Comparing Prevalence of Sarcopenia Using Twelve Sarcopenia Definitions in a Large Multinational European Population of Community-Dwelling Older Adults

Abstract

Objectives: Multinational prevalence data on sarcopenia among generally healthy older adults is limited. The aim of the study was to assess prevalence of sarcopenia in the DO-HEALTH European trial based on twelve current sarcopenia definitions.

Setting and participants: This is an analysis of the DO-HEALTH study including 1495 of 2157 community-dwelling participants age 70+ years from Germany, France, Portugal, and Switzerland with complete measurements of the sarcopenia toolbox including muscle mass by DXA, grip strength, and gait speed.

Measurements: The twelve sarcopenia definitions applied were Asian Working Group on Sarcopenia (AWGS1), AWGS2, Baumgartner, Delmonico, European Working Group on Sarcopenia in Older People (EWGSOP1), EWGSOP2, EWGSOP2-lower extremities, Foundation for the National Institutes of Health (FNIH1), FNIH2, International Working Group on Sarcopenia in Older People (IWGS), Morley, and Sarcopenia Definitions and Outcomes Consortium (SDOC).

Results: Mean age was 74.9 years (SD 4.4); 63.3% were women. Sarcopenia prevalence ranged between 0.7% using the EWGSOP2 or AWGS2 definition, up to 16.8% using the Delmonico definition. Overall, most sarcopenia definitions, including Delmonico (16.8%), Baumgartner (12.8%), FNIH1(10.5%), IWGS (3.6%), EWGSOP1 (3.4%), SDOC (2.0%), Morley (1.3%), and AWGS1 (1.1%) tended to be higher than the prevalence based on EWGSOP2 (0.7%). In contrast, the definitions AWGS2 (0.7%), EWGSOP2-LE (1.1%), FNIH2 (1.0%) - all based on muscle mass and muscle strength - showed similar lower prevalence as EWGSOP2 (0.7%). Moreover, most sarcopenia definitions did not overlap on identifying sarcopenia on an individual participant-level.

Conclusion: In this multinational European trial of community-dwelling older adults we found major discordances of sarcopenia prevalence both on a population- and on a participant- level between various sarcopenia definitions. Our findings suggest that the concept of sarcopenia may need to be rethought to reliably and validly identify people with impaired muscle health.

Keywords: EWGSOP; SDOC; Sarcopenia; aged; geriatric assessment; hand strength; muscle health; prevalence study.

Figure 1

Criteria for sarcopenia definitions and number of participants with sarcopenia in the DO-HEALTH at baseline (n=1495) Abbreviations. EWGSOP, European Working Group on Sarcopenia in Older People; SDOC, Sarcopenia Definitions and Outcomes Consortium, FNIH, Foundation for the National Institutes of Health Biomarkers Consortium Sarcopenia project; IWGS, International Working Group on Sarcopenia Definition; AWGS, Asian Working Group on Sarcopenia; ASM, appendicular skeletal muscle mass, ALM, appendicular lean mass; BMI, body mass index; SPPB, short physical performance battery. a) For better readability specific cut-off values and their corresponding units for sarcopenia definitions are not displayed. b) Low muscle strength and/or low muscle performance. c) Low muscle mass and/or low muscle performance. Muscle strength of the lower extremities was assessed by the repeated chair stands test. Participants were instructed to perform 5 repeats of the sit-to stand chair test using manual timing.

Figure 2 Panel A

Venn plot comparing the three most recent sarcopenia definitions (EWGSOP2, AWGS2, SDOC) for sarcopenia diagnosis displaying absolute numbers of patients (n)

Figure 2 Panel B

Venn plot comparing different criteria combinations using two criteria for sarcopenia diagnosis (SDOC=low grip and low gait; IWGS= low mass and low gait; EWGSOP2=low mass and low grip) displaying aboluate numbers of patients (n)

Figure 2 Panel C

Venn plot comparing different sarcopenia definitions all based on low grip strength and low muscle mass (EWGSOP2, AWGS2, FNIH2) for sarcopenia diagnosis displaying absolute numbers of patients (n)

Figure 2 Panel D

Venn plot comparing different sarcopenia definition all based on low muscle mass only (Baumgartner, Delmonico, FNIH1) for sarcopenia diagnosis displaying absolute numbers of patients (n)

Figure 2 Panel E

Venn plot comparing different sarcopenia definitions all based on low gait speed and either low grip strength (SDOC) or low muscle mass (Morley, IWGS) for sarcopenia diagnosis displaying absolute numbers of patients (n)