Sarcopenia and mortality in different clinical conditions: A meta-analysis

Abstract

Objectives: Sarcopenia is recognized to be a health problem which is as serious as obesity, but its relevance to mortality is unclear. We conducted a meta-analysis of cohort studies on lean mass and mortality in populations with different health conditions.

Methods: In this study, a systematic search of PubMed, Cochrane Library and Embase was performed for cohort studies published before Dec 20, 2017 which examined the relationship between lean mass and mortality. We included studies reporting lean mass measurement by dual-energy X-ray absorptiometry, bioimpedance analysis or computed tomography, as continuous (per standard deviation [SD] decrease) or binary variables (using sarcopenia cutoffs). We excluded studies which used muscle mass surrogates, anthropometric measurement of muscle, rate of change in muscle mass, and sarcopenia defined by composite criteria. The primary study outcome was all-cause mortality. Pooled hazard ratio estimates were calculated using a random effects model.

Results: A total of 9602 articles were identified from the systematic search, and 188 studies with 98 468 participants from 34 countries were included in the meta-analysis. Of the 68 studies included in the present meta-analysis, the pooled HR was 1.36 and 1.74 for every SD decrease in lean mass and in people with low lean mass (cutoffs), respectively. Significant associations were also observed in elderly and all disease subgroups, irrespective of the measurement modalities.

Conclusions: Lower lean mass is robustly associated with increased mortality, regardless of health conditions and lean mass measurement modalities. This meta-analysis highlighted low lean mass as a key public health issue.

Keywords: Chronic diseases; Meta-analysis; Mortality; Sarcopenia; Systematic review.

Fig. 1

Forest plots of the association of reduced lean mass (per SD decrease) with all-cause mortality by subgroups. Legend: M: Male F: Female Durand 2014/i: 2002–2007 cohortDurand 2014/ii: 2007–2011 cohort Nishikawa 2017/1: Refer to Cheung et al Supplement Reference (119) in the same issue Nishikawa 2017/2: Refer to Cheung et al Supplement Reference (120) in the same issue Nishikawa 2017/3: Refer to Cheung et al Supplement Reference (121) in the same issue Nishikawa 2017/4: Refer to Cheung et al Supplement Reference (122) in the same issue Okumura 2017/1: Refer to Cheung et al Supplement Reference (127) in the same issue Okumura 2017/2: Refer to Cheung et al Supplement Reference (128) in the same issue Fukushima 2016/1: Refer to Cheung et al Supplement Reference (41) in the same issue Fukushima 2016/2: Refer to Cheung et al Supplement Reference (42) in the same issue. (a) Elderly; (b) cancer patients; (c) patients with cardiovascular diseases; (d) patients with liver diseases; (e) patients with lung disease; (f) patients with renal disease; (g) patients with other conditions.

Fig. 1

Forest plots of the association of reduced lean mass (per SD decrease) with all-cause mortality by subgroups. Legend: M: Male F: Female Durand 2014/i: 2002–2007 cohortDurand 2014/ii: 2007–2011 cohort Nishikawa 2017/1: Refer to Cheung et al Supplement Reference (119) in the same issue Nishikawa 2017/2: Refer to Cheung et al Supplement Reference (120) in the same issue Nishikawa 2017/3: Refer to Cheung et al Supplement Reference (121) in the same issue Nishikawa 2017/4: Refer to Cheung et al Supplement Reference (122) in the same issue Okumura 2017/1: Refer to Cheung et al Supplement Reference (127) in the same issue Okumura 2017/2: Refer to Cheung et al Supplement Reference (128) in the same issue Fukushima 2016/1: Refer to Cheung et al Supplement Reference (41) in the same issue Fukushima 2016/2: Refer to Cheung et al Supplement Reference (42) in the same issue. (a) Elderly; (b) cancer patients; (c) patients with cardiovascular diseases; (d) patients with liver diseases; (e) patients with lung disease; (f) patients with renal disease; (g) patients with other conditions.

Fig. 1

Forest plots of the association of reduced lean mass (per SD decrease) with all-cause mortality by subgroups. Legend: M: Male F: Female Durand 2014/i: 2002–2007 cohortDurand 2014/ii: 2007–2011 cohort Nishikawa 2017/1: Refer to Cheung et al Supplement Reference (119) in the same issue Nishikawa 2017/2: Refer to Cheung et al Supplement Reference (120) in the same issue Nishikawa 2017/3: Refer to Cheung et al Supplement Reference (121) in the same issue Nishikawa 2017/4: Refer to Cheung et al Supplement Reference (122) in the same issue Okumura 2017/1: Refer to Cheung et al Supplement Reference (127) in the same issue Okumura 2017/2: Refer to Cheung et al Supplement Reference (128) in the same issue Fukushima 2016/1: Refer to Cheung et al Supplement Reference (41) in the same issue Fukushima 2016/2: Refer to Cheung et al Supplement Reference (42) in the same issue. (a) Elderly; (b) cancer patients; (c) patients with cardiovascular diseases; (d) patients with liver diseases; (e) patients with lung disease; (f) patients with renal disease; (g) patients with other conditions.

Fig. 1

Forest plots of the association of reduced lean mass (per SD decrease) with all-cause mortality by subgroups. Legend: M: Male F: Female Durand 2014/i: 2002–2007 cohortDurand 2014/ii: 2007–2011 cohort Nishikawa 2017/1: Refer to Cheung et al Supplement Reference (119) in the same issue Nishikawa 2017/2: Refer to Cheung et al Supplement Reference (120) in the same issue Nishikawa 2017/3: Refer to Cheung et al Supplement Reference (121) in the same issue Nishikawa 2017/4: Refer to Cheung et al Supplement Reference (122) in the same issue Okumura 2017/1: Refer to Cheung et al Supplement Reference (127) in the same issue Okumura 2017/2: Refer to Cheung et al Supplement Reference (128) in the same issue Fukushima 2016/1: Refer to Cheung et al Supplement Reference (41) in the same issue Fukushima 2016/2: Refer to Cheung et al Supplement Reference (42) in the same issue. (a) Elderly; (b) cancer patients; (c) patients with cardiovascular diseases; (d) patients with liver diseases; (e) patients with lung disease; (f) patients with renal disease; (g) patients with other conditions.

Fig. 2

Forest plots of the association of low lean mass with all-cause mortality by subgroups. Legend: M: MaleF: Female Durand 2014/i: 2002–2007 cohort Durand 2014/ii: 2007–2011 cohort Nishikawa 2017/1: Refer to Cheung et al Supplement Reference (119) in the same issue Nishikawa 2017/2: Refer to Cheung et al Supplement Reference (120) in the same issue Nishikawa 2017/3: Refer to Cheung et al Supplement Reference (121) in the same issue Nishikawa 2017/4: Refer to Cheung et al Supplement Reference (122) in the same issue Okumura 2017/1: Refer to Cheung et al Supplement Reference (127) in the same issue Okumura 2017/2: Refer to Cheung et al Supplement Reference (128) in the same issue Fukushima 2016/1: Refer to Cheung et al Supplement Reference (41) in the same issue Fukushima 2016/2: Refer to Cheung et al Supplement Reference (42) in the same issue. (a) Elderly; (b) cancer patients; (c) patients with cardiovascular diseases; (d) patients with liver diseases; (e) patients with lung disease; (f) patients with renal disease; (g) patients with other conditions.

Fig. 2

Forest plots of the association of low lean mass with all-cause mortality by subgroups. Legend: M: MaleF: Female Durand 2014/i: 2002–2007 cohort Durand 2014/ii: 2007–2011 cohort Nishikawa 2017/1: Refer to Cheung et al Supplement Reference (119) in the same issue Nishikawa 2017/2: Refer to Cheung et al Supplement Reference (120) in the same issue Nishikawa 2017/3: Refer to Cheung et al Supplement Reference (121) in the same issue Nishikawa 2017/4: Refer to Cheung et al Supplement Reference (122) in the same issue Okumura 2017/1: Refer to Cheung et al Supplement Reference (127) in the same issue Okumura 2017/2: Refer to Cheung et al Supplement Reference (128) in the same issue Fukushima 2016/1: Refer to Cheung et al Supplement Reference (41) in the same issue Fukushima 2016/2: Refer to Cheung et al Supplement Reference (42) in the same issue. (a) Elderly; (b) cancer patients; (c) patients with cardiovascular diseases; (d) patients with liver diseases; (e) patients with lung disease; (f) patients with renal disease; (g) patients with other conditions.

Fig. 2

Forest plots of the association of low lean mass with all-cause mortality by subgroups. Legend: M: MaleF: Female Durand 2014/i: 2002–2007 cohort Durand 2014/ii: 2007–2011 cohort Nishikawa 2017/1: Refer to Cheung et al Supplement Reference (119) in the same issue Nishikawa 2017/2: Refer to Cheung et al Supplement Reference (120) in the same issue Nishikawa 2017/3: Refer to Cheung et al Supplement Reference (121) in the same issue Nishikawa 2017/4: Refer to Cheung et al Supplement Reference (122) in the same issue Okumura 2017/1: Refer to Cheung et al Supplement Reference (127) in the same issue Okumura 2017/2: Refer to Cheung et al Supplement Reference (128) in the same issue Fukushima 2016/1: Refer to Cheung et al Supplement Reference (41) in the same issue Fukushima 2016/2: Refer to Cheung et al Supplement Reference (42) in the same issue. (a) Elderly; (b) cancer patients; (c) patients with cardiovascular diseases; (d) patients with liver diseases; (e) patients with lung disease; (f) patients with renal disease; (g) patients with other conditions.

Fig. 2

Forest plots of the association of low lean mass with all-cause mortality by subgroups. Legend: M: MaleF: Female Durand 2014/i: 2002–2007 cohort Durand 2014/ii: 2007–2011 cohort Nishikawa 2017/1: Refer to Cheung et al Supplement Reference (119) in the same issue Nishikawa 2017/2: Refer to Cheung et al Supplement Reference (120) in the same issue Nishikawa 2017/3: Refer to Cheung et al Supplement Reference (121) in the same issue Nishikawa 2017/4: Refer to Cheung et al Supplement Reference (122) in the same issue Okumura 2017/1: Refer to Cheung et al Supplement Reference (127) in the same issue Okumura 2017/2: Refer to Cheung et al Supplement Reference (128) in the same issue Fukushima 2016/1: Refer to Cheung et al Supplement Reference (41) in the same issue Fukushima 2016/2: Refer to Cheung et al Supplement Reference (42) in the same issue. (a) Elderly; (b) cancer patients; (c) patients with cardiovascular diseases; (d) patients with liver diseases; (e) patients with lung disease; (f) patients with renal disease; (g) patients with other conditions.