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Quality of life and physical components linked to sarcopenia: The SarcoPhAge study

INTRODUCTION The SarcoPhAge project is an ongoing longitudinal study following community-dwelling elderly subjects with the objective to assess some health and functional consequences of sarcopenia. The sarcopenia diagnosis algorithm developed by the European Working Group on Sarcopenia in Older People (EWGSOP) and used in the present study needs further validation through cross-sectional and longitudinal studies. The aim of the present study is to assess, using this algorithm, the prevalence of sarcopenia and the clinical components linked to this geriatric syndrome. METHODS Participants were community dwelling subjects aged 65years or older. To diagnose sarcopenia, we applied the definition of the EWGSOP. Muscle mass was measured by dual-energy X-ray absorptiometry, muscle strength by a hydraulic dynamometer and physical performance by the SPPB test. Large amounts of socio-demographic, anamnestic and clinical data were collected in all subjects. RESULTS OVER ONE YEAR 534 subjects were recruited for this study (60.5% of women, mean age of 73.5±6.16years), among whom 73 subjects were diagnosed sarcopenic, which represents a global prevalence of 13.7%. Prevalence was 11.8% in men and 14.9% in women. Sarcopenic subjects were older; had a lower Body Mass Index, lower calf, waist, wrist and arm circumferences; presented more cognitive impairments (Mini-Mental State Examination), more comorbidities; were more often malnourished; and consumed more drugs. After adjustment for age, BMI, cognitive status, nutritional status, number of comorbidities and number of drugs, sarcopenic subjects had a worse physical health-related quality of life (SF-36) for the domain of physical functioning, were at higher risk of falls (Timed Up and Go test), were more frail (Fried), presented more often tiredness for the achievement of activities of daily living (Mobility-test), presented less fat mass and obviously less lean mass. Sarcopenic women were also more dependent for housekeeping and handling finances (Lawton scale) than non-sarcopenic ones. CONCLUSION Sarcopenia seems to be associated with many harmful clinical components making this geriatric syndrome a real public health burden. Follow-up data of the SarcoPhAge study will be helpful to assess the outcomes of sarcopenia based on the EWGSOP diagnosis algorithm and its different proposed cut-offs.

Osteoporosis in Frail Patients: A Consensus Paper of the Belgian Bone Club.

In this consensus paper, the Belgian Bone Club aims to provide a state of the art on the epidemiology, diagnosis, and management of osteoporosis in frail individuals, including patients with anorexia nervosa, patients on dialysis, cancer patients, persons with sarcopenia, and the oldest old. All these conditions may indeed induce bone loss that is superimposed on physiological bone loss and often remains under-recognized and under-treated. This is of particular concern because of the major burden of osteoporotic fractures in terms of morbidity, mortality, and economic cost. Therefore, there is an urgent need to appreciate bone loss associated with these conditions, as this may improve diagnosis and management of bone loss and fracture risk in clinical practice.

Prevalence of concomitant bone and muscle wasting in elderly women from the SarcoPhAge cohort: preliminary results

BACKGROUND Recent studies suggest that bone and muscle wasting are closely interconnected. OBJECTIVE The aim was of this study is to assess the prevalence of osteoporosis in a population of women diagnosed with sarcopenia. Participants, setting and design: We analyzed cross-sectional data of women, aged 65 years and above, for whom bone mineral density was available at the time of inclusion in the SarcoPhAge (Sarcopenia and Physical impairment with advancing Age) cohort, an ongoing prospective study with the aim to assess consequences of sarcopenia. MEASUREMENTS Muscle strength was evaluated with a hydraulic hand-dynamometer, appendicular lean mass and bone mineral density by Dual-Energy X-Ray Absorptiometry and physical performance by the Short Physical Performance Battery test (SPPB). Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People definition, i.e. a low muscle mass plus either low muscle strength or low physical performance. A bone mineral density T-score equal to or below -2.5SD at the lumbar spine, at the total hip or at the femoral neck was used to define osteoporosis (World Health Organization definition). RESULTS A total of 126 women aged 74.38±6.32 years were included. Among them, 26 were assessed with sarcopenia (20.6%) and 34 (27.0%) with osteoporosis. There were more osteoporotic women among sarcopenic subjects (46.1%) than among non-sarcopenic subjects (22.0%) (p-value=0.011). A significant lower appendicular lean mass index was observed in osteoporotic women (p-value=0.025). We also observed, in osteoporotic subjects, a lower muscle strength (p-value=0.023). Numerical values of bone mineral density were lower in the sarcopenic population but the differences did not reach the level of statistical significance. CONCLUSION Our study demonstrated that muscle mass and strength are lower in patients with osteoporosis. Prospective changes in bone and muscle mass will be investigated during the follow-up of our cohort.

Comparison of the performance of five screening methods for sarcopenia

Background Sarcopenia leads to serious adverse health consequences. There is a dearth of screening tools for this condition, and performances of these instruments have rarely been evaluated. Our aim was to compare the performance of five screening tools for identifying elders at risk of sarcopenia against five diagnostic definitions. Subjects and methods We gathered cross-sectional data of elders from the SarcoPhAge (“Sarco”penia and “Ph”ysical Impairment with Advancing “Age”) study. Lean mass was measured with X-ray absorptiometry, muscle strength with a dynamometer and physical performance with the Short Physical Performance Battery (SPPB) test. Performances of screening methods were described using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC), according to five diagnostic definitions of sarcopenia. For each screening tool, optimal cutoff points were computed using two methods. Results A total of 306 subjects (74.8±5.9 years, 59.5% women) were included. The prevalence of sarcopenia varied from 5.7% to 16.7% depending on the definition. The best sensitivity (up to 100%) and the best NPV (up to 99.1%) were obtained with the screening test of Ishii et al, regardless of the definition applied. The highest AUC (up to 0.914) was also demonstrated by the instrument of Ishii et al. The most specific tool was the algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP; up to 91.1%). All NPVs were above 87.0%, and all PPVs were below 51.0%. New cutoffs related to each screening instrument were also proposed to better discriminate sarcopenic individuals from non-sarcopenic individuals. Conclusion Screening instruments for sarcopenia can be relevantly used in clinical practice to make sure to identify individuals who do not suffer from the syndrome. The screening test of Ishii et al showed better properties in terms of distinguishing those at risk of sarcopenia from those who were not at risk.

French translation and validation of the sarcopenia screening tool SARC-F

IntroductionThe purpose of the present study is to translate and validate into French the SARC-F questionnaire, a simple and easy screening tool for sarcopenia.Materials and methodsThe translation process has been divided into two consecutive parts: (1) the translation of the questionnaire from English to French and its language validation (inter-rater reliability and test–retest reliability); (2) the clinical validation of the French SARC-F to assess its performance (sensitivity, specificity, predictive positive value and predictive negative value) in a cohort of elderly Belgian subjects against 7 existing definitions of sarcopenia.ResultsThe translated French version of the SARC-F demonstrated an excellent inter-rater reliability, with an intraclass correlation coefficient (ICC) of 0.90 (95% CI 0.76–0.96), as well as excellent test–retest reliability, with an ICC of 0.86 (95% CI 0.66–0.94). Afterwards, 306 subjects took part in the clinical validation of the French version of the SARC-F questionnaire. The results showed that sensitivity of the tool ranged from 22.1 to 75.0%, depending on the definition used for the diagnosis of sarcopenia, and the specificity ranged from 84.9 to 87.1%. Moreover, all positive predictive values were always below 50%; the lowest negative predictive value was 68.1%, and the best one reached approximately 99%.ConclusionsThe results are in line with the psychometric performance found in the initial English validation of the SARC-F and seem to indicate that this screening tool can detect with precision the absence of sarcopenia, but seems less precise in affirming the presence of this geriatric syndrome.

Quality of life in sarcopenia measured with the SarQoL®: impact of the use of different diagnosis definitions

BackgroundThe SarQoL® is a recently developed quality of life questionnaire specific to sarcopenia.AimTo compare the quality of life (QoL) of subjects identified as sarcopenic with that of non-sarcopenic subjects when using six different operational definitions of sarcopenia.MethodsParticipants of the SarcoPhAge study (Belgium) completed the SarQoL®. Among the six definitions used, two were based on low lean mass alone (Baumgartner, Delmonico), and four required both low muscle mass and decreased performance (Cruz-Jentoft, Studenski, Fielding, Morley). Physical assessments included measurements of muscle mass with dual energy X-ray absorptiometry, muscle strength with a handheld dynamometer and gait speed over a 4-m distance.ResultsA total of 387 subjects completed the SarQoL®. Prevalence of sarcopenia varied widely across the different definitions. Using the SarQoL®, a lower QoL was found for sarcopenic subjects compared to non-sarcopenic subjects when using the definitions of Cruz-Jentoft (56.3 ± 13.4 vs 68.0 ± 15.2, p < 0.001), Studenski (51.1 ± 14.5 vs 68.2 ± 14.6, p < 0.001), Fielding (53.8 ± 12.0 vs 68.3 ± 15.1, p < 0.001), and Morley (53.3 ± 12.5 vs 67.1 ± 15.3, p < 0.001). No QoL difference between sarcopenic and non-sarcopenic subjects was found when using the definitions of Baumgartner or Delmonico, which were only based on the notion of decreased muscle mass.Discussion and conclusionsThe SarQoL® was able to discriminate sarcopenic from non-sarcopenic subjects with regard to their QoL, regardless of the definition used for diagnosis as long as the definition includes an assessment of both muscle mass and muscle function. Poorer QoL, therefore, seems more related to muscle function than to muscle mass.

Current review of the SarQoL®: a health-related quality of life questionnaire specific to sarcopenia

ABSTRACT Introduction: Sarcopenia, defined by a progressive and generalized loss of muscle mass and muscle function, is associated with many harmful clinical consequences. Several studies have reported the impact of sarcopenia on health-related quality of life (HRQoL) using generic quality of life (QoL) questionnaires. The results of these observational studies are quite heterogenous. Indeed, generic tools may not be able to detect subtle effects of sarcopenia on QoL. Recently, a sarcopenia-specific HRQoL questionnaire was developed and validated in a population of sarcopenic subjects to more accurately assess the impact of sarcopenia on QoL. Areas covered: The purpose of this review is to present evidence regarding the impact of sarcopenia on QoL and to introduce a new specific HRQoL questionnaire, the SarQoL®. Expert commentary: The self-administered SarQoL®, initially developed in French, comprises 55 items translated into 22 questions. The questionnaire has been shown to be understandable, valid, consistent, and reliable and can therefore be recommended for clinical and research purposes. The questionnaire is now available in 11 different languages with another 20 translations in progress. The instrument’s sensitivity to change still needs to be assessed in future longitudinal studies.

Subjective sleep quality among sarcopenic and non-sarcopenic older adults: results from the sarcophage cohort

BackgroundIt seems that sleep quality could impact the physiological process related to loss of muscle mass.ObjectiveWe seek to compare subjective sleep quality of sarcopenic and non-sarcopenic subjects diagnosed according to 6 definitions.DesignCross-sectional data used in this analysis were collected from the SarcoPhAge (Sarcopenia & Physical Impairment with Advancing Age) cohort, a prospective study aiming to assess clinical parameters linked to sarcopenia.ParticipantsThe present study was interested in community-dwelling older adults with and without sarcopenia. Measurements–A diagnosis of sarcopenia was established according to 6 definitions. Three assessments were carried out: an evaluation of lean mass, a measurement of muscle strength and an assessment of physical performance. In addition, to evaluate the parameters of subjective sleep, we used the Pittsburgh Sleep Quality Index (PSQI), a self-administered questionnaire evaluating 7 components of sleep architecture.ResultsA total of 255 individuals aged 74.7±5.8 years were included. Based on the 6 different definitions, the prevalence of sarcopenia ranged from 5.9% to 32.5%. There was no significant difference between sarcopenic and non-sarcopenic subjects regarding most of the components of subjective sleep quality. However, the definition of Cruz-Jentoft et al. (2010) indicated that sarcopenic subjects had higher scores than non-sarcopenic subjects for two components: sleep latency and day-time dysfunction (p=0.03 and p=0.04, adjusted for confounders). Moreover, some parameters of sleep quality were correlated with components of sarcopenia.ConclusionsSome properties of subjective sleep quality seem to be associated with sarcopenia and seem correlated with at least one of the three components of the condition.

Influence of environmental factors on food intake among nursing home residents: a survey combined with a video approach

Background In addition to the well-known physiological factors, dietary behavior that affects health seems to be influenced by a wide variety of environmental factors. The aim of this study was to assess, by means of an original video approach, the influence of the environment on food intake in nursing homes. Methods The perception of the environment during meals in nursing homes was evaluated by residents and by two groups of volunteers who either work in the field of geriatrics, or who do not work in the field of geriatrics. First, a random sample of residents answered a self-administered questionnaire related to different indicators (ie, noise, space, comfort, light, odors, perceived satisfaction of meals, taste of meals, presentation of meals, service and setting). Second, two separate panels, one including the people who work in the field of geriatrics (ie, experts) and one including the people who have no particular interest in geriatrics (ie, nonexperts), were asked to answer a questionnaire on their perception of the environment after having watched a video of the lunch in each nursing home. Then, the food intake of the residents was measured by a precise food-weighing method. Results A total of 88 residents from nine different nursing homes, 18 experts and 45 nonexperts answered the questionnaires. This study highlighted that, on the one hand, after adjustment on confounding variables, the perception of the quantity of food served by the residents is the only single factor associated with food consumption (P=0.003). On the other hand, experts and nonexperts did not perceive any environmental factor that seems to be significantly associated with residents’ food intake. Conclusion Our results highlighted that, in a nursing home setting, environmental factors have limited influence on the food intake of the residents, with the exception of their own perception of the quantity served. The relevance of this factor deserves further investigation.