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. 2024 Mar 4;7(3):e243604.
doi: 10.1001/jamanetworkopen.2024.3604.

Sarcopenia and Sarcopenic Obesity and Mortality Among Older People

Elizabeth Benz  1   2   3 , Alexandre Pinel  1 , Christelle Guillet  1 , Frederic Capel  1 , Bruno Pereira  4 , Marie De Antonio  4 , Melanie Pouget  5 , Alfonso J Cruz-Jentoft  6 , Doris Eglseer  7 , Eva Topinkova  8 , Rocco Barazzoni  9 , Fernando Rivadeneira  3 , M Arfan Ikram  2 , Marinka Steur  2 , Trudy Voortman  2 , Josje D Schoufour  10 , Peter J M Weijs  10   11 , Yves Boirie  1   5
Affiliations

Sarcopenia and Sarcopenic Obesity and Mortality Among Older People

Elizabeth Benz et al. JAMA Netw Open. .

Abstract

Importance: Sarcopenia and obesity are 2 global concerns associated with adverse health outcomes in older people. Evidence on the population-based prevalence of the combination of sarcopenia with obesity (sarcopenic obesity [SO]) and its association with mortality are still limited.

Objective: To investigate the prevalence of sarcopenia and SO and their association with all-cause mortality.

Design, setting, and participants: This large-scale, population-based cohort study assessed participants from the Rotterdam Study from March 1, 2009, to June 1, 2014. Associations of sarcopenia and SO with all-cause mortality were studied using Kaplan-Meier curves, Cox proportional hazards regression, and accelerated failure time models fitted for sex, age, and body mass index (BMI). Data analysis was performed from January 1 to April 1, 2023.

Exposures: The prevalence of sarcopenia and SO, measured based on handgrip strength and body composition (BC) (dual-energy x-ray absorptiometry) as recommended by current consensus criteria, with probable sarcopenia defined as having low handgrip strength and confirmed sarcopenia and SO defined as altered BC (high fat percentage and/or low appendicular skeletal muscle index) in addition to low handgrip strength.

Main outcome and measure: The primary outcome was all-cause mortality, collected using linked mortality data from general practitioners and the central municipal records, until October 2022.

Results: In the total population of 5888 participants (mean [SD] age, 69.5 [9.1] years; mean [SD] BMI, 27.5 [4.3]; 3343 [56.8%] female), 653 (11.1%; 95% CI, 10.3%-11.9%) had probable sarcopenia and 127 (2.2%; 95% CI, 1.8%-2.6%) had confirmed sarcopenia. Sarcopenic obesity with 1 altered component of BC was present in 295 participants (5.0%; 95% CI, 4.4%-5.6%) and with 2 altered components in 44 participants (0.8%; 95% CI, 0.6%-1.0%). An increased risk of all-cause mortality was observed in participants with probable sarcopenia (hazard ratio [HR], 1.29; 95% CI, 1.14-1.47) and confirmed sarcopenia (HR, 1.93; 95% CI, 1.53-2.43). Participants with SO plus 1 altered component of BC (HR, 1.94; 95% CI, 1.60-2.33]) or 2 altered components of BC (HR, 2.84; 95% CI, 1.97-4.11) had a higher risk of mortality than those without SO. Similar results for SO were obtained for participants with a BMI of 27 or greater.

Conclusions and relevance: In this study, sarcopenia and SO were found to be prevalent phenotypes in older people and were associated with all-cause mortality. Additional alterations of BC amplified this risk independently of age, sex, and BMI. The use of low muscle strength as a first step of both diagnoses may allow for early identification of individuals at risk for premature mortality.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Benz reported receiving grants from Agence Nationale de la Recherche during the conduct of the study. Dr Cruz-Jentoft reported receiving research grants from the Agencia Estatal de Investigación during the conduct of the study and personal fees from Abbott Nutrition, Danone-Nutricia, Nestlé Health Science, and Fresenius-Kabi outside the submitted work. Dr Barazzoni reported being a member of advisory board panels for Pfizer, Eli Lilly, Novo Nordisk, and Nutricia Research. Dr Boirie reported receiving grants from Agence Nationale de la Recherche during the conduct of the study and personal fees from Fresenius Kabi, Nestlé Health Science, Sanofi France, Novo Nordisk, and Lilly outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of the Study Population Diagnosed as Having Sarcopenic Obesity
Diagnostic criteria for sarcopenic obesity were adapted from the European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity consensus. Cutoffs for muscle function were a low handgrip strength of less than 27 kg for men and less than 16 kg for women. Cutoffs for body composition were low appendicular lean mass (ALM) divided by weight of less than 25.7% for men and less than 19.4% for women and high percentage of body fat of more than 29% for men and more than 41% for women at younger than 60 years and greater than 31% for men and greater than 43% for women at 60 years or older. For altered body composition, 1 component indicates low ALM divided by weight or high percentage of body fat and 2 components indicate low ALM divided by weight and high percentage of body fat.
Figure 2.
Figure 2.. Flowchart of the Total Study Population
DXA indicates dual-energy x-ray absorptiometry; ESPEN/EASO, European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity; EWGSOP2, European Working Group of Sarcopenia in Older People.
Figure 3.
Figure 3.. Kaplan-Meier Curves for Survival Time
Kaplan-Meier curves for survival time are shown according to diagnostic criteria of sarcopenic obesity categories defined by the European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity consensus. BC indicates body composition; BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); HGS, handgrip strength.
Figure 4.
Figure 4.. Association Between Sarcopenic Obesity and All-Cause Mortality
Participants without sarcopenic obesity were used as the reference group. Data presented as adjusted hazard ratios (HRs) with 95% CIs (models adjusted accordingly for age, sex, and body mass index [BMI; calculated as weight in kilograms divided by height in meters squared]). BC indicates body composition; HGS, handgrip strength.
See this image and copyright information in PMC

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