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Geriatr Gerontol Int 2014; 14 (Suppl. 1): 69–75
ORIGINAL ARTICLE
Prevalence and associated factors of sarcopenia and severe sarcopenia in older Taiwanese living in rural community: The Tianliao Old People study 04 Chih-Hsing Wu,1,9 Kuan-Ting Chen,2 Meng-Tzu Hou,3 Yin-Fan Chang,1 Chin-Sung Chang,1,8 Ping-Yen Liu,4,8 Shin-Jiuan Wu,5 Ching-Ju Chiu,9 I-Ming Jou6 and Chuan-Yu Chen7 1
Department of Family Medicine, 4Department of Internal Medicine, 6Department of Orthopedics, National Cheng Kung University Hospital, 2Department of Medicine, College of Medicine, 8Graduate Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 5Department of Food and Nutrition, Chung Hwa University of Medical Technology, Tainan, 9Institute of Gerontology, National Cheng Kung University Medical College, Tainan, 3Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, and 7Department of Community Medicine, St. Martin De Poress Hospital, Chiayi, Taiwan
Aim: The aim of the present study was to show the prevalence and associated factors of sarcopenia and severe sarcopenia in rural community-dwelling older Taiwanese. Methods: Using the whole community sampling method, a total of 285 men and 264 women aged over 65 years were randomly sampled (response rate = 50%) from Tianliao District, southern Taiwan, in 2012. Participants were interviewed by trained investigators to complete a validated structural questionnaire. Body composition was measured by bioelectrical impedance analysis, and skeletal muscle mass was estimated by Janssen’s equation. The MiniNutritional Assessment (MNA) score, Short Portable Mental Status Questionnaire, grip strength, gait speed and short physical performance battery (SPPB) were obtained by the standard procedures. Sarcopenia and severe sarcopenia were defined according to the 2010 consensus of the Report of the European Working Group on Sarcopenia in Older People. Results: Of the 549 study participants, 39 (7.1%) were classified as having sarcopenia and 31 (5.6%) participants were classified as having severe sarcopenia. Using multiple logistic regression models, the age, sex, working status, waist circumference, body mass index, hypertensive history, MNA and SPPB score were independently associated with different stages of sarcopenia. Conclusions: Approximately one-fifth of community-dwelling older adults were facing the threat of sarcopenia in southern Taiwan. The older age, female sex, lower body mass index, higher waist circumference, a history of hypertension, lower MNA or SPPB score and not working regularly were associated factors for either sarcopenia or severe sarcopenia. Geriatr Gerontol Int 2014; 14 (Suppl. 1): 69–75. Keywords: bioelectrical impedance analysis, Mini-Nutritional Assessment, short physical performance battery, skeletal muscle mass.
Introduction Sarcopenia is named to reflect the status of decreased skeletal muscle mass (SMM) in aging people.1 As the SMM is one of the major human body components
Accepted for publication 2 December 2013. Correspondence: Dr Chih-Hsing Wu MD, Department of Family Medicine, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan, 70428, Taiwan. Email: [email protected]
© 2014 Japan Geriatrics Society
responsible for daily activities, sarcopenia has an influence on self-independence in activities of daily living, such as eating, taking a shower and walking,2–5 and results in adverse outcomes, including falls, hip fractures, comorbidities6–8 and mortality.9,10 Therefore, the importance of sarcopenia is increasingly emphasized in the aging society worldwide.6,11,12 It is believed that sarcopenia is an economic burden for both caregivers and the healthcare system in an aging society.12 However, there are still limited studies or inconsistent prevalence of sarcopenia in Chinese populations.3,5,9,13–18 In contrast, most of the reports were doi: 10.1111/ggi.12233
|
69
C-H Wu et al.
collected from subjects either living in nursing homes,15 hospital-based3,18 or as volunteers.13,14 Few studies focused on the systemic sampling of older adults living in metropolitan areas.9,16,17 Bioelectrical impedance analysis (BIA) is nonradiating, relatively cheap and portable, making it possible to measure body composition in rural communities. Many studies have shown that BIA-derived skeletal muscle mass index (SMI) can be used to define sarcopenia,3,13,19,20 it is plausible to use BIA rather than dual energy X-ray absorptiometry (DXA) to measure the SMM in a community survey. In 2010, the consensus of the Report of the European Working Group on Sarcopenia in Older People (EWGSOP) redefined the criterion for sarcopenia in which not only the muscle mass is taken into consideration, but muscle strength and muscle performance are also considered for the definition of sarcopenia.21 Therefore, combined with muscle function and physical performance, the level of decreased SMM was newly categorized as presarcopenia, sarcopenia and severe sarcopenia.21 The aging population is endemic, especially in rural townships. However, the healthcare facilities are relatively inadequate when compared with that in metropolitan areas. Therefore, to obtain the status of sarcopenia in rural communities is urgent and important for public health policy. To the best of our knowledge, nearly none of the systemic sampling surveys of sarcopenia have focused on the rural communities in China or Taiwan. Furthermore, none of the studies have reported the different stages of sarcopenia and the associated risk factors concomitantly. The aims of the present study were to determine the prevalence of sarcopenia and severe sarcopenia of older adults living in rural communities in southern Taiwan. The associated factors of different stages of sarcopenia were also evaluated accordingly. Through the comprehensive evaluation of sarcopenia in rural communities, intervention and preventive strategy can be applied appropriately.
Methods In July 2012, a cross-sectional survey following the Tianliao Old People (TOP) study22,23 was carried out in Tianliao District, Kaohsiung City in southern Taiwan. In the 2012 census report, in the total population of 7800, 1966 subjects (25.2% of the total population) were aged 65 years and over. After excluding empty houses (n = 489), death (n = 40), non-ambulatory subjects (subjects with significant disabilities, such as handicapped cerebral vascular accident, cancerous cachexia, unstable chronic diseases or psychiatric disorders, severe arthritis or inflammatory disease, uncomfortable anorexia by any medications, n = 138) and non-reachable subjects (n = 201), a total of 285 men and 70
|
264 women, aged 65–102 years, were enrolled (response rate: 549/1098 = 50%) by the whole district sampling method.24 The sex distribution of the 549 respondents was not statistically different from the 1417 nonresponders (P = 0.132). However, the mean age was relatively younger for respondents (76.0 ± 6.2 vs 76.8 ± 7.4 years, P = 0.001). For convenience and accessibility, all the participants received the survey in five locally designated examination centers evenly distributed in the Tianliao District. This study was approved by the institute review board of National Cheng Kung University Hospital (IRB number: B-ER-101-119). Each participant signed an informed consent before examination. Participants were interviewed to complete a validated structural questionnaire,22,23 which included basic characteristics, smoking and drinking habits, working status, and medical history. We defined participants to have a smoking habit if they had smoked more than 100 cigarettes and still smoked one pack (20 cigarettes) at least per month for more than 6 months, and alcohol drinking was defined by if participants still drank one time per week for more than 6 months.23 A history of hypertension or diabetes was assessed by referring to the self-reported physician’s diagnosis. Participants who still worked at a farm or had regular work were defined as working regularly. The long form Mini-Nutritional Assessment (MNA) was used as a screening tool to evaluate nutritional status.25,26 Cognitive function was evaluated by the wrong answer of the 10-item Short Portable Mental Status Questionnaire (SPMSQ).27
Anthropometry and body composition Bodyweight and standing height were measured by DETECTO (Detecto, Webb City, MO, USA), with participants dressed in light clothing and barefoot. Body mass index (BMI) was calculated by bodyweight divided by square of height (kg/m2). The waist circumference (WC) was measured (Gulick II; Gays Mills, WI, USA; to the nearest mm) midway between the lateral lower rib margin and the superior anterior iliac crest at the end of a gentle expiration phase.22 A single frequency 8-electrode bioelectrical impedance analysis (BIA) device (BC-418; Tanita, Tokyo, Japan) was used to measure body composition, which had been validated to measure the SMM.28 SMM (kg) was estimated using the Janssen’s equation:20 SMM = ([Ht2 / R × 0.401] + [sex × 3.825) + (age × −0.071]) + 5.102, where height is in cm; resistance is in ohms; for sex, men = 1 and women = 0; and age is in years. SMM is divided by square of height to obtain SMI (kg/m2) for defining low SMM and sarcopenia.2,3,21
Physical performance Functional limitations were assessed by using the short physical performance battery (SPPB).29 A higher © 2014 Japan Geriatrics Society
Sarcopenia in community-dwelling older Taiwanese
summary performance score represents a better performance, and vice versa.30 In the present study, the SPPB score was dichotomized as 28 kg/m2 were ≤29 kg, ≤ 30 kg, and ≤32 kg, respectively; for women with BMI ≤23 kg/ m2, 23.1∼26 kg/m2, 26.1∼29 kg/m2, and >29 kg/m2 were ≤17 kg, ≤17.3 kg, ≤18 kg, and ≤21 kg, respectively.21 The gait speed was assessed by a 15-ft walking test. Low physical performance was determined when the gait speed was ≤0.8 m/s.3
Definition of non-sarcopenia, sarcopenia and severe sarcopenia In the present study, we took the same young reference values that have been validated by the National Health Research Institute in Taiwan.3 In short, 498 healthy males and 500 females aged 20–40 years were recruited for body composition assessment using the same BIA (BC-418) with segmental measures for developing the reference SMI.3 With the definition of low muscle mass set at two standard deviations below the mean value of SMI in the young reference groups, the cut-off points for men and women were 7.70 and 5.67 kg/m2, respectively.3 Subjects were defined according to the 2010 consensus of Report of the European Working Group on Sarcopenia in Older People.21 Those who had SMI higher than the cut-offs3 were classified as normal. Low SMM (also named as presarcopenia) was defined as participants with SMI under two standard deviations of the young reference of the same ancestry from 18 to 40 years-of-age.21 Sarcopenia was defined as participants with low SMI and either low muscle function (reflected by grip strength) or low physical performance (reflected by walking speed). Severe sarcopenia was defined when the aforementioned three conditions were present concomitantly.21 Normal and presarcopenia were reclassified as non-sarcopenia for statistical analysis.
Statistical analysis Statistical analysis was carried out by using the Statistical Package of Social Science for Windows software Version 17 (SPSSWIN, version 17.0; Chicago, IL, USA). Continuous and categorical variables were expressed as means ± SD and percentages, respectively. The comparisons between groups in regard to categorical variables were analyzed using the χ2-test, and continuous variables were analyzed using one-way © 2014 Japan Geriatrics Society
ANOVA. Multiple logistic regression models were used to evaluate the independently associated factors between different stages of sarcopenia. Statistical significance was defined as P < 0.05 for two-tailed analysis.
Results All the basic characteristics are shown in Table 1. Of the 549 subjects, including 285 males and 264 females, 101 (18.4%) subjects with 35 (12.3%) men and 66 (25.0%) women had SMI less than 7.70 and 5.67 kg/m2, respectively.3 The prevalence of sarcopenia and severe sarcopenia were 7.1% (n = 39) and 5.6% (n = 31), respectively. Women had a higher prevalence of sarcopenia and severe sarcopenia than men (Table 2). Nonsarcopenic participants were younger, more likely to be working regularly, had higher BMI, WC, SMI, MNA and SPPB score, but lower gait speed and SPMSQ score than sarcopenic and severe sarcopenic participants of both sexes. No statistical difference of demographic characteristics could be found between sarcopenia and severe sarcopenia. Using multiple logistic regression models, the associated factors for different stages of sarcopenia are shown in Table 3. Age was a positive independent factor for all stages of sarcopenia. BMI was a negative independent factor for all stages of sarcopenia. Sex was an independent factor in models I, II and III. WC was shown to be an associated factor for all stages of sarcopenia, but was only significant in model I. A lack of regular work was an independent factor in model I. A History of hypertension and low MNA score were also the independent factors in model III. Low SPPB score was also an independent factor in models II and IV. Other variables including WC, habitual smoking, drinking alcohol, history of diabetes and SPMSQ score showed no statistic significance in all different stages of sarcopenia.
Discussion Compared with studies carried out in Taiwan3,13,16,17 and other countries,6,9,14,15,18,31,32 the prevalence of sarcopenia and severe sarcopenia in Tianliao, Kaohsiung, is consistently within the range of 5–30%. Interestingly, in the present study, the prevalence of sarcopenia and severe sarcopenia for women is notably higher than that of men. Although men are supposed to have a higher prevalence of sarcopenia than women because of the higher rate of muscular atrophy than women,11 the prevalence might be inverted while using different diagnostic criteria of sarcopenia.16,33 As the present study was carried out in a farming village, most of the male participants (50.2%) were still working more regularly than the female participants (37.1%). Furthermore, gait speed was higher in men than women (1.00 ± 0.28 m/s |
71
72
| 448 75.2 ± 5.9 250/198 155.2 ± 8.2 61.1 ± 10.2 25.4 ± 3.9 88.8 ± 9.9 19.0 ± 4.7 7.8 ± 1.4 48.3 28.3 17.9 51.3 17.9 26.2 ± 2.3 1.6 ± 1.5 0.94 ± 0.29 76.4
549 76.0 ± 6.2 285/264 154.6 ± 8.4 58.8 ± 10.9 24.6 ± 4.1 87.0 ± 10.3 18.1 ± 4.9 7.4 ± 1.5 44.0 26.2 16.5 49.5 17.2 25.9 ± 2.6 1.9 ± 1.9 0.92 ± 0.29 72.2
31 76.4 ± 5.9 12/19 156.1 ± 7.6 52.7 ± 7.7 21.6 ± 2.3 80.8 ± 7.1 15.1 ± 3.9 6.1 ± 1.2 38.7 19.4 12.9 22.6 16.1 25.6 ± 2.7 2.9 ± 2.2 1.10 ± 0.18 93.5
Presarcopenia 479 75.3 ± 5.9 262/217 155.3 ± 8.2 60.5 ± 10.3 25.1 ± 4.0 88.3 ± 9.9 18.8 ± 4.7 7.7 ± 1.4 47.7 27.7 17.6 49.5 17.8 26.2 ± 2.3 1.7 ± 1.8 0.95 ± 0.28 77.5
Non-sarcopenia 39 80.4 ± 5.9† 11/28† 150.8 ± 8.4† 48.7 ± 7.5† 21.5 ± 3.0† 78.9 ± 9.2† 13.3 ± 3.1† 5.8 ± 0.9† 18.4† 10.5 13.2 55.3 13.2 23.4 ± 3.4† 3.0 ± 2.5† 0.82 ± 0.22† 56.8†
Sarcopenia
31 81.8 ± 5.7‡ 12/19‡ 149.4 ± 8.8‡ 45.5 ± 7.2‡ 20.4 ± 2.4‡ 78.3 ± 8.5‡ 13.5 ± 3.8‡ 5.9 ± 1.1‡ 19.4‡ 22.6 3.2 41.9 12.9 24.2 ± 2.6‡ 3.0 ± 2.4‡ 0.59 ± 0.14‡ 9.7‡
Severe sarcopenia
–
Geriatr Gerontol Int 2014; 14 (Suppl. 1): 69–75
ORIGINAL ARTICLE
Prevalence and associated factors of sarcopenia and severe sarcopenia in older Taiwanese living in rural community: The Tianliao Old People study 04 Chih-Hsing Wu,1,9 Kuan-Ting Chen,2 Meng-Tzu Hou,3 Yin-Fan Chang,1 Chin-Sung Chang,1,8 Ping-Yen Liu,4,8 Shin-Jiuan Wu,5 Ching-Ju Chiu,9 I-Ming Jou6 and Chuan-Yu Chen7 1
Department of Family Medicine, 4Department of Internal Medicine, 6Department of Orthopedics, National Cheng Kung University Hospital, 2Department of Medicine, College of Medicine, 8Graduate Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 5Department of Food and Nutrition, Chung Hwa University of Medical Technology, Tainan, 9Institute of Gerontology, National Cheng Kung University Medical College, Tainan, 3Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, and 7Department of Community Medicine, St. Martin De Poress Hospital, Chiayi, Taiwan
Aim: The aim of the present study was to show the prevalence and associated factors of sarcopenia and severe sarcopenia in rural community-dwelling older Taiwanese. Methods: Using the whole community sampling method, a total of 285 men and 264 women aged over 65 years were randomly sampled (response rate = 50%) from Tianliao District, southern Taiwan, in 2012. Participants were interviewed by trained investigators to complete a validated structural questionnaire. Body composition was measured by bioelectrical impedance analysis, and skeletal muscle mass was estimated by Janssen’s equation. The MiniNutritional Assessment (MNA) score, Short Portable Mental Status Questionnaire, grip strength, gait speed and short physical performance battery (SPPB) were obtained by the standard procedures. Sarcopenia and severe sarcopenia were defined according to the 2010 consensus of the Report of the European Working Group on Sarcopenia in Older People. Results: Of the 549 study participants, 39 (7.1%) were classified as having sarcopenia and 31 (5.6%) participants were classified as having severe sarcopenia. Using multiple logistic regression models, the age, sex, working status, waist circumference, body mass index, hypertensive history, MNA and SPPB score were independently associated with different stages of sarcopenia. Conclusions: Approximately one-fifth of community-dwelling older adults were facing the threat of sarcopenia in southern Taiwan. The older age, female sex, lower body mass index, higher waist circumference, a history of hypertension, lower MNA or SPPB score and not working regularly were associated factors for either sarcopenia or severe sarcopenia. Geriatr Gerontol Int 2014; 14 (Suppl. 1): 69–75. Keywords: bioelectrical impedance analysis, Mini-Nutritional Assessment, short physical performance battery, skeletal muscle mass.
Introduction Sarcopenia is named to reflect the status of decreased skeletal muscle mass (SMM) in aging people.1 As the SMM is one of the major human body components
Accepted for publication 2 December 2013. Correspondence: Dr Chih-Hsing Wu MD, Department of Family Medicine, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan, 70428, Taiwan. Email: [email protected]
© 2014 Japan Geriatrics Society
responsible for daily activities, sarcopenia has an influence on self-independence in activities of daily living, such as eating, taking a shower and walking,2–5 and results in adverse outcomes, including falls, hip fractures, comorbidities6–8 and mortality.9,10 Therefore, the importance of sarcopenia is increasingly emphasized in the aging society worldwide.6,11,12 It is believed that sarcopenia is an economic burden for both caregivers and the healthcare system in an aging society.12 However, there are still limited studies or inconsistent prevalence of sarcopenia in Chinese populations.3,5,9,13–18 In contrast, most of the reports were doi: 10.1111/ggi.12233
|
69
C-H Wu et al.
collected from subjects either living in nursing homes,15 hospital-based3,18 or as volunteers.13,14 Few studies focused on the systemic sampling of older adults living in metropolitan areas.9,16,17 Bioelectrical impedance analysis (BIA) is nonradiating, relatively cheap and portable, making it possible to measure body composition in rural communities. Many studies have shown that BIA-derived skeletal muscle mass index (SMI) can be used to define sarcopenia,3,13,19,20 it is plausible to use BIA rather than dual energy X-ray absorptiometry (DXA) to measure the SMM in a community survey. In 2010, the consensus of the Report of the European Working Group on Sarcopenia in Older People (EWGSOP) redefined the criterion for sarcopenia in which not only the muscle mass is taken into consideration, but muscle strength and muscle performance are also considered for the definition of sarcopenia.21 Therefore, combined with muscle function and physical performance, the level of decreased SMM was newly categorized as presarcopenia, sarcopenia and severe sarcopenia.21 The aging population is endemic, especially in rural townships. However, the healthcare facilities are relatively inadequate when compared with that in metropolitan areas. Therefore, to obtain the status of sarcopenia in rural communities is urgent and important for public health policy. To the best of our knowledge, nearly none of the systemic sampling surveys of sarcopenia have focused on the rural communities in China or Taiwan. Furthermore, none of the studies have reported the different stages of sarcopenia and the associated risk factors concomitantly. The aims of the present study were to determine the prevalence of sarcopenia and severe sarcopenia of older adults living in rural communities in southern Taiwan. The associated factors of different stages of sarcopenia were also evaluated accordingly. Through the comprehensive evaluation of sarcopenia in rural communities, intervention and preventive strategy can be applied appropriately.
Methods In July 2012, a cross-sectional survey following the Tianliao Old People (TOP) study22,23 was carried out in Tianliao District, Kaohsiung City in southern Taiwan. In the 2012 census report, in the total population of 7800, 1966 subjects (25.2% of the total population) were aged 65 years and over. After excluding empty houses (n = 489), death (n = 40), non-ambulatory subjects (subjects with significant disabilities, such as handicapped cerebral vascular accident, cancerous cachexia, unstable chronic diseases or psychiatric disorders, severe arthritis or inflammatory disease, uncomfortable anorexia by any medications, n = 138) and non-reachable subjects (n = 201), a total of 285 men and 70
|
264 women, aged 65–102 years, were enrolled (response rate: 549/1098 = 50%) by the whole district sampling method.24 The sex distribution of the 549 respondents was not statistically different from the 1417 nonresponders (P = 0.132). However, the mean age was relatively younger for respondents (76.0 ± 6.2 vs 76.8 ± 7.4 years, P = 0.001). For convenience and accessibility, all the participants received the survey in five locally designated examination centers evenly distributed in the Tianliao District. This study was approved by the institute review board of National Cheng Kung University Hospital (IRB number: B-ER-101-119). Each participant signed an informed consent before examination. Participants were interviewed to complete a validated structural questionnaire,22,23 which included basic characteristics, smoking and drinking habits, working status, and medical history. We defined participants to have a smoking habit if they had smoked more than 100 cigarettes and still smoked one pack (20 cigarettes) at least per month for more than 6 months, and alcohol drinking was defined by if participants still drank one time per week for more than 6 months.23 A history of hypertension or diabetes was assessed by referring to the self-reported physician’s diagnosis. Participants who still worked at a farm or had regular work were defined as working regularly. The long form Mini-Nutritional Assessment (MNA) was used as a screening tool to evaluate nutritional status.25,26 Cognitive function was evaluated by the wrong answer of the 10-item Short Portable Mental Status Questionnaire (SPMSQ).27
Anthropometry and body composition Bodyweight and standing height were measured by DETECTO (Detecto, Webb City, MO, USA), with participants dressed in light clothing and barefoot. Body mass index (BMI) was calculated by bodyweight divided by square of height (kg/m2). The waist circumference (WC) was measured (Gulick II; Gays Mills, WI, USA; to the nearest mm) midway between the lateral lower rib margin and the superior anterior iliac crest at the end of a gentle expiration phase.22 A single frequency 8-electrode bioelectrical impedance analysis (BIA) device (BC-418; Tanita, Tokyo, Japan) was used to measure body composition, which had been validated to measure the SMM.28 SMM (kg) was estimated using the Janssen’s equation:20 SMM = ([Ht2 / R × 0.401] + [sex × 3.825) + (age × −0.071]) + 5.102, where height is in cm; resistance is in ohms; for sex, men = 1 and women = 0; and age is in years. SMM is divided by square of height to obtain SMI (kg/m2) for defining low SMM and sarcopenia.2,3,21
Physical performance Functional limitations were assessed by using the short physical performance battery (SPPB).29 A higher © 2014 Japan Geriatrics Society
Sarcopenia in community-dwelling older Taiwanese
summary performance score represents a better performance, and vice versa.30 In the present study, the SPPB score was dichotomized as 28 kg/m2 were ≤29 kg, ≤ 30 kg, and ≤32 kg, respectively; for women with BMI ≤23 kg/ m2, 23.1∼26 kg/m2, 26.1∼29 kg/m2, and >29 kg/m2 were ≤17 kg, ≤17.3 kg, ≤18 kg, and ≤21 kg, respectively.21 The gait speed was assessed by a 15-ft walking test. Low physical performance was determined when the gait speed was ≤0.8 m/s.3
Definition of non-sarcopenia, sarcopenia and severe sarcopenia In the present study, we took the same young reference values that have been validated by the National Health Research Institute in Taiwan.3 In short, 498 healthy males and 500 females aged 20–40 years were recruited for body composition assessment using the same BIA (BC-418) with segmental measures for developing the reference SMI.3 With the definition of low muscle mass set at two standard deviations below the mean value of SMI in the young reference groups, the cut-off points for men and women were 7.70 and 5.67 kg/m2, respectively.3 Subjects were defined according to the 2010 consensus of Report of the European Working Group on Sarcopenia in Older People.21 Those who had SMI higher than the cut-offs3 were classified as normal. Low SMM (also named as presarcopenia) was defined as participants with SMI under two standard deviations of the young reference of the same ancestry from 18 to 40 years-of-age.21 Sarcopenia was defined as participants with low SMI and either low muscle function (reflected by grip strength) or low physical performance (reflected by walking speed). Severe sarcopenia was defined when the aforementioned three conditions were present concomitantly.21 Normal and presarcopenia were reclassified as non-sarcopenia for statistical analysis.
Statistical analysis Statistical analysis was carried out by using the Statistical Package of Social Science for Windows software Version 17 (SPSSWIN, version 17.0; Chicago, IL, USA). Continuous and categorical variables were expressed as means ± SD and percentages, respectively. The comparisons between groups in regard to categorical variables were analyzed using the χ2-test, and continuous variables were analyzed using one-way © 2014 Japan Geriatrics Society
ANOVA. Multiple logistic regression models were used to evaluate the independently associated factors between different stages of sarcopenia. Statistical significance was defined as P < 0.05 for two-tailed analysis.
Results All the basic characteristics are shown in Table 1. Of the 549 subjects, including 285 males and 264 females, 101 (18.4%) subjects with 35 (12.3%) men and 66 (25.0%) women had SMI less than 7.70 and 5.67 kg/m2, respectively.3 The prevalence of sarcopenia and severe sarcopenia were 7.1% (n = 39) and 5.6% (n = 31), respectively. Women had a higher prevalence of sarcopenia and severe sarcopenia than men (Table 2). Nonsarcopenic participants were younger, more likely to be working regularly, had higher BMI, WC, SMI, MNA and SPPB score, but lower gait speed and SPMSQ score than sarcopenic and severe sarcopenic participants of both sexes. No statistical difference of demographic characteristics could be found between sarcopenia and severe sarcopenia. Using multiple logistic regression models, the associated factors for different stages of sarcopenia are shown in Table 3. Age was a positive independent factor for all stages of sarcopenia. BMI was a negative independent factor for all stages of sarcopenia. Sex was an independent factor in models I, II and III. WC was shown to be an associated factor for all stages of sarcopenia, but was only significant in model I. A lack of regular work was an independent factor in model I. A History of hypertension and low MNA score were also the independent factors in model III. Low SPPB score was also an independent factor in models II and IV. Other variables including WC, habitual smoking, drinking alcohol, history of diabetes and SPMSQ score showed no statistic significance in all different stages of sarcopenia.
Discussion Compared with studies carried out in Taiwan3,13,16,17 and other countries,6,9,14,15,18,31,32 the prevalence of sarcopenia and severe sarcopenia in Tianliao, Kaohsiung, is consistently within the range of 5–30%. Interestingly, in the present study, the prevalence of sarcopenia and severe sarcopenia for women is notably higher than that of men. Although men are supposed to have a higher prevalence of sarcopenia than women because of the higher rate of muscular atrophy than women,11 the prevalence might be inverted while using different diagnostic criteria of sarcopenia.16,33 As the present study was carried out in a farming village, most of the male participants (50.2%) were still working more regularly than the female participants (37.1%). Furthermore, gait speed was higher in men than women (1.00 ± 0.28 m/s |
71
72
| 448 75.2 ± 5.9 250/198 155.2 ± 8.2 61.1 ± 10.2 25.4 ± 3.9 88.8 ± 9.9 19.0 ± 4.7 7.8 ± 1.4 48.3 28.3 17.9 51.3 17.9 26.2 ± 2.3 1.6 ± 1.5 0.94 ± 0.29 76.4
549 76.0 ± 6.2 285/264 154.6 ± 8.4 58.8 ± 10.9 24.6 ± 4.1 87.0 ± 10.3 18.1 ± 4.9 7.4 ± 1.5 44.0 26.2 16.5 49.5 17.2 25.9 ± 2.6 1.9 ± 1.9 0.92 ± 0.29 72.2
31 76.4 ± 5.9 12/19 156.1 ± 7.6 52.7 ± 7.7 21.6 ± 2.3 80.8 ± 7.1 15.1 ± 3.9 6.1 ± 1.2 38.7 19.4 12.9 22.6 16.1 25.6 ± 2.7 2.9 ± 2.2 1.10 ± 0.18 93.5
Presarcopenia 479 75.3 ± 5.9 262/217 155.3 ± 8.2 60.5 ± 10.3 25.1 ± 4.0 88.3 ± 9.9 18.8 ± 4.7 7.7 ± 1.4 47.7 27.7 17.6 49.5 17.8 26.2 ± 2.3 1.7 ± 1.8 0.95 ± 0.28 77.5
Non-sarcopenia 39 80.4 ± 5.9† 11/28† 150.8 ± 8.4† 48.7 ± 7.5† 21.5 ± 3.0† 78.9 ± 9.2† 13.3 ± 3.1† 5.8 ± 0.9† 18.4† 10.5 13.2 55.3 13.2 23.4 ± 3.4† 3.0 ± 2.5† 0.82 ± 0.22† 56.8†
Sarcopenia
31 81.8 ± 5.7‡ 12/19‡ 149.4 ± 8.8‡ 45.5 ± 7.2‡ 20.4 ± 2.4‡ 78.3 ± 8.5‡ 13.5 ± 3.8‡ 5.9 ± 1.1‡ 19.4‡ 22.6 3.2 41.9 12.9 24.2 ± 2.6‡ 3.0 ± 2.4‡ 0.59 ± 0.14‡ 9.7‡
Severe sarcopenia
–
