Osteoporosis International

, Volume 25, Issue 2, pp 589–596 | Cite as

Prevalence of sarcopenia and associated risk factors by two diagnostic criteria in community-dwelling older men: the São Paulo Ageing & Health Study (SPAH)

  • C. P. Figueiredo
  • D. S. Domiciano
  • J. B. Lopes
  • V. F. Caparbo
  • M. Scazufca
  • E. Bonfá
  • R. M. R. Pereira
Original Article



Sarcopenia is an aging syndrome that can be characterized by many criteria adjusted or not by fat mass. This study suggested that the optimal criteria should be selected according to body mass index (BMI) in older men and identified age, BMI, race, smoking, physical activity, hip bone mineral density (BMD) as risk factors for this syndrome.


This study aims to analyze the prevalence of sarcopenia and associated risk factors using appendicular skeletal mass (ASM)/height2 and ASM adjusted for total fat mass criteria in older men from community.


Three hundred ninety-nine men were included and answered a questionnaire about lifestyle and medical history. Individuals were classified by their BMI using the classification adjusted by age. Body composition and bone mineral density were measured by dual X-ray absorptiometry. Sarcopenia was classified according to both criteria. Logistic regression models were used to analyze risk factors associated with sarcopenia.


The mean BMI was 26.46 kg/m2: 12.5 % underweight, 43.6 % normal, and 43.9 % overweight/obese. Fifty-four (13.5 %) were considered sarcopenic by ASM/height2 and 79 (19.8 %) by ASM adjusted for fat (p = 0.001). Fifty-one (12.8 %) individuals had discordant sarcopenia classification: 13 were classified only by ASM/height2 and 38 only by ASM adjusted for fat. Of the 13 subjects classified as sarcopenic only by ASM/height2, 84.6 % (11/13) were underweight and solely one (7.7 %) was considered overweight/obese. In contrast, of those 38 older men classified as sarcopenic only by ASM adjusted for fat, none were underweight and 53 % (20/38) were overweight/obese. Subjects classified as sarcopenic according to both criteria had the same risk factors in the final model analyses (age, BMI, race, smoking, physical activity, hip BMD; p < 0.05).


This study suggested that the optimal criteria for sarcopenia should be selected according to BMI in community-dwelling older men.


BMI Body composition Older men Risk factors Sarcopenia 


  1. 1.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, European Working Group on Sarcopenia in Older People et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39:412–423PubMedCrossRefGoogle Scholar
  2. 2.
    Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH, Kritchevsky SB (2006) Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci 61(1):72–77PubMedCrossRefGoogle Scholar
  3. 3.
    Rantanen T, Harris T, Leveille SG, Visser M, Foley D, Masaki K et al (2000) Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. J Gerontol A Biol Sci Med Sci 55(3):M168–M173PubMedCrossRefGoogle Scholar
  4. 4.
    Gale CR, Martyn CN, Cooper C, Sayer AA (2007) Grip strength, body composition, and mortality. Int J Epidemiol 36(1):228–235PubMedCrossRefGoogle Scholar
  5. 5.
    Chumlea WMC, Cesari M, Evans WJ, Ferrucci L, Fielding RA, Pahor M (2011) Sarcopenia: designing phase IIb trials—International Working Group On Sarcopenia. J Nutr Health Aging 15(6):450–455PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR et al (1998) Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147:755–763PubMedCrossRefGoogle Scholar
  7. 7.
    Flegal KM, Carroll MD, Ogden CL, Johnson CL (2002) Prevalence and trends in obesity among US adults, 1999–2000. JAMA 288:1723–1727PubMedCrossRefGoogle Scholar
  8. 8.
    Mokdad AH, Bowman BA, Ford ES, Vinicor F, Marks JS, Koplan JP (2001) The continuing epidemics of obesity in the United States. JAMA 286:1195–1200PubMedCrossRefGoogle Scholar
  9. 9.
    Deurenberg P, Yap M (1999) The assessment of obesity: methods for measuring body fat and global prevalence of obesity. Baillieres Best Pract Res Clin Endocrinol Metab 13:1–11PubMedCrossRefGoogle Scholar
  10. 10.
    Gutiérrez-Fisac JL, López E, Banegas JR, Graciani A, Rodríguez-Artalejo F (2004) Prevalence of overweight and obesity in elderly people in Spain. Obes Res 12:710–715PubMedCrossRefGoogle Scholar
  11. 11.
    Newman AB, Kupelian V, Visser M, Simonsick E, Goodpaster B, Nevitt M, Health ABC Study Investigators et al (2003) Sarcopenia: alternative definitions and associations with lower extremity function. J Am Geriatr Soc 51:1602–1609PubMedCrossRefGoogle Scholar
  12. 12.
    Domiciano DS, Figueiredo CP, Lopes JB, Caparbo VF, Takayama L, Menezes PR et al (2013) Discriminating sarcopenia in community-dwelling older women with high frequency of overweight/obesity: the São Paulo Ageing & Health Study (SPAH). Osteoporos Int 24:595–603PubMedCrossRefGoogle Scholar
  13. 13.
    Lopes JB, Danilevicius CF, Takayama L, Caparbo VF, Scazufca M, Bonfá E et al (2009) Vitamin D insufficiency: a risk factor to vertebral fractures in community-dwelling elderly women. Maturitas 64:218–222PubMedCrossRefGoogle Scholar
  14. 14.
    World Health Organisation (1998) Obesity: preventing and managing the global epidemic. World Health Organisation, Geneva, Technical Report Series 894Google Scholar
  15. 15.
    Lopes JB, Danilevicius CF, Takayama L, Caparbo VF, Menezes PR, Scazufca M et al (2011) Prevalence and risk factors of radiographic vertebral fracture in Brazilian community-dwelling elderly. Osteopor Int 22(2):711–719CrossRefGoogle Scholar
  16. 16.
    Seeley DG, Browner WS, Nevitt MC, Genant HK, Scott JC, Cummings SR (1991) Which fractures are associated with low appendicular bone mass in elderly women? The Study of Osteoporotic Fractures Research Group. Ann Intern Med 115:837–842PubMedCrossRefGoogle Scholar
  17. 17.
    Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148PubMedCrossRefGoogle Scholar
  18. 18.
    Schwartz AV, Villa ML, Prill M, Kelsey JA, Galinus JA, Delay RR et al (1999) Falls in older Mexican-American women. J Am Geriatr Soc 47:1371–1378PubMedGoogle Scholar
  19. 19.
    Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Fitti JE, Kovar M (1997) The supplement on aging to the 1984 national health interview survey. Vital Health Stat 1:1–115Google Scholar
  21. 21.
    Angbratt M, Möller M (1999) Questionnaire about calcium intake: can we trust the answers? Osteoporos Int 9:220–225PubMedCrossRefGoogle Scholar
  22. 22.
    Fuchs SC, Guimarães SM, Sortica C, Wainberg F, Dias KO, Ughini M et al (2002) Reliability of race assessment based on the race of the ascendants: a cross-sectional study. BMC Publ Health 2:1–5CrossRefGoogle Scholar
  23. 23.
    Lipschitz DA (1994) Screening for nutritional status in the elderly. Prim Care 21:55–67PubMedGoogle Scholar
  24. 24.
    Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41PubMedCrossRefGoogle Scholar
  25. 25.
    Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP et al (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96:1911–1930PubMedCrossRefGoogle Scholar
  26. 26.
    Sheperd JA, Lu Y, Wilson K, Fuerst T, Genant H, Hangartner TN et al (2006) Cross-calibration and minimum precision standards for dual-energy x-ray absorptiometry: the 2005 ISCD official positions. J Clin Densitom 9:31–36CrossRefGoogle Scholar
  27. 27.
    Baumgartner RN (1999) Errata. Re: Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 149:1161Google Scholar
  28. 28.
    Lau EM, Lynn HS, Woo JW, Kwok TC, Melton LJ 3rd (2005) Prevalence of and risk factors for sarcopenia in elderly Chinese men and women. J Gerontol A Biol Sci Med Sci 60:213–216PubMedCrossRefGoogle Scholar
  29. 29.
    Kim TN, Yang SJ, Yoo HJ, Lim KI, Kang HJ, Song W et al (2009) Prevalence of sarcopenia and sarcopenic obesity in Korean adults: the Korean sarcopenic obesity study. Int J Obes (Lond) 33:885–892CrossRefGoogle Scholar
  30. 30.
    Castillo EM, Goodman-Gruen D, Kritz-Silverstein D, Morton DJ, Wingard DL, Barrett-Connor E (2003) Sarcopenia in elderly men and women: the Rancho Bernardo study. Am J Prev Med 25:226–231PubMedCrossRefGoogle Scholar
  31. 31.
    Iannuzzi-Sucich M, Prestwood KM, Kenny AM (2002) Prevalence of sarcopenia and predictors of skeletal muscle mass in healthy, older men and women. J Gerontol A Biol Sci Med Sci 57:M772–M777PubMedCrossRefGoogle Scholar
  32. 32.
    Landi F, Liperoti R, Fusco D, Mastropaolo S, Quattrociocchi D, Proia A et al (2012) Prevalence and risk factors of sarcopenia among nursing home older residents. J Gerontol A Biol Sci Med Sci 67(1):48–55PubMedCrossRefGoogle Scholar
  33. 33.
    Tieland M, Borgonjen-Van den Berg KJ, van Loon LJ, de Groot LC (2012) Dietary protein intake in community-dwelling, frail, and institutionalised elderly people: scope for improvement. Eur J Nutr 51(2):173–179PubMedCrossRefGoogle Scholar
  34. 34.
    Waters DL, Baumgartner RN (2011) Sarcopenia and obesity. Clin Geriatr Med 27:401–421PubMedCrossRefGoogle Scholar
  35. 35.
    Arterburn DE, Crane PK, Sullivan SD (2004) The coming epidemic of obesity in elderly Americans. J Am Geriatr Soc 52(11):1907–1912PubMedCrossRefGoogle Scholar
  36. 36.
    Berghofer A, Pischon T, Reinhold T, Apovian CM, Sharma AM, Willich SM (2008) Obesity prevalence from a European perspective: a systematic review. BMC Publ Health 8:200CrossRefGoogle Scholar
  37. 37.
    Ruiz-Arregui L, Castillo-Martinez L, Orea-Tejeda A, Mejía-Arango S, Miguel-Jaimes A (2007) Prevalence of self-reported overweight-obesity and its association with socioeconomic and health factors among older Mexican adults. Salud Publica Mex 49(Suppl 4):S482–S487PubMedCrossRefGoogle Scholar
  38. 38.
    Estrada M, Kleppinger A, Judge JO, Walsh SJ, Kuchel SA (2007) Functional impact of relative versus absolute sarcopenia in healthy older women. J Am Geriatr Soc 55(11):1712–1719PubMedCrossRefGoogle Scholar
  39. 39.
    Instituto Brasileiro de Geografia e Estatística (2011) Censo 2010: Brazil Available at http://www.ibge.gov.br/censo, Accessed 20 March 2011
  40. 40.
    Scazufca M, Menezes PR, Araya R, Di Rienzo VD, Almeida OP, Gunnell D, Sao Paulo Ageing & Health Study et al (2008) Risk factors across the life course and dementia in a Brazilian population: results from the São Paulo Ageing & Health Study (SPAH). Int J Epidemiol 37:879–890PubMedCrossRefGoogle Scholar
  41. 41.
    Sanada K, Miyachi M, Tanimoto M, Yamamoto K, Murakami H, Okumura S et al (2010) A cross-sectional study of sarcopenia in Japanese men and women: reference values and association with cardiovascular risk factors. Eur J Appl Physiol 110:57–65PubMedCrossRefGoogle Scholar
  42. 42.
    Lee JS, Auyeung TW, Kwok T, Lau EM, Leung PC, Woo J (2007) Associated factors and health impact of sarcopenia in older Chinese men and women: a cross-sectional study. Gerontology 53(6):404–410PubMedCrossRefGoogle Scholar
  43. 43.
    Janssen I, Heymsfield SB, Ross R (2002) Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 50:889–896PubMedCrossRefGoogle Scholar
  44. 44.
    Szulc P, Beck TJ, Marchand F, Delmas PD (2005) Low skeletal muscle mass is associated with poor structural parameters of bone and impaired balance in elderly men—the MINOS Study. J Bone Miner Res 20(5):721–729PubMedCrossRefGoogle Scholar
  45. 45.
    Visser M, Deeg DJ, Lips P, Harris TB, Bouter LM (2000) Skeletal muscle mass and muscle strength in relation to lower extremity performance in older men and women. J Am Geriatr Soc 48:381–386PubMedGoogle Scholar
  46. 46.
    Hunter GR, Byrne NM, Sirikul B, Fernández JR, Zuckerman PA, Darnell BE et al (2008) Resistance training conserves fat-free mass and resting energy expenditure following weight loss. Obesity 16(5):1045–1051PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • C. P. Figueiredo
    • 1
  • D. S. Domiciano
    • 1
  • J. B. Lopes
    • 1
  • V. F. Caparbo
    • 1
  • M. Scazufca
    • 2
  • E. Bonfá
    • 1
  • R. M. R. Pereira
    • 1
  1. 1.Bone Metabolism Laboratory, Rheumatology Division, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
  2. 2.Departament of Psychiatry, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil

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