Impact of Malnutrition Status on Muscle Parameter Changes over a 5-Year Follow-Up of Community-Dwelling Older Adults from the SarcoPhAge Cohort

Abstract

This study aimed to assess the impact of malnutrition on the 5-year evolution of physical performance, muscle mass and muscle strength in participants from the SarcoPhAge cohort, consisting of community-dwelling older adults. The malnutrition status was assessed at baseline (T0) according to the “Global Leadership Initiatives on Malnutrition” (GLIM) criteria, and the muscle parameters were evaluated both at T0 and after five years of follow-up (T5). Lean mass, muscle strength and physical performance were assessed using dual X-ray absorptiometry, handgrip dynamometry, the short physical performance battery test and the timed up and go test, respectively. Differences in muscle outcomes according to nutritional status were tested using Student’s t-test. The association between malnutrition and the relative 5-year change in the muscle parameters was tested using multiple linear regressions adjusted for several covariates. A total of 411 participants (mean age of 72.3 ± 6.1 years, 56% women) were included. Of them, 96 individuals (23%) were diagnosed with malnutrition at baseline. Their muscle parameters were significantly lower than those of the well-nourished patients both at baseline and after five years of follow-up (all p-values < 0.05), except for muscle strength in women at T5, which was not significantly lower in the presence of malnutrition. However, the 5-year changes in muscle parameters of malnourished individuals were not significantly different than those of well-nourished individuals (all p-values > 0.05).

Inflammation as a diagnostic criterion in the GLIM definition of malnutrition—what CRP-threshold relates to reduced food intake in older patients with acute disease?

“…After the GLIM format was described, some authors have utilized relatively low degrees of inflammation, and independently from any diagnosis of chronic disease, for the fulfillment of the GLIM inflammation criterion. For example, in a recent cohort study of 534 community-dwelling older participants, malnutrition was diagnosed according to the GLIM criteria using an interleukin-6 cutoff value within the normal range of healthy persons (interleukin-6 > 3.84 pg/mL in men and >2.99 pg/mL in women) [23]. In another prospective cohort study of community-dwelling Chinese subjects (median age: 72 years), high-sensitivity CRP cut-off levels of ≥0.32 mg/dl in men and ≥0.38 mg/dl in women were used for the diagnosis of malnutrition according to GLIM [24].…”

Malnutrition in Older Adults—Recent Advances and Remaining Challenges

“…Disease-related malnutrition therefore leads to rapid skeletal muscle wasting, whereas age-related malnutrition is associated with a slower but progressive loss of muscle mass. The effects of protein catabolism are prominently reflected by lower muscle mass, muscle strength and function with severe implications for physical performance [ 17 ]. At the same time, malnutrition [ 18 ] but also reduced dietary protein intake per se [ 19 ] are associated with a decrease in bone mineral mass in higher age.…”

“…One particularity of malnutrition in older adults is that the impact appears to be more severe than in younger adults. Studies have not only shown that changes in body composition in malnutrition occur to a greater extent in older compared to younger adults [ 28 ], but also that recovery of low body cell mass or muscle mass is impaired in higher age following weight loss [ 17 ]. This predisposes malnourished older adults to the risk of developing the so-called geriatric syndromes which have been described as multifactorial syndromes typical in higher age [ 29 ].…”

“…Recent studies have compared the ability of screening tools for malnutrition such as the MNA short or long form to predict the development of sarcopenia to newer diagnostic tools such as the GLIM criteria [ 58 , 59 ]. In the SarcoPhAge cohort, the GLIM criteria did predict incident sarcopenia, whereas neither of the MNA forms did [ 17 ].…”

Nutrition and Muscle Health

“…Generally, physical performance, muscle mass, and muscle strength were significantly lower in malnourished than in well-nourished subjects. Unexpectedly, after 5 years, these parameters did not necessarily change, as described in the SarcoPhAge study [2].…”