Sarcopenia and malnutrition in relation to mortality in hospitalised patients in geriatric care - predictive validity of updated diagnoses.

BACKGROUND AND AIM: The definition of sarcopenia was recently updated by the European Working Group on Sarcopenia (EWGSOP2), and consensus criteria for the diagnosis of malnutrition have been presented by the Global Leadership Initiative on Malnutrition (GLIM). The aim of this study was to investigate prevalence and mortality related to categorisation of patients according to these definitions in a geriatric hospital setting. METHOD: Fifty-six consecutive geriatric inpatients (84y (SD 7.3), 68% women) underwent test of handgrip strength (HGS) and five-rise chair stand test (5CST). Muscle mass and fat free mass (FFM) were evaluated by Dual X-ray Absorptiometry (DXA). Calf circumference (CC) was recorded. Probable sarcopenia was defined, according to EWGSOP2, as low HGS (<27/16 kg for men/women) and/or 5CST >15 s; sarcopenia was confirmed when coupled with low appendicular skeletal muscle index (ASMI <7.0 and <5.5 kg/m2 (m/w)). Malnutrition was defined according to GLIM as weight loss >5% (past 6 mo); BMI <20/22 kg/m2 (<70/>70y); and FFM-index <17/15 kg/m2 (m/w) combined with reduced food intake and/or disease burden/inflammatory condition. Alternatively, CC <31 cm was used as a proxy for low muscle mass for both sarcopenia and malnutrition. One- and two-year mortality was registered. RESULTS: All participants displayed probable sarcopenia; 46% and 20% were sarcopenic depending on whether muscle mass was estimated by DXA or CC. Malnutrition according to the GLIM criteria was prevalent in 64% or 60% (muscle mass by DXA or CC, respectively). Nine in ten with sarcopenia were also malnourished. Twenty-six participants (46%) died within two years. Sarcopenia defined by CC <31 cm, but not by DXA, was associated with increased mortality; e.g. 2-y mortality HR was 3.19 (95% CI 1.31-7.75). Similarly, malnutrition according to GLIM related to increased 1-y mortality (HR 4.83, 95% CI 1.04-22.39) when DXA was used for muscle mass estimation. All of the participants with CC <31 cm were categorised as both sarcopenic and malnourished. CONCLUSION: In this small set of well-characterised geriatric inpatients all displayed probable sarcopenia. Prevalence of sarcopenia (EWGSOP2) and malnutrition (GLIM) was 20-46% and 60-64%, respectively. Both conditions related to mortality. CC <31 cm hold promises to be an acceptable alternative for DXA as a proxy for low muscle mass.

Sarcopenia prevalence and associations with mortality and hospitalisation by various sarcopenia definitions in 85-89 year old community-dwelling men: a report from the ULSAM study.

BACKGROUND: Operational definitions of sarcopenia, i.e. loss of muscle function and mass, have been proposed by the European Working Group on Sarcopenia in Older People (EWGSOP) and the Foundation for the National Institutes of Health Sarcopenia Project (FNIH). The aim of this study was to analyse the prevalence and outcome, i.e. all-cause mortality and hospitalisation, of sarcopenia and its diagnostic components in octogenarian community-dwelling men. METHODS: In total 287 men, aged 85-89 y, participating in the Uppsala Longitudinal Study of Adult Men (ULSAM) underwent Dual X-ray Absorptiometry (DXA), measurement of hand grip strength (HGS), gait speed (GS), and a five-times chair stand test (CS). Sarcopenia and probable sarcopenia were defined according to EWGSOP (2010), EWGSOP2 (2018), and FNIH (2014). All-cause mortality and hospitalisations over 3 years were registered. RESULTS: Sarcopenia according to EWGSOP, EWGSOP2 and FNIH was observed in 21%, 20%, and 8% of the men, respectively, while probable sarcopenia (EWGSOP2; eq. reduced muscle strength only) was seen in 73%. "Sarcopenia (EWGSOP)" and "probable sarcopenia (EWGSOP2)" were associated with increased mortality (HR 1.95, 95% CI 1.12-3.40 and HR 3.26, 95% CI 1.38-7.70, respectively). "Probable sarcopenia (EWGSOP2)" was associated with days of hospitalisation (RR 2.12, 95% CI 1.36-3.30), whereas sarcopenia according to FNIH showed an association with the number of hospitalisations (RR 1.75, 95% CI 1.10-2.81). CONCLUSIONS: In very old men, reduced muscle strength, i.e. probable sarcopenia, was common and associated with mortality and length of stay during hospitalisation. When combined with low muscle mass (according to DXA), i.e. sarcopenia, the various definitions were associated more weakly with the adverse outcomes. The findings support the emphasis on reduced muscle strength as the major determinant of sarcopenia.