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Geriatr Gerontol Int 2014; 14 (Suppl. 1): 36–45
ORIGINAL ARTICLE
Sarcopenia, and its association with cardiometabolic and functional characteristics in Taiwan: Results from I-Lan Longitudinal Aging Study Li-Kuo Liu,1,3 Wei-Ju Lee,1,4 Liang-Yu Chen,1,2,3 An-Chun Hwang,1,2,3 Ming-Hsien Lin,1,3 Li-Ning Peng1,2,3 and Liang-Kung Chen1,2 1
Aging and Health Research Center, 2Institute of Public Health, National Yang Ming University, 3Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei and 4Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Land, Taiwan
Aim: Sarcopenia is a well-recognized geriatric syndrome, which is associated with a variety of adverse outcomes. The present study aimed to evaluate the prevalence of sarcopenia and its associative clinical characteristics in Taiwan. Methods: Data of the I-Lan Longitudinal Aging Study (ILAS) were retrieved for this study. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People criteria, and comparisons of demographic characteristics, physical performance, body composition, cardiometabolic profiles and functionality indicators were carried out. Results: Overall, data of 1008 participants (mean age 65.2 ± 9.3 years, male 50.6%) were retrieved for analysis. The cut-off value of relative appendicular skeletal muscle was 7.0 kg/m2 for men and 5.9 kg/m2 for women. Sarcopenia was significantly related to low body mass index, smaller waist circumference, poor nutrition and poor cognition. The mean carotid intima-media thickness and cardiometabolic parameters showed no statistically significant findings. Conclusions: The present paper showed the epidemiology of sarcopenia, and the strong connection to functionality indicators. However, sarcopenia was not associated with cardiometabolic risk or carotid intima media thickness in the present study. Geriatr Gerontol Int 2014; 14 (Suppl. 1): 36–45. Keywords: cardiovascular disease, community-dwelling elderly, frailty, sarcopenia.
Introduction In recent years, sarcopenia has been well recognized as a geriatric syndrome,1 and has been defined as an agerelated decline in skeletal muscle mass plus low muscle strength and/or low physical performance.2,3 The association of sarcopenia with various cardiometabolic disorders and diseases has been reported,4,5 such as diabetes,6 chronic pulmonary diseases,7 impaired heart functions8,9 and atherosclerosis.10,11 In addition, sarcopenia is also related to impaired functional status, frailty and poorer quality of life of older adults.12 Sarcopenia is also associated with adverse clinical consequences, such
Accepted for publication 5 November 2013. Correspondence: Dr Liang-Kung Chen MD PhD, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec 2, Shihpai Road, Taipei, Taiwan. Email: [email protected]
36
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doi: 10.1111/ggi.12208
as infectious and non-infectious complications of hospital inpatients, and all-cause mortality.13,14 The European Working Group on Sarcopenia in Older People (EWGSOP) recommended a diagnostic algorithm and standardized measurements of sarcopenia,3 which has been supported by a great variety of studies internationally. However, based on different assessment instruments and cut-off values in different study populations, the prevalence of sarcopenia varied from 3% to 30% from study to study.15–17 As the measurements of muscle mass and muscle strength were closely related to body size and ethnic backgrounds, providing an optimal diagnosis for sarcopenia in Asian countries is challenging. In particular, the population demography forecast clearly showed the escalation of the elderly population in Asia, which might consequently increase the impact of sarcopenia in Asia. Although Taiwan is known to be one of the fastest aging countries in the world,18,19 little is known regarding the impact of sarcopenia in Taiwan.20,21 Therefore, the aim © 2014 Japan Geriatrics Society
Sarcopenia in Taiwan
of the present study was to evaluate the prevalence of sarcopenia among the community-dwelling middleaged and elderly population in Taiwan, and to provide comprehensive demographic and clinical characteristics, physical and mental function, health behaviors and nutritional status and cardiometabolic profiles for further studies of sarcopenia.
Methods
depression status described by the Center for Epidemiologic Studies Depression Scale (CES-D),25 and the nutritional status using Mini-Nutrition Assessment (MNA).26 All participants underwent anthropometric measurements by research nurses, including height, bodyweight and waist circumferences. Body mass index (BMI) was calculated as weight (kg) divided by height (m) squared. Systolic blood pressure and diastolic blood pressure were measured at rest and recorded.
Study design The I-Lan Longitudinal Aging Study (ILAS) is a population-based aging cohort study in I-Lan County of Taiwan. ILAS aimed to evaluate the complex interrelationship between aging, frailty, sarcopenia and cognitive decline. Community-dwelling adults aged 50 years and older were randomly sampled through the household registrations of the county government in Yuanshan Township of I-Lan County in Taiwan. Selected residents were invited to participate by mail or telephone invitations from the research team, and were enrolled when they had fully consented and agreed for participation. The inclusion criteria were: (i) inhabitants who then lived in I-Lan County without a plan to move in the near future; and (ii) inhabitants aged 50 years or older. Any respondents that met any one of the following conditions were excluded from the study: (i) the respondent was unable to communicate with the interviewer and grant an interview; (ii) the respondent had a poor function status, which could lead to a fail in evaluation, such as unable to complete a 6-m timed walk within a reasonable period of time; (iii) the respondent had a limited life expectancy (in general,
Geriatr Gerontol Int 2014; 14 (Suppl. 1): 36–45
ORIGINAL ARTICLE
Sarcopenia, and its association with cardiometabolic and functional characteristics in Taiwan: Results from I-Lan Longitudinal Aging Study Li-Kuo Liu,1,3 Wei-Ju Lee,1,4 Liang-Yu Chen,1,2,3 An-Chun Hwang,1,2,3 Ming-Hsien Lin,1,3 Li-Ning Peng1,2,3 and Liang-Kung Chen1,2 1
Aging and Health Research Center, 2Institute of Public Health, National Yang Ming University, 3Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei and 4Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Land, Taiwan
Aim: Sarcopenia is a well-recognized geriatric syndrome, which is associated with a variety of adverse outcomes. The present study aimed to evaluate the prevalence of sarcopenia and its associative clinical characteristics in Taiwan. Methods: Data of the I-Lan Longitudinal Aging Study (ILAS) were retrieved for this study. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People criteria, and comparisons of demographic characteristics, physical performance, body composition, cardiometabolic profiles and functionality indicators were carried out. Results: Overall, data of 1008 participants (mean age 65.2 ± 9.3 years, male 50.6%) were retrieved for analysis. The cut-off value of relative appendicular skeletal muscle was 7.0 kg/m2 for men and 5.9 kg/m2 for women. Sarcopenia was significantly related to low body mass index, smaller waist circumference, poor nutrition and poor cognition. The mean carotid intima-media thickness and cardiometabolic parameters showed no statistically significant findings. Conclusions: The present paper showed the epidemiology of sarcopenia, and the strong connection to functionality indicators. However, sarcopenia was not associated with cardiometabolic risk or carotid intima media thickness in the present study. Geriatr Gerontol Int 2014; 14 (Suppl. 1): 36–45. Keywords: cardiovascular disease, community-dwelling elderly, frailty, sarcopenia.
Introduction In recent years, sarcopenia has been well recognized as a geriatric syndrome,1 and has been defined as an agerelated decline in skeletal muscle mass plus low muscle strength and/or low physical performance.2,3 The association of sarcopenia with various cardiometabolic disorders and diseases has been reported,4,5 such as diabetes,6 chronic pulmonary diseases,7 impaired heart functions8,9 and atherosclerosis.10,11 In addition, sarcopenia is also related to impaired functional status, frailty and poorer quality of life of older adults.12 Sarcopenia is also associated with adverse clinical consequences, such
Accepted for publication 5 November 2013. Correspondence: Dr Liang-Kung Chen MD PhD, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec 2, Shihpai Road, Taipei, Taiwan. Email: [email protected]
36
|
doi: 10.1111/ggi.12208
as infectious and non-infectious complications of hospital inpatients, and all-cause mortality.13,14 The European Working Group on Sarcopenia in Older People (EWGSOP) recommended a diagnostic algorithm and standardized measurements of sarcopenia,3 which has been supported by a great variety of studies internationally. However, based on different assessment instruments and cut-off values in different study populations, the prevalence of sarcopenia varied from 3% to 30% from study to study.15–17 As the measurements of muscle mass and muscle strength were closely related to body size and ethnic backgrounds, providing an optimal diagnosis for sarcopenia in Asian countries is challenging. In particular, the population demography forecast clearly showed the escalation of the elderly population in Asia, which might consequently increase the impact of sarcopenia in Asia. Although Taiwan is known to be one of the fastest aging countries in the world,18,19 little is known regarding the impact of sarcopenia in Taiwan.20,21 Therefore, the aim © 2014 Japan Geriatrics Society
Sarcopenia in Taiwan
of the present study was to evaluate the prevalence of sarcopenia among the community-dwelling middleaged and elderly population in Taiwan, and to provide comprehensive demographic and clinical characteristics, physical and mental function, health behaviors and nutritional status and cardiometabolic profiles for further studies of sarcopenia.
Methods
depression status described by the Center for Epidemiologic Studies Depression Scale (CES-D),25 and the nutritional status using Mini-Nutrition Assessment (MNA).26 All participants underwent anthropometric measurements by research nurses, including height, bodyweight and waist circumferences. Body mass index (BMI) was calculated as weight (kg) divided by height (m) squared. Systolic blood pressure and diastolic blood pressure were measured at rest and recorded.
Study design The I-Lan Longitudinal Aging Study (ILAS) is a population-based aging cohort study in I-Lan County of Taiwan. ILAS aimed to evaluate the complex interrelationship between aging, frailty, sarcopenia and cognitive decline. Community-dwelling adults aged 50 years and older were randomly sampled through the household registrations of the county government in Yuanshan Township of I-Lan County in Taiwan. Selected residents were invited to participate by mail or telephone invitations from the research team, and were enrolled when they had fully consented and agreed for participation. The inclusion criteria were: (i) inhabitants who then lived in I-Lan County without a plan to move in the near future; and (ii) inhabitants aged 50 years or older. Any respondents that met any one of the following conditions were excluded from the study: (i) the respondent was unable to communicate with the interviewer and grant an interview; (ii) the respondent had a poor function status, which could lead to a fail in evaluation, such as unable to complete a 6-m timed walk within a reasonable period of time; (iii) the respondent had a limited life expectancy (in general,
