Muscle Strength, Mass, and Function in Older Persons
Original Study
Sarcopenia Definitions and Their Associations With Mortality in Older Australian Women

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Abstract

Objectives

To investigate the relationship of 4 sarcopenia definitions with long-term all-cause mortality risk in older Australian women.

Design

Data from the Perth Longitudinal Study in Aging Women from 2003 to 2013 was examined in this prospective cohort study. The 4 sarcopenia definitions were the United States Foundation for the National Institutes of Health (FNIH), the European Working Group on Sarcopenia in Older People (EWGSOP), and adapted FNIH (AUS-POPF) and EWGSOP (AUS-POPE) definitions using Australian population-specific cut-points [<2 standard deviation (SD)] below the mean of young healthy Australian women. All-cause mortality was captured via linked data systems.

Setting and Participants

In total, 903 community-dwelling older Australian women (baseline mean age 79.9 ± 2.6 years) with concurrent measures of muscle strength (grip strength), physical function (timed-up-and-go; TUG) and appendicular lean mass (ALM) were included.

Measures

Cox-proportional hazards modeling was used to examine the relationship between sarcopenia definitions and mortality over 5 and 9.5 years.

Results

Baseline prevalence of sarcopenia by the 4 definitions differed substantially [FNIH (9.4%), EWGSOP (24.1%), AUS-POPF (12.0%), AUS-POPE (10.7%)]. EWGSOP and AUS-POPE had increased age-adjusted hazard ratios (aHRs) for mortality over 5 years [aHR 1.88 95% confidence interval (CI) (1.24‒2.85), P < .01; aHR 2.52 95% CI (1.55‒4.09), P < .01, respectively] and 9.5 years (aHR 1.39 95% CI (1.06‒1.81), P = .02; aHR 1.94 95% CI (1.40‒2.69), P < .01, respectively). No such associations were observed for FNIH or AUS-POPF. Sarcopenia components including weaker grip strength (per SD, 4.9 kg; 17%) and slower TUG (per SD, 3.1 seconds; 40%) but not ALM adjusted-variants (ALM/body mass index or ALM/height2) were associated with greater relative hazards for mortality over 9.5 years.

Conclusions/Relevance

Unlike FNIH, the EWGSOP sarcopenia definition incorporating weak muscle strength and/or poor physical function was related to prognosis, as was the regionally adapted version of EWGSOP. Although sarcopenia definitions were not developed based on prognosis, this is an important consideration for globally standardizing the sarcopenia framework.

Section snippets

Study Population

The population is older community-dwelling individuals that participated in the Perth Longitudinal Study of Aging in Women (n = 1500, PLSAW; http://www.lsaw.com.au). Women were predominantly Caucasian (99.3%) and originally recruited in 1998 to a 5-year, double-blind, randomized controlled trial of daily calcium supplementation to prevent fracture, the Calcium Intake Fracture Outcome Study (CAIFOS).17 The participants from CAIFOS were re-enrolled in 2003 into 2 additional 5-year extension

Results

Baseline characteristics for all participants (n = 903, mean age = 79.9 ± 2.6 years) by the 4 sarcopenia definitions are displayed in Table 1. The proportion of women categorized as presenting with sarcopenia differed substantially by definition (Table 1). When comparing the number of women presenting with sarcopenia, 58 and 191 individuals were captured only by the FNIH and EWGSOP definition, respectively, while 27 were captured by both definitions. When comparing FNIH and AUS-POPF, 85 women

Discussion

The main finding from this prospective cohort study in older Australian women was that sarcopenia was associated with increased relative hazards for all-cause mortality according to the EWGSOP and AUS-POPE definitions. However, no definition compared with age alone improved model discrimination for all-cause mortality over 5 and 9.5 years. Among the 4 sarcopenia definitions tested, AUS-POPE was associated with the highest relative hazard for mortality, especially over shorter follow-up periods

Conclusions/Relevance

In summary, among the 4 definitions presently examined, AUS-POPE (adapted from the EWGSOP) had the strongest association with long-term all-cause mortality risk in older community-dwelling Australian women. As the aforementioned definitions include poor physical function, this finding may be largely explained by the inverse relationship recorded between TUG and mortality. In addition, our results suggest that regional population-specific cut-points (where available) may be applied to the EWGSOP

Acknowledgments

The authors thank the staff at the Western Australia Data Linkage Branch, Hospital Morbidity Data Collection and Registry of Births, Deaths, and Marriages for their work on providing the data for this study. The Perth Longitudinal Study of Aging in Women (PLSAW) was funded by Healthway, the Western Australian Health Promotion Foundation and by project grants 254627, 303169 and 572604 from the National Health and Medical Research Council (NHMRC) of Australia.

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    The Perth Longitudinal Study of Ageing in Women (PLSAW) was funded by Healthway, the Western Australian Health Promotion Foundation and by project grants 254627, 303169 and 572604 from the National Health and Medical Research Council (NHMRC) of Australia. The salary of J.M.H. is supported by a NHMRC of Australia Senior Research Fellowship and a Royal Perth Hospital Medical Research Foundation Fellowship. The salary of J.R.L. and D.S are supported by a NHMRC of Australia Career Development Fellowship. None of these funding agencies had any input into any aspect of the design and management of this study.

    The authors declare no conflicts of interest.

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