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      Sarcopenia and sarcopenic obesity among community-dwelling Peruvian adults: A cross-sectional study

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          Abstract

          Introduction

          Sarcopenia and sarcopenic obesity (SO) have emerged as significant contributors to negative health outcomes in the past decade. We aimed to estimate the prevalence of probable sarcopenia, sarcopenia, and SO in a community-dwelling population of 1151 adults aged ≥55 years in Lima, Peru.

          Methods

          This cross-sectional study was conducted between 2018 and 2020. Sarcopenia was defined as the presence of low muscle strength (LMS) and low muscle mass (LMM) according to European (EWGSOP2), US (FNIH) and Asian (AWGS2) guidelines. We measured muscle strength by maximum handgrip strength and muscle mass using bioelectrical impedance analyzer. SO was defined as a body mass index ≥ 30 kg/m 2 and sarcopenia.

          Results

          The study participants had a mean age of 66.2 years (SD 7.1), age range between 60 to 92 years old, of which 621 (53.9%) were men. Among the sample, 41.7% were classified as obese (BMI ≥30.0 kg/m²). The prevalence of probable sarcopenia was estimated to be 22.7% (95%CI: 20.3–25.1) using the EWGSOP2 criteria and 27.8% (95%CI: 25.2–30.4) using the AWGS2 criteria. Sarcopenia prevalence, assessed using skeletal muscle index (SMI), was 5.7% (95%CI: 4.4–7.1) according to EWGSOP2 and 8.3% (95%CI: 6.7–9.9) using AWGS2 criteria. The prevalence of sarcopenia based on the FNIH criteria was 18.1% (95%CI: 15.8–20.3). The prevalence of SO, considering different sarcopenia definitions, ranged from 0.8% (95%CI: 0.3–1.3) to 5.0% (95%CI: 3.8–6.3).

          Conclusion

          Our findings reveal substantial variation in the prevalence of sarcopenia and SO, underscoring the necessity for context-specific cut-off values. Although the prevalence of SO was relatively low, this result may be underestimated. Furthermore, the consistently high proportion of probable sarcopenia and sarcopenia point to a substantial public health burden.

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          Most cited references38

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          Sarcopenia: revised European consensus on definition and diagnosis

          Abstract Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.
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            Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

            Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as "age-related loss of muscle mass, plus low muscle strength, and/or low physical performance" and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength <28 kg for men and <18 kg for women; criteria for low physical performance are 6-m walk <1.0 m/s, Short Physical Performance Battery score ≤9, or 5-time chair stand test ≥12 seconds. AWGS 2019 retains the original cutoffs for height-adjusted muscle mass: dual-energy X-ray absorptiometry, <7.0 kg/m2 in men and <5.4 kg/m2 in women; and bioimpedance, <7.0 kg/m2 in men and <5.7 kg/m2 in women. In addition, the AWGS 2019 update proposes separate algorithms for community vs hospital settings, which both begin by screening either calf circumference (<34 cm in men, <33 cm in women), SARC-F (≥4), or SARC-CalF (≥11), to facilitate earlier identification of people at risk for sarcopenia. Although skeletal muscle strength and mass are both still considered fundamental to a definitive clinical diagnosis, AWGS 2019 also introduces "possible sarcopenia," defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions. Although defining sarcopenia by body mass index-adjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, more evidence is needed before changing current recommendations. Lifestyle interventions, especially exercise and nutritional supplementation, prevail as mainstays of treatment. Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia in Asians.
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              A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.

              A short battery of physical performance tests was used to assess lower extremity function in more than 5,000 persons age 71 years and older in three communities. Balance, gait, strength, and endurance were evaluated by examining ability to stand with the feet together in the side-by-side, semi-tandem, and tandem positions, time to walk 8 feet, and time to rise from a chair and return to the seated position 5 times. A wide distribution of performance was observed for each test. Each test and a summary performance scale, created by summing categorical rankings of performance on each test, were strongly associated with self-report of disability. Both self-report items and performance tests were independent predictors of short-term mortality and nursing home admission in multivariate analyses. However, evidence is presented that the performance tests provide information not available from self-report items. Of particular importance is the finding that in those at the high end of the functional spectrum, who reported almost no disability, the performance test scores distinguished a gradient of risk for mortality and nursing home admission. Additionally, within subgroups with identical self-report profiles, there were systematic differences in physical performance related to age and sex. This study provides evidence that performance measures can validly characterize older persons across a broad spectrum of lower extremity function. Performance and self-report measures may complement each other in providing useful information about functional status.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: ResourcesRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: ValidationRole: Writing – original draft
                Role: Formal analysisRole: Funding acquisitionRole: InvestigationRole: Writing – review & editing
                Role: Funding acquisitionRole: ValidationRole: Writing – review & editing
                Role: Funding acquisitionRole: InvestigationRole: ValidationRole: Writing – review & editing
                Role: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: SupervisionRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Project administrationRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLOS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                9 April 2024
                2024
                : 19
                : 4
                : e0300224
                Affiliations
                [1 ] Universidad de San Martin de Porres, Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Lima, Peru
                [2 ] Asociación Benéfica PRISMA, Lima, Peru
                [3 ] Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
                [4 ] Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
                [5 ] Division of Pulmonary and Critical Care, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
                [6 ] UCL Respiratory, University College London, London, United Kingdom
                [7 ] Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Peru
                [8 ] NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
                Fondazione Don Carlo Gnocchi, ITALY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ OFF and AZM are joint authorship on this work.

                Author information
                https://orcid.org/0000-0002-9780-937X
                https://orcid.org/0000-0002-5314-8469
                https://orcid.org/0000-0002-0336-0584
                Article
                PONE-D-23-32929
                10.1371/journal.pone.0300224
                11003669
                38593158
                6f42a14a-c430-4d56-9661-2ebc629a06a9
                © 2024 Flores-Flores et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 14 October 2023
                : 25 February 2024
                Page count
                Figures: 1, Tables: 4, Pages: 13
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000061, Fogarty International Center;
                Award ID: D43 TW009340
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000061, Fogarty International Center;
                Award ID: K43TW011586
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000050, National Heart, Lung, and Blood Institute;
                Award ID: 1K01HL140048
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100000265, Medical Research Council;
                Award ID: MR/P008984/1
                Award Recipient :
                OFF was supported by NIH Research Training Grant # D43 TW009340 funded by the NIH Fogarty International Center, NINDS, NIMH, and NHBLI, and the Award Number K43TW011586. SLP was supported by a Mentored Research Scientist Development Award [1K01HL140048] from the National Heart, Lung, and Blood Institute, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. https://www.nih.gov The parent GECo (Global Excellence in Chronic Obstructive Pulmonary Disease Outcomes) study was supported by the UK Medical Research Council (MR/P008984/1, PI: JH) under the Global Alliance for Chronic Disease. https://www.ukri.org/councils/mrc/ The funders did not play any role in the study design, data collection, analysis, decision to publish or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Clinical Medicine
                Signs and Symptoms
                Sarcopenia
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Obesity
                Biology and Life Sciences
                Biomechanics
                Hand Strength
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Body Mass Index
                Biology and Life Sciences
                Anatomy
                Musculoskeletal System
                Muscles
                Skeletal Muscles
                Medicine and Health Sciences
                Anatomy
                Musculoskeletal System
                Muscles
                Skeletal Muscles
                People and Places
                Geographical Locations
                Europe
                People and places
                Population groupings
                Ethnicities
                Latin American people
                Research and Analysis Methods
                Bioassays and Physiological Analysis
                Muscle Analysis
                Custom metadata
                The dataset used in our study is a part of the Global Excellence for COPD outcomes (GECO). The Principal Investigator of the GECO study, Professor John Hurst from University College London, is a co-author of this manuscript. Professor Hurst also serves as the President of the Steering Committee for the study. Formal verification of permission to use the dataset is not applicable in this context.We confirm that there were no special privileges granted to us in accessing the GECO data. The dataset was accessed following standard procedures that are available to all interested researchers. Our use of the data did not involve any exclusive or preferential treatment. Researchers who meet the criteria for access confidential data and are interested in accessing the GECO dataset can direct their requests to Professor John Hurst at University College London. He can be contacted via email at j.hurst@ 123456ucl.ac.uk . Additionally, data requests can be directed to the University College London Research Ethics Committee (reference number 9661/001), chaired by Professor Sarah Edwards. Contact email: ethics@ 123456ucl.ac.uk ; URL: UCL Research Ethics Service.

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