Stage-specific prevalence and progression of sarcopenia among aging hemodialysis patients: a multicenter cross-sectional study

New criteria of the Asian working group for sarcopenia (AWGS) were updated in 2019. However, the impact of this change on hospitalized patients has not been fully evaluated. We aimed to investigate the prevalence of sarcopenia and its distribution by age and gender in hospitalized patients. Furthermore, we explored the effects of the new criteria on sarcopenia prevalence compared to the previous criteria. From July 2020 to August 2021, a total of 380 patients underwent skeletal muscle mass assessment using dual-energy X-ray absorptiometry. Handgrip strength and usual gait speed were used to evaluate muscle strength and physical performance. Based on both AWGS 2014 and AWGS 2019 criteria, the prevalence of sarcopenia was significantly higher in males compared to females in the age groups of ≥65 years and ≥75 years. According to the AWGS criteria from 2014 to 2019, the prevalence of sarcopenia showed a significant increase from 35.3% to 37.6%. Specifically, the prevalence rate in males increased from 38.1% to 41.6%, while in females, it increased from 31.2% to 31.8%. The prevalence of severe sarcopenia, a new diagnostic category in the AWGS 2019 criteria, was 25.8%. Surprisingly, the majority of sarcopenic patients in the age group of ≥65 years fell into this category. By applying the new criteria, more patients were classified as sarcopenia in males. In addition, a new category called severe sarcopenia is expected to contribute to subdividing sarcopenic patients in detail and facilitating more proactive management strategies.

To investigate the value of neutrophil-to-lymphocyte ratio (NLR) for diagnosing sarcopenia in patients undergoing maintenance hemodialysis (MHD) and efficacy of Baduanjin exercise combined with nutritional support on MHD patients with sarcopenia. A total of 220 patients undergoing MHD in MHD centers were selected, among which 84 had occurred with sarcopenia confirmed by measurements from the Asian Working Group for Sarcopenia. Data were collected for analyzing the influencing factors that lead to the onset of sarcopenia in MHD patients with the use of one-way analysis of variance and multivariate logistic regression. The role of NLR in the diagnosis of sarcopenia was explored, and its correlation with relevant diagnostic measurement performance such as grip strength, gait speed and skeletal muscle mass index was analyzed. In the end, some 74 patients with sarcopenia that qualify for further intervention and observation standards were divided into observation group (Baduanjin exercise plus nutritional support) and control group (nutritional support only), which were both intervened for 12 weeks. A total of 68 patients finished all interventions, with 33 patients in the observation group and 35 in the control group. The grip strength, gait speed, skeletal muscle mass index as well as the NLR were compared between the two groups. With the employment of multivariate logistic regression analysis, it was found that age, hemodialysis duration and NLR were risk factors for the onset of sarcopenia in MHD patients (P < 0.05). The area under ROC curve for NLR of MHD patients with sarcopenia was 0.695, and NLR was negatively correlated with a biochemical indicator-human blood albumin (P < 0.05). NLR was also negatively correlated with patient's grip strength, gait speed and skeletal muscle mass index, with the same correlation found in sarcopenia patients (all P < 0.05). After intervention, patient's grip strength and gait speed were both higher, and the NLR lower in the observation group than those in the control group (P < 0.05). The occurrence of sarcopenia in MHD patients is associated with patient's age, hemodialysis duration and NLR. Therefore, it has been concluded that NLR has certain values in the diagnosis of sarcopenia in patients undergoing MHD. Moreover, the muscular strength can be enhanced and inflammation decreased in sarcopenia patients through nutritional support and physical exercise, i.e., Bajinduan exercise.

The prevalence of sarcopenia and the health status of affected individuals, particularly among the young elderly, are unclear in Japan. We determined the prevalence of possible sarcopenia, a concept proposed by the Asian Working Group for Sarcopenia (AWGS) in 2019, and then investigated its clinical features in community-dwelling young elderly individuals in Kobe, a representative large city in Japan. This retrospective cross-sectional study examined 1768 residents of Kobe aged 65 years who underwent health and frailty checkups implemented by Kobe City between April 2017 and March 2019. Possible sarcopenia was diagnosed by the AWGS 2019 algorithm. Frailty status was assessed with the use of the Kihon Checklist, which was developed to identify senior citizens requiring nursing care in Japan. Fifty-one of the 1768 subjects were diagnosed with possible sarcopenia (overall prevalence of 2.9% [confidence interval: 2.1-3.7%]), with the prevalence being higher in women than in men. Individuals with possible sarcopenia had a lower body mass index, abdominal circumference, diastolic blood pressure and percentage of taking lipid-lowering drugs as well as a higher high-density lipoprotein cholesterol level and estimated glomerular filtration rate. They also showed a higher degree of frailty. A low body mass index and physical inactivity were significantly associated with possible sarcopenia. The prevalence of possible sarcopenia based on the AWGS 2019 criteria was 2.9% among 65-year-olds in Japan, with affected individuals more likely to be frail compared with those without this condition. Geriatr Gerontol Int 2021; 21: 689-696.

BackgroundThe single-pool model urea clearance index (single-pool Kt/Vurea; spKt/V) is the most commonly used method for dialysis adequacy assessment. However, only a few studies have examined the relationship between spKt/V values and parameters related to sarcopenia and nutritional status. This study aimed to evaluate whether the spKt/V is an indicator of sarcopenia and nutritional status in patients undergoing maintenance hemodialysis (MHD).MethodsA total of 142 patients were included in this single-center, cross-sectional study. Venous blood samples were collected shortly before the hemodialysis session. The adequacy of dialysis in patients receiving MHD was assessed using spKt/V. Sarcopenia was identified according to the Asian Working Group for Sarcopenia (2019) definition. Receiver operating characteristic curve and area under the curve were used to evaluate the predictive value of spKt/V in sarcopenia. Univariate and multivariate binary logistic regression analyses were used to determine the association between spKt/V and sarcopenia and nutritional status. ResultsThe mean spKt/V level was 1.3 ± 0.2, the prevalence of sarcopenia was 15.5% in patients on MHD. The best cutoff value of spKt/V in sarcopenia was 1.45 for both sexes, 1.33 and 1.45 for men and women, respectively (P < 0.05). The multivariate binary logistic regression shown that the spKt/V was independently positively associated with sarcopenia (OR = 122.88, 95% CI = 0.64–0.87, P = 0.002). Grouping spKt/V by the best cutoff value, when spKt/V ≥ 1.45, the OR of sarcopenia was 11.75 (95% CI = 3.16–43.67, P < 0.001). Subgroup analyses showed that when spKt/V ≥ 1.33 in men and spKt/V ≥ 1.45 in woman, the OR of sarcopenia was 9.73 (95% CI = 2.25–42.11, P = 0.002) and 14.52 (95% CI = 1.06–199.67, P = 0.045), respectively.ConclusionsThe present study showed that spKt/V was an important influencing factor of sarcopenia and malnutrition in Asian patients on MHD.

Sarcopenia in Korean Community-Dwelling Adults Aged 70 Years and Older: Application of Screening and Diagnostic Tools From the Asian Working Group for Sarcopenia 2019 Update

Neutrophil-to-lymphocyte ratio (NLR), a novel inflammatory marker, is strongly associated with the risk of sarcopenia. Notably, being overweight has been found to accelerate the loss of skeletal muscle mass and function in chronic kidney disease (CKD) patients. However, the effect of overweight status on the relationship between NLR and sarcopenia risk has been poorly studied. We conducted a cross-sectional study at a hemodialysis center in Chengdu, China, from September to December 2022. The prevalence of sarcopenia was determined according to the Asian Working Group for Sarcopenia (AWGS). Participants were stratified based on body mass index (BMI) categories for the Asian population (non-overweight < 23 kg/m2 and overweight ≥ 23 kg/m2). 272 participants aged 18–85 years were included, with 144 being male. The overall prevalence of sarcopenia was 32.72% (89/272). After adjusting for covariates, NLR was significantly associated with sarcopenia risk in overweight participants (OR 1.60, 95% CI 1.15–2.24, p = 0.006), whereas it was not significant in the non-overweight group (OR 0.88, 95% CI 0.70–1.10, p = 0.254). Moreover, subgroup analysis showed a significant interactive association between NLR and overweight status with respect to sarcopenia. These findings emphasize the potential significance of regular screening of NLR for the early detection of sarcopenia in overweight patients undergoing maintenance hemodialysis.

BackgroundThe aim of the present study was to validate the usefulness of the new octapolar multifrequency bioelectrical impedance analysis (BIA) for assessment of appendicular skeletal muscle mass (ASM) by comparing it with that of dual-energy X-ray absorptiometry (DXA) and to investigate the prevalence of sarcopenia in Chinese community-dwelling elderly according to Asian Working Group for Sarcopenia (AWGS) definition.MethodsA cross-sectional study was conducted in communities of Chengdu, China. A total of 944 community-dwelling elderly adults aged ≥60 years were included. ASM was measured by using DXA as a criterion method to validate a standing eight-electrode multifrequency BIA (InBody 720), followed by a further estimation of the prevalence of sarcopenia according the AWGS definition.ResultsIn the Bland-Altman analysis, no significant difference was found between DXA and BIA based on the ASM measurements. The prevalence of AWGS-defined sarcopenia was 12.5% in the elderly women and 8.2% in the elderly men.ConclusionsBIA is suitable for body composition monitoring (ASM) in elderly Chinese as a fast, noninvasive, and convenient method; therefore, it may be a better choice in large epidemiological studies in the Chinese population. The prevalence of AWGS-defined sarcopenia was approximately 10.4% and increased with age in the Chinese community-dwelling elderly in this study.

Prevalence and factors affecting sarcopenia in middle-aged and older adults with knee osteoarthritis: A multicenter cross-sectional study from South China.

BackgroundThe Asian Working Group for Sarcopenia (AWGS) 2019 recommended the use of dual‐energy X‐ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA) to assess appendicular lean mass (ALM). AWGS, European Working Group on Sarcopenia in Older People 2 (EWGSOP2), Foundation for the National Institutes of Health Sarcopenia Project (FNIH), and International Working Group on Sarcopenia (IWGS) reported different cutoff values for sarcopenia. We aimed to validate these cutoff values in a Japanese population using DXA and two different devices of segmental multi‐frequency BIA (MF‐BIA).MethodsWe examined the data of Japanese individuals aged 18–86 years using the DXA (n = 756) and two 8‐electrode MF‐BIA devices (InBody and TANITA MC) (n = 1884). To validate these cutoff values, we used a population aged 18–40 years, and calculated the 95% confidence intervals (CIs) of [mean−2SD].ResultsIn DXA, the 95%CIs of [mean−2SD] for ALM/Ht2 were 5.2–5.8 and 6.6–7.3 kg/m2 in women and men, respectively. The AWGS (<5.4 in women and <7.0 in men), and IWGS (≤5.67 in women and ≤7.23 in men) cutoffs were acceptable. Regarding TANITA MC, the 95%CIs of [mean−2SD] for ALM/Ht2 were 5.6–6.0 and 6.9–7.4 kg/m2 in women and men, respectively. The AWGS (<5.7 in women and <7.0 in men), EWGSOP2 (<6.0 in women and <7.0 in men), and IWGS cutoffs were acceptable. Regarding InBody, the 95%CIs of [mean−2SD] for ALM/Ht2 were 4.8–5.2 and 6.4–6.8 kg/m2 in young women and men, respectively. All cutoff values were too high compared to those measured by InBody. InBody and TANITA MC were highly correlated (P < 0.001), but the values by InBody were significantly lower than those by TANITA MC or DXA. Using Yamada's equation for InBody raw data, the AWGS, EWGSOP2, or IWGS cutoffs were acceptable. The BMI‐adjusted muscle mass cutoff values were <0.60 and <0.82 m2 in women and men, respectively. We also obtained the 20th percentile in older adult population (ALM/Ht2, <6.2 in women and <7.5 in men for TANITA MC; <5.4 in women and <7.0 in men for InBody).ConclusionsThe AWGS and IWGS cutoffs were valid for DXA, and the AWGS, IWGS, and EWGSOP2 cutoffs were valid for TANITA MC in Japanese population. Because the prevalence of sarcopenia is too low particularly in women when using those criteria, the 20th percentile might be a good alternative criteria. If the ALM original InBody values are used, the cutoffs should be <5.0 kg/m2 in women and <6.6 kg/m2 in men.

The Prevalence of Sarcopenia in Chinese Elderly Nursing Home Residents: A Comparison of 4 Diagnostic Criteria

The Evolving Landscape of Sarcopenia in Asia: A Systematic review and meta-analysis following the 2019 Asian working group for sarcopenia (AWGS) diagnostic criteria

Aims/IntroductionOlder adults with diabetes mellitus are susceptible to sarcopenia. Diffusion tensor imaging studies have also shown that patients with diabetes have altered white matter integrity. However, the relationship between these structural changes in white matter and sarcopenia remains poorly understood.Materials and MethodsThe study included 284 older patients (aged ≥65 years) who visited the Tokyo Metropolitan Geriatric Hospital Frailty Clinic. We used diffusion tensor imaging to measure fractional anisotropy (FA) and mean diffusivity (MD) to evaluate changes in white matter integrity. We investigated the associations between sarcopenia, or its diagnostic components, and FA or MD in seven white matter tracts considered to be associated with sarcopenia according to the patients’ diabetes status.ResultsWe found significantly low FA or high MD values in the bilateral anterior thalamic radiations (ATR) and right inferior fronto‐occipital fasciculus (IFOF) of patients with Asian Working Group for Sarcopenia 2019‐defined sarcopenia, in all patients and those with diabetes. Using binominal regression analyses, we associated low FA values in the left ATR and right IFOF with sarcopenia in all patients and those with diabetes, after adjusting for age, gender, HbA1c, blood pressure, cognitive function, physical activity, depression, nutritional status, and inflammation.ConclusionsWhite matter alterations in left ATR and right IFOF are associated with the prevalence of sarcopenia in patients with diabetes. Specific changes to the left ATR and right IFOF tracts could play critical roles in the occurrence of sarcopenia in patients with diabetes.

Sarcopenic obesity is a new category of obesity and is a specific condition of sarcopenia. This study aimed to find the relationship of the basal metabolic rate (BMR) and body water distribution with muscle health and their prospective roles in screening for sarcopenic obesity and sarcopenia. The role of nutrients such as carbohydrates in the relationship was further detected. A total of 402 elderly subjects were recruited. Body composition was estimated by bioelectrical impedance analysis. Sarcopenia was defined by the Asian Working Group for Sarcopenia 2019. The cutoff values were determined by the receiver operating characteristic curve. Mediation analyses were performed using SPSS PROCESS. Higher BMR and BMR/body surface area (BSA) were protective factors against sarcopenic obesity (OR = 0.047, p = 0.004; OR = 0.035, p = 0.002) and sarcopenia (OR = 0.085, p = 0.001; OR = 0.100, p = 0.003) in elderly people. Low extracellular water (ECW)/intracellular water (ICW) and ECW/total body water (TBW) were negatively correlated with the skeletal muscle index (SMI). The intake of dietary carbohydrates in people with sarcopenic obesity was the lowest, but in subjects with obesity, it was the highest (p = 0.023). The results of the moderated mediation model showed that BMR fully mediated the positive relationship between carbohydrates and SMI, which was more obvious in the population with an abnormal body water distribution. BMR or BMR/BSA had the potential role of predicting a higher risk of sarcopenic obesity and sarcopenia. Higher BMR and lower ECW/ICW and ECW/TBW may benefit muscle health. The overconsumption of carbohydrates (especially > AMDR) might be a risk factor for obesity. Moderate dietary carbohydrate intake might promote SMI by regulating BMR and body water distribution in the elderly.

Lipid accumulation product (LAP) has recently gained attention as a novel indicator of metabolic dysfunction. However, the association between LAP and sarcopenia, a metabolic condition characterized by loss of muscle mass, strength, and function, remains unclear. This study aimed to explore the relationship between LAP and both the prevalence and incidence of sarcopenia using data from the China Health and Retirement Longitudinal Study (CHARLS). Sarcopenia was defined according to the criteria established by the Asian Working Group for Sarcopenia in 2019. LAP was calculated using waist circumference and triglyceride levels. A cross-sectional analysis was performed with 7,004 participants from the baseline survey, utilizing logistic regression models to evaluate the association between LAP and sarcopenia prevalence. Additionally, a longitudinal cohort analysis involved 4,484 individuals who were free of sarcopenia at baseline and followed from 2011 to 2015. Cox proportional hazards models were employed to assess the longitudinal association between baseline LAP levels and incident sarcopenia. Furthermore, restricted cubic spline regression (RCS) and subgroup analyses were conducted to explore potential nonlinear relationships and differences across various subgroups. Receiver operating characteristic (ROC) curves was used to evaluate the discriminatory ability of LAP for identifying sarcopenia. Cross-sectional analyses and RCS revealed a significant inverse linear relationship between LAP and the prevalence of sarcopenia [odds ratio (OR) = 0.95, 95% confidence interval (CI): 0.94-0.96]. Participants within the highest LAP tertile demonstrated substantially lower odds of sarcopenia compared to those in the lowest tertile (OR = 0.21, 95% CI: 0.14-0.31). Longitudinal analyses similarly indicated that elevated LAP levels were associated with reduced sarcopenia incidence, with the highest LAP tertile associated with notably decreased risk (HR = 0.17, 95% CI: 0.11-0.27). The nonlinear pattern identified through RCS analysis indicated significant risk reductions up to a LAP threshold of 27.577. Furthermore, subgroup analyses consistently supported this inverse association across various demographic and clinical subgroups. Finally, diagnostic performance of LAP was assessed using the ROC curve (0.763 ([CI]: 0.744-0.783) in the longitudinal study). Elevated LAP levels are inversely associated with both the prevalence and incidence of sarcopenia among middle-aged and elderly adults in China. These findings suggest LAP could serve as a useful metabolic indicator for predicting reduced sarcopenia risk, warranting additional studies to confirm and further elucidate these relationships.

Sarcopenia is an emerging issue, but there is no universal consensus regarding its screening and diagnosis, especially regarding the influence of the Asian Working Group for Sarcopenia (AWGS) 2019 new definition on the prevalence of community-dwelling adults. To compare the prevalence of sarcopenia between the 2019 and 2014 definitions, a cross-sectional study including 606 normal nutritional status subjects (203 men/403 women; mean age 63.3 ± 10.0 years) was performed. Sarcopenic parameters, including calf circumference, grip strength, 6-m gait speed, and bioelectrical-impedance-analysis-derived skeletal mass index (SMI), were evaluated. According to the 2019 AWGS definition, the prevalence of possible sarcopenia and sarcopenia among community-dwelling adults was 7.4 and 2.8%, respectively. There were highly consistent findings regarding sarcopenia between the 2019 and 2014 AWGS definitions according to Cohen's kappa coefficient (0.668). However, the prevalence of possible sarcopenia according to 2014 and 2019 AWGS in males increased 7.9%; in contrast, sarcopenia decreased from 7.4 to 3.7% in females (p < 0.001). In conclusion, the AWGS 2019 definition is more convenient for sarcopenia case screening and remains considerably consistent in sarcopenia identification in community-dwelling adults in Taiwan. The discordance of possible sarcopenia and sarcopenia by sex is a concern.