Strength measures are better than muscle mass measures in predicting health-related outcomes in older people: time to abandon the term sarcopenia?
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There is no clear consensus on definition, cut-points or standardised assessments of sarcopenia. We found a lower limb strength assessment was at least as effective in predicting balance, mobility and falls in 419 older people as muscle mass-based measures of sarcopenia.
There is currently no consensus on the definition, cut-points or standardised assessments of sarcopenia. This study aimed to investigate whether several published definitions of sarcopenia differentiate between older people with respect to important functional and health outcomes.
Four hundred nineteen community-living older adults (mean age 81.2 ± 4.5, 49 % female) completed assessments of body composition (dual-energy X-ray absorptiometry), strength, balance, mobility and disability. Falls were recorded prospectively for a year using monthly calendars. Sarcopenia was defined according to four skeletal mass-based definitions, two strength-based definitions (handgrip or knee extensor force) and a consensus algorithm (low mass and low strength or slow gait speed). Obesity was defined according to percentage fat mass or waist circumference.
The four skeletal mass-based definitions varied considerably with respect to the percentage of participants classified as sarcopenic and their predictive accuracy for functional and health outcomes. The knee extension strength-based definition was equivalent to or better than the mass-based and consensus algorithm definitions; i.e. weaker participants performed poorly in tests of leaning balance, stepping reaction time, gait speed and mobility. They also had higher physiological fall risk scores and were 43 % more likely to fall at home than their stronger counterparts. Adding obesity to sarcopenia definitions identified participants with greater self-reported disability.
A simple lower limb strength assessment was at least as effective in predicting balance, functional mobility and falls in older people as more expensive and time-consuming muscle mass-based measures. These findings imply that functional terms such as muscle weakness or motor impairment are preferable to sarcopenia.
KeywordsAccidental falls Aged Balance Mobility Muscle strength Obesity Sarcopenia
We are grateful to the many people who assisted with this study, including Melissa Brodie and the cohort of participants who volunteered their time.
Compliance with ethical standards
The participants in this study were drawn from the Memory and Ageing Study of the Brain and Ageing Program, School of Psychiatry, UNSW, funded by a NHMRC Program Grant (No. 350833) to Professors P. Sachdev, H. Brodaty and G. Andrews. This study was partly funded by an Early career researcher grant from the Faculty of Medicine at the University of New South Wales awarded in 2010 to J. Menant.
Conflicts of interest
- 1.Rosenberg IH (1989) Summary comments. Am J Clin Nutr 50:1231–1233Google Scholar
- 8.Bouchard DR, Beliaeff S, Dionne IJ, Brochu M (2007) Fat mass but not fat-free mass is related to physical capacity in well-functioning older individuals: nutrition as a determinant of successful aging (NuAge)—the Quebec Longitudinal Study. J Gerontol A Biol Sci Med Sci 62:1382–1388CrossRefPubMedGoogle Scholar
- 15.da Silva Alexandre T, de Oliveira Duarte YA, Ferreira Santos JL, Wong R, Lebrao ML (2014) Sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) versus dynapenia as a risk factor for mortality in the elderly. J Nutr Health Aging 18:751–756. doi: 10.1007/s12603-014-0450-3 CrossRefGoogle Scholar
- 16.Batsis JA, Barre LK, Mackenzie TA, Pratt SI, Lopez-Jimenez F, Bartels SJ (2013) Variation in the prevalence of sarcopenia and sarcopenic obesity in older adults associated with different research definitions: dual-energy X-ray absorptiometry data from the National Health and Nutrition Examination Survey 1999–2004. J Am Geriatr Soc 61:974–980. doi: 10.1111/jgs.12260 CrossRefPubMedGoogle Scholar
- 17.Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39:412–423. doi: 10.1093/ageing/afq034 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Sachdev PS, Brodaty H, Reppermund S, Kochan NA, Trollor JN, Draper B et al (2010) The Sydney Memory and Ageing Study (MAS): methodology and baseline medical and neuropsychiatric characteristics of an elderly epidemiological non-demented cohort of Australians aged 70–90 years. Int Psychogeriatr 22:1248–1264. doi: 10.1017/S1041610210001067 CrossRefPubMedGoogle Scholar
- 25.Snijder MB, Visser M, Dekker JM, Seidell JC, Fuerst T, Tylavsky F et al (2002) The prediction of visceral fat by dual-energy X-ray absorptiometry in the elderly: a comparison with computed tomography and anthropometry. Int J Obes Relat Metab Disord 26:984–993. doi: 10.1038/sj.ijo.0801968 CrossRefPubMedGoogle Scholar
- 32.Schoene D, Wu SM, Mikolaizak AS, Menant JC, Smith ST, Delbaere K et al (2013) Discriminative ability and predictive validity of the timed up and go test in identifying older people who fall: systematic review and meta-analysis. J Am Geriatr Soc 61:202–208. doi: 10.1111/jgs.12106 CrossRefPubMedGoogle Scholar
- 34.Lamb SE, Jorstad-Stein EC, Hauer K, Becker C, Prevention of Falls Network E, Outcomes Consensus G (2005) Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. J Am Geriatr Soc 53:1618–1622. doi: 10.1111/j.1532-5415.2005.53455.x CrossRefPubMedGoogle Scholar
- 43.Carty CP, Barrett RS, Cronin NJ, Lichtwark GA, Mills PM (2012) Lower limb muscle weakness predicts use of a multiple-versus single-step strategy to recover from forward loss of balance in older adults. J Gerontol A Biol Sci Med Sci 67:1246–1252. doi: 10.1093/gerona/gls149 CrossRefPubMedGoogle Scholar
- 47.Cawthon PM, Fox KM, Gandra SR, Delmonico MJ, Chiou CF, Anthony MS et al (2009) Do muscle mass, muscle density, strength, and physical function similarly influence risk of hospitalization in older adults? J Am Geriatr Soc 57:1411–1419. doi: 10.1111/j.1532-5415.2009.02366.x CrossRefPubMedPubMedCentralGoogle Scholar
- 48.Lord SR, Sambrook PN, Gilbert C, Kelly PJ, Nguyen T, Webster IW et al (1994) Postural stability, falls and fractures in the elderly: results from the Dubbo Osteoporosis Epidemiology Study. Med J Aust 160(684–685):688–691Google Scholar