Prevalence of characteristics associated with sarcopenia in elders: a cross-sectional study

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TL;DR

This cross-sectional study of 384 older adults in Brazilian primary care units found that 25.52% had probable sarcopenia, 11.98% had sarcopenia, and 9.90% had severe sarcopenia. Male sex (PR 1.75), polypharmacy (PR 1.57), osteoporosis (PR 2.16 for severe sarcopenia), and calf circumference below 31 cm (PR 2.24 for sarcopenia, PR 2.19 for severe sarcopenia) were significantly associated with sarcopenia. These findings highlight modifiable risk factors that primary care providers can target to prevent sarcopenia and its complications in aging populations.

Full summary

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{"Background": "Sarcopenia, recognized as a muscle disease in 2016 (ICD-10-MC-M62.84), is characterized by loss of strength and muscle mass with multifactorial causes including aging, genetics, hormonal changes, and mitochondrial dysfunction. Worldwide prevalence ranges from 3% to 86.5%, while in Brazil it averages 15.4% with significant regional variation (Florian\u00f3polis 33.3%, S\u00e3o Paulo 4.8%, Salvador 17.8%, Natal 10.7%). Untreated sarcopenia impairs daily activities and leads to falls, fractures, institutionalization, hospitalization, and death. This study aimed to identify the prevalence and characteristics associated with sarcopenia in elders attending Primary Health Care Units in Fortaleza, Brazil.", "Methods": "This cross-sectional epidemiological study followed STROBE guidelines and was conducted from April 2018 to June 2019 in six Primary Health Care Units in Fortaleza. The sample of 384 elders was calculated using the formula for cross-sectional studies with infinite populations (50% proportion, 5% error, 95% CI). Stratified sampling was used based on the six Regional Secretariats. Inclusion criteria were age 60 years or older; exclusion criteria were dementia diagnosis. Sarcopenia was evaluated using EWGSOP2 criteria: grip strength measured with a Jamar hydraulic dynamometer (cutoffs: <27 kgf for men, <16 kgf for women), muscle mass calculated using the anthropometric equation for Total Muscle Mass (MMI cutoffs: <7.0 kg/m\u00b2 for men, <5.5 kg/m\u00b2 for women), and physical performance via the 10-Meter gait speed test (cutoff: \u22640.8 m/s). Elders were classified as probable sarcopenia (low strength only), sarcopenia (low strength + low muscle mass), or severe sarcopenia (low strength + low muscle mass + low physical performance). Chi-squared test and multinomial logistic regression were used, with results converted from OR to prevalence ratio (PR) using the delta method. Associations with p<0.05 were considered significant.", "Key Results": "Among 384 participants (median age 69 years, 67.5% female), the prevalence of probable sarcopenia was 25.52%, sarcopenia 11.98%, and severe sarcopenia 9.90%. In the multivariate analysis, males were 1.75 times more likely to have probable sarcopenia (PR 1.75; CI95%: 1.25-2.46; p=0.001). Osteoporosis was 2.16 times more prevalent in severe sarcopenia (PR 2.16; CI95%: 1.17-3.97; p=0.013). Polypharmacy (\u22655 medications) increased the prevalence of probable sarcopenia by 1.57 times (PR 1.57; CI95%: 1.10-2.56; p=0.014). Dyslipidemia was associated with both probable sarcopenia (PR 0.48; CI95%: 0.24-0.98; p=0.043) and sarcopenia (PR 2.05; CI95%: 1.13-3.73; p=0.018). Physical exercise reduced the prevalence of severe sarcopenia (PR 0.39; CI95%: 0.17-0.92; p=0.031). Overweight (PR 1.78; CI95%: 1.20-2.61; p=0.003) and obesity (PR 1.72; CI95%: 1.19-2.50; p=0.003) were associated with probable sarcopenia. Calf circumference below 31 cm increased the prevalence of sarcopenia by 2.24 times (CI95%: 1.23-4.07; p=0.009) and severe sarcopenia by 2.19 times (CI95%: 1.16-4.17; p=0.016).", "Clinical Implications": "This study demonstrates that sarcopenia screening using EWGSOP2 criteria is feasible in primary care settings using accessible tools like dynamometry, anthropometric equations, and gait speed tests. The high prevalence of probable sarcopenia (25.52%) suggests that early identification of low muscle strength\u2014before significant muscle mass loss occurs\u2014could enable timely interventions. Modifiable risk factors identified include polypharmacy, physical inactivity, and abnormal BMI, all of which can be addressed through primary care interventions. The strong association between calf circumference below 31 cm and both sarcopenia and severe sarcopenia supports its use as a simple, low-cost screening tool. The association with osteoporosis underscores the importance of evaluating muscle-bone interactions in older adults. Limitations include the cross-sectional design preventing causal inference, self-reported comorbidities, and exclusion of elders with cognitive restrictions or those who were bedridden, potentially underestimating true prevalence. Longitudinal studies are needed to evaluate sarcopenia development over time."}