Sarcopenia, Dynapenia, and the Impact of Advancing Age on Human Skeletal Muscle Size and Strength; a Quantitative Review
TL;DR: The aim of this review is to present current knowledge of the decline in human muscle mass and strength with advancing age and the associated risk to health and survival and to review the underlying changes in muscle characteristics and the etiology of sarcopenia.
Abstract: Changing demographics make it ever more important to understand the modifiable risk factors for disability and loss of independence with advancing age. For more than two decades there has been increasing interest in the role of sarcopenia, the age related loss of muscle or lean mass, in curtailing active and healthy aging. There is now evidence to suggest that lack of strength, or dynapenia, is a more constant factor in compromised wellbeing in old age and it is apparent that the decline in muscle mass and the decline in strength can take quite different trajectories. This demands recognition of the concept of muscle quality; that is the force generating per capacity per unit cross-sectional area (CSA). An understanding of the impact of aging on skeletal muscle will require attention to both the changes in muscle size and the changes in muscle quality. The aim of this review is to present current knowledge of the decline in human muscle mass and strength with advancing age and the associated risk to health and survival and to review the underlying changes in muscle characteristics and the aetiology of sarcopenia. Cross-sectional studies comparing young (18-45yrs) and old (>65yrs) samples show dramatic variation based on the technique used and population studied. The median of values of rate of loss reported across studies is 0.47% per year in men and 0.37% per year in women. Longitudinal studies show that in people aged 75yrs, muscle mass is lost at a rate of 0.64-0.70% per year in women and 0.80-0.98% per year in men. Strength is lost more rapidly. Longitudinal studies show that at age 75yrs, strength is lost at a rate of 3-4% per year in men and 2.5-3% per year in women. Studies that assessed changes in mass and strength in the same sample report a loss of strength 2 – 5 times faster than loss of mass. Loss of strength is a more consistent risk for disability and death than is loss of muscle mass.
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TL;DR: The effects of the Nrf2-Keap1 system in the physiology and pathophysiology of striated muscle tissue taking into account its role(s) in oxidative stress and reductive stress are highlighted.
892 citations
TL;DR: In this article, the authors performed a systematic review to assess the short-, middle and long-term consequences of sarcopenia, and the results showed a higher rate of mortality among sarcopenic subjects (pooled OR of 3.596 (95% CI 2.96-4.37).
Abstract: Objective
The purpose of this study was to perform a systematic review to assess the short-, middle- and long-term consequences of sarcopenia.
Methods
Prospective studies assessing the consequences of sarcopenia were searched across different electronic databases (MEDLINE, EMBASE, EBM Reviews, Cochrane Database of Systematic Reviews, EBM Reviews ACP Journal Club, EBM Reviews DARE and AMED). Only studies that used the definition of the European Working Group on Sarcopenia in Older People to diagnose sarcopenia were included. Study selection and data extraction were performed by two independent reviewers. For outcomes reported by three or more studies, a meta-analysis was performed. The study results are expressed as odds ratios (OR) with 95% CI.
Results
Of the 772 references identified through the database search, 17 were included in this systematic review. The number of participants in the included studies ranged from 99 to 6658, and the duration of follow-up varied from 3 months to 9.8 years. Eleven out of 12 studies assessed the impact of sarcopenia on mortality. The results showed a higher rate of mortality among sarcopenic subjects (pooled OR of 3.596 (95% CI 2.96–4.37)). The effect was higher in people aged 79 years or older compared with younger subjects (p = 0.02). Sarcopenia is also associated with functional decline (pooled OR of 6 studies 3.03 (95% CI 1.80–5.12)), a higher rate of falls (2/2 studies found a significant association) and a higher incidence of hospitalizations (1/1 study). The impact of sarcopenia on the incidence of fractures and the length of hospital stay was less clear (only 1/2 studies showed an association for both outcomes).
Conclusion
Sarcopenia is associated with several harmful outcomes, making this geriatric syndrome a real public health burden.
600 citations
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TL;DR: It is suggested here that there is no single formal strategy that must be used in order to achieve sustainability, and a range of built work for sustainable qualities is investigated.
Abstract: Are designed landscapes conceived as geometric compositions or abstractions of nature incompatible with sustainable design? Does mimesis result in the only truly sustainable form in the landscape? This paper attempts to answer these questions by drawing on the observations of practitioners and educators in the field as well as investigating a range of built work for sustainable qualities. The built work is categorized according to four approaches to form genesis, geometric composition, abstractions of nature, mimesis, and combinations of the three. It is suggested here that there is no single formal strategy that must be used in order to achieve sustainability.
600 citations
TL;DR: A brief, inexpensive screening test for sarcopenia would be helpful for clinicians and their patients by developing a simple five‐item questionnaire (SARC‐F) based on cardinal features or consequences of sarc Openia.
Abstract: Background
A brief, inexpensive screening test for sarcopenia would be helpful for clinicians and their patients. To screen for persons with sarcopenia, we developed a simple five-item questionnaire (SARC-F) based on cardinal features or consequences of sarcopenia.
Methods
We investigated the utility of SARC-F in the African American Health (AAH) study, Baltimore Longitudinal Study of Aging (BLSA), and National Health and Nutrition Examination Survey (NHANES). Internal consistency reliability for SARC-F was determined using Cronbach's alpha. We evaluated SARC-F factorial validity using principal components analysis and criterion validity by examining its association with exam-based indicators of sarcopenia. Construct validity was examined using cross-sectional and longitudinal differences among those with high (≥4) vs. low (<4) SARC-F scores for mortality and health outcomes.
Results
SARC-F exhibited good internal consistency reliability and factorial, criterion, and construct validity. AAH participants with SARC-F scores ≥ 4 had more Instrumental Activity of Daily Living (IADL) deficits, slower chair stand times, lower grip strength, lower short physical performance battery scores, and a higher likelihood of recent hospitalization and of having a gait speed of <0.8 m/s. SARC-F scores ≥ 4 in AAH also were associated with 6 year IADL deficits, slower chair stand times, lower short physical performance battery scores, having a gait speed of <0.8 m/s, being hospitalized recently, and mortality. SARC-F scores ≥ 4 in the BLSA cohort were associated with having more IADL deficits and lower grip strength (both hands) in cross-sectional comparisons and with IADL deficits, lower grip strength (both hands), and mortality at follow-up. NHANES participants with SARC-F scores ≥ 4 had slower 20 ft walk times, had lower peak force knee extensor strength, and were more likely to have been hospitalized recently in cross-sectional analyses.
Conclusions
The SARC-F proved internally consistent and valid for detecting persons at risk for adverse outcomes from sarcopenia in AAH, BLSA, and NHANES.
578 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: 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
"Sarcopenia, Dynapenia, and the Impa..." refers background or methods in this paper
...Sarcopenia, as described above by Baumgartner, was independently associated with use of a frame or walker, with falls, and, in both sexes, with physical disability even when adjusted for age, obesity, and comorbidities (Baumgartner et al., 1998)....
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...In a fashion analogous to the approach used to define underweight, overweight, and obese from BMI, sarcopenia was defined as relative muscle mass lower than two standard deviations below the mean of a large sex-specific reference population aged 18–40 years (Baumgartner et al., 1998)....
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...Sarcopenia was generally more prevalent in Hispanics than non-Hispanic whites (Baumgartner et al., 1998)....
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01 Jan 1994
TL;DR: There is little evidence that osteoporosis can usefully be tackled by a public health policy to influence risk factors such as smoking, exercise and nutrition, so the selective use of screening techniques will improve the cost-benefit ratio of intervention.
3,008 citations
"Sarcopenia, Dynapenia, and the Impa..." refers methods in this paper
...This approach was considered comparable to the use of bone mineral density of a young reference group in the classification of normal bone density, osteopenia, and osteoporosis (Kanis, 1994)....
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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
"Sarcopenia, Dynapenia, and the Impa..." refers background or methods in this paper
...According to the definition of Janssen et al. (2002) described above, in a study using a nationally representative cohort of Americans, 50% of men and 72% of women over 80 years were sarcopenic; with 7 and 11% suffering Class II sarcopenia....
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...Janssen’s definition of sarcopenia was also used to associate low muscle mass with functional impairment and disability (Janssen et al., 2002)....
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...Although men loose more muscle with aging, in absolute and relative terms, it seems that women suffer more from the consequences of lean tissue mass (Janssen et al., 2002), perhaps due to their lower starting mass and their greater longevity....
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...Class I sarcopenia was considered present when a subject’s SMI was between one and two standard deviations below the young adult values and class II sarcopenia was present in those subjects more than two standard deviations below the young adult reference (Janssen et al., 2002)....
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TL;DR: It is indicated that men have more SM than women and that these gender differences are greater in the upper body.
Abstract: We employed a whole body magnetic resonance imaging protocol to examine the influence of age, gender, body weight, and height on skeletal muscle (SM) mass and distribution in a large and heterogene...
2,361 citations