Recent sarcopenia definitions - prevalence, agreement and association with mortality among men: findings from five population-based cohorts

Authors: WESTBURY, LEO - University Of Southampton; BEAUDART, CHARLOTTE - University De Liege; BRUYERE, OLIVIER - University Of Liege; CAULEY, JANE - University Of Pittsburgh; CAWTHON, PEGGY - California Pacific Medical Center Research Institute; CRUZ-JENTOFT, ALSONSO - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; CURTIS, ELIZABETH - University Of Southampton; ENSRUD, KRISTINE - University Of Minnesota; FIELDING, ROGER - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; JOHANSSON, HELENA - Australian Catholic University; KANIS, JOHN - University Of Sheffield Medical School; KARLSSON, MAGNUS - Lund University; LANE, NANCY - University Of California, Davis; LENGELE, LAETITIA - Toulouse University Hospital; LORENTZON, MATTIS - University Of Gothenburg; MCCLOSKEY, EUGENE - University Of Sheffield; MELLSTROM, DAN - University Of Gothenburg; NEWMAN, ANN - University Of Pittsburgh; OHLSSON, CLAES - University Of Gothenburg; ORWOLL, ERIC - Oregon Health & Science University; REGINSTER, JEAN-YVES - University Of Liege; RIBOM, EVA - Uppsala University; ROSENGREN, BJORN - Lund University; SCHOUSBOE, JOHN - University Of Minnesota; SHIROMA, ERIC - National Institutes Of Health (NIH); HARVEY, NICHOLAS - University Of Southampton; DENNISON, ELAINE - University Of Southampton; COOPER, CYRUS - University Of Southampton; KWOK, TIMOTHY - The Chinese University Of Hong Kong (CUHK)

Submitted to: Journal of Cachexia, Sarcopenia and Muscle
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/5/2023
Publication Date: 2/14/2023
Citation: Westbury, L., Beaudart, C., Bruyere, O., Cauley, J.A., Cawthon, P., Cruz-Jentoft, A.J., Curtis, E., Ensrud, K., Fielding, R., Johansson, H., Kanis, J.A., Karlsson, M.K., Lane, N., Lengele, L., Lorentzon, M., McCloskey, E., Mellstrom, D., Newman, A.B., Ohlsson, C., Orwoll, E., Reginster, J., Ribom, E., Rosengren, B., Schousboe, J.T., Shiroma, E.J., Harvey, N.C., Dennison, E.M., Cooper, C., Kwok, T. 2023. Recent sarcopenia definitions - prevalence, agreement and association with mortality among men: findings from five population-based cohorts. Journal of Cachexia, Sarcopenia and Muscle. https://doi.org/10.1002/jcsm.13160.
DOI: https://doi.org/10.1002/jcsm.13160

Interpretive Summary: Sarcopenia is the age-associated loss of skeletal muscle mass and function is associated with falls fractures and death among older adults. Recently, two groups of scientists published new criteria for sarcopenia in older adults. In the present study, we examined whether these new criteria were similar and how well they predicted risk of death. We found poor agreement between the two new criteria. Interestingly both criteria were predictive of subsequent mortality (death), suggesting the importance of sarcopenia as a condition that requires medical and or lifestyle intervention.

Technical Abstract: Background The 2019 European Working Group on Sarcopenia in Older People (EWGSOP2) and the Sarcopenia Definitions and Outcomes Consortium (SDOC) have recently proposed sarcopenia definitions. However, comparisons of the performance of these approaches in terms of thresholds employed; concordance in individuals; and prediction of important health-related outcomes such as death; are limited. We addressed this in a large multinational assembly of cohort studies which included information on lean mass, muscle strength, physical performance and health outcomes. Methods White men from the Health Aging and Body Composition (Health ABC) Study, Osteoporotic Fractures in Men (MrOS) Study cohorts (Sweden, United States), the Hertfordshire Cohort Study (HCS) and the Sarcopenia and Physical impairment with advancing Age (SarcoPhAge) Study were analysed. Appendicular lean mass (ALM) was ascertained using DXA; muscle strength by grip dynamometry; and usual gait speed was measured as a marker of mobility. Deaths were recorded and verified. Definitions of sarcopenia were as follows: EWGSOP2 (grip strength <27 kg and ALM index <7.0 kg/m2); SDOC (grip strength <35.5 kg and gait speed <0.8 m/s); and Modified SDOC (grip strength <35.5 kg and gait speed <1.0 m/s). Cohen's kappa statistic was used to assess agreement regarding EWGSOP2 in relation to SDOC and Modified SDOC. Presence versus absence of sarcopenia according to each definition in relation to mortality risk was examined using Cox regression; estimates were combined across cohorts using meta-analysis. Results Mean (SD) age of participants (n=9316) was 74.2 (5.0) years; 5929 participants died during a mean (SD) follow-up of 12.1 (5.5) years. The proportion with sarcopenia according to each definition was: EWGSOP2 (1.1%); SDOC (1.7%); and Modified SDOC (5.3%). Agreement was weak between EWGSOP2 and SDOC (?=0.17) and between EWGSOP2 and Modified SDOC (?=0.11). Hazard ratios (95% CI) for mortality were: EWGSOP2 (2.94 (2.38, 3.62)); SDOC (4.00 (2.47, 6.51)); and Modified SDOC (2.71 (1.98, 3.70)). Conclusions There was low prevalence and poor agreement among recent sarcopenia definitions in community-dwelling cohorts of older white men. The Modified SDOC definition was associated with mortality, despite having a higher prevalence than other definitions. The strong relationship between sarcopenia and mortality, regardless of the definition, illustrates that appropriate management and lifecourse intervention strategies for this condition are of paramount importance.