The prevalence patterns and risk factor profiles of poor muscle health and its associated components in multiethnic older Asians: The PIONEER study

Abstract

Background: We aim to determine the multiethnic patterns of the prevalence and associated factors of poor muscle health and its associated components in older Chinese, Malays, and Indian Asian adults.

Methods: We included 2199 participants (mean age ± SD: 72.9 ± 8.3 years; 54.3% female) from the baseline assessment of the Population Health and Eye Disease Profile in Elderly Singaporeans (PIONEER; 2017-2022) cohort study. Poor muscle health was defined as the presence of either low muscle mass (DEXA), or low muscle strength (handgrip strength), or low physical performance (gait speed). Its components include poor muscle function (low muscle strength and/or low physical performance without low muscle mass), pre-sarcopenia (low muscle mass only), and any sarcopenia (low muscle mass with low muscle strength and/or low physical performance). Sociodemographic, clinical, and lifestyle factors were assessed using biochemistry, clinical tests, and validated questionnaires. Regression models were utilized to evaluate the independent risk factors of poor muscle health and its components.

Results: The national census-adjusted prevalence of poor muscle health (88%) was similar across the three ethnic groups. However, Chinese individuals had higher prevalence of pre-sarcopenia and any sarcopenia, and a lower prevalence of poor muscle function compared with Indians or Malays. We observed ethnic differences in modifiable risk factors (low physical activity, diabetes, osteoporosis, and obesity) of poor muscle health and its components. Although obesity was protective of pre-sarcopenia (RRR = 0.19, 95% CI: 0.11, 0.36) and any sarcopenia (RRR = 0.29, 95% CI: 0.18, 0.47) in the overall population and across ethnic groups, it was associated with 1.7 times (95% CI: 1.07, 2.67) the likelihood of poor muscle function in the entire population.

Conclusions: Almost 90% of community dwelling Singaporean aged ≥60 years have poor muscle health across the three ethnic groups with ethnic disparities in modifiable risk factors, highlighting an urgent need for community-wide targeted interventions to promote muscle health.

Keywords: Muscle function; Muscle health; Muscle mass; Muscle strength; Physical performance; Sarcopenia.

Figure 1

National census‐adjusted prevalence of poor muscle health and its components. The percentages have been independently adjusted based on the census of 2020, and hence cannot be derived from the unadjusted (n) in each group. Normal muscle health: absence of all three factors (low muscle mass, low muscle strength, and low physical performance); poor muscle health: the presence of any one low muscle mass, low muscle strength, or low physical performance; poor muscle function: low muscle strength and/or low physical performance but without low muscle mass. Poor muscle function comprises three groups: low muscle strength only, low physical performance only, and both low muscle strength and low physical performance. Pre‐sarcopenia: the occurrence of low muscle mass only; sarcopenia: low muscle mass with the presence of either low muscle strength or low gait speed, whereas the presence of all three factors constituted severe sarcopenia. Any sarcopenia: the presence of either sarcopenia or severe sarcopenia.