures using the EWGSOP definition of sarcopenia, in well-defined populations of adults aged ≥50 years were selected.RESULTS: prevalence of sarcopenia was, with regional and age-related variations, 1-29% in community-dwelling populations, 14-33% in long-term care populations and 10% in the only acute hospital-care population examined. Moderate quality evidence suggests that exercise interventions improve muscle strength and physical performance. The results of nutrition interventions are equivocal due to the low number of studies and heterogeneous study design. Essential amino acid (EAA) supplements, including ∼2.5 g of leucine, and β-hydroxy β-methylbutyric acid (HMB) supplements, show some effects in improving muscle mass and function parameters. Protein supplements have not shown consistent benefits on muscle mass and function.CONCLUSION: prevalence of sarcopenia is substantial in most geriatric settings. Well-designed, standardised studies evaluating exercise or nutrition interventions are needed before treatment guidelines can be developed. Physicians should screen for sarcopenia in both community and geriatric settings, with diagnosis based on muscle mass and function. Supervised resistance exercise is recommended for individuals with sarcopenia. EAA (with leucine) and HMB may improve muscle outcomes.
1,415 citations
574 citations
TL;DR: Low muscle strength was more strongly associated with aging, protein-energy wasting, physical inactivity, inflammation, and mortality than low muscle mass.
Abstract: Background and objectives Reduced muscle mass and strength are prevalent conditions in dialysis patients. However, muscle strength and muscle mass are not congruent; muscle strength can diminish even though muscle mass is maintained or increased. This study addresses phenotype and mortality associations of these muscle dysfunction entities alone or in combination ( i.e., concurrent loss of muscle mass and strength/mobility, here defined as sarcopenia). Design, setting, participants, & measurements This study included 330 incident dialysis patients (203 men, mean age 53±13 years, and mean GFR 7±2 ml/min per 1.73 m 2 ) recruited between 1994 and 2010 and followed prospectively for up to 5 years. Low muscle mass (by dual-energy x-ray absorptiometry appendicular mass index) and low muscle strength (by handgrip) were defined against young reference populations according to the European Working Group on Sarcopenia in Older People. Results Whereas 20% of patients had sarcopenia, low muscle mass and low muscle strength alone were observed in a further 24% and 15% of patients, respectively. Old age, comorbidities, protein-energy wasting, physical inactivity, low albumin, and inflammation associated with low muscle strength, but not with low muscle mass (multivariate ANOVA interactions). During follow-up, 95 patients (29%) died and both conditions associated with mortality as separate entities. When combined, individuals with low muscle mass alone were not at increased risk of mortality (adjusted hazard ratio [HR], 1.23; 95% confidence interval [95% CI], 0.56 to 2.67). Individuals with low muscle strength were at increased risk, irrespective of their muscle stores being appropriate (HR, 1.98; 95% CI, 1.01 to 3.87) or low (HR, 1.93; 95% CI, 1.01 to 3.71). Conclusions Low muscle strength was more strongly associated with aging, protein-energy wasting, physical inactivity, inflammation, and mortality than low muscle mass. Assessment of muscle functionality may provide additional diagnostic and prognostic information to muscle-mass evaluation.
373 citations
Cites background from "Prevalence of sarcopenia in communi..."
..., reduced muscle mass with limited mobility/function) has been associated with frailty, cachexia, and functional disability, leading to worse quality of life and higher mortality rates (8)....
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Columbia University1, California Pacific Medical Center2, University of Central Florida3, National Institutes of Health4, Beth Israel Deaconess Medical Center5, University of Maryland, Baltimore6, University of Connecticut Health Center7, Wake Forest University8, Foundation for the National Institutes of Health9, University of Pittsburgh10
TL;DR: The FNIH criteria result in a more conservative operational definition of sarcopenia, and the prevalence was lower compared with other proposed criteria, including the International Working Group and the European Working Group for Sarcopenia in Older Persons.
Abstract: Low muscle mass and weakness are potential contributors to disability in older persons. Although the term “sarcopenia” has become widespread, the criteria for an operational definition vary among studies and experts. Initial work on defining sarcopenia was based on measures of muscle mass alone, and the prevalence of sarcopenia when compared with a young reference population ranged between 13% and 24% among adults younger than 70 years to more than 50% among adults older than 80 years (1). However, a growing body of research suggests that there is a disconnect between muscle mass and strength. Thus, recent definitions of sarcopenia have incorporated elements of strength and physical performance in addition to muscle mass in the criteria for sarcopenia (2–5). However, these consensus statements were based on expert opinions and lacked access to large data sets to validate their recommendations. Thus, the goal of the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project was to create a data-driven set of criteria for clinically relevant weakness and low lean mass using pooled data from multiple studies.
This is the fifth report of the FNIH Sarcopenia Project. The first manuscript describes the rationale for the FNIH Sarcopenia Project and characteristics of the participating studies. The second and third manuscripts describe in detail the development of cutpoints for weakness and low lean mass; and the fourth manuscript demonstrates the predictive validity of these cutpoints. The purpose of the analyses presented here is to compare the criteria developed by the FNIH project to other published criteria, in order to assess prevalence, agreement, and discrepancies between candidate criteria. Our goal is to provide data-driven evidence to the field in order to advance professional consensus regarding clinically relevant cutpoints and terminology.
319 citations
TL;DR: Sarcopenia affects 15% of patients with stable COPD and impairs function and health status and does not impact on response to PR, which can lead to a reversal of the syndrome in select patients.
Abstract: Background Age-related loss of muscle, sarcopenia, is recognised as a clinical syndrome with multiple contributing factors. International European Working Group on Sarcopenia in Older People (EWGSOP) criteria require generalised loss of muscle mass and reduced function to diagnose sarcopenia. Both are common in COPD but are usually studied in isolation and in the lower limbs.
Objectives To determine the prevalence of sarcopenia in COPD, its impact on function and health status, its relationship with quadriceps strength and its response to pulmonary rehabilitation (PR).
Methods EWGSOP criteria were applied to 622 outpatients with stable COPD. Body composition, exercise capacity, functional performance, physical activity and health status were assessed. Using a case–control design, response to PR was determined in 43 patients with sarcopenia and a propensity score-matched non-sarcopenic group.
Results Prevalence of sarcopenia was 14.5% (95% CI 11.8% to 17.4%), which increased with age and Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) stage, but did not differ by gender or the presence of quadriceps weakness (14.9 vs 13.8%, p=0.40). Patients with sarcopenia had reduced exercise capacity, functional performance, physical activity and health status compared with patients without sarcopenia (p<0.001), but responded similarly following PR; 12/43 patients were no longer classified as sarcopenic following PR.
Conclusions Sarcopenia affects 15% of patients with stable COPD and impairs function and health status. Sarcopenia does not impact on response to PR, which can lead to a reversal of the syndrome in select patients.
315 citations
References
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TL;DR: The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia as discussed by the authors.
Abstract: The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics-European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as 'presarcopenia', 'sarcopenia' and 'severe sarcopenia'. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.
8,440 citations
TL;DR: Skinfold thicknesses at four sites – biceps, triceps, subscapular and supra-iliac – and total body density were measured on 209 males and 272 females aged from 16 to 72 years, finding it necessary to use the logarithm of skinfold measurements in order to achieve a linear relationship with body density.
Abstract: The fat content of the human body has physiological and medical importance. It may influence morbidity and mortality, it may aIter the effectiveness of drugs and anaesthetics, and it may affect the ability to withstand exposure to cold and starvation. Thus the measurement of the total body fat provides useful information. In many people, but by no means everyone, a moderately satisfactory estimate of the body fat content can be obtained from the height and weight. However, for more precise evaluation several methods are available which give a reasonably accurate measure of body fat both in normal subjects and in individuals with unusual body builds. Most of these methods are based on the assumption that the body can be considered to consist of two compartments of relatively constant composition but which are distinctly different; these compartments are: (I) the body fat, which includes the entire content of chemical fat or lipids in the body, and (2) the fat-free mass (FFM), which includes all the rest of the body apart from fat. The body fat compartment is anhydrous, contains no potassium and has a fairly constant density of about 0.90 x 103 kg/m3. The fat-free compartment on the other hand probably has a fairly constant density of about 1.10 x 103 kg/m3, a potassium content of about 68 mequiv./kg in males (about 10% less in females) and a water content of about 720 g/kg. Thus measurement of body density or of total body K or of total body water allows a calculation of the relative proportion of these two compartments in the body and therefore also of the total fat content. The accuracy of these measures, however, is limited by the variability of the composition and density of the fat-free compartment in different individuals. In particular, individuals with a relatively high or
6,287 citations
"Prevalence of sarcopenia in communi..." refers methods in this paper
...Percentage body fat was derived from the average SFT [24]....
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...In the HCS PP sample, body composition was assessed by SFT only [21]....
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...FFM, a proxy for lean muscle mass, was estimated by subtracting fat mass from body weight [24]....
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...Body composition in the HSS was assessed by DXA (Hologic Discovery, software version 12.5) and multisite skin-fold thickness (SFT) measurement....
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TL;DR: Some of the first estimates of the extent of the public health problem posed by sarcopenia are provided, independent of ethnicity, age, morbidity, obesity, income, and health behaviors.
Abstract: Muscle mass decreases with age, leading to "sarcopenia," or low relative muscle mass, in elderly people. Sarcopenia is believed to be associated with metabolic, physiologic, and functional impairments and disability. Methods of estimating the prevalence of sarcopenia and its associated risks in elderly populations are lacking. Data from a population-based survey of 883 elderly Hispanic and non-Hispanic white men and women living in New Mexico (the New Mexico Elder Health Survey, 1993-1995) were analyzed to develop a method for estimating the prevalence of sarcopenia. An anthropometric equation for predicting appendicular skeletal muscle mass was developed from a random subsample (n = 199) of participants and was extended to the total sample. Sarcopenia was defined as appendicular skeletal muscle mass (kg)/height2 (m2) being less than two standard deviations below the mean of a young reference group. Prevalences increased from 13-24% in persons under 70 years of age to >50% in persons over 80 years of age, and were slightly greater in Hispanics than in non-Hispanic whites. Sarcopenia was significantly associated with self-reported physical disability in both men and women, independent of ethnicity, age, morbidity, obesity, income, and health behaviors. This study provides some of the first estimates of the extent of the public health problem posed by sarcopenia.
3,478 citations
"Prevalence of sarcopenia in communi..." refers background in this paper
...For example, in 883 participants of the New Mexico Elder Study, prevalence increased from 13% to 24% in people under 70 years of age to >50% in persons over 80 years and differed by ethnicity [13]....
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TL;DR: To establish the prevalence of sarc Openia in older Americans and to test the hypothesis that sarcopenia is related to functional impairment and physical disability in older persons is established.
Abstract: OBJECTIVES: To establish the prevalence of sarcopenia in older Americans and to test the hypothesis that sarcope- nia is related to functional impairment and physical dis- ability in older persons. DESIGN: Cross-sectional survey. SETTING: Nationally representative cross-sectional sur- vey using data from the Third National Health and Nutri- tion Examination Survey (NHANES III). PARTICIPANTS: Fourteen thousand eight hundred eigh- teen adult NHANES III participants aged 18 and older. MEASUREMENTS: The presence of sarcopenia and the relationship between sarcopenia and functional impairment and disability were examined in 4,504 adults aged 60 and older. Skeletal muscle mass was estimated from bioimped- ance analysis measurements and expressed as skeletal mus- cle mass index (SMIskeletal muscle mass/body mass � 100). Subjects were considered to have a normal SMI if their SMI was greater than -one standard deviation above the sex-specific mean for young adults (aged 18-39). Class I sarcopenia was considered present in subjects whose SMI was within -one to -two standard deviations of young adult values, and class II sarcopenia was present in subjects whose SMI was below -two standard deviations of young adult values. RESULTS: The prevalence of class I and class II sarcope- nia increased from the third to sixth decades but remained relatively constant thereafter. The prevalence of class I (59% vs 45%) and class II (10% vs 7%) sarcopenia was greater in the older ( � 60 years) women than in the older men ( P � .001). The likelihood of functional impairment and disability was approximately two times greater in the older men and three times greater in the older women with class II sarcopenia than in the older men and women with a normal SMI, respectively. Some of the associations be- tween class II sarcopenia and functional impairment re- mained significant after adjustment for age, race, body mass index, health behaviors, and comorbidity. CONCLUSIONS: Reduced relative skeletal muscle mass in older Americans is a common occurrence that is signifi- cantly and independently associated with functional im- pairment and disability, particularly in older women. These observations provide strong support for the prevailing view that sarcopenia may be an important and potentially re- versible cause of morbidity and mortality in older persons. J Am Geriatr Soc 50:889-896, 2002.
2,710 citations
"Prevalence of sarcopenia in communi..." refers result in this paper
...In spite of methodological differences, the prevalence of sarcopenia in our study is broadly comparable with that from similar studies in the literature [14, 26, 31]....
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United States Department of Agriculture1, French Institute of Health and Medical Research2, Research Triangle Park3, Boston University4, Saint Louis University5, University of Pittsburgh6, University of Erlangen-Nuremberg7, Nestlé8, Uppsala University9, Merck & Co.10, Sapienza University of Rome11, National Institutes of Health12, Novartis13, University of Verona14
TL;DR: Sarcopenia should be considered in all older patients who present with observed declines in physical function, strength, or overall health, and patients who meet these criteria should further undergo body composition assessment using dual energy x-ray absorptiometry with sarcopenia being defined using currently validated definitions.
2,378 citations
"Prevalence of sarcopenia in communi..." refers background in this paper
...A few consensus operational definitions of sarcopenia have been developed based on low muscle mass and gait speed [18, 30], but these have invariably relied on comparison with healthy young reference values....
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...This is evident in studies that have defined sarcopenia as a skeletal muscle mass index and in those that have used anthropometry as a marker of muscle mass [14, 18, 26]....
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...Previous cross-sectional studies in North America and Europe have described a sarcopenia index (muscle mass/ height(2)) and used a cut-off that is two standard deviations (SD) or more lower than a mean derived from a healthy young reference sample [1, 18]....
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