Prevalence of low muscle mass and associated factors in community-dwelling older adults in Singapore

Abstract

The population is rapidly aging worldwide, and there is an age-related decline in muscle mass. Therefore, it is important to examine the prevalence and associated factors of low appendicular skeletal muscle mass index (ASMI) in older adults. The objectives of this cross-sectional study were (i) to determine the prevalence of low ASMI (ASM/height2) and (ii) to identify factors associated with low ASMI. This study included 1211 community-dwelling adults aged ≥ 65 years. Low ASMI was defined as < 7.0 kg/m2 in males and < 5.7 kg/m2 in females (bioelectrical impedance analysis). Gender-specific cut-off values of calf circumference for low ASMI were determined. The prevalence of low ASMI in the overall cohort was 59.9%, i.e., 57.0% among males and 61.8% among females, with no significant difference between genders (P = 0.1068). The prevalence of low ASMI was 81.3% in individuals at risk of malnutrition compared to 20.6% in their counterparts with normal nutritional status (P < 0.0001). Participants with low ASMI were older, had lower physical activity scores, and greater likelihood of hospitalization in prior 6 months compared with normal ASMI (all P < 0.0001). Low ASMI was associated with risk of malnutrition (odds ratio: 3.58 for medium risk, odds ratio: 12.50 for high risk), older age, smoking, drinking, smaller calf circumference, and lower bone mass (all P ≤ 0.0328). Cut-off values of calf circumference for low ASMI for males was 33.4 cm and for females was 32.2 cm. In conclusion, we found that low ASMI was highly prevalent among community-dwelling older adults at risk of malnutrition. Other significant factors associated with low ASMI were age, smoking, drinking, calf circumference, and bone mass. Screening community-dwelling older adults for risk of malnutrition can prevent or delay onset of low ASMI.

Prevalence and associated factors of sarcopenia in community-dwelling older adults at risk of malnutrition

“…In addition to the significant increase in risk of sarcopenia in malnourished versus normal nutrition in older adults, with odds ratio ranging from 9.9 to 13.6 [ 11 , 29 ], our findings show that there is a doubling of odds ratio for sarcopenia amongst those at high risk versus medium risk of malnutrition. This association is further highlighted in a recent study from our group, which reported that compared to older adults with normal nutritional status, the odds of having low ASMI was 3.58 for those at medium risk of malnutrition and 12.50 for those at high risk of malnutrition [ 45 ]. Taken together, the presence of malnutrition is a strong predictor of concomitant poor muscle health.…”

“…In the present study, using the individual criteria of the AWGS updated consensus 2019 [2], 81% of participants had low ASMI, 83% had low muscle strength, and 78% had low physical performance. Across Asia, low muscle mass was reported to occur commonly in community-dwelling older adults, ranging from 20 to 65% [12,[44][45][46][47]. Specifically referring to sarcopenia in older community-living Asian adults, the prevalence ranged from 18 to 46% [3,[8][9][10][11][12].…”

“…Calf circumference is a recognized surrogate marker for muscle mass [53] and is also used as one of the criteria for case finding in sarcopenia [2]. A recent study from our group using the receiver operating characteristic (ROC) curve analysis reported that the cut-off values of calf circumference for low ASMI for men was < 33.4 cm and for women was < 32.2 cm [45], which is in line with AWGS 2019 consensus update case finding for sarcopenia cut-offs set at < 34 cm for men and < 33 cm for women [2]. Previous studies have reported that higher calf circumference was associated with lower odds of having sarcopenia [14,15], and this relationship was also observed in the present study.…”

Good nutrition across the lifespan is foundational for healthy aging and sustainable development

“…People in the older population, including those living in the community, are among the most vulnerable to malnutrition. Poor nutrition in older people commonly leads to declining physical function, along with social and economic burdens (58,(83)(84)(85)(86)(87)(88). However, these problems have often gone unrecognized until very recently.…”

External validation of BIA equations to estimate appendicular skeletal muscle mass in older adults: Importance of the bias analysis and derivation of correction factors to achieve agreement

“…From the age of 45, the skeletal muscle mass is progressively lost (2). The loss of skeletal muscle is associated with malnutrition, sarcopenia, loss of functionality and other adverse effects in older adults (3)(4)(5)(6)(7). Therefore, it should be a priority to assess this body composition component in this age group.…”