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Long-Term Mortality Risk in Older Adults with Sarcopenia: An 11-Year Prospective Cohort Study Comparing AWGS 2014 and AWGS 2019 Guidelines for Enhanced Clinical Utility and Accurate Risk Prediction

  • Original Research
  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

To discern the diagnostic accuracy between the updated diagnostic consensus of the Asian Working Group for Sarcopenia (AWGS) in 2019 (AWGS 2019) and the previous AWGS 2014 guidelines.

Design

A prospective population-based cohort study.

Setting and Participants

The study included 731 older community-dwelling adults aged ≥ 65 years who participated in face-to-face interviews and were followed up for 11-year mortality until 31 Mar 2022.

Measurements

We utilized a handgrip strength dynamometer to measure participants’ muscle strength, while their walking speed was determined by a timed 6-meter walk test at their usual pace. Additionally, muscle mass was measured using dual-energy X-ray absorptiometry scanning. Sarcopenia was defined as the presence of low muscle mass in combination with weakness and/or slowness both by AWGS 2014 and 2019 criteria.

Results

The present study followed 731 participants (mean age 73.4 ± 5.4 years, men predominant 52.8%) over a period of 11 years, yielding 5927 person-years and 159 deaths. Prevalence of sarcopenia defined by AWGS 2019 and 2014 criteria were 8.5% and 6.8%, respectively. Sarcopenia defined by AWGS 2019 (HR 1.62, 95% CI 1.04–2.54, p=0.034) but not AWGS 2014 was significantly associated with mortality in community-living older adults after adjusting for potential confounders such as age, sex, education, drinking, disease burden and serum level of testosterone. The study also found that the AWGS 2019 criteria had a better model fitness than AWGS 2014 criteria in predicting mortality.

Conclusion

AWGS 2019 criteria outperformed AWGS 2014 in identifying sarcopenia risk and predicting mortality. Screening for sarcopenia in older adults may improve health outcomes by identifying those at increased mortality risk.

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References

  1. Cruz-Jentoft AJ, Sayer AA. Sarcopenia. Lancet. 2019;393:2636–46. Epub 2019/06/07. doi: https://doi.org/10.1016/S0140-6736(19)31138-9. PubMed PMID: 31171417.

    Article  PubMed  Google Scholar 

  2. Borges RC, Correa DI, Correa LJS, Colombo AS, Carvalho CRF. Prevalence and Factors Associated with Sarcopenia in Hospitalized Elderly Patients. Aging Med Healthc. 2022;13:49–50.

    Article  Google Scholar 

  3. Liu LK, Lee WJ, Chen LY, Hwang AC, Lin MH, Peng LN, et al. Sarcopenia, and its association with cardiometabolic and functional characteristics in Taiwan: results from I-Lan Longitudinal Aging Study. Geriatr Gerontol Int. 2014;14 Suppl 1:36–45. Epub 2014/01/24. doi: https://doi.org/10.1111/ggi.12208. PubMed PMID: 24450559.

    Article  PubMed  Google Scholar 

  4. Peng LN, Yu PC, Hsu CC, Tseng SH, Lee WJ, Lin MH, et al. Sarcojoint(R), the branched-chain amino acid-based supplement, plus resistance exercise improved muscle mass in adults aged 50 years and older: A double-blinded randomized controlled trial. Exp Gerontol. 2022;157:111644. Epub 2021/11/29. doi: https://doi.org/10.1016/j.exger.2021.111644. PubMed PMID: 34838980.

    Article  CAS  PubMed  Google Scholar 

  5. Petermann-Rocha F, Balntzi V, Gray SR, Lara J, Ho FK, Pell JP, et al. Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2022;13:86–99. Epub 2021/11/25. doi: https://doi.org/10.1002/jcsm.12783. PubMed PMID: 34816624; PubMed Central PMCID: PMCPMC8818604.

    Article  PubMed  Google Scholar 

  6. Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15:95–101. Epub 2014/01/28. doi: https://doi.org/10.1016/j.jamda.2013.11.025. PubMed PMID: 24461239.

    Article  PubMed  Google Scholar 

  7. Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020;21:300–7e2. Epub 2020/02/09. doi: https://doi.org/10.1016/j.jamda.2019.12.012. PubMed PMID: 32033882.

    Article  PubMed  Google Scholar 

  8. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370:1453–7. Epub 2007/12/08. doi: https://doi.org/10.1016/S0140-6736(07)61602-X. PubMed PMID: 18064739.

    Article  PubMed  Google Scholar 

  9. Lee WJ, Peng LN, Lin MH, Loh CH, Hsiao FY, Chen LK. Intrinsic capacity differs from functional ability in predicting 10-year mortality and biological features in healthy aging: results from the I-Lan longitudinal aging study. Aging (Albany NY). 2023;15. Epub 2023/02/08. doi: https://doi.org/10.18632/aging.204508. PubMed PMID: 36750172.

  10. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83. Epub 1987/01/01. doi: https://doi.org/10.1016/0021-9681(87)90171-8. PubMed PMID: 3558716.

    Article  CAS  PubMed  Google Scholar 

  11. Hebert R, Carrier R, Bilodeau A. The Functional Autonomy Measurement System (SMAF): description and validation of an instrument for the measurement of handicaps. Age Ageing. 1988;17:293–302. Epub 1988/09/01. doi: https://doi.org/10.1093/ageing/17.5.293. PubMed PMID: 2976575.

    Article  CAS  PubMed  Google Scholar 

  12. Vrieze SI. Model selection and psychological theory: a discussion of the differences between the Akaike information criterion (AIC) and the Bayesian information criterion (BIC). Psychol Methods. 2012;17:228–43. Epub 2012/02/09. doi: https://doi.org/10.1037/a0027127. PubMed PMID: 22309957; PubMed Central PMCID: PMCPMC3366160.

    Article  PubMed  PubMed Central  Google Scholar 

  13. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–45. Epub 1988/09/01. PubMed PMID: 3203132.

    Article  CAS  PubMed  Google Scholar 

  14. Pencina MJ, D’Agostino RB, Sr., D’Agostino RB, Jr., Vasan RS. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med. 2008;27:157–72; discussion 207–12. Epub 2007/06/15. doi: https://doi.org/10.1002/sim.2929. PubMed PMID: 17569110.

    Article  PubMed  Google Scholar 

  15. Xu J, Wan CS, Ktoris K, Reijnierse EM, Maier AB. Sarcopenia Is Associated with Mortality in Adults: A Systematic Review and Meta-Analysis. Gerontology. 2022;68:361–76. Epub 2021/07/28. doi: https://doi.org/10.1159/000517099. PubMed PMID: 34315158.

    Article  PubMed  Google Scholar 

  16. Chen Z, Li WY, Ho M, Chau PH. The Prevalence of Sarcopenia in Chinese Older Adults: Meta-Analysis and Meta-Regression. Nutrients. 2021;13. Epub 2021/05/01. doi: https://doi.org/10.3390/nu13051441. PubMed PMID: 33923252; PubMed Central PMCID: PMCPMC8146971.

  17. Yuki A, Ando F, Otsuka R, Shimokata H. Sarcopenia based on the Asian Working Group for Sarcopenia criteria and all-cause mortality risk in older Japanese adults. Geriatr Gerontol Int. 2017;17:1642–7. Epub 2017/03/07. doi: https://doi.org/10.1111/ggi.12946. PubMed PMID: 28261905.

    PubMed  Google Scholar 

  18. Kim JH, Lim S, Choi SH, Kim KM, Yoon JW, Kim KW, et al. Sarcopenia: an independent predictor of mortality in community-dwelling older Korean men. J Gerontol A Biol Sci Med Sci. 2014;69:1244–52. Epub 2014/04/12. doi: https://doi.org/10.1093/gerona/glu050. PubMed PMID: 24721723.

    Article  PubMed  Google Scholar 

  19. Gao K, Cao LF, Ma WZ, Gao YJ, Luo MS, Zhu J, et al. Association between sarcopenia and cardiovascular disease among middle-aged and older adults: Findings from the China health and retirement longitudinal study. EClinicalMedicine. 2022;44:101264. Epub 2022/01/22. doi: https://doi.org/10.1016/j.eclinm.2021.101264. PubMed PMID: 35059617; PubMed Central PMCID: PMCPMC8760427.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kitamura A, Seino S, Abe T, Nofuji Y, Yokoyama Y, Amano H, et al. Sarcopenia: prevalence, associated factors, and the risk of mortality and disability in Japanese older adults. J Cachexia Sarcopenia Muscle. 2021;12:30–8. Epub 2020/11/27. doi: https://doi.org/10.1002/jcsm.12651. PubMed PMID: 33241660; PubMed Central PMCID: PMCPMC7890144.

    Article  PubMed  Google Scholar 

  21. Yamaguchi R, Katayama O, Lee S, Makino K, Harada K, Morikawa M, et al. Association of sarcopenia and systolic blood pressure with mortality: A 5-year longitudinal study. Arch Gerontol Geriatr. 2023;110:104988. Epub 2023/03/16. doi: https://doi.org/10.1016/j.archger.2023.104988. PubMed PMID: 36921505.

    Article  PubMed  Google Scholar 

  22. Liu X, Hou L, Zhao W, Xia X, Hu F, Zhang G, et al. The Comparison of Sarcopenia Diagnostic Criteria using AWGS 2019 with the Other Five Criteria in West China. Gerontology. 2021;67:386–96. Epub 2021/02/18. doi: https://doi.org/10.1159/000513247. PubMed PMID: 33596568.

    Article  CAS  PubMed  Google Scholar 

  23. Tabara Y, Ikezoe T, Setoh K, Sugimoto K, Kawaguchi T, Kosugi S, et al. Comparison of diagnostic significance of the initial versus revised diagnostic algorithm for sarcopenia from the Asian Working Group for Sarcopenia. Arch Gerontol Geriatr. 2020;89:104071. Epub 2020/05/04. doi: https://doi.org/10.1016/j.archger.2020.104071. PubMed PMID: 32361225.

    Article  PubMed  Google Scholar 

  24. Pang BWJ, Wee SL, Lau LK, Jabbar KA, Seah WT, Ng DHM, et al. Prevalence and Associated Factors of Sarcopenia in Singaporean Adults-The Yishun Study. J Am Med Dir Assoc. 2021;22:885e1–e10. Epub 2020/07/23. doi: https://doi.org/10.1016/j.jamda.2020.05.029. PubMed PMID: 32693999.

    Article  Google Scholar 

  25. Ko CH, Chuang HY, Wu SJ, Yu SC, Chang YF, Chang CS, et al. Changes of sarcopenia case finding by different Asian Working Group for Sarcopenia in community indwelling middle-aged and old people. Front Med (Lausanne). 2022;9:1041186. Epub 2022/11/26. doi: https://doi.org/10.3389/fmed.2022.1041186. PubMed PMID: 36425107; PubMed Central PMCID: PMCPMC9680091.

    Article  PubMed  Google Scholar 

  26. Luk FWL, Li T, Ho HY, Chan YY, Cheung SK, Wong V, et al. Sarcopenia in people living with HIV in Hong Kong: which definition correlates with health outcomes? J Int AIDS Soc. 2022;25 Suppl 4(Suppl 4):e25988. Epub 2022/09/30. doi: https://doi.org/10.1002/jia2.25988. PubMed PMID: 36176015; PubMed Central PMCID: PMCPMC9522638.

    PubMed  PubMed Central  Google Scholar 

  27. Lee D, Kim M, Won CW. Common and different characteristics among combinations of physical frailty and sarcopenia in community-dwelling older adults: The Korean Frailty and Aging Cohort Study. Geriatr Gerontol Int. 2022;22:42–9. Epub 2021/11/25. doi: https://doi.org/10.1111/ggi.14314. PubMed PMID: 34816568.

    Article  PubMed  Google Scholar 

  28. Zhang X, Huang P, Dou Q, Wang C, Zhang W, Yang Y, et al. Falls among older adults with sarcopenia dwelling in nursing home or community: A meta-analysis. Clin Nutr. 2020;39:33–9. Epub 2019/01/23. doi: https://doi.org/10.1016/j.clnu.2019.01.002. PubMed PMID: 30665817.

    Article  PubMed  Google Scholar 

  29. Xu W, Chen T, Cai Y, Hu Y, Fan L, Wu C. Sarcopenia in Community-Dwelling Oldest Old Is Associated with Disability and Poor Physical Function. J Nutr Health Aging. 2020;24:339–45. Epub 2020/03/03. doi: https://doi.org/10.1007/s12603-020-1325-4. PubMed PMID: 32115617.

    Article  CAS  PubMed  Google Scholar 

  30. Hwang AC, Liu LK, Lee WJ, Chen LY, Lin MH, Peng LN, et al. Association of androgen with skeletal muscle mass and muscle function among men and women aged 50 years and older in Taiwan: results from the I-Lan longitudinal aging study. Rejuvenation Res. 2013;16:453–9. Epub 2013/08/06. doi: https://doi.org/10.1089/rej.2013.1442. PubMed PMID: 23909377.

    Article  CAS  PubMed  Google Scholar 

  31. Lee WJ, Peng LN, Lin CH, Chen RC, Lin SZ, Loh CH, et al. Effects of incorporating multidomain interventions into integrated primary care on quality of life: a randomised controlled trial. Lancet Healthy Longev. 2021;2:e712–e23. Epub 2022/09/14. doi: https://doi.org/10.1016/S2666-7568(21)00248-8. PubMed PMID: 36098028.

    Article  PubMed  Google Scholar 

  32. Beaudart C, Zaaria M, Pasleau F, Reginster JY, Bruyère O. Health Outcomes of Sarcopenia: A Systematic Review and Meta-Analysis. PLoS One. 2017;12:e0169548. Epub 2017/01/18. doi: https://doi.org/10.1371/journal.pone.0169548. PubMed PMID: 28095426; PubMed Central PMCID: PMCPMC5240970.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Chen LK, Hwang AC, Lee WJ, Peng LN, Lin MH, Neil DL, et al. Efficacy of multidomain interventions to improve physical frailty, depression and cognition: data from cluster-randomized controlled trials. J Cachexia Sarcopenia Muscle. 2020;11:650–62. Epub 2020/03/07. doi: https://doi.org/10.1002/jcsm.12534. PubMed PMID: 32134208; PubMed Central PMCID: PMCPMC7296266.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors express their gratitude to the staff from the ILAS Research Group for data gathering and to all the participants for their assistance.

Funding

The whole study was funded by the National Science and Technology Council (NSTC 112-2923-B-A49 -002 -MY2, and NSTC 111-2314-B-A49-048-MY2), National Health Research Institute (NHRI-11A1-CG-CO-01-2225-1), and Taipei Veterans General Hospital (111 VACE-001).

Author information

Authors and Affiliations

  1. Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    C.-K. Liang

  2. Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, No. 155, Sec.2, Linong St, Taipei, 112304, Taiwan

    C.-K. Liang, L.-N. Peng, M.-H. Lin, C.-H. Loh, Wei-Ju Lee & L.-K. Chen

  3. Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan

    L.-N. Peng, M.-H. Lin & L.-K. Chen

  4. Center of Health and Aging, Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation, Hualien County, Taiwan

    C.-H. Loh

  5. Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Lan County, Taiwan

    Wei-Ju Lee

  6. Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan

    F.-Y. Hsiao

  7. Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan

    F.-Y. Hsiao

  8. Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan

    L.-K. Chen

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  1. C.-K. Liang
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  2. L.-N. Peng
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  5. Wei-Ju Lee
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Corresponding author

Correspondence to Wei-Ju Lee.

Ethics declarations

All participants signed a written informed consent after full consented by research nurses. The institutional review board of the National Yang Ming University (YM103008) and Taipei Veterans General Hospital (2018-05-003B) approved the study protocol. The study design and executive procedures were carried out in accordance with the principles of the Declaration of Helsinki.

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Conflict of interests

All authors declared no conflict of interests.

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Liang, CK., Peng, LN., Lin, MH. et al. Long-Term Mortality Risk in Older Adults with Sarcopenia: An 11-Year Prospective Cohort Study Comparing AWGS 2014 and AWGS 2019 Guidelines for Enhanced Clinical Utility and Accurate Risk Prediction. J Nutr Health Aging 27, 507–513 (2023). https://doi.org/10.1007/s12603-023-1940-y

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  • DOI: https://doi.org/10.1007/s12603-023-1940-y

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