Dominik Spira

Association of Low Lean Mass With Frailty and Physical Performance: A Comparison Between Two Operational Definitions of Sarcopenia—Data From the Berlin Aging Study II (BASE-II)

BACKGROUND For prevention and treatment of sarcopenia, defined as a decline in lean mass, reliable diagnostic criteria and cutpoints reflecting a clinically relevant threshold are indispensable. As of yet, various parameters have been proposed but no gold standard exists. The aim of this study was to compare cutpoints of appendicular lean mass related to body mass index (ALMBMI) or height (ALM/height(2)) regarding their association with self-reported physical limitations and frailty status in a sample of community-dwelling older adults. METHODS A total of 1,343 participants from the Berlin Aging Study II were included. ALM index was assessed with dual-energy X-ray absorptiometry. Limitations in physical performance were assessed via questionnaire and frailty status was defined according to the Fried criteria. RESULTS In a risk factor-adjusted analysis, participants with an ALMBMI below the cutpoints had 1.4-2.8 times higher odds of difficulties in several domains of physical activity (p = .031 to p < .0001) compared with participants with normal ALMBMI. In participants with low ALM/height(2), no associations with physical limitations were found. Moreover, the odds of being prefrail/frail were statistically significant for the low ALMBMI group only (odds ratio = 2.403, 95% confidence interval: 1.671-3.454, p < .0001) and not for the low ALM/height(2) group. CONCLUSIONS This study showed striking differences between the two operational criteria ALM/height(2) and ALMBMI concerning their association with physical limitations and prefrailty/frailty. The low ALMBMI cutpoints seem suitable to detect patients at risk for negative outcomes such as frailty who might benefit from interventions targeted at improving lean mass.

Prevalence and definition of sarcopenia in community dwelling older people: Data from the Berlin Aging Study II (BASE-II)

BackgroundSarcopenia describes the age-associated loss of muscle mass, strength and function. The aim of this study was to compare the prevalence of sarcopenia in a cohort of community dwelling elderly people living in Berlin, Germany, according to the criteria proposed by current consensus statements and to study the respective impact on self-reported physical performance.Material and methodsThis study included 1405 participants from the Berlin aging study II (BASE-II). The appendicular skeletal muscle mass index (SMI) was assessed with dual energy X-ray absorptiometry (DXA), muscle strength was measured by hand grip strength and the timed up and go” test (TUG) was performed as a functional parameter to reflect mobility.ResultsThe prevalence of sarcopenia was 24.3 % in terms of reduced SMI only and considerably lower for sarcopenia with reduced grip strength (4.1 %) and sarcopenia with limited mobility (2.4 %). Only 0.6 % of the participants fulfilled all three criteria. Of the subjects with a normal SMI, 8.6 % had reduced grip strength and 5.1 % had limited mobility, whereas 1.3 % subjects fulfilled both criteria. Participants with reduced strength or function reported severe difficulties in performing physical tasks significantly more often than participants with normal or reduced SMI alone (p <0.029–p <0.0001).ConclusionIn BASE-II low skeletal muscle mass was much more frequent than reduced grip strength or poor function. Reduced strength and function were found to be associated with a greater impact on physical performance than reduced muscle mass. Low SMI does not seem to be a prerequisite for low strength or limitations in mobility.ZusammenfassungHintergrundSarkopenie beschreibt den altersassoziierten Verlust von Muskelmasse, -kraft und -funktion. Ziel dieser Studie war es, die Sarkopenieprävalenz in einer Stichprobe zu Hause lebender Senioren nach verschiedenen, gegenwärtig empfohlenen Kriterien zu bestimmen und einen Zusammenhang mit subjektiver physischer Leistungsfähigkeit in Aktivitäten des täglichen Lebens zu erforschen.Material und MethodeUntersucht wurden 1405 Teilnehmer der Berliner Altersstudie II (BASE-II). Appendikuläre Skelettmuskelmasse und Skelettmuskelmasseindex (SMI) wurden mittels Doppel-Röntgen-Absorptiometrie (DXA) bestimmt. Die Muskelkraft wurde als Greifkraft gemessen, und die Mobilität als funktioneller Parameter mit dem Timed-up-and-go-Test (TUG) eingeschätzt.ErgebnisseDie Prävalenz der Sarkopenie betrug 24,3 % bezogen auf einen niedrigen SMI als alleiniges Kriterium und zeigte sich erheblich niedriger in Kombination der Kriterien niedriger SMI und reduzierte Greifkraft (4,1 %) oder niedriger SMI und eingeschränkte Mobilität (2,4 %). Nur 0,6 % aller Teilnehmer erfüllten alle 3 Kriterien. Von Teilnehmern mit normalem SMI hatten 8,6 % eine reduzierte Greifkraft und 5,1 % eine eingeschränkte Mobilität. Im Vergleich zu Teilnehmern mit normaler Kraft oder Funktion gaben jene mit reduzierter Kraft oder Funktion signifikant häufiger Schwierigkeiten in der physischen Performance an (p <0,029–p <0,0001).DiskussionEine reduzierte Skelettmuskelmasse zeigte sich erheblich häufiger als eine reduzierte Greifkraft oder eingeschränkte Mobilität. Ein niedriger SMI scheint keine Voraussetzung zu sein für eine verringerte Muskelkraft oder -funktion, die ihrerseits einen stärkeren Zusammenhang mit der subjektiven physischen Leistungsfähigkeit von Senioren aufwiesen als eine reduzierte Muskelmasse.

Prevalence and definition of sarcopenia in community dwelling older people

BackgroundSarcopenia describes the age-associated loss of muscle mass, strength and function. The aim of this study was to compare the prevalence of sarcopenia in a cohort of community dwelling elderly people living in Berlin, Germany, according to the criteria proposed by current consensus statements and to study the respective impact on self-reported physical performance.Material and methodsThis study included 1405 participants from the Berlin aging study II (BASE-II). The appendicular skeletal muscle mass index (SMI) was assessed with dual energy X-ray absorptiometry (DXA), muscle strength was measured by hand grip strength and the timed up and go” test (TUG) was performed as a functional parameter to reflect mobility.ResultsThe prevalence of sarcopenia was 24.3 % in terms of reduced SMI only and considerably lower for sarcopenia with reduced grip strength (4.1 %) and sarcopenia with limited mobility (2.4 %). Only 0.6 % of the participants fulfilled all three criteria. Of the subjects with a normal SMI, 8.6 % had reduced grip strength and 5.1 % had limited mobility, whereas 1.3 % subjects fulfilled both criteria. Participants with reduced strength or function reported severe difficulties in performing physical tasks significantly more often than participants with normal or reduced SMI alone (p <0.029–p <0.0001).ConclusionIn BASE-II low skeletal muscle mass was much more frequent than reduced grip strength or poor function. Reduced strength and function were found to be associated with a greater impact on physical performance than reduced muscle mass. Low SMI does not seem to be a prerequisite for low strength or limitations in mobility.ZusammenfassungHintergrundSarkopenie beschreibt den altersassoziierten Verlust von Muskelmasse, -kraft und -funktion. Ziel dieser Studie war es, die Sarkopenieprävalenz in einer Stichprobe zu Hause lebender Senioren nach verschiedenen, gegenwärtig empfohlenen Kriterien zu bestimmen und einen Zusammenhang mit subjektiver physischer Leistungsfähigkeit in Aktivitäten des täglichen Lebens zu erforschen.Material und MethodeUntersucht wurden 1405 Teilnehmer der Berliner Altersstudie II (BASE-II). Appendikuläre Skelettmuskelmasse und Skelettmuskelmasseindex (SMI) wurden mittels Doppel-Röntgen-Absorptiometrie (DXA) bestimmt. Die Muskelkraft wurde als Greifkraft gemessen, und die Mobilität als funktioneller Parameter mit dem Timed-up-and-go-Test (TUG) eingeschätzt.ErgebnisseDie Prävalenz der Sarkopenie betrug 24,3 % bezogen auf einen niedrigen SMI als alleiniges Kriterium und zeigte sich erheblich niedriger in Kombination der Kriterien niedriger SMI und reduzierte Greifkraft (4,1 %) oder niedriger SMI und eingeschränkte Mobilität (2,4 %). Nur 0,6 % aller Teilnehmer erfüllten alle 3 Kriterien. Von Teilnehmern mit normalem SMI hatten 8,6 % eine reduzierte Greifkraft und 5,1 % eine eingeschränkte Mobilität. Im Vergleich zu Teilnehmern mit normaler Kraft oder Funktion gaben jene mit reduzierter Kraft oder Funktion signifikant häufiger Schwierigkeiten in der physischen Performance an (p <0,029–p <0,0001).DiskussionEine reduzierte Skelettmuskelmasse zeigte sich erheblich häufiger als eine reduzierte Greifkraft oder eingeschränkte Mobilität. Ein niedriger SMI scheint keine Voraussetzung zu sein für eine verringerte Muskelkraft oder -funktion, die ihrerseits einen stärkeren Zusammenhang mit der subjektiven physischen Leistungsfähigkeit von Senioren aufwiesen als eine reduzierte Muskelmasse.

Leukocyte telomere length is related to appendicular lean mass: cross-sectional data from the Berlin Aging Study II (BASE-II)

BACKGROUND Age-related progressive loss of muscle mass is an increasing problem in our aging society, affecting physical ability, risk of falls, and need for health care. Telomere length has been recognized as a marker of biological age on the population level. The relation between muscle mass in advanced age and telomere length, however, has rarely been examined. OBJECTIVE We evaluated the relation between appendicular lean mass (ALM) and relative leukocyte telomere length (rLTL) in 1398 participants of the Berlin Aging Study II (mean ± SD age: 68.2 ± 3.7 y; 49.6% men). DESIGN rLTL was determined by real-time polymerase chain reaction. Lean mass was estimated by dual X-ray absorptiometry and examined as leg lean mass (LLM), ALM, and the ratio of ALM to body mass index (ALMBMI). RESULTS Weak, but highly significant (P < 0.001), correlations of rLTL with ALM (r = 0.248), ALMBMI (r = 0.254), and LLM (r = 0.263) were found. In the fully adjusted model that included age, BMI, low-grade inflammation, lifestyle factors, and morbidities as potential confounders, rLTL was associated with ALM (β = 1.11, SEM = 0.46, P = 0.017), LLM (β = 1.20, SEM = 0.36, P = 0.001), and ALMBMI (β = 0.04, SEM = 0.02, P = 0.013) in men and with LLM in women (β = 0.78, SEM = 0.35, P = 0.026). CONCLUSIONS Our results suggest that short telomeres may be a risk factor for lower ALM, particularly for low LLM. To confirm the association between telomere attrition and loss of LLM and ALMBMI, which are highly relevant for physical ability, further research in a longitudinal context is needed. The medical portion of this trial was registered in the German Clinical Trials Registry (http://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=start) as DRKS00009277.

Identifying Sarcopenia in Metabolic Syndrome: Data from the Berlin Aging Study II

BACKGROUND The metabolic syndrome (MetS) is a cluster of cardiovascular risk factors which has been linked with a decline in muscle mass. However, with a variety of sarcopenia definitions, it is unclear which approach is suitable to detect reduced muscle mass in subjects with MetS who are frequently characterized by an increased fat mass and higher body weight. METHODS We analyzed cross-sectional data of 1,402 (51.1% female; 69±3.7 years) old community-dwelling subjects of the Berlin Aging Study II. MetS was defined according to the guidelines of the International Diabetes Federation/American Heart Association/National Heart, Lung, and Blood Institute (IDF/AHA/NHLBI, 2009). Sarcopenia was defined as suggested by Baumgartner et al. (low appendicular lean mass corrected for height, ALM/HT(2)) and according to standardized residuals following the approach suggested by Newman et al., which corrects appendicular lean mass (ALM) for weight and height. RESULTS MetS was identified in 35% of the participants, 25.6% had sarcopenia according to ALM/HT(2), 20% according to the residual approach. We compared the two operational parameters and found that the majority of physical and metabolic parameters were more impaired and self-reported difficulties in physical performance were greater in individuals defined sarcopenic according to residuals than subjects who were sarcopenic according to a low ALM/HT(2). CONCLUSION Our results indicate that an approach to define sarcopenia which corrects ALM both for height and weight is more suitable to detect increased physical limitations as well as higher metabolic impairment, compared to adjustment of ALM only for height.

Adherence to a Mediterranean-Style Diet and Appendicular Lean Mass in Community-Dwelling Older People: Results From the Berlin Aging Study II

BACKGROUND Selected nutrients or food groups have often been studied with regard to long-term mortality and cardiovascular disease, whereas the relation between diet quality and appendicular lean mass (ALM) has rarely been researched. OBJECTIVE The aim of this study was to explore the association between a Mediterranean-style diet and ALM in community-dwelling older people. METHODS Cross-sectional data from the Berlin Aging Study II were available for 1,509 participants (51% women, 68.2±3.7 years). Nutrient intake was assessed using the European Prospective Investigation into Cancer and Nutrition Food Frequency Questionnaire. Adherence to a Mediterranean-style diet was evaluated with the modified Mediterranean-type diet score (mMedTypeDiet). ALM was determined by dual-energy X-ray absorptiometry and related to body mass index (ALM/BMI). A general linear regression model was carried out to assess the association between mMedTypeDiet score groups and ALM/BMI. RESULTS ALM/BMI was higher in women with a higher adherence to the mMedTypeDiet (0.64±0.1 vs 0.62±0.1 and 0.61±0.1 in low and medium adherence, retrospectively, p = .004). In the risk factor-adjusted general linear regression analysis, a higher adherence to the mMedTypeDiet was associated with higher ALM/BMI in women and better ALM/fat mass ratio when compared to a medium and a low diet quality. No significant associations were seen in men. CONCLUSIONS Higher adherence to a Mediterranean-style diet was associated with a positive effect on ALM/BMI in women.

Sleep, Muscle Mass and Muscle Function in Older People: A Cross-Sectional Analysis Based on Data From the Berlin Aging Study II (BASE-II)

BACKGROUND Loss of muscle mass, particularly in old age, can restrict mobility and physical function. Sleep is thought to play a key role in the maintenance of muscle mass; sleep disturbances have a prevalence of 6-30% in Germany. In this study, based on data from the Berlin Aging Study II (BASE-II), we analyze the relationship between sleep efficiency and quality on the one hand, and muscle mass and muscle function on the other. METHODS We analyzed cross-sectional data from 1196 subjects (52.5% women; 68 ± 4 years). Sleep behavior was assessed with questions from the Pittsburgh Sleep Quality Index; appendicular lean mass (ALM) with dual x-ray absorp - tiometry; and muscle function with a measure of grip strength and with questionnaires about physical activity and impairment of physical activities. Low muscle mass was determined from the ALM corrected by the body-mass index (BMI), i.e., from the ratio ALM/BMI. RESULTS 19.1% of the women and 13.4% of the men reported poor sleep quality. Men whose ALM/BMI ratio was below the cutoff value for low muscle mass more frequently reported very poor sleep efficiency (9.1% , versus 4.8% in women; p<0.002). The adjusted odds ratio for low muscle mass was 2.8 for men with poor sleep quality (95% confidence interval: [1.1; 6.7]) and 4.3 for men with poor sleep efficiency [1.2; 15.1]. In women, there was no statistically significant association between sleep quality and efficiency on the one hand and ALM/BMI values below cutoff on the other, but poor sleep quality was found to be associated with reduced grip strength (16.25 kg ± 2.33 kg versus 15.67 kg ± 2.38 kg; p = 0.009) and low appendicular lean mass (ALM: 16.25 kg ± 2.33 kg versus 15.67 kg ± 2.38 kg; p = 0.016). CONCLUSION These findings support the hypothesis of a link between sleep and muscle mass. The dependence of muscle mass on sleep behavior needs to be investigated in longitudinal studies.

Sleep, Muscle Mass and Muscle Function in Older People.

BACKGROUND Loss of muscle mass, particularly in old age, can restrict mobility and physical function. Sleep is thought to play a key role in the maintenance of muscle mass; sleep disturbances have a prevalence of 6-30% in Germany. In this study, based on data from the Berlin Aging Study II (BASE-II), we analyze the relationship between sleep efficiency and quality on the one hand, and muscle mass and muscle function on the other. METHODS We analyzed cross-sectional data from 1196 subjects (52.5% women; 68 ± 4 years). Sleep behavior was assessed with questions from the Pittsburgh Sleep Quality Index; appendicular lean mass (ALM) with dual x-ray absorp - tiometry; and muscle function with a measure of grip strength and with questionnaires about physical activity and impairment of physical activities. Low muscle mass was determined from the ALM corrected by the body-mass index (BMI), i.e., from the ratio ALM/BMI. RESULTS 19.1% of the women and 13.4% of the men reported poor sleep quality. Men whose ALM/BMI ratio was below the cutoff value for low muscle mass more frequently reported very poor sleep efficiency (9.1% , versus 4.8% in women; p<0.002). The adjusted odds ratio for low muscle mass was 2.8 for men with poor sleep quality (95% confidence interval: [1.1; 6.7]) and 4.3 for men with poor sleep efficiency [1.2; 15.1]. In women, there was no statistically significant association between sleep quality and efficiency on the one hand and ALM/BMI values below cutoff on the other, but poor sleep quality was found to be associated with reduced grip strength (16.25 kg ± 2.33 kg versus 15.67 kg ± 2.38 kg; p = 0.009) and low appendicular lean mass (ALM: 16.25 kg ± 2.33 kg versus 15.67 kg ± 2.38 kg; p = 0.016). CONCLUSION These findings support the hypothesis of a link between sleep and muscle mass. The dependence of muscle mass on sleep behavior needs to be investigated in longitudinal studies.

Association between Metabolic Syndrome and Bone Mineral Density - Data from the Berlin Aging Study II (BASE-II)

Background: Decreased bone mineral density (BMD) has been linked to metabolic disorders, such as type 2 diabetes. However, results regarding the metabolic syndrome (MetS), a cluster of at least 3 of 5 cardiovascular risk parameters with potentially contradictory effects on BMD are still inconclusive. Objective: We investigated the effect of MetS and its single parameters on BMD at 3 sites in community-dwelling older subjects. Methods: 1,402 subjects (51.1% female, 68 ± 4 years old) from the Berlin Aging Study II (BASE-II) were included. MetS was defined as suggested by IDF/NHLBI/AHA. Insulin resistance (IR) was assessed by the homeostasis model of IR. BMD (lumbar spine, femur neck, hip) and trunk fat were measured by dual-energy X-ray absorptiometry. Osteoporosis was defined by a T score of ≤-2.5. Results: MetS was present in 29.6% of women and 41.7% of men. In regression models, we observed a positive association of MetS with the BMD of the lumbar spine (p = 0.005) and hip (p = 0.028) in women even after adjustment for risk factors, but no effect of the single parameters apart from IR. In contrast, there was no association between MetS and BMD in men. However, higher trunk fat and higher waist circumference were associated with lower levels of BMD in men with or without MetS (p < 0.05). Conclusion: We obtained different results in men and women. In women, the positive though slight effect of MetS on BMD could not be explained by single MetS components apart from IR. In men, central obesity was negatively associated with BMD, suggesting that the metabolic effects driven by visceral fat have a negative impact.

Mild-to-moderate chronic kidney disease and geriatric outcomes: Analysis of cross-sectional data from the Berlin Aging Study II

Background: Mild-to-moderate chronic kidney disease (CKD G3a) is prevalent in older adults. Substantial evidence suggests that individuals with advanced CKD face a high risk for common geriatric conditions, like functional impairment and cognitive decline, whereas the relationships between mild-to-moderate CKD and functional impairment and cognitive decline, but also poor nutritional status and mood disorders, are still unclear. Objective: The aim of this study was to explore associations between mild-to-moderate CKD and impairments in the core domains of geriatric assessment (GA) in a large cohort of community-dwelling older adults. Methods: This was a cross-sectional analysis of 1,476 participants of the Berlin Aging Study II. Study participants were stratified as to presence or absence of CKD G3a (estimated glomerular filtration rate [eGFR] 45-59 mL/min/1.73 m2 vs. eGFR ≥60 mL/min/1.73 m2). GA comprised the following instruments: the Activities of Daily Living Scale (ADL), the Timed up and Go (TUG), the Tinetti test (Tinetti), the Mini-Mental-State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Mini Nutritional Assessment (MNA). We used logistic regression models to estimate multivariable-adjusted associations between CKD G3a and impairments in the respective domains. Results: A total of 282 subjects with mild-to-moderate CKD (CKD G3a) were identified (19.1%). Overall, the prevalence of impairments identified was higher among subjects with compared to without CKD G3a (21 vs. 15.9%, p = 0.043). In multivariable-adjusted models, CKD G3a was consistently associated with increased odds of an impaired gait performance as to the TUG (adjusted odds ratio 2.06, 95% CI 1.04-4.09). In contrast, on average, individuals with and without CKD G3a did not differ as to their results in the MMSE, the ADL, the MNA, and the GDS. Conclusion: GA identified impairments in 21 versus 15.9% of older adults with and without mild-to-moderate CKD, respectively. However, except for an increased likelihood of impaired gait performance (TUG) with mild-to-moderate CKD, we did not find independent associations between mild-to-moderate CKD and geriatric conditions.