Associations of medicine use and ejection fraction with the coexistence of frailty and sarcopenia in a sample of heart failure outpatients: a cross-sectional study.

BACKGROUND: Frailty and sarcopenia have been extensively studied in heart failure (HF) patients, but their coexistence is unknown. The aim of this work is to describe the coexistence of these conditions in a sample of HF outpatients and its association with the use of medication and left-ventricular ejection fraction. METHODS: Participants in this cross-sectional study were recruited from a HF outpatients' clinic in northern Portugal. Frailty phenotype was assessed according to Fried et al. Sarcopenia was evaluated according to the revised consensus of the European Working Group on Sarcopenia in Older People. RESULTS: A total of 136 HF outpatients (33.8% women, median age 59 years) integrated this study. Frailty and sarcopenia accounted for 15.4% and 18.4% of the sample, respectively. Coexistence of frailty and sarcopenia was found in 8.1% of the participants, while 17.6% had only one of the conditions. In multivariable analysis (n = 132), increasing age (OR = 1.13;95%CI = 1.06,1.20), being a woman (OR = 65.65;95%CI = 13.50, 319.15), having heart failure with preserved ejection fraction (HFpEF) (OR = 5.61; 95%CI = 1.22, 25.76), and using antidepressants (OR = 11.05; 95%CI = 2.50, 48.82), anticoagulants (OR = 6.11; 95%CI = 1.69, 22.07), furosemide (OR = 3.95; 95%CI = 1.07, 14.55), and acetylsalicylic acid (OR = 5.01; 95%CI = 1.10, 22.90) were associated with increased likelihood of having coexistence of frailty and sarcopenia, while using statins showed the inverse effect (OR = 0.06; 95%CI = 0.01, 0.30). CONCLUSIONS: The relatively low frequency of coexistence of frailty and sarcopenia signifies that each of these two conditions still deserve individual attention from health professionals in their clinical practice and should be screened separately. Being a woman, older age, having HFpEF, using anticoagulants, antidepressants, loop diuretics and acetylsalicylic acid, and not using statins, were associated with having concomitant frailty and sarcopenia. These patients can potentially benefit from interventions that impact their quality of life such as nutritional and mental health interventions and exercise training.

Statins are associated with reduced likelihood of sarcopenia in a sample of heart failure outpatients: a cross-sectional study.

BACKGROUND: Sarcopenia is prevalent in heart failure (HF) patients, contributing to its poor prognosis. Statin use is postulated as a probable risk for developing sarcopenia, but little is known regarding this association in HF patients. This work aims at classifying and characterising sarcopenia and at describing the association of statin use with sarcopenia in a sample of Portuguese HF outpatients. METHODS: In this cross-sectional study, a sample of 136 HF patients (median age: 59 years, 33.8% women) was recruited from an HF outpatients' clinic of a University Hospital in Portugal. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People 2. Clinical, nutritional, and dietary data were collected. RESULTS: A total of 25 (18.4%) individuals were categorised as sarcopenic, ranging from 12.2% in younger (< 65 years) participants vs. 30.4% in older ones and from 3.3% in men vs. 47.8% in women. Severe sarcopenia accounted for 7.4% of the sample and sarcopenic obesity was identified in 5.1% of the individuals. A total of 65.4% of the participants were statin users. In multivariable analysis (n = 132, 25 sarcopenic), the use of statins was inversely associated with sarcopenia (OR = 0.03; 95% CI = 0.01, 0.30). Each additional age year was associated with a 9% increase in the likelihood of being sarcopenic (OR = 1.09; 95% CI = 1.01, 1.17), and each Kg.m-2 increment in body mass index was associated with a 21% decrease in the likelihood of sarcopenia (OR = 0.79; 95% CI = 0.65, 0.96). The daily use of five or more medicines was also directly associated with sarcopenia (OR = 26.87; 95% CI = 2.01, 359.26). On the other hand, being a man and being physically active were inversely associated with sarcopenia (OR = 0.01; 95% CI = 0.00, 0.07 and OR = 0.09; 95% CI = 0.01, 0.65, respectively). CONCLUSIONS: Contrary to what was expected, patients medicated with statins were less likely to be sarcopenic. Although this finding deserves further research, we hypothesise that this might be related to the pleiotropic effects of statins on endothelial function, contributing to better neuromuscular fitness.

Which is the best alternative to estimate muscle mass for sarcopenia diagnosis when DXA is unavailable?

BACKGROUND: Dual x-ray absorptiometry (DXA) is widely adopted to estimate muscle mass for research, but for daily practice is only available in a limited number of facilities. AIM: To elucidate if it is anthropometry or bioelectrical impedance analysis (BIA) the method more concordant with DXA in estimating muscle mass for sarcopenia diagnosis among older adults, and to investigate the impact of several cut-off points in sarcopenia frequency. METHODS: 159 older adults (≥65 years) were included in a cross-sectional analysis. Sarcopenia was identified using the 2018 EWGSOP2 definition, plus previous definitions for muscle mass. Estimation of muscle mass by DXA (appendicular skeletal muscle mass (ASM) and ASM/height2), by BIA (skeletal muscle mass/height2 (SMM/height2) and skeletal muscle mass index (SMI)), and anthropometry (calf and mid-arm muscle circumferences (CC and MAMC, respectively)) was carried out, as well as measurements of handgrip strength and gait speed. RESULTS: Sarcopenia frequency varied from 5.0 to 42.1% depending on the method and cut-off point applied. All surrogate diagnostic criteria had a higher agreement with the DXA defined criterion ASM over ASM/height2. A substantial agreement was also found with BIA SMM/height2 (κ= 0.67), and with BIA SMI (κ= 0.65), and a moderate agreement with MAMC (κ= 0.42), p<0.001. Using the DXA ASM and ASM/height2 criteria as reference, CC showed a specificity of 100% and 94%, respectively. CONCLUSIONS: BIA is a suitable method to evaluate muscle mass in sarcopenia diagnosis when DXA is unavailable. Furthermore, CC showed to be a valid indicator to rule in the presence of sarcopenia.

Frailty status is related to general and abdominal obesity in older adults.

The association between frailty and obesity may differ according to the heterogeneity of body mass index (BMI) and waist circumference (WC) phenotypes in older adults. We hypothesized that the use of simple indicators of general and abdominal obesity combined, may more accurately represent obesity and allow to further elucidate on how frailty status and its criteria are related to obesity. A sample of 1444 older adults, aged ≥65 years (Nutrition UP 65 study) was included in a cross-sectional analysis. General and abdominal obesity were defined according to World Health Organization BMI and WC cut-offs, and frailty by Fried et al. phenotype. A cluster analysis defined groups according to BMI and WC levels. Overweight (BMI between 25.0 and 29.9 kg/m2; 44.6%), general obesity (BMI ≥30.0 kg/m2; 39.0%), and abdominal obesity (WC >102 cm for men and >88 cm for women) were highly frequent (66.5%). Prefrailty (odds ratio [OR]: 2.33; 95% confidence interval [CI]: 1.52-3.57) and frailty (OR: 2.87; 95% CI: 1.58-5.22) were directly associated with the "general and abdominal obesity" cluster. Regarding frailty criteria, low handgrip strength (OR: 2.29; 95% CI: 1.55-3.38) and weight loss (OR: 0.27; 95% CI: 0.14-0.52) were also associated with this cluster. In this sample of older adults presenting a high frequency of overweight and obesity, prefrailty and frailty are linked to higher levels of adiposity, but only when both general and abdominal obesity are present. Present results emphasize the importance of the evaluation of both BMI and WC in the geriatric clinical practice and suggest that older adults presenting both general and abdominal obesity should be routinely screened for frailty.

Sarcopenia, physical frailty, undernutrition and obesity cooccurrence among Portuguese community-dwelling older adults: results from Nutrition UP 65 cross-sectional study.

OBJECTIVES: To investigate the coexistence of sarcopenia, frailty, undernutrition and obesity and to identify the factors associated with the cooccurrence of these conditions in an older population. DESIGN: Cross-sectional. SETTING: Portugal. PARTICIPANTS: 1454 older adults with 65 years or older, from Nutrition UP 65 study. PRIMARY AND SECONDARY OUTCOME MEASURES: Sarcopenia was identified using the European Working Group on Sarcopenia in Older People 2 guidelines and physical frailty using Fried phenotype. Mini-Nutritional Assessment-Short Form was used to ascertain undernutrition, and obesity was evaluated by body mass index. RESULTS: 57.3% presented at least one condition, 38.0% were identified with one and 19.3% were identified with two or more conditions. When all preconditions were considered, 95.7% of the older adults presented at least one of these preconditions or conditions. Multinomial logistic regression multivariate analysis revealed that being male (OR 0.61; 95% CI 0.43 to 0.88), being married or in a common-law marriage (OR 0.58; 95% CI 0.40 to 0.84) and having a higher educational level (OR 0.23; 95% CI 0.07 to 0.73) were inversely associated with having two or more conditions, while age >75 years (OR 1.60; 95% CI 1.14 to 2.24), a poor self-perception of health status (OR 5.61; 95% CI 3.50 to 9.01), ≥5 medications (OR 3.11; 95% CI 1.77 to 5.46) and cognitive impairment (OR 1.84; 95% CI 1.37 to 2.48) were directly associated. CONCLUSIONS: Almost three out of five older adults presented at least one of the conditions related to nutritional status, and about one in five had two or more of these occurrences. However, the low coexistence observed between all of these reinforces the need to assess them all individually during the geriatric assessment.

Factors associated with sarcopenia and undernutrition in older adults.

AIM: The aim of this study was to describe sarcopenia frequency, to identify the factors associated with sarcopenia and undernutrition, and to evaluate their coexistence. METHODS: A total of 1500 Portuguese older adults aged ≥65 years from the Nutrition UP 65 study were evaluated using a cross-sectional analysis. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People (EWGSOP)2 guidelines (2018), using anthropometric measures. Undernutrition status was evaluated by Mini-Nutritional Assessment-Short Form. RESULTS: Sarcopenia frequency was 4.4% (n = 66). Sarcopenia coexists with undernutrition or undernutrition risk in 1.5% of this sample. In the multivariate analysis, sarcopenia was directly associated with age >75 years (odds ratio (OR): 2.14; 95% confidence interval (CI): 1.19-3.84), undernutrition or undernutrition risk (OR: 1.86; 95% CI: 1.01-3.43) and inversely associated with male gender (OR: 0.52; 95% CI: 0.29-0.97), overweight (OR: 0.24; 95% CI: 0.13-0.42) or obesity (OR: 0.02; 95% CI: 0.01-0.09) and moderate alcohol consumption (OR: 0.47; 95% CI: 0.24-0.90). Undernutrition or undernutrition risk was associated with a poor or very poor self-perception of health status (OR: 3.53; 95% CI: 2.32-5.37), a low physical activity level (OR: 1.74; 95% CI: 1.23-2.47), sarcopenia (OR: 1.85; 95% CI: 1.02-3.36), and being overweight (OR: 0.40; 95% CI: 0.27-0.59) or obese (OR: 0.43; 95% CI: 0.28-0.65). CONCLUSIONS: The majority of the older adults presented low muscle strength (probable sarcopenia), but only a small number had concomitantly low muscle quantity or quality (sarcopenia). Coexistence between these conditions is low which reinforces the need to assess them both individually during geriatric assessment.

The association between 25(OH)D levels, frailty status and obesity indices in older adults.

BACKGROUND: Vitamin D deficiency is common in older adults and has been linked with frailty and obesity, but it remains to be studied whether frail obese older adults are at higher risk of vitamin D deficiency. Therefore, the aim of this study is to explore the association between frailty, obesity indices and serum 25(OH)D concentrations. METHODS: 1447 individuals with 65 years or older, participating in a cross-sectional study (Nutrition UP 65) were included. Frailty, according to Fried et al., body mass index (BMI), waist circumference (WC), body roundness index (BRI) and body shape index (ABSI) were evaluated. A stepwise multinomial logistic regression was carried out to quantify the association between 25(OH)D quartiles and independent variables. RESULTS: Median 25(OH)D levels were lower in individuals presenting both frailty and obesity (p<0.001). In the multivariate analysis, pre-frailty (OR: 2.65; 95% CI: 1.63-4.33) and frailty (OR: 3.77; 95% CI: 2.08-6.83) were associated with increased odds of lower 25(OH)D serum levels (first quartile). Regarding obesity indices, the highest categories of BMI (OR: 1.74; 95% CI: 1.06-2.86), WC (OR: 3.46; 95% CI: 1.95-6.15), BRI (OR: 4.35; 95% CI: 2.60-7.29) and ABSI (OR: 3.17 95% CI: 1.86-5.38) were directly associated with lower 25(OH)D serum levels (first quartile). CONCLUSIONS: A positive association between frailty or obesity and lower vitamin D levels was found. Moreover, besides BMI and WC, other indicators of body adiposity, such as BRI and ABSI, were associated with lower 25(OH)D serum concentrations.

Sarcopenia and Undernutrition Among Portuguese Older Adults: Results From Nutrition UP 65 Study.

BACKGROUND: Although undernutrition and sarcopenia are common among older adults and both result in worse health outcomes, data concerning the burden of these conditions in Portuguese community-dwelling older adults are scarce. OBJECTIVE: The aim of this study was to firstly describe the occurrence of sarcopenia and undernutrition among a nationwide community-dwelling sample of older adults. METHODS: Using a cross-sectional analysis, 1493 Portuguese older adults age ≥65 years from the Nutrition UP 65 study were evaluated. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People, and undernutrition status was evaluated by Mini-Nutritional Assessment-Short Form. RESULTS: Sarcopenia frequency was 11.6%, and of these, 4.4% were classified with severe sarcopenia. Furthermore, 0.8% presented sarcopenic obesity. Undernutrition frequency was 1.3%, and 14.7% of the older adults were classified as being at undernutrition risk. CONCLUSION: Sarcopenia is present in one-tenth of the sample. This frequency taken together with undernutrition data warrants further study and preventive measures.