Sarcopenia and homocysteine: is there a possible association in the elderly? A narrative review

Rachele De Giuseppe,Hellas Cena,Ilaria Di Napoli,Massimo Negro,Alessandra Vincenti,Chiara Elena Tomasinelli

doi:10.1017/s095442242100010x

Abstract

Sarcopenia (SA) is a progressive skeletal muscle disorder, associated with increased risk of adverse outcomes, including falls, fractures, physical disability and mortality. Several risks factors may contribute to the development of SA in the elderly; among them, nutrition plays a key role in muscle health. The elderly are at risk of inadequate intake in terms of micronutrients affecting muscle homeostasis, such as B vitamins, related to homocysteine (Hcy) metabolism. This narrative review analysed the association between increased Hcy levels and SA, according to the criteria of the International Working Group on Sarcopenia, the European Working Group on Sarcopenia in Older People and the Asian Working Group for Sarcopenia. The authors focused not only on SA per se but also on exploring the association between increased Hcy levels and components of SA, including muscle mass, muscle strength and physical performance. Results are inconsistent, except for muscle mass, showing no significant associations with Hcy levels. Few and conflicting data emerged in this review on the association between SA and increased Hcy levels due to numerous differences between studies that change the significance of the association of Hcy and SA, as well as the muscle strength, muscle mass and physical performance. Furthermore, because the ageing process is not uniform in the population owing to differences in genetics, lifestyle and general health, chronological age fails to address the observed heterogeneity among the 'elderly' of the studies reported in this revision. Therefore, further studies are still needed.

Highlights

Sarcopenia (SA) is defined as an age-related loss of muscle mass and function(1).Research focusing on the definition and diagnostic criteria of SA has been conducted all over the world, leading to publication and update of international consensus(1–3), including the recent International Working Group on Sarcopenia (IWGS)(2), published in 2011; the European Working Group on Sarcopenia in Older People (EWGSOP)(4), published in 2010 and updated in 2019(1); and the Asian Working Group for Sarcopenia (AWGS)(5), published in 2014 and updated in 2020(3) (Table 1).The IWGS defined SA as the combination of low whole-body or appendicular fat-free mass and poor physical function(2)
Few and conflicting data emerged in this review on the association between SA and increased Hcy levels due to numerous differences between studies that change the significance of the association of Hcy and SA, as well as the muscle strength, muscle mass and physical performance
Lee et al(26) defined SA according to the new AWGS2 criteria(3), while the other authors(22–25) defined SA in the elderly according to the old version of EWGSOP(4) and AWGS(5)

Summary

Introduction

Sarcopenia (SA) is defined as an age-related loss of muscle mass and function(1). The IWGS defined SA as the combination of low whole-body or appendicular fat-free mass and poor physical function(2). The updated version of the EWGSOP (EWGSOP2) reported a new ‘operational’ definition of SA, adopting poor muscle strength as the primary criterion for SA diagnosis(1). SA is ‘probable’ when poor muscle strength is detected, while SA diagnosis is ‘confirmed’ when there is a concomitant loss of muscle quantity/quality(1). When poor muscle strength, loss of muscle quantity/quality and low physical performance are detected, SA is considered severe(1). Sarcopenia (SA) is a progressive skeletal muscle disorder, associated with increased risk of adverse outcomes, including falls, fractures, physical disability and mortality. The elderly are at risk of inadequate intake in terms of micronutrients affecting muscle homeostasis, such as B vitamins, related to homocysteine (Hcy) metabolism

Objectives

Methods

Results

Discussion

Conclusion