Development and Validation of a Nomogram for Predicting Sarcopenia in Community-Dwelling Older Adults

ObjectiveTo establish and validate a nomogram that predicts the risk of sarcopenia for community-dwelling older residents.DesignRetrospective study.Setting and ParticipantsA total of 1050 community-dwelling older adults.MethodsData from a survey of community-dwelling older residents (≥60 years old) in Hunan, China, from June to September 2019 were retrospectively analyzed. The survey included general demographic information, diet, and exercise habits. Sarcopenia diagnosis was according to 2019 Asian Working Group for Sarcopenia criteria. Participants were randomly divided into the development group and validation groups. Independent risk factors were screened by multivariate logistic regression analysis. Based on the independent risk factors, a nomogram model was developed to predict the risk of sarcopenia for community-dwelling older adults. Both in the development and validation sets, the discrimination, calibration, and clinical practicability of the nomogram were verified using receiver operating characteristic curve analysis, Hosmer-Lemeshow test, and decision curve analysis, respectively.ResultsSarcopenia was identified in 263 (25.0%) participants. Age, body mass index, marital status, regular physical activity habit, uninterrupted sedentary time, and dietary diversity score were significant contributors to sarcopenia risk. A nomogram for predicting sarcopenia in community-dwelling older adults was developed using these factors. Receiver operating characteristic curve analysis showed that the area under the curve was 0.827 (95% CI 0.792-0.860) and 0.755 (95% CI 0.680-0.837) in the development and validation sets, respectively. The Hosmer-Lemeshow test yielded P values of .609 and .565, respectively, for the 2 sets. The nomogram demonstrated a high net benefit in the clinical decision curve in both sets.Conclusions and ImplicationsThis study developed and validated a risk prediction nomogram for sarcopenia among community-dwelling older adults. Sarcopenia risk was classified as low (<11%), moderate (11%-70%), and high (>70%). This nomogram provides an accurate visual tool to medical staff, caregivers, and older adults for prediction, early intervention, and graded management of sarcopenia.     

Comparison of Three Screening Methods for Sarcopenia in Community-Dwelling Older Persons

ObjectiveThe 2019 Asian Working Group on Sarcopenia in Older People (AWGS 2019) recommends using either calf circumference or the strength, assistance in walking, rising from a chair, climbing stairs, and falls (SARC-F) or SARC-F combined with calf circumference (SARC-CalF) questionnaires for sarcopenia screening. The aim of this study was to compare the ability and applicability of calf circumference, SARC-F, and SARC-CalF for screening sarcopenia among community-dwelling older adults.DesignCross-sectional study.Setting and ParticipantsA total of 1050 community-dwelling older people were enrolled.MethodsSarcopenia was diagnosed according to the AWGS 2019 criteria: bioimpedance analysis for appendicular skeletal muscle index, hand grip, and 6-m gait speed test. Participants also completed the SARC-F questionnaire and calf circumference measurement. The screening tools’ performances were evaluated through receiver operating characteristic (ROC) curves, area under the ROC curves (AUC), and sensitivity/specificity analyses.ResultsSarcopenia was identified in 263 (25.0%) participants by the AWGS 2019 criteria. Calf circumference had a sensitivity of 81.4% and a specificity of 77.0%. Sensitivity and specificity of SARC-F for screening sarcopenia were 17.9% and 93.7%, respectively. SARC-CalF improved the sensitivity of SARC-F (47.5%) while keeping similar specificity (92.0%). The AUCs of calf circumference, SARC-F, and SARC-CalF were 0.79 [95% confidence interval (CI), 0.77–0.82], 0.56 (95% CI, 0.52–0.59), and 0.70 (95% CI, 0.67–0.73), respectively. The differences across ROC curves were statistically significant among 3 screening tools (P < .001).Conclusions and ImplicationsThe overall screening ability of calf circumference was better than that of SARC-F and SARC-CalF for sarcopenia in community-dwelling older persons despite gender, age, and cognitive function. SARC-F and SARC-CalF have high specificity but are susceptible to the preceding factors.     

Preserved Lower Limb Muscle Mass Prevents Insulin Resistance Development in Nondiabetic Older Adults

ObjectiveTo investigate roles of sarcopenia indexes in prediction of development of insulin resistance in nondiabetic older adults.DesignA 2-year follow-up cohort.Setting and participantsThe Tanno-Sobetsu study, a prospective observational cohort, included 194 community-dwelling nondiabetic older adults during 2017-2019.MethodsLower limb, upper limb, appendicular, and trunk muscle masses by a bioelectrical impedance analysis, grip strength, knee extension torque, and walking speed were measured in study participants aged ≥65 years (79 men and 115 women) at baseline. Muscle mass and strength were divided by the weight, and then multiplied by 100 to calculate the weight ratio (%). Insulin resistance was assessed by homeostasis model (HOMA-IR) at baseline, and the study participants whose HOMA-IR was less than 1.73 at baseline were followed for a maximum of 2 years. The study endpoint was development of insulin resistance defined as HOMA-IR ≥1.73. The adjusted hazard ratio (HR) of each sarcopenia component for development of insulin resistance was calculated.ResultsLower limb muscle mass (HR 0.88, 95% CI 0.79-0.98) and appendicular muscle mass (HR 0.89, 95% CI 0.81-0.99), but not other sarcopenia components, were associated with the development of insulin resistance, independently of sex and age, HOMA-IR, and waist circumference at baseline.Conclusions and ImplicationsThe loss of lower limb muscle mass is a significant risk factor for development of insulin resistance independently of obesity in nondiabetic older adults. The lower limb muscle mass may be a novel target of interventions for the prevention of diabetes in older adults.     

Development and Validation of a Nomogram to Predict Frailty Progression in Nonfrail Chinese Community-Living Older Adults

ObjectiveFrailty state progression is common among older adults, so it is necessary to identify predictors to implement individualized interventions. We aimed to develop and validate a nomogram to predict frailty progression in community-living older adults.DesignProspective cohort study.Setting and ParticipantsA total of 3170 Chinese community-living people aged ≥60 years were randomly assigned to a training set or validation set at a ratio of 6:4.MethodsCandidate predictors (demographic, lifestyle, and medical characteristics) were used to predict frailty state progression as measured with the Fried frailty phenotype at a 4-year follow-up, and multivariate logistic regression analysis was conducted to develop a nomogram, which was validated internally with 1000 bootstrap resamples and externally with the use of a validation set. The C index and calibration plot were used to assess discrimination and calibration of the nomogram, respectively.ResultsAfter a follow-up period of 4 years, 64.1% (917/1430) of the participants in the robust group and 26.0% (453/1740) in the prefrail group experienced frailty progression, which included 9.1% and 21.0%, respectively, who progressed to frailty. Predictors in the final nomogram were age, marital status, physical exercise, baseline frailty state, and diabetes. Based on this nomogram, an online calculator was also developed for easy use. The discriminative ability was good in the training set (C index = 0.861) and was validated using both the internal bootstrap method (C index = 0.861) and an external validation set (C index = 0.853). The calibration plots showed good agreement in both the training and validation sets.Conclusions and ImplicationsAn easy-to-use nomogram was developed with good apparent performance using 5 readily available variables to help physicians and public health practitioners to identify older adults at high risk for frailty progression and implement medical interventions.     

Sarcopenia in Korean Community-Dwelling Adults Aged 70 Years and Older: Application of Screening and Diagnostic Tools From the Asian Working Group for Sarcopenia 2019 Update

ObjectiveTo describe the prevalence of sarcopenia in a large group of community-dwelling older adults using the Asian Working Group for Sarcopenia (AWGS) 2019 definition and algorithm.DesignCross-sectional data analysis of a cohort study.SettingThe Nationwide Korean Frailty and Aging Cohort Study (KFACS).ParticipantsA total of 2123 ambulatory community-dwelling older adults, aged 70 to 84 years (mean, 75.9 ± 3.9 years; 49.5% women) were enrolled in the KFACS.MethodsAppendicular skeletal muscle mass was measured by dual-energy x-ray absorptiometry. Physical function was assessed by handgrip strength, usual gait speed, the 5-times-sit-to-stand test, the timed up-and-go test, and the Short Physical Performance Battery. In a case-finding assessment, screening for sarcopenia was performed using the calf circumference (CC), SARC-F questionnaire, and SARC-F combined with CC (SARC-CalF).ResultsAccording to the AWGS 2019 algorithm, 43.5%, 7.5%, and 26.0% of the subjects in the whole study sample were classified as those at risk for sarcopenia according to CC, SARC-F, and SARC-CalF, respectively. The prevalence rates of possible sarcopenia using 3 screening tools for case-finding and muscle strength or physical performance tests according to the AWGS 2019 diagnostic algorithm were 20.1% in men and 29.2% in women. The prevalence rates of sarcopenia, when defined as low muscle mass plus low handgrip strength and/or slow gait speed, were significantly higher according to the AWGS 2019 (21.3% in men and 13.8% in women) than the AWGS 2014 (10.3% in men and 8.1% in women) definitions. The prevalence of severe sarcopenia was 6.4% in men and 3.2% in women.Conclusions/ImplicationsThe results of our study suggest that the use of CC and SARC-CalF to screen for possible sarcopenia may be more suited than using the SARC-F questionnaire alone according to the AWGS 2019 diagnostic algorithm in community-dwelling adults aged 70 to 84 years. The prevalence of sarcopenia was significantly higher according to the AWGS 2019 than AWGS 2014 criteria.     

Effect of Sarcopenia Status on Disability Incidence Among Japanese Older Adults

ObjectivesThe updated definition of sarcopenia by the European Working Group on Sarcopenia in Older People (EWGSOP2) recommends both low muscle mass and quality to diagnose sarcopenia; concurrent poor physical performance is considered indicative of severe sarcopenia; however, the relationship between the revised definition and disability incidence among Japanese older adults is unclear. Therefore, we aimed to examine the associations between EWGSOP2-defined sarcopenia and disability incidence among community-dwelling older Japanese adults.DesignNationwide study.Setting and participantsWe included 4561 individuals aged ≥65 years and enrolled in the National Center for Geriatrics and Gerontology–Study of Geriatric Syndromes (NCGG-SGS).MethodsSkeletal muscle mass was assessed using a bioimpedance analysis device; handgrip strength and walking speed were measured as physical performance indicators. We used the Asian Working Group for Sarcopenia cutoffs to define low muscle mass and poor physical performance. We stratified all participants into nonsarcopenia, sarcopenia, and severe sarcopenia groups. Disability incidence was prospectively determined over 49 months using data extracted from the Japanese long-term care insurance system.ResultsThe prevalence of sarcopenia and severe sarcopenia was 3.4% and 1.7%, respectively. Participants with any form of sarcopenia were at a higher risk of disability [hazard ratio (HR) 1.78, 95% confidence interval (CI) 1.27-2.49]. Although participants with severe sarcopenia showed a higher risk of disability (HR 2.00, 95% CI 1.32-3.02), there was no significant disability risk in the sarcopenia group (HR 1.54, 95% CI 0.97-2.46). Grip strength (HR 0.96, 95% CI 0.94-0.98) and walking speed (HR 0.19, 95% CI 0.12-0.30) negatively correlated with disability incidence.Conclusions and implicationsSevere sarcopenia, involving low muscle mass and poor physical performance, might increase disability risk in older adults, as opposed to low muscle mass alone. Further studies are needed to determine whether sarcopenia without poor physical performance increases disability risk.     

High Prevalence of Probable Sarcopenia in a Representative Sample From Colombia: Implications for Geriatrics in Latin America

ObjectivesThe European Working Group on Sarcopenia in Older People 2 (EWGSOP2) recently defined the new concept of probable sarcopenia to help improve screening and prevent future sarcopenia. We investigated the prevalence of probable sarcopenia, defined as weak grip strength, in community-dwelling older Colombian adults, and examined the long-term associated conditions.DesignCross-sectional study.SettingUrban and rural Colombian older adults from the “Estudio Nacional de Salud, Bienestar y Envejecimiento (SABE) study”.Participants5237 Colombian older adults aged ≥60 years.MeasurementsProbable sarcopenia was assessed following the cut-off points for weak grip strength recommended by EWGSOP2 guidelines. Odds ratios (ORs) of the relationship between long-term conditions and probable sarcopenia were determined using logistic regression.ResultsThe prevalence of probable sarcopenia defined as weak grip strength was 46.5% [95% confidence interval (CI), 45.1-47.8]. Physical inactivity “proxy” (OR 1.35, 95% CI 1.14-1.59); diabetes (OR 1.32, 95% CI 1.11-1.56); and arthritis, osteoarthritis, and rheumatism (OR 1.44, 95% CI 1.25-1.67) were independently associated with probable sarcopenia.Conclusions and ImplicationsWe found that almost half of all the Colombian older adults in our sample had probable sarcopenia. Individuals with physical inactivity, diabetes, arthritis, or osteoarthritis and rheumatism had a higher prevalence of probable sarcopenia. Probable sarcopenia is clinically highly relevant, and several of the factors associated with this condition are potentially preventable, treatable, and reversible.     

Relationship between Diabetes Status and Sarcopenia in Community-Dwelling Older Adults

ObjectivesDiabetes mellitus (DM) is associated with risk of sarcopenia. However, whether glycated hemoglobin (HbA1c) levels are associated with sarcopenia has not reached a consensus. The purpose of this study was to examine the association between diabetes status based on HbA1c levels and sarcopenia indices in community-dwelling older adults stratified by body mass index (BMI) status.DesignAn observational cross-sectional study.Setting and ParticipantsGeneral community setting. The participants were 18,940 community-dwelling older adults (mean age 73.7 ± 5.7 years, 45.0% men).MethodsAccording to their medical history for diabetes mellitus and blood HbA1c levels the participants were classified into the control group (no DM history and HbA1c ≤5.6%), pre-DM group (no DM history and HbA1c 5.7%–6.4%), or DM group (DM history or HbA1c ≥6.5%). For assessments of sarcopenia, muscle mass and muscle strength were measured based on the clinical definition.ResultsA multiple logistic regression analysis showed that the DM group did not have a clear association with sarcopenia [odds ratio (OR) 1.06, 95% confidence interval (CI) 0.82–1.38] or low muscle mass (OR 1.15, 95% CI 0.94–1.39), and was associated with low muscle strength (OR 1.21, 95% CI 1.08–1.36) in the adjusted model including BMI. There was a positive correlation between BMI and skeletal muscle index (r = 0.57, P < .001). Stratified by BMI, the DM group was associated with low muscle mass among the underweight participants (OR 1.87, 95% CI 1.03–3.39), and low muscle strength among the overweight participants (OR 1.22, 95% CI 1.04–1.43).Conclusions and ImplicationsDiabetes status was associated with low muscle mass and low muscle strength, and the association depended on BMI. Our findings could be helpful for identifying older adults with a high risk of sarcopenia, although further study is needed.     

Sarcopenic Obesity and Risk of Disability in Community-Dwelling Japanese Older Adults: A 5-Year Longitudinal Study

ObjectivesPrevious studies have indicated that sarcopenic obesity is a risk factor for disability onset. However, these studies had disparities in terms of criteria for sarcopenia, study design, or study population. No longitudinal study has investigated the effect of sarcopenic obesity on disability onset in an Asian population using the Asian Working Group for Sarcopenia 2019 criteria for sarcopenia definition. Herein, we aimed to investigate the longitudinal effect of sarcopenic obesity on disability onset in Japanese older adults and extend the generalizability of results to other populations.DesignLongitudinal cohort study.Setting and ParticipantsA total of 4197 Japanese older adults (mean age 74.6 ± 5.0 years, 54.2% women) formed our study population.MeasurementsSarcopenia was identified using the Asian Working Group for Sarcopenia 2019 algorithm. Obesity was determined when body fat percentage was ≥25%, or when visceral fat content was ≥100 cm² for either sex. Disability onset was defined as a new case of long-term care insurance system certification for 5 years from baseline. Missing values were managed with multi-imputation. Cox proportional hazard regression analysis was used with disability onset as dependent variable and group (nonsarcopenia/nonobesity as a reference, nonsarcopenia/obesity, sarcopenia/non-obesity, possible sarcopenia/obesity, possible sarcopenia/non-obesity, sarcopenic obesity) as explanatory variable, and was adjusted for potential confounding factors.ResultsWhen the nonsarcopenia/nonobesity group was used as the reference category, other groups such as possible-sarcopenia/nonobesity [hazard ratio (HR) 1.38, 95% confidential interval (95% CI) 1.29‒1.47, P < .028], possible-sarcopenia/obesity (HR 1.54, 95% CI 1.46‒1.62 P < .001), sarcopenia/nonobesity (HR 2.09, 95% CI 1.96‒2.23, P < .001), and sarcopenic obesity (HR 2.48, 95% CI 2.24‒2.75, P < .001) showed significantly increased HRs.Conclusions and ImplicationsThe risk of disability onset because of sarcopenic obesity was exceedingly higher compared with sarcopenia alone among community-dwelling older adults in Japan The health providers should consider assessing the co-existence of sarcopenia and obesity to screen for the risk of disability onset in the community-dwelling population.     

Combinations of Sarcopenia Diagnostic Criteria by Asian Working Group of Sarcopenia (AWGS) 2019 Guideline and Incident Adverse Health Outcomes in Community-Dwelling Older Adults

ObjectivesThis study aimed to investigate the association between combinations of sarcopenia criteria by the Asian Working Group of Sarcopenia (AWGS) 2019 guideline and incident adverse health outcomes.DesignLongitudinal analyses of a cohort study.Setting and ParticipantsWe conducted prospective 2-year follow-up analyses (N = 1959) among community-dwelling older adults enrolled in the nationwide Korean Frailty and Aging Cohort Study (KFACS).MethodsFrom the KFACS, 1959 older adults (52.8% women; mean age = 75.9 ± 3.9 years) who underwent assessments for appendicular skeletal mass using dual-energy X-ray absorptiometry, handgrip strength, usual gait speed, 5-times sit-to-stand test, and Short Physical Performance Battery (SPPB) at baseline were included. Participants with each adverse health outcome [mobility disability, falls, and instrumental activities of daily living (IADL) disabilities] at baseline were excluded for each corresponding analysis. Multivariable logistic regression was performed to examine whether sarcopenia defined by different diagnostic criteria was associated with incident adverse health outcomes after 2 years.ResultsA total of 444 participants (22.7%) were diagnosed with sarcopenia as defined by AWGS 2019. In the multivariable analysis, sarcopenia defined as both low muscle mass and low physical performance increased the risk of mobility disability (OR 2.14, 95% CI 1.35-3.38) and falls (1.74, 95% CI 1.21-2.49). Only the criterion defined as both low muscle mass and physical performance using the SPPB increased the risk of falls with fracture (2.53, 95% CI 1.01-6.35) and IADL disabilities (2.77, 95% CI 1.21-6.33). However, sarcopenia defined as both low muscle mass and low hand grip strength showed no associations with the incidence of any of the adverse health outcomes.Conclusions and ImplicationsOur study suggests that the predictive value of adverse health outcomes for community-dwelling older adults is better when diagnosed with sarcopenia based on low muscle mass and physical performance. Furthermore, using the SPPB as a diagnostic tool for low physical performance may improve the predictive validity for falls with fracture and IADL disability. Our findings may be helpful for the early detection of individuals with sarcopenia who have a higher risk of adverse health outcomes.     

Cognitive Impairment Predicts Sarcopenia 9 Years Later among Older Adults

ObjectiveTo assess the longitudinal association between cognitive impairment and sarcopenia in a sample of Brazilian community-dwelling older adults.DesignNine-year observational prospective study.Setting and ParticipantsA total of 521 community-dwelling older adults from 2 Brazilian sites of the Frailty in Brazilian Older Adults (FIBRA in Portuguese) study.MethodsSarcopenia was defined as low hand-grip strength and low muscle mass. Cognitive impairment was determined at baseline using the Mini-Mental State Examination, with education-adjusted cutoff scores. The logistic regression model was used to assess the association between cognitive impairment and incident sarcopenia after adjusting for gender, age, education, morbidities, physical activity, and body mass index. Inverse probability weighting was applied to correct for sample loss at follow-up.ResultsThe mean age of the study population was 72.7 (±5.6) years, and 365 were women (70.1%). Being 80 years and older [odds ratio (OR), 4.62; 95% CI, 1.38–15.48; P = .013], being under- and overweight (OR, 0.29; 95% CI, 0.11–0.76; P = .012, and OR, 5.12; 95% CI, 2.18–12.01; P < .001, respectively) and having cognitive impairment (OR, 2.44; 95% CI, 1.18–5.04; P = .016) at baseline predicted sarcopenia after 9 years.Conclusion and ImplicationsCognitive impairment may predict sarcopenia in Brazilian older adults. More studies are necessary to identify the main mechanisms shared by sarcopenia and cognitive decline, which could support the development of prevention interventions.     

Osteosarcopenia Predicts Falls,Fractures, and Mortality in Chilean Community-Dwelling Older Adults

ObjectivesThe objective of this study was to describe the prevalence of osteosarcopenia and its association with falls, fractures, and mortality in community-dwelling older adults.DesignFollow-up of ALEXANDROS cohorts designed to study disability associated with obesity in older adults.Setting and ParticipantsCommunity-dwelling people aged 60 years and older living in Chile.MeasuresAt baseline, 1119 of 2372 participants had a dual-energy X-ray absorptiometry scan and the measurements for the diagnosis of sarcopenia. World Health Organization standards for bone mineral density were used to classify them as normal, osteopenia, and osteoporosis. Sarcopenia was identified using the algorithm from the European Working Group on Sarcopenia in Older People 1, validated for the Chilean population.Osteosarcopenia was defined as having sarcopenia plus osteoporosis or osteopenia.ResultsThe sample of 1119 participants (68.5% female) had a mean age of 72 years. At baseline, osteoporosis was identified in 23.2%, osteopenia in 49.8%, sarcopenia in 19.5%, and osteosarcopenia in 16.4% of the sample. The prevalence of osteosarcopenia increases with age, reaching 33.7% for those older than 80 years. Sarcopenia was found in 34.4% of osteoporotic people and osteoporosis in 40.8% of those with sarcopenia. After 5640 person-years of follow-up, 86 people died. The mortality was significantly higher for the group with osteosarcopenia (15.9%) compared with those without the condition (6.1%). After an adjusted Cox Regression analysis, the hazard ratio for death in people with osteosarcopenia was 2.48. Falls, fractures, and functional impairment were significantly more frequent in osteosarcopenic patients.Conclusions and ImplicationsOsteosarcopenia is a common condition among older adults and is associated with an increased risk of falls, fractures, functional impairment, and mortality. Considering the high proportion of sarcopenia among osteoporotic patients and vice versa, screening for the second condition when the first is suspected should be advised.     

Prevalence of Sarcopenia in Community-Dwelling Japanese Older Adults

Background

Sarcopenia, the age-dependent loss of skeletal muscle mass, is highly prevalent among older adults in many countries; however, the prevalence of sarcopenia in healthy Japanese community-dwelling older adults is not well characterized.

Objective

The aim of this study was to evaluate the prevalence of sarcopenia and to examine the association of sarcopenia with falls and fear of falling in community-dwelling Japanese older adults.

Design

This is a cross-sectional study.

Setting and Subjects

Healthy men (568) and women (1314) aged 65 to 89 years participated in this research.

Measurements

For all participants, 3 measurements were taken: skeletal muscle mass measurement using bioelectrical impedance, 10 m at a usual walking speed, and handgrip strength. Sarcopenia was defined as the presence of both poor muscle function (low physical performance or low muscle strength) and low muscle mass.

Results

The prevalence of sarcopenia, determined using the European Working Group on Sarcopenia in Older People–suggested algorithm, in men and women aged 65 to 89 years was 21.8% and 22.1%, respectively. The prevalence of sarcopenia increased age-dependently, especially in those older than 75 years in both genders. In the young old, the prevalence of sarcopenia was higher in women than in men; however, in those older than 85 years, the prevalence of sarcopenia was lower in women than in men (P < .05). In addition, fall incidents and fear of falling were more prevalent in sarcopenic older adults than in nonsarcopenic older adults (P < .05).

Conclusions

These results suggest that sarcopenia is highly prevalent in community-dwelling Japanese older adults and is related to falls and fear of falling.     

German Version of SARC-F: Translation,Adaption, and Validation

ObjectivesTranslation, adaptation, and validation of the German version of the SARC-F for community-dwelling older adults in Germany.DesignCross-sectional.Setting and Participants117 community-dwelling outpatients with a mean age of 79.1 ± 5.2 years were included in the study; 94 (80.4%) of them were female. Sixty-three (53.8%) had a positive SARC-F score of ≥4 points. According to the definition of sarcopenia from the European Working Group on Sarcopenia in Older People (EWGSOP2), 8 patients (6.8%) were identified as sarcopenic and 57 (48.7%) as probable sarcopenic.MethodsAccording to EWGSOP2, probable sarcopenia was defined for patients with reduced hand grip strength (women: <16.0 kg; men: <27.0 kg) and/or impaired chair-rise time (both genders: >15 seconds). Patients with additional low skeletal muscle index were classified as sarcopenic (women: <5.5 kg/m²; men: <7.0 kg/m²). Translation and cultural adaption was composed of 7 different steps that were in general based on the guidelines put forward by the World Health Organization. Validation include test-retest and the inter-rater reliability (intraclass correlation coefficient) as well as internal consistency (Cronbach alpha). Furthermore, sensitivity, specificity, positive predictive value, and negative predictive value of the SARC-F were calculated. Receiver-operating characteristic analysis was performed to calculate the area under the curve.ResultsThe translated and culturally adapted version of the SARC-F for the German language has shown excellent inter-rater reliability and good test-retest reliability. The internal consistency is acceptable. Sensitivity (63%) and specificity (47%) for sarcopenia is low. For detecting patients with probable sarcopenia, the SARC-F in the German version has shown 75% sensitivity and 67% specificity.Conclusions and ImplicationsBecause of a low sensitivity for detecting sarcopenia but an acceptable sensitivity for identifying probable sarcopenia, the German version of the SARC-F is a suitable tool for case finding of probable sarcopenia.     

Development and Validation of a Nomogram for Predicting the 6-Year Risk of Cognitive Impairment Among Chinese Older Adults

ObjectiveAlthough some people with mild cognitive impairment may not suffer from dementia lifelong, about 5% of them will progress to dementia within 1 year in community settings. However, a general tool for predicting the risk of cognitive impairment was not adequately studied among older adults.DesignProspective cohort study.SettingCommunity-living, older adults from 22 provinces in China.ParticipantsWe included 10,066 older adults aged 65 years and above (mean age, 83.2 ± 11.1 years), with normal cognition at baseline in the 2002–2008 cohort and 9354 older adults (mean age, 83.5 ± 10.8 years) in the 2008–2014 cohort of the Chinese Longitudinal Healthy Longevity Survey.MethodsWe measured cognitive function using the Chinese version of the Mini-Mental State Examination. Demographic, medical, and lifestyle information was used to develop the nomogram via a Lasso selection procedure using a Cox proportional hazards regression model. We validated the nomogram internally with 2000 bootstrap resamples and externally in a later cohort. The predictive accuracy and discriminative ability of the nomogram were measured by area-under-the-curves and calibration curves, respectively.ResultsEight factors were identified with which to construct the nomogram: age, baseline of the Mini-Mental State Examination, activities of daily living and instrumental activities of daily living score, chewing ability, visual function, history of stroke, watching TV or listening to the radio, and growing flowers or raising pets. The area-under-the-curves for internal and external validation were 0.891 and 0.867, respectively, for predicting incident cognitive impairment. The calibration curves showed good consistency between nomogram-based predictions and observations.Conclusions and ImplicationsThe nomogram-based prediction yielded consistent results in 2 separate large cohorts. This feasible prognostic nomogram constructed using readily ascertained information may assist public health practitioners or physicians to provide preventive interventions of cognitive impairment.     

Incremental Predictive Value of Sarcopenia for Incident Fracture in an Elderly Chinese Cohort: Results From the Osteoporotic Fractures in Men (MrOs) Study

ObjectivesWe examined whether sarcopenia is predictive of incident fractures among older men, whether the inclusion of sarcopenia in models adds any incremental value to bone mineral density (BMD), and whether sarcopenia is associated with a higher risk of fractures in elderly with osteoporosis.MethodsA cohort of 2000 community-dwelling men aged ≥65 years were examined for which detailed information regarding demographics, socioeconomic, medical history, clinical, and lifestyle factors were documented. Body composition and BMD were measured using dual energy X-ray absorptiometry. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) algorithm. Incident fractures were documented during the follow-up period from 2001 to 2013, and related to sarcopenia and its component measures using Cox proportional hazard regressions. The contribution of sarcopenia for predicting fracture risk was evaluated by receiver operating characteristic analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).ResultsDuring an average of 11.3 years of follow-up, 226 (11.3%) men sustained at least 1 incident fracture, making the incidence of fractures 1200.6/100,000 person-years. After multivariate adjustments, sarcopenia was associated with increased fracture risk (hazard ratio [HR], 1.87, 95% confidence interval [CI], 1.26–2.79) independent of BMD and other clinical risk factors. The addition of sarcopenia did not significantly increase area under curve or IDI but significantly improved the predictive ability on fracture risk over BMD and other clinical risk factors by 5.12% (P < .05) using the NRI approach. In addition, the combination of osteoporosis and sarcopenia (sarco-osteoporosis) resulted in a significantly increased risk of fractures (HR, 3.49, 95% CI, 1.76–6.90) compared with those with normal BMD and without sarcopenia.ConclusionsThis study confirms that sarcopenia is a predictor of fracture risk in this elderly men cohort, establishes that sarcopenia provides incremental predictive value for fractures over the integration of BMD and other clinical risk factors, and suggests that the combination of osteoporosis and sarcopenia could identify a subgroup with a particularly high fracture risk.     

Minerals and Sarcopenia in Older Adults: An Updated Systematic Review

ObjectiveThis systematic review aims to reevaluate the role of minerals on muscle mass, muscle strength, physical performance, and the prevalence of sarcopenia in community-dwelling and institutionalized older adults.DesignSystematic review.Setting and ParticipantsIn March 2022, a systematic search was performed in PubMed, Scopus, and Web of Sciences using predefined search terms. Original studies on dietary mineral intake or mineral serum blood concentrations on muscle mass, muscle strength, and physical performance or the prevalence of sarcopenia in older adults (average age ≥65 years) were included.MethodsEligibility screening and data extraction was performed by 2 independent reviewers. Quality assessment was performed with the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. Risk of bias was evaluated using the Risk Of Bias In Non-randomized Studies-of Exposure (ROBINS-E) tool.ResultsFrom the 15,622 identified articles, a total of 45 studies were included in the review, mainly being cross-sectional and observational studies. Moderate quality of evidence showed that selenium (n = 8) and magnesium (n = 7) were significantly associated with muscle mass, strength, and physical performance as well as the prevalence of sarcopenia. For calcium and zinc, no association could be found. For potassium, iron, sodium, and phosphorus, the association with sarcopenic outcomes remains unclear as not enough studies could be included or were nonconclusive (low quality of evidence).Conclusions and ImplicationsThis systematic review shows a potential role for selenium and magnesium on the prevention and treatment of sarcopenia in older adults. More randomized controlled trials are warranted to determine the impact of minerals on sarcopenia in older adults.     

Sleep Duration and Sarcopenia: An Updated Systematic Review and Meta-Analysis

ObjectivesIn adults, short and long sleep duration has been associated with sarcopenia risk. Studies have shown that various factors, including biological and psychological factors, could be the underlying cause of the association between aberrant sleep duration and sarcopenia risk. In this study, we have qualitatively and quantitatively summarized previously published studies on sleep duration to assess the relationship between sleep duration and sarcopenia risk in adults. This would aid in enhancing our understanding of recent advancements in this field and the association between sleep duration and sarcopenia risk.DesignSystematic review and meta-analysis.Setting and ParticipantsIn this review, we included studies evaluating the association between the duration of sleep and sarcopenia in adults in observational studies.MethodsFive electronic databases (PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Web of Science) were searched to April 20, 2023, to identify studies related to sarcopenia and sleep duration. Next, we calculated the odds ratios (ORs) for sarcopenia prevalence based on the adjusted data from individual studies. Statistical analyses were performed using Stata 11.0.ResultsSarcopenia prevalence was high (18%) in adults with long sleep duration. Our results showed a significant association between short duration of sleep and high sarcopenia prevalence in older adults (OR 1.2, 95% CI 1.02-1.41, I² = 56.6%). Furthermore, a significant association was observed between all participants with long-duration sleep and high sarcopenia prevalence (OR 1.53, 95% CI 1.34-1.75, I² = 56.8%). We also observed significant heterogeneity in the adjusted ORs.Conclusions and ImplicationsThere was a correlation between sarcopenia and short or long sleep duration, especially in older adults. In adults with a long duration of sleep, sarcopenia prevalence was relatively high.     

Prevalence and Mortality of Sarcopenia in a Community-dwelling Older Japanese Population: The Hisayama Study

BackgroundThe prevalence of sarcopenia defined using the Asian Working Group for Sarcopenia (AWGS) criteria in Asian communities has not been fully addressed. Moreover, few studies have addressed the influence of sarcopenia on mortality.MethodsA total of 1,371 and 1,597 residents aged 65 years or older participated in health surveys in 2012 and 2017. Sarcopenia was determined using the AWGS definition. Factors associated with the presence of sarcopenia were assessed using a logistic regression model in participants in the 2012 survey. Subjects in the 2012 survey were followed-up prospectively for a median of 4.3 years. Mortality risk for subjects with sarcopenia was examined using the Cox proportional hazards model.ResultsThe crude prevalence of sarcopenia was 7.4% and 6.6% in participants at the 2012 and 2017 surveys, respectively; there was no significant difference between surveys (P = 0.44). The prevalence of sarcopenia increased significantly with age in both sexes (both P for trend <0.001). Subjects with sarcopenia were more likely to exercise less regularly, to intake less total energy, and to exhibit a disability in activity of daily living than those without. The multivariable-adjusted hazard ratio for all-cause mortality was 2.20 (95% confidence interval, 1.25–3.85) in subjects with sarcopenia, compared to those without.ConclusionsApproximately 7% of older subjects had sarcopenia in a community-dwelling older Japanese population. Moreover, subjects with sarcopenia had an increased mortality risk. Our findings suggest that a public health strategy for sarcopenia is needed to extend healthy life expectancy.Key words: sarcopenia, Asian Working Group for Sarcopenia, prevalence, mortality     

Screening for malnutrition in community dwelling older Japanese: Preliminary development and evaluation of the Japanese Nutritional Risk Screening Tool (NRST)

Background

Early and effective screening for age-related malnutrition is an essential part of providing optimal nutritional care to older populations.

Objective

This study was performed to evaluate the adaptation of the original SCREEN II questionnaire (Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II) for use in Japan by examining its measurement properties and ability to predict nutritional risk and sarcopenia in community-dwelling older Japanese people. The ultimate objective of this preliminary validation study is to develop a license granted full Japanese version of the SCREEN II.

Participants

The measurement properties and predictive validity of the NRST were examined in this cross-sectional study of 1921 community-dwelling older Japanese people.

Measurements

Assessments included medical history, and anthropometric and serum albumin measurements. Questions on dietary habits that corresponded to the original SCREEN II were applied to Nutritional Risk Screening Tool (NRST) scoring system. Nutritional risk was assessed by the Geriatric Nutrition Risk Index (GNRI) and the short form of the Mini-Nutritional Assessment (MNA-SF). Sarcopenia was diagnosed according to the criteria of the European Working Group on Sarcopenia in Older People.

Results

The nutritional risk prevalences determined by the GNRI and MNA-SF were 5.6% and 34.7%, respectively. The prevalence of sarcopenia was 13.3%. Mean NRST scores were significantly lower in the nutritionally at-risk than in the well-nourished groups. Concurrent validity analysis showed significant correlations between NRST scores and both nutritional risk parameters (GNRI or MNA-SF) and sarcopenia. The areas under the receiver operating characteristic curves (AUC) of NRST for the prediction of nutritional risk were 0.635 and 0.584 as assessed by GNRI and MNA-SF, respectively. AUCs for the prediction of sarcopenia were 0.602 (NRST), 0.655 (age-integrated NRST), and 0.676 (age and BMI-integrated NRST).

Conclusions

These results indicate that the NRST is a promising screening tool for the prediction of malnutrition and sarcopenia in community-dwelling older Japanese people. Further development of a full Japanese version of the SCREEN II is indicated.