Laura A. Schaap

Adiposity, Muscle Mass, and Muscle Strength in Relation to Functional Decline in Older Persons

Aging is associated with changes in body composition and muscle strength. This review aimed to determine the relation between different body composition measures and muscle strength measures and functional decline in older men and women. By use of relevant databases (PubMed, Embase, and CINAHL) and keywords in a search from 1976 to April 2012, 50 articles were reviewed that met the inclusion criteria (written in English, a prospective, longitudinal design, involving older persons aged 65 years or more, and at least one of the measures that follow: body mass index (BMI), waist circumference, waist/hip ratio, midarm circumference, fat mass, muscle fat infiltration, muscle mass, or strength as independent variables and a measure of functional decline as outcome measure). Meta-analyses were performed and revealed that BMI ≥30 and low muscle strength were associated with functional decline (pooled odds ratio (OR) = 1.60, 95% confidence interval (CI): 1.43, 1.80, for BMI ≥30 and OR = 1.86, 95% CI: 1.32, 2.64, for muscle strength). Low muscle mass was not significantly associated with functional decline (pooled OR = 1.19, 95% CI: 0.98, 1.45). Future intervention research should focus on positive changes in body composition to prevent onset or worsening of functional decline in old age.

Elevated homocysteine levels are associated with low muscle strength and functional limitations in older persons

ObjectiveThe current study aimed to examine homocysteine in relation to different aspects of physical functioning.Design, setting and participantsCross-sectional and longitudinal data (3-years follow-up) from the Longitudinal Aging Study Amsterdam (LASA) were used. The study was performed in persons aged ≥ 65 years (N= 1301 after imputation).MeasurementsDifferent measures of physical functioning, including muscle mass, grip strength, functional limitations, and falling were regarded as outcomes. Gender and serum creatinine level were investigated as effect modifiers.ResultsResults were stratified by gender. In men, higher homocysteine levels were associated with lower grip strength (Quartile 4: regression coefficient (B)= −3.07 (−4.91; −1.22)), and more functional limitations at baseline (Quartile 4: B= 1.15 (0.16–2.14)). In women, higher homocysteine levels were associated with more functional limitations after 3 years (Quartile 4: B= 1.19 (0.25; 2.13)). Higher homocysteine levels were not associated with low muscle mass or falling.ConclusionsThese data suggest an inverse association of homocysteine levels with functional limitations in older men and women, and with muscle strength in older men.

Associations of vitamin D status and vitamin D-related polymorphisms with sex hormones in older men

OBJECTIVE Evidence regarding relationships of serum 25-hydroxyvitamin D (25(OH)D) with sex hormones and gonadotropin concentrations remains inconsistent. Polymorphisms in vitamin D-related genes may underly these relationships. Our aim was to examine the relationship of vitamin D status and polymorphisms in vitamin D-related genes with sex hormone and gonadotropin levels. DESIGN AND MEASUREMENTS We analysed data from the Longitudinal Aging Study Amsterdam, an ongoing population-based cohort study of older Dutch individuals (65-89 years). We included data of men with measurements of serum 25-hydroxyvitamin D (25(OH)D) (n=643) and determination of vitamin D-related gene polymorphisms (n=459). 25(OH)D concentrations were classified into four categories: <25, 25-50, 50-75 and >75nmol/L. Outcome measures were total testosterone, calculated bioavailable and free fraction testosterone, SHBG, estradiol, LH and FSH concentrations. Hypogonadism was defined as a total testosterone level <8.0nmol/L. RESULTS Serum 25(OH)D was positively associated with total and bioavailable testosterone levels. After adjustments for confounders, men with serum 25(OH)D less than 25 (n=56), 25-50 (n=199) and 50-75nmol/L (n=240) had lower total testosterone levels compared to men with serum 25(OH)D higher than 75nmol/L (n=148) (β (95% confidence interval): -2.1 (-3.7 to -0.4nmol/L), -0.8 (-1.9 to 0.4nmol/L) and -1.4 (-2.4 to -0.3nmol/L), respectively). For bioavailable testosterone the association was significant only for men with serum 25(OH)D less than 25nmol/L (-0.8 (-1.4 to -0.1nmol/L)) compared to men with serum 25(OH)D >75nmol/L. Serum 25(OH)D was not related to SHBG, estradiol or gonadotropin levels. Hypogonadism (n=29) was not associated with lower serum 25(OH)D. No significant differences were found in hormone levels between the different genotypes of the vitamin D-related gene polymorphisms. Also, the polymorphisms did not modify the relationships of serum 25(OH)D with sex hormones or gonadotropins. CONCLUSION Vitamin D status is positively associated with testosterone levels. No association was found between vitamin D-related gene polymorphisms and hormone levels.

Diagnostic accuracy of self-reported arthritis in the general adult population is acceptable

OBJECTIVE To summarize the diagnostic accuracy of self-reported osteoarthritis (OA), rheumatoid arthritis (RA), and arthritis (i.e., unspecified) in the general adult population. STUDY DESIGN AND SETTING A systematic literature search identified studies reporting diagnostic data on self-reported diagnosis of OA, RA, or arthritis in adults in population-based or primary care samples. Index tests included any form of participant-reported presence of the condition. Reference tests included rheumatologist, physician, or health professional examination; medical record review; physician interview; laboratory tests; or radiography. Relevant articles were scored using the QUADAS tool. Diagnostic values were summarized using pooled estimates for sensitivity and specificity. RESULTS The search strategy identified 16 articles: 11 for OA, 5 for RA, and 4 for arthritis. Four of 16 articles scored high on quality. The pooled sensitivity and specificity were 0.75 [95% confidence interval (CI): 0.56, 0.88] and 0.89 (95% CI: 0.77, 0.95) for OA, 0.88 (95% CI: 0.59, 0.97) and 0.93 (95% CI: 0.66, 0.99) for RA, and 0.71 (95% CI: 0.59, 0.80) and 0.79 (95% CI: 0.65, 0.89) for arthritis. There were not enough studies to conduct meta-analyses for joint-specific OA. CONCLUSION The accuracy of self-reported OA and RA is acceptable for large-scale studies in which rheumatologist examination is not feasible. More high-quality studies are required to confirm the accuracy of self-reported arthritis and joint-specific OA.

The Effect of Type 2 Diabetes on Body Composition of Older Adults

This review describes the effect of type 2 diabetes on fat mass, fat distribution, and lean mass, and changes in these parameters, in older adults, focusing on observational studies. Studies show that type 2 diabetes is associated with an unfavorable body composition characterized by more visceral fat, less thigh subcutaneous fat, and more fat infiltration in the muscle compared with persons without the disease. Longitudinal studies found an accelerated decline in muscle mass in older persons with type 2 diabetes. Studies are needed to examine the consequences of these changes in body composition on physical functioning, morbidity, and mortality risk.

Associations of Sarcopenia Definitions, and Their Components, With the Incidence of Recurrent Falling and Fractures: The Longitudinal Aging Study Amsterdam

Background The aim was to investigate the associations of sarcopenia as defined by European Working Group on Sarcopenia in Older People (EWGSOP) and Foundation for the National Institutes of Health (FNIH) Sarcopenia Project, and their underlying components, with the incidence of recurrent falling and fractures. Methods In 498 older men and women (mean age = 75.2 [SD = 6.4]) from the Longitudinal Aging Study Amsterdam (LASA), the sarcopenia components lean mass (DXA), handgrip strength (handheld dynamometer), and gait speed were measured. Data on falls (3-year follow-up) and fractures (10-year follow-up) were collected. Cox regression analyses were performed, adjusting for age, sex, and total body fat. Results Recurrent falling occurred in 130 persons and 60 persons experienced a fracture during follow-up. Participants who were identified as sarcopenic based on the FNIH definitions had a more than 2-fold increased risk to become a recurrent faller. There was no association between sarcopenia based on the EWGSOP definition and incidence of recurrent falling. When the sarcopenia components were examined individually, only a low grip strength was associated with incidence of recurrent falling, independent of a low lean mass or a slow gait speed. Sarcopenia according to both definitions was not associated with incident fractures, which may be caused by low statistical power. Conclusion Sarcopenia according to the FNIH definitions, but not according to the EWGSOP definition was associated with recurrent falling. When examining the individual components, only a low grip strength was independently associated with recurrent falling. No associations between sarcopenia with incidence of fractures were found.

Availability and use of neighborhood resources by older people with osteoarthritis: Results from the European Project on OSteoArthritis

This study examines the availability and use of neighborhood resources in relation to clinical lower limb osteoarthritis (LLOA) in older participants from six European countries. Of the 2757 participants (65-85 years), 22.7% had LLOA. Participants with LLOA made more use of places to sit (OR=2.50; CI: 1.36-4.60 in the UK), and less use of parks and walking areas (OR=0.30; CI: 0.12-0.75 in Sweden), compared to participants without LLOA, particularly in countries with high availability of resources. The results suggest that specific features of the environment impact the use of neighborhood resources by older adults with LLOA.

Adherence to a standardized protocol for measuring grip strength and appropriate cut-off values in adults over 65 years with sarcopenia: a systematic review protocol

Review question/objective The objective of this review is to examine the use of grip strength analysis in well and unwell populations in adults 65 years and over as a tool to establish muscle strength in sarcopenia. More specifically, the main review question is: 1. What protocol, if any, is most commonly used among older adults with sarcopenia and does this match the standardized protocol suggested in 2011 by Roberts et al.1? Secondary review questions are: 2. What are the reported cut‐off values being used to determine sarcopenia in older adults, with consideration for ethnic and gender variability? 3. Is grip strength, as a tool to measure muscle strength, suitable for people with common comorbidities and geriatric syndromes, such as osteoarthritis, often associated with sarcopenia? Background Sarcopenia, a commonly used concept in geriatrics and gerontology, is characterized by a loss of muscle mass, muscle strength and/or physical functioning.1 Prevalence rates vary between 1‐39% in community dwelling older populations and 14‐33% in long‐term care populations.2 Several epidemiological studies have shown the association of sarcopenia with adverse health outcomes such as falls, disability, hospitalization and mortality.3‐4 Originally, sarcopenia refers to the loss of muscle mass with aging5, which was later complemented with loss of muscle strength and physical functioning. In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) reported a consensus definition of sarcopenia, which included measurement of low muscle mass and low muscle function (strength or physical performance).1 This consensus definition can be used to identify sarcopenia patients in clinical practice and to select individuals for clinical trials. Well‐designed clinical trials could ultimately lead to effective treatment and prevention strategies for sarcopenia. Since the publication of the consensus report, many studies have adopted this definition, which could potentially lead to better comparison of results between studies. On the other hand, within this definition there still is wide variability in measurement tools and use of cut‐off values, which could actually hamper comparability between studies. To assess muscle strength, the EWGSOP has recommended grip strength measurement which is easy and inexpensive. A recent systematic review on the measurement properties of tools to assess sarcopenia concluded that grip strength measurement is a valid and reliable method.6 In a comprehensive review of the measurement of grip strength in clinical and epidemiological studies by Roberts et al.,7 it was shown that there is wide variability in the choice of equipment and protocols for measuring grip strength. To enable comparison between studies, a standardized approach, incorporating more consistent measurement of grip strength is warranted. Based on the results of the review, a standardized approach was described7 including the utilization of the widely used Jamar hydraulic hand dynamometer, as was a clear assessment protocol. So far, it is unknown whether this approach has been adopted in studies investigating grip strength for sarcopenia. The primary aim of this current review is to identify whether studies are adhering to the suggested protocol, or whether a more common method is prevalent. The EWGSOP has suggested multiple cut‐off values to define sarcopenia regarding muscle strength: an absolute cut‐off score of 20 kilograms (kg) for women and 30 kg for men,8 and Body Mass Index (BMI) specific cut‐off values for men and women.9 Alternatively, the Foundation for the National Institutes of Health (FNIH) Sarcopenia Study suggested cut‐off points of 26kg for males and 16kg for females, based on the likelihood of mobility impairment.10 Similar values have also been suggested by Dodds et al.,11 who generated grip strength reference values and calculated cut‐off points 2.5 standard deviations below the mean from 12 United Kingdom (U.K)based epidemiology studies. Recently, Beaudart et al.12 showed that large differences in sarcopenia prevalence occur when both cut‐off values are compared, especially in women.12 Additionally, prevalence has also shown to be dependent upon the tool used to assess muscle strength.13 Evidently, cut‐off values are highly varied and may be selected for statistical, theoretical or practical reasons, and/or are based on the type and magnitude of association with clinical endpoints such as hospitalization, falls or mobility. Difficulties arise in promoting a clear‐cut definition of sarcopenia with no consistent recommendation for cut‐off values of grip strength available. It is therefore important to identify which grip strength cut‐off values should be used for the identification of sarcopenia patients and how comorbidities such as osteoarthritis may affect such values. This review will aim to report on the cut‐off values used, the justification for and the considerations of comorbidities within the identified articles. Furthermore, a study has suggested that cut‐off values may be different within Asian populations. Therefore, ethnicity will also be taken into account for variations in appropriate cut‐off values.14 The overarching objective of this review is to provide insight into the current use of grip strength within the literature among older adults aged 65 and over and, subsequently, to provide commentary on the consistency of protocol and cut‐off values reported for grip strength measures. This insight into current research practice will lead to well‐considered recommendations concerning the measurement of grip strength in research and clinical practice. A preliminary search for sarcopenia revealed five systematic reviews in the Cochrane Library and two within the JBI Database of Systematic Reviews and Implementation Reports, but none that examine the protocol of grip strength measures. A single study was identified through a search of Medline [Via EBSCOhost] which examines the psychometric properties of common measures of muscle mass, strength and physical performance in sarcopenia6, but it was not specific to grip strength measures, nor did it examine the used protocol within studies. A lack of research into this area warrants further research and the need for the conduct of this proposed review.

The relationship between serum IGF-1, handgrip strength, physical performance and falls in elderly men and women

OBJECTIVE Human aging is accompanied by a decrease in growth hormone secretion and serum insulin-like growth factor (IGF)-1 levels. Also, loss of muscle mass and strength and impairment of physical performance, ending in a state of frailty, are seen in elderly. We aimed to investigate whether handgrip strength, physical performance and recurrent falls are related to serum IGF-1 levels in community-dwelling elderly. DESIGN Observational cohort study (cross-sectional and prospective). METHODS We studied the association between IGF-1 and handgrip strength, physical performance and falls in participants of the Longitudinal Aging Study Amsterdam. A total of 1292 participants were included (633 men, 659 women). Serum IGF-1 levels were divided into quartiles (IGF-1-Q1 to IGF-1-Q4). Data on falls were collected prospectively for a period of 3 years. All analyses were stratified for age and physical activity and adjusted for relevant confounders. RESULTS Men with a low physical activity score in IGF-1-Q1 and IGF-1-Q2 of the younger age group had a lower handgrip strength compared to IGF-1-Q4. In younger more active males in IGF-1-Q2 physical performance was worse. Recurrent fallers were less prevalent in older, low active males with low IGF-1 levels. In females, recurrent fallers were more prevalent in older, more active females in IGF-1-Q2. IGF-1 quartile may predict changes in handgrip strength and physical performance in men and women. CONCLUSIONS Our results indicate that lower IGF-1 levels are associated with lower handgrip strength and worse physical performance, but less recurrent fallers especially in men. Associations were often more robust in IGF-1-Q2. Future studies on this topic are desirable.

Body weight and body composition in old age and their relationship with frailty.

Purpose of review Aging is associated with various changes in body composition, including changes in weight, loss of muscle mass, and increase in fat mass. This article describes the role of body weight and body composition, and their changes, in the risk of frailty in old age. Recent findings Based on current literature, observational studies on obesity and high waist circumference show most convincing results for an association with frailty. The independent role of muscle mass and muscle fat infiltration remains unclear, mainly due to a lack of studies and a lack of accurate measurement of body composition by computed tomography or MRI. Weight loss and exercise training intervention studies can be of benefit to frail older adults. Summary Obesity and high waist circumference may be important determinants of frailty in old age, whereas the role of muscle mass and muscle fat infiltration is still unclear. More prospective studies that will specifically focus on frailty as an outcome measure are needed to identify specific body composition components as potential targets for the prevention of frailty in old age.