Abstract
BackgroundAge-related declines in skeletal muscle mass and strength, representing “sarcopenia,” are a growing concern in aging societies. However, the prevalence of low muscle mass based on the height2-adjustment has been shown to be extremely low, and a more appropriate definition of low muscle mass is needed, particularly for Asian women. The aim of this study was to explore the most appropriate adjustment of appendicular lean mass (ALM) for predicting mortality or disability risk using ALM or any of 5 adjustments of ALM among community-dwelling Japanese.MethodsSubjects comprised 1026 men and 952 women between 40 and 79 years old at baseline (1997–2000) who participated in the National Institute for Longevity Sciences - Longitudinal Study of Aging, Japan. ALM (kg) and 5 adjusted indices of ALM (ALM/leg length, ALM/height, ALM/height2, ALM/weight, and ALM/body mass index [BMI]) were assessed at baseline. Disability was defined by long-term care insurance certification based on responses to a survey mailed in 2013, and death records were obtained as vital statistics until December 2014. Crude and adjusted Cox proportional hazard models were used to estimate hazard ratios for mortality or disability by sex-stratified quintiles of each ALM index (ALM and adjusted ALM) or sarcopenia-related indices. The area under the curve (AUC) was calculated with the multivariate-adjusted logistic regression model. Additionally, mixed-effects analyses were used to clarify the age-related ALM indices decline over 12 years (n = 1838).ResultsCrude Cox proportional hazard models and multivariate-adjusted logistic model (AUC) indicated that higher ALM and ALM/BMI in women, and higher ALM, ALM/leg length, ALM/height, and ALM/BMI in men were associated with lower risks for mortality or disability than ALM/height2. The mixed effect model indicated all ALM indices in men, and ALM, ALM/leg length, and ALM/height in women could better predict age-related lean muscle mass decline.ConclusionsUnadjusted ALM in women, and ALM/leg length, ALM/height, ALM/BMI, and ALM in men may be more appropriate for predicting future mortality or disability than ALM/height2. Considering the age-related muscle mass decline, unadjusted ALM would be the first variable to assess, regardless of sex, in this Japanese cohort study.
Highlights
Age-related declines in skeletal muscle mass and strength, representing “sarcopenia,” are a growing concern in aging societies
Crude Cox proportional hazard models and area under the curve (AUC) indicated that higher appendicular lean mass (ALM) and ALM/body mass index (BMI) in women, and higher ALM, ALM/leg length, ALM/height, and ALM/BMI in men were associated with lower risks for mortality or disability than ALM/ height2
This study indicated that crude ALM and ALM/BMI values in women and crude ALM, ALM/leg length, ALM/height, and ALM/BMI in men were positively associated with lower risks for mortality or disability, respectively
Summary
Age-related declines in skeletal muscle mass and strength, representing “sarcopenia,” are a growing concern in aging societies. The prevalence of low muscle mass based on the height2-adjustment has been shown to be extremely low, and a more appropriate definition of low muscle mass is needed, for Asian women. Age-related declines in skeletal muscle mass and strength, referred to as “sarcopenia” [1,2,3], are a growing concern in Asian countries as the population ages [4], because sarcopenia is associated with adverse health outcomes in older adults [5]. The sarcopenia criteria using these definitions by FNIH better predicted mortality among Korean men, and there was no positive association in women [12]. An alternative and more appropriate definition of low muscle mass is still needed [13], for Asian women
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