Nutritional status and body fat mass: Determinants of sarcopenia in community-dwelling older adults
Introduction
Sarcopenia is defined as an age-related muscle reduction syndrome, which was originally described by Rosenberg in the 1980s (Rosenberg, 1989). Parallel to the development of researches in Europe and Asia, definition and diagnostic criteria for sarcopenia have evolved in the last two decades (Rolland et al., 2011). International research groups tried to clarify the practical clinical definition of sarcopenia to elucidate the parameters. In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) asserted that sarcopenia is a condition characterized by progressive decline in the skeletal muscle mass in combination with low muscle function (decreased muscle strength or/and physical performance) (Cruz-Jentoft et al., 2010). In 2014, the Asian Working Group for Sarcopenia (AWGS) suggested a similar approach to estimate sarcopenia based on Asian countries (Chen et al., 2014). The recently updated sarcopenia definition by EWGSOP “focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia” (Cruz-Jentoft et al., 2018).
Sarcopenia is a prevalent condition that is associated with major clinical problems in public health (Chen et al., 2016). Studies have shown that the morbidity rate of sarcopenia was 5–13% in the elderly individuals between 60 and 70 years old, and this rate increased to 11–50% in those older than 80 years (von Haehling et al., 2010). Its adverse outcomes for the elderly were closely related to the functional decline (Bastiaanse et al., 2012), high risk of falls and fractures (Yu et al., 2014), disability (Bravo-José et al., 2018), poor quality of life (Beaudart et al., 2015a), increased hospitalization rates (Gariballa and Alessa, 2013), and mortality (Batsis et al., 2014). Therefore, identifying the features and pathogenesis of this condition is vital to reduce its onset and development as well as to find better ways for its management. The underlying pathophysiological pathways of sarcopenia might be pertinent to various factors, such as reduction of anabolic hormones, abnormal protein metabolism, oxidative stress, chronic inflammations, nutritional deficiencies, and physical inactivity (Walrand et al., 2011; Evans, 2010; Fielding et al., 2011).
Sarcopenia is an important area of public and geriatric health. However, results on its prevalence are controversial due to the variety of definitions and methodologies used to assess sarcopenia parameters. Indeed, its prevalence widely varied from 3% to 52% (Fielding et al., 2011). In subsequent studies, the mean prevalence of sarcopenia was reported to be 5–13% in individuals aged 60–70 years and 11–50% in those older than 80 years (Morley et al., 2014).
With a rapid rise in the elderly population and the increase in life expectancy in the recent decades, sarcopenia has become a growing concern worldwide (Wu et al., 2016). Despite numerous studies on sarcopenia in the East Asian countries, few studies have been conducted in the Middle East (Gariballa and Alessa, 2013), especially Iran (Hashemi et al., 2016). In the recent years, Iran has encountered a rapid growth in its elderly population, and 29.9% of the population is expected to reach over 65 years old by 2050 (Afshar et al., 2016). Therefore, it is predictable that the elderly population will most likely be afflicted by sarcopenia, and more attention is warranted for assessing sarcopenia by global medical community. However, there are still limited studies in this area. This study aims to evaluate the prevalence of sarcopenia and severe sarcopenia according to the AWGS guideline in order to identify the associated factors among community-dwelling elderly population in southern Iran.
Section snippets
Study design and population
The present study was a geriatric health examination survey for assessing the frequency of sarcopenia and its determinants among Iranian elderly individuals. This cross-sectional, population-based study was conducted in Shiraz, southern Iran with the total population of 1,565,572 people. The sample size was estimated to include 501 participants selected via multi-stage sampling. At first, three main health sectors providing health services to general public and private Primary Health Care (PHC)
Participants
A total of 501 participants, including 254 males (50.7%), with the mean age of 70.35 ± 4.60 years were recruited in this study. Comparison of the participants with and without sarcopenia with respect to anthropometrics and biochemical variables has been shown in Table 1. Compared to the participants without sarcopenia, those with sarcopenia were significantly older (p < 0.0001) and current or former smokers (p = 0.002). Considering body composition characteristics, the sarcopenic participants
Discussion
This cross-sectional study was the first to evaluate the prevalence and associated factors of sarcopenia in elderly population in southern Iran. According to AWGS cutoff point, 27.5% of males and 13.8% of females participating in this study had sarcopenia. Overall, 20.8% of the participants were sarcopenic. The prevalence of sarcopenia has been estimated up to 29% of the elderly in community-dwelling population and 14–33% in those requiring long-term care worldwide (Fuggle et al., 2017). It is
Funding
This work was supported by Shiraz University of Medical Sciences (grant No. 8413633) in collaboration with School of Nutrition and Endocrinology and Metabolic Research Institute.
Conflict of interest
The authors have no conflict of interests to declare.
Ethical approval
The local Medical Ethics Committee of Shiraz University of Medical Sciences reviewed and approved the study protocol. All participants gave their written informed consents after receiving explanation about the study protocol.
Authors' contribution
N-N was responsible for the research idea, study design, data acquisition, data interpretation, and writing and preparation of the manuscript.
MH-D was responsible for the research idea, study design, data interpretation, and critical revision of the paper.
Z-S was responsible for the research idea, study design, data interpretation, and critical revision of the paper.
Acknowledgment
The authors wish to thank Dr. Z. Bagheri for her invaluable assistance in statistical analysis of the data. They would also like to appreciate Ms. A. Keivanshekouh at the Research Improvement Center of Shiraz University of Medical Sciences for improving the use of English in the manuscript. Finally, the authors are thankful for the participants for their great and kind contribution to the research.
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