Chang Won

Sarcopenia in Asia: Consensus Report of the Asian Working Group for Sarcopenia

Sarcopenia, a newly recognized geriatric syndrome, is characterized by age-related decline of skeletal muscle plus low muscle strength and/or physical performance. Previous studies have confirmed the association of sarcopenia and adverse health outcomes, such as falls, disability, hospital admission, long term care placement, poorer quality of life, and mortality, which denotes the importance of sarcopenia in the health care for older people. Despite the clinical significance of sarcopenia, the operational definition of sarcopenia and standardized intervention programs are still lacking. It is generally agreed by the different working groups for sarcopenia in the world that sarcopenia should be defined through a combined approach of muscle mass and muscle quality, however, selecting appropriate diagnostic cutoff values for all the measurements in Asian populations is challenging. Asia is a rapidly aging region with a huge population, so the impact of sarcopenia to this region is estimated to be huge as well. Asian Working Group for Sarcopenia (AWGS) aimed to promote sarcopenia research in Asia, and we collected the best available evidences of sarcopenia researches from Asian countries to establish the consensus for sarcopenia diagnosis. AWGS has agreed with the previous reports that sarcopenia should be described as low muscle mass plus low muscle strength and/or low physical performance, and we also recommend outcome indicators for further researches, as well as the conditions that sarcopenia should be assessed. In addition to sarcopenia screening for community-dwelling older people, AWGS recommends sarcopenia assessment in certain clinical conditions and healthcare settings to facilitate implementing sarcopenia in clinical practice. Moreover, we also recommend cutoff values for muscle mass measurements (7.0 kg/m(2) for men and 5.4 kg/m(2) for women by using dual X-ray absorptiometry, and 7.0 kg/m(2) for men and 5.7 kg/m(2) for women by using bioimpedance analysis), handgrip strength (<26 kg for men and <18 kg for women), and usual gait speed (<0.8 m/s). However, a number of challenges remained to be solved in the future. Asia is made up of a great number of ethnicities. The majority of currently available studies have been published from eastern Asia, therefore, more studies of sarcopenia in south, southeastern, and western Asia should be promoted. On the other hand, most Asian studies have been conducted in a cross-sectional design and few longitudinal studies have not necessarily collected the commonly used outcome indicators as other reports from Western countries. Nevertheless, the AWGS consensus report is believed to promote more Asian sarcopenia research, and most important of all, to focus on sarcopenia intervention studies and the implementation of sarcopenia in clinical practice to improve health care outcomes of older people in the communities and the healthcare settings in Asia.

Prevalence of Chronic Fatigue and Chronic Fatigue Syndrome in Korea: Community-Based Primary Care Study

There have been many epidemiological and clinical researches on chronic fatigue (CF) and chronic fatigue syndrome (CFS) since the 1990s, but such studies have been quite limited in Korea. The aim of this study was to investigate the point prevalence of CF and CFS in patients who visited community-based eight primary care clinics in Korea. The study subjects were 1,648 patients aged 18 yr and over who visited one of eight primary care clinics in Korea between the 7th and 17th of May 2001. The physicians determined the status of the subjects through fatigue-related questionnaires, medical history, physical examination, and laboratory tests. The subjects were categorized into no fatigue, prolonged fatigue, CF and then CF were further classified to medically explained CF (Physical CF and Psychological CF) and medically unexplained CF (CFS and idiopathic chronic fatigue). The point prevalence of CF and CFS were 8.4% (95% CI 7.1-9.7%) and 0.6% (95% CI 0.2-1.0%). Medically explained CF was 80.5% of CF, of which 57.1% had psychological causes. The clinical characteristics of CFS were distinguished from explained CF. CF was common but CFS was rare in community-based primary care settings in Korea.

Global Prevalence of Physical Frailty by Fried's Criteria in Community-Dwelling Elderly With National Population-Based Surveys

This study presents a brief review of 6 articles published between 2001 and 2014 that examined the prevalence of frailty as defined by the Fried scale in community-dwelling adults representative of the national population, age 65 years and older.

The Association between the Low Muscle Mass and Osteoporosis in Elderly Korean People

The purpose of this study was to predict osteoporosis risk as decreasing muscle mass and to declare the cut-off value of low muscle mass in an elderly Korean population. This study was based on data from the 2008-2010 Korea National Health and Nutritional Examination Surveys (KNHANES). The subjects included 1,308 men and 1,171 women over 65 yr. Bone mineral density (BMD) and appendicular skeletal muscle (ASM) were measured by dual energy X-ray absorptiometry (DXA), and appendicular skeletal muscle was adjusted by height as a marker of sarcopenia. After confirming the correlation between low muscle mass and BMD, the best cut-off value of muscle mass to estimate osteoporosis was suggested through the receiver operating characteristic (ROC) curve. For both men and women, BMD correlated positively with low muscle mass when ASM/Ht2 was used as a marker for sarcopenia. The ROC curve showed that ASM/Ht2 was the best marker for osteoporosis at a cut-off value of 6.85 kg/m2 for men and 5.96 kg/m2 for women. When these cut-off values were used to determine sarcopenia, the risk of osteoporosis increased 4.14 times in men and 1.88 times in women. In particular, men (OR 2.12) with sarcopenia were more greatly affected than women (OR 1.15), even after adjusting for osteoporosis risk factors. In elderly Korean people, sarcopenia is positively correlated with BMD and there is a strong correlation between sarcopenia and osteoporosis with risk of bone fracture.

Association of Androgen with Skeletal Muscle Mass and Muscle Function Among Men and Women Aged 50 Years and Older in Taiwan: Results from the I-Lan Longitudinal Aging Study

PURPOSE The main aim of this study was to explore the association between skeletal muscle mass and muscle function by three different measures of bioactive testosterone, as well as dehydroepiandrosterone sulfate (DHEA-S) among men and women aged 50 years and older in Taiwan to facilitate further investigations of sarcopenia and androgen profile. METHODS The data of 532 participants (mean age 64.6±9.5 years; male, 53.0%) recruited from the I-Lan Longitudinal Aging Study was retrieved for analysis. Appendicular muscle mass, grip strength, and walking speed were stratified into quartiles in both genders to explore their associations with different hormones measures. RESULTS Among three different bioactive testosterone measures, the free androgen index had significant positive association with muscle mass (p both <0.001) and muscle strength in both genders (p<0.001 in men and p=0.03 in women), whereas free testosterone and bioavailable testosterone displayed similar correlations only in the skeletal muscle mass of woman (p both <0.001) and muscle strength of men (p=0.007, p=0.002, respectively). Serum levels of DHEA-S were correlated positively with skeletal muscle mass in men (p=0.013) and women aged 65 years and older (p=0.004) and handgrip strength in both genders (p<0.001 in men and p=0.009 in women). None of the bioactive testosterone measurements was associated with walking speed, whereas DHEA-S was significantly positively correlated with gait speed in both genders (p both=0.001). CONCLUSION In conclusion, the free androgen index increased remarkably along with muscle mass and muscle strength among men and women aged 50 years and older. Moreover, DHEA-S was positively associated with muscle mass in men and older women and muscle strength in both sexes, and was also associated with aging and gait speed in both genders.

What Is the Optimal Duration of Participation in a Community-Based Health Promotion Program for Older Adults?

Optimizing duration of participation in health promotion programs has important implications for program reach and costs. We examine data from 355 participants in EnhanceWellness to determine whether improvements in disability risk factors (depression, physical inactivity) occurred early or late in the enrollment period. Participants had a mean age of 74 years; 76% were women, and 16% were non-White. The percentage depressed declined from enrollment to 6 months (35% to 28%, p = .001) and from 6 to 12 months (28% to 22%, p = .03). The percentage physically inactive declined over the first 6 months, without substantial change thereafter (47%, 29%, and 29%). Those remaining inactive at 6 months had worse self-rated health and more depressive symptoms initially; a subset of those increased their physical activity by 12 months. These data suggest that enrollment could be reduced from 12 to 6 months without compromising favorable effects of EW participation, although additional benefits may accrue beyond 6 months.

Body Mass Index and C-Reactive Protein in the Healthy Korean Aged Men

The purpose of this study was to determine the relationship between plasma C-reactive protein (CRP) and body mass index (BMI) in elderly Korean men. A review of routine health examination records were done. Out of 671 eligible elderly men, who had their routine health examination in 2001 at a Health Promotion Center of a university hospital, 367 subjects were included after excluding inflammatory conditions. Subgroup analyses were performed on those who did not smoke and exercised regularly. Body composition, blood pressure, blood samples and radiologic examinations including chest radiography and abdominal ultrasound were obtained from each subject. Age, BMI, current smoking, regular exercise, WBC count, HDL-cholesterol, gamma glutamyl transferase were independently associated with logCRP. BMI subgroups according to the Asia-Pacific guideline did not show any difference in CRP level from each other by ANCOVA (p>0.05). However, BMI groups subdivided according to our criteria showed an association with CRP; the CRP level was lowest in the group of BMI between 18.5-19.4 and showed significant difference from BMI group of the highest BMI group (≥29.0). Since elevated CRP levels are associated with higher risk for cardiovascular disease, lower BMI (18.5-19.4) levels may be advised for healthy elderly men in Korea.

Optimal Cutoff Points of Anthropometric Parameters to Identify High Coronary Heart Disease Risk in Korean Adults

Several published studies have reported the need to change the cutoff points of anthropometric indices for obesity. We therefore conducted a cross-sectional study to estimate anthropometric cutoff points predicting high coronary heart disease (CHD) risk in Korean adults. We analyzed the Korean National Health and Nutrition Examination Survey data from 2007 to 2010. A total of 21,399 subjects aged 20 to 79 yr were included in this study (9,204 men and 12,195 women). We calculated the 10-yr Framingham coronary heart disease risk score for all individuals. We then estimated receiver-operating characteristic (ROC) curves for body mass index (BMI), waist circumference, and waist-to-height ratio to predict a 10-yr CHD risk of 20% or more. For sensitivity analysis, we conducted the same analysis for a 10-yr CHD risk of 10% or more. For a CHD risk of 20% or more, the area under the curve of waist-to-height ratio was the highest, followed by waist circumference and BMI. The optimal cutoff points in men and women were 22.7 kg/m2 and 23.3 kg/m2 for BMI, 83.2 cm and 79.7 cm for waist circumference, and 0.50 and 0.52 for waist-to-height ratio, respectively. In sensitivity analysis, the results were the same as those reported above except for BMI in women. Our results support the re-classification of anthropometric indices and suggest the clinical use of waist-to-height ratio as a marker for obesity in Korean adults.

Nursing Homes and Their Contracted Doctors: Korean Experience

Cited from Major Statistics in Long-Term Care Insurance. National Health Insurance Corporation; 2011. Available at: http://www.nhis.or.kr/cms/board/board/Board.jsp? searchType1⁄4ALL&searchWord1⁄4&list_start_date1⁄4&list_end_date1⁄4&pageSize1⁄4&bra nch_id1⁄4&branch_child_id1⁄4&communityKey1⁄4B0163&pageNum1⁄41&list_show_ans wer1⁄4N&boardId1⁄428&act1⁄4VIEW. Accessed March 12, 2015. Note: Each recipient registers their most representative diseases. To the Editor: The Korean elderly population is rapidly increasing; currently, approximately 13.4% of the population is 65 years or older,1 and this proportion is expected to reach 37.0% by 2050, which will give Korea the second-highest elderly population proportion among Organisation for Economic Co-operation and Development countries, after Japan.2 Since 2008, the Korean government has provided a national long-term care insurance (LTCI) program.3,4 Accordingly, there has been huge growth in the number of existing nursing homes and residents, from 128 nursing homes with 7864 residents in 2001 to 4079 nursing homes with 103,973 residents in 2013.5 Senior citizens who are 65 years or older and citizens who are younger than 65 years but have chronic senile diseases are eligible for LTCI services. If the eligible participants apply for LTCI services, a social worker and/or nurse from the National Health Insurance (NHI) Corporation agencies visits applicants to assess their capacity for activities of daily living (ADLs) according to the assessment criteria defined by LTCI law. LTCI recipients are finally classified into 5 categories according to the care needs of local LTCI committees taking account of the doctor’s note. They must be at least within category 3 to be admitted to a nursing home. LTCI is funded by the NHI. The NHI and the government are responsible for 80% (institutional services) to 85% (in-home services) of the expense of long-term care services (Table 1).6e9 One of the key challenges facing this program is that national LTCI and NHI are separate entities in Korea. Therefore, medical care in nursing homes is not reimbursed by LTCI. In reality, more than 95% of long-term care beneficiaries require medical services after being institutionalized in nursing homes (Table 2). To address these issues, long-term care facilities, by regulation, must contract with physician(s) or form agreements with local hospital(s), or both; the number of contracted doctors was reported to be 1166 as of the end of 2013.10 However, this regulation does not apply to group homes with a maximum capacity

Nutritional Status and Frailty in Community-Dwelling Older Korean Adults: The Korean Frailty and Aging Cohort Study

ObjectivesTo examine the association between nutritional status and frailty in older adults.DesignCross-sectional study.SettingCommunity-dwelling older adults were recruited from 10 study sites in South Korea.Participants1473 volunteers aged 70–84 years without severe cognitive impairment and who participated in the Korean Frailty and Aging Cohort Study (KFACS) conducted in 2016.MeasurementsNutritional status was measured using the Mini Nutritional Assessment Short Form (MNA-SF). Frailty was assessed with the Fried’s frailty index. The relationship between nutritional status and frailty was examined using the multinomial regression analysis, adjusting for covariates.ResultsOf the respondents 14.3% had poor nutrition (0.8% with malnutrition, 13.5% at risk of malnutrition). There were 10.7% who were frail, with 48.5% being prefrail, and 40.8% robust. Poor nutrition was related to a significantly increased risk of being prefrail (odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.09–2.32) and frail (OR: 3.30, 95% CI: 1.96–5.54).ConclusionPoor nutritional status is strongly associated with frailty in older adults. More research to understand the interdependency between nutritional status and frailty may lead to better management of the two geriatric conditions.