Relationship Between Sarcopenia and Frailty in the Toledo Study of Healthy Aging: A Population Based Cross-Sectional Study.

Frailty and sarcopenia are correlates of musculoskeletal aging that represent a state of vulnerability increasing the risk of negative health outcomes. Standardized definitions are lacking for both, and sometimes both concepts are used interchangeably. However, no large study has assessed the coexistence of these 2 entities in a cohort of older community-dwelling people. Data were taken from the Toledo Study of Healthy Aging (TSHA), a study of community-dwelling elderly (≥65 years). The study population consists of 1611 participants with frailty and sarcopenia assessments. For sarcopenia, we used 3 criteria: European Working Group on Sarcopenia in Older People (EWGSOP), the Foundation for the National Institutes of Health (FNIH), and the FNIH fitted to the cut-off points of our population [standardized FNIH (sFNIH)]. Frailty was assessed according to the Fried criteria with cut-off points adjusted to our population. We used logistic regression to assess the relationship between sarcopenia and frailty and measures of diagnostic accuracy to evaluate the potential use of sarcopenia as a diagnostic marker for frailty. The mean age of the population was 75.42 years (±5.86). Overall, 72 (4.5%) were frail. In addition, 352 (21.8%), 332 (20.6%), and 453 (28.1%) participants were considered sarcopenic according to the EWGSOP, FNIH, and sFNIH criteria, respectively. The prevalence of frailty among those with sarcopenia was 8.2% (29/352), 15.7% (52/332), and 10.4% (47/453). Moreover, among frail people, the prevalence of sarcopenia was 40.27%, 72.2%, and 65.3% according to the used criteria. Sarcopenia showed a low sensitivity (<10%) but high specificity (>97%) for the diagnosis of frailty, with a low intercorrelation (Cramer V = 0.16, 0.40, and 0.30) between the 3 criteria and frailty. Using multivariate logistic regression, frailty was associated with sarcopenia according to EWGSOP [odds ratio (OR) = 1.67, 95% confidence interval (CI) = 0.95, 2.96], FNIH (OR = 10.61, 95% CI = 5.8, 19.4), and sFNIH (OR = 6.63, 95% CI =3.5, 12.53). Frailty and sarcopenia are distinct but related conditions. Sarcopenia is not a useful clinical biomarker of frailty, but its absence might be useful to exclude frailty.

Davies B ，García F ，Ara I ，Artalejo FR ，Rodriguez-Mañas L ，Walter S ... -  《-》

Diagnostic and prognostic value of calf circumference for sarcopenia in community-dwelling older adults.

An age-dependent normative values of calf circumference (CC) has been recently proposed as an accessible proxy for muscle mass. However, its usefulness to estimate sarcopenia has not been assessed. The objectives of the present study were to determine if the substitution of the classical way to assess muscle mass by these values have enough diagnostic accuracy and prognostic value among older adults living in the community. Data from the Toledo Study of Healthy Ageing (TSHA) were used. CC was measured using an anthropometric tape. We used two age-groups CC cut-off points: the TSHA CC median and the one proposed in the Longevity Check-up 7+ (Lookup 7+) project. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People (EWGSOP2), the Foundation for the National Institutes of Health (FNIH), and FNIH criteria standardized for our population (sFNIH). Frailty (according to the Frailty Phenotype and the Frailty Trait Scale-5) and disability (Katz index) were assessed at baseline and follow-up. Mortality and first hospitalization were also recorded. Logistic (incident frailty and worsening disability) and Cox (mortality and hospitalization) regressions were performed. Diagnostic accuracy was assessed through Kappa index, AUCs, positive and negative predictive values. Predictive ability was assessed through AUCs and integrated AUCs (IAUCs). 1531 participants (74.8 ± 5.8 years; 45.6% men) were included in the analysis. Prevalence rates of sarcopenia were 22.7% (sFNIH), 15.0% (FNIH), and 13.9% (EWGSOP2). Using TSHA-based cut-points of CC, the prevalence of sarcopenia was 16.8% (sFNIH), 11.0% (FNIH), and 11.5% (EWGSOP2). According to LC7+-based CC cut-off points, sarcopenia prevalence was 17.6% (sFNIH), 11.9% (FNIH), and 12.4% (EWGSOP2). CC cut-off points showed low-to-moderate agreement (Kappa Index values between 0.49 and 0.69) with appendicular lean mass for the evaluation of sarcopenia. Sarcopenia identified by Lookup 7+ and TSHA CC cut-off points was associated with the adverse events examined, with similar AUCs and IAUCs than original sarcopenia definitions, and were lost after adjustment by baseline frailty, except when the original EWGSOP2 definition was used. Using normalized values of CC as a criteria of muscle mass shows moderate agreement with classical criteria for diagnosing sarcopenia and offer similar predictive value in community-dwelling older adults.

Álvarez-Bustos A ，Carnicero JA ，Coelho-Junior HJ ，Calvani R ，García-García FJ ，Marzetti E ，Landi F ，Rodriguez-Mañas L ... -  《-》

The Prevalence of Sarcopenia in Chinese Elderly Nursing Home Residents: A Comparison of 4 Diagnostic Criteria.

To investigate the prevalence and associated factors of sarcopenia defined by different criteria in nursing home residents. A cross-sectional study. Four nursing homes in Chengdu, China. Elderly adults aged 65 years or older. We applied 4 diagnostic criteria [European Working Group on Sarcopenia in Older People (EWGSOP), Asia Working Group for Sarcopenia (AWGS), International Working Group on Sarcopenia (IWGS), and Foundation for the National Institutes of Health (FNIH)] to define sarcopenia. Muscle mass, strength, and function were measured based on bioimpedance analysis, handgrip strength, and walking speed, respectively. Nutrition status, activities of daily living, calf circumference (CC), and other covariates were evaluated. We included 277 participants. The prevalence of sarcopenia was 32.5%, 34.3%, 38.3%, and 31.4% according to the EWGSOP, AWGS, IWGS, and FNIH criteria, respectively. Fifty-eight participants (20.9%) were sarcopenic by all the 4 criteria. Regardless of the diagnostic criteria of sarcopenia, malnutrition was independently associated with sarcopenia [EWGSOP: odds ratio (OR) 4.02, 95% confidence interval (CI) 1.05-15.39; IWGS: OR 2.46, 95% CI 1.23-4.90; AWGS: OR 3.29, 95% CI 1.49-7.28; FNIH: OR 4.52, 95% CI 1.28-16.00], whereas CC was negatively associated with sarcopenia [EWGSOP: OR per standard deviation (SD) 0.32, 95% CI 0.20-0.52; IWGS: OR per SD 0.26, 95% CI 0.15-0.43; AWGS: OR per SD 0.32, 95% CI 0.19-0.52; FNIH: OR per SD 0.39, 95% CI 0.25-0.60]. Furthermore, falls ≥1 time in the past year were associated with AWGS-defined sarcopenia (OR 2.92, 95% CI 1.04-8.22). Sarcopenia is highly prevalent in elderly Chinese nursing home residents regardless of the diagnostic criteria. Malnutrition and CC are associated with sarcopenia defined by different criteria. Therefore, it is important to assess sarcopenia and malnutrition in the management of nursing home residents. Prospective studies addressing the outcomes of sarcopenia in nursing home residents are warranted.

Zeng Y ，Hu X ，Xie L ，Han Z ，Zuo Y ，Yang M ... -  《-》

The feasibility of assessing frailty and sarcopenia in hospitalised older people: a comparison of commonly used tools.

Ibrahim K ，Howson FFA ，Culliford DJ ，Sayer AA ，Roberts HC ... -  《BMC Geriatrics》

Performance of the European Working Group on Sarcopenia in Older People algorithm in screening older adults for muscle mass assessment.

There is a lack of consensus on the diagnosis of sarcopenia. A screening and diagnostic algorithm was proposed by the European Working Group on Sarcopenia in Older People (EWGSOP). To assess the performance of the EWGSOP algorithm in determining the proportion of subjects suspected of having sarcopenia and selected to undergo subsequent muscle mass (MM) measurement. A cross-sectional study. The cohorts, Frailty in Brazilian Older People Study-Rio de Janeiro (FIBRA-RJ), Brazil; Coyoacan Cohort (CC), Mexico City, Mexico; and Toledo Study for Healthy Aging (TSHA), Toledo, Spain. Three thousand two hundred and sixty community-dwelling individuals, 65 years and older. Initially, the EWGSOP algorithm was applied using its originally proposed cut-off values for gait speed and handgrip strength; in the second step, values tailored for the specific cohorts were used. Using the originally suggested EWGSOP cut-off points, 83.4% of the total cohort (94.4% in TSHA, 75.5% in FIBRA-RJ, 67.8% in CC) would have been considered as suspected of sarcopenia. Adapted cut-off values lowered the proportion of abnormal results to 34.2% (quintile-based approach) and 23.71% (z-score approach). The algorithm proposed by the EWGSOP is of limited clinical utility in screening older adults for sarcopenia due to the high proportion of subjects selected to further undergo MM assessment. Tailoring cut-off values to specific characteristics of the population being studied reduces the number of people selected for MM assessment, probably improving the performance of the algorithm. Further research including the objective measure of MM is needed to determine the accuracy of these specific cut-off points.

Lourenço RA ，Pérez-Zepeda M ，Gutiérrez-Robledo L ，García-García FJ ，Rodríguez Mañas L ... -  《-》