Functional Measures of Sarcopenia: Prevalence, and Associations with Functional Disability in 10,892 Adults Aged 65 Years and Over from Six Lower- and Middle-Income Countries
Identification of sarcopenia in lower- and middle-income countries (LMICs) is limited by access to technologies that assess muscle mass. We investigated associations between two functional measures of sarcopenia, grip strength and gait speed (GS), with functional disability in adults from six LMICs. Data were extracted from the World Health Organization (WHO) Study on global AGEing and adult health Wave 1 (2007–2010) for adults (≥ 65 years) from China, Mexico, Ghana, India, Russia and South Africa (n = 10,892, 52.8% women). We calculated country-specific prevalence of low grip strength, slow GS (≤ 0.8 m/s), and both measures combined. Using multivariable negative binomial regression, we separately assessed associations between low grip strength, slow GS, and both measures combined, with the WHO Disability Assessment Schedule 2.0, accounting for selected socioeconomic factors. In women, low grip strength ranged from 7 in South Africa to 51% in India; in men, it ranged from 17 in Russia to 51% in Mexico. Country-specific proportions of slow GS ranged from 77 in Russia, to 33% in China. The concomitant presence of both was the lowest in South Africa and the highest in India (12.3% vs. 33%). Independent of age, those with both low grip strength and slow GS had between 1.2- and 1.5-fold worse functional disability scores, independent of comorbidities, low education, and low wealth (all country-dependent). Low grip strength, slow GS, and the combination of both, were all associated with higher levels of functional disability, thus indicating these objective measures offer a reasonably robust estimate for potential poor health outcomes.
KeywordsGrip strength Gait speed Function Strength Disability Lower- and middle-income countries Socioeconomic conditions
SLB-O is the recipient of a Career Development Fellowship from the National Health and Medical Research Council (NHMRC) of Australia (1107510). SAGE is supported by WHO and the Division of Behavioral and Social Research (BSR) at the US National Institute on Aging (NIA) through interagency agreements (OGHA 04034785; YA1323-08-CN-0020; Y1-AG-1005-01) with WHO. In addition, the governments of Shanghai, China and South Africa provided financial or other support for Wave 1 of their national SAGE study. All collaborating institutions provided substantial resources to conduct their respective studies. We thank the participants in each country for their contributions to SAGE and acknowledge the contributions and expertise of the country-specific investigators and their respective survey teams. We acknowledge the intellectual input of Dr Jesse Zanker and Mr Steven Phu regarding recommended measurement of, and cut-points for, gait speed and grip strength in terms of sarcopenia assessment.
Compliance with Ethical Standards
Conflict of interest
Sharon L. Brennan-Olsen, Steven J. Bowe, Paul Kowal, Nirmala Naidoo, Nekehia T. Quashie, Geeta Eick, Sutapa Agrawal, and Catherine D’Este declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article contains studies with human subjects and all participants gave written informed consent in accordance with the Declaration of Helsinki. This study did not include animals.
- 6.Reijnierse EM, Trappenburg MC, Leter MH, Blauw GJ, Sipila S, Sillanpaa E, Narici MV, Hogrel JY, Butler-Browne G, McPhee JS, Gapeyeva H, Paasuke M, de van der Schueren MA, Meskers CG, Maier AB (2015) The impact of different diagnostic criteria on the prevalence of sarcopenia in healthy elderly participants and geriatric outpatients. Gerontology 61:491–496CrossRefGoogle Scholar
- 7.Volpato S, Bianchi L, Cherubini A, Landi F, Maggio M, Savino E, Bandinelli S, Ceda GP, Guralnik JM, Zuliani G, Ferrucci L (2014) Prevalence and clinical correlates of sarcopenia in community-dwelling older people: application of the EWGSOP definition and diagnostic algorithm. J Gerontol Ser A 69:438–446CrossRefGoogle Scholar
- 11.Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M, Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2 (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48:16–31CrossRefGoogle Scholar
- 12.Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, Chou MY, Chen LY, Hsu PS, Krairit O, Lee JS, Lee Y, Liang CK, Limpawattana P, Lin CS, Peng LN, Satake S, Suzuki T, Won CH, Wu SN, Zhang T, Zeng P, Akishita M, Aria H (2014) Sarcopenia in Asia: consensus report of the Asian Working Group for sarcopenia. J Am Med Dir Assoc 15:95–101CrossRefGoogle Scholar
- 13.Stringhini S, Carmeli C, Jokela M, Avendano M, McCrory C, d’Errico A, Bochud M, Barros H, Cost G, Chadeau-Hyam M, Delpierre C, Gandini M, Fraga S, Goldberg M, Giles GG, Lassale C, Kenny RA, Kelly-Irving M, Paccaud F, Layte R, Muennig P, Marmot MG, Ribeiro AI, Severi G, Steptoe A, Shipley MJ, Zins M, Mackenbach JP, Vineis P, Kivimaki M, for the LIFEPATH Consortium (2018) Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: multi-cohort population based study. BMJ 360:k1046CrossRefGoogle Scholar
- 15.Kowal P, Chatterji S, Naidoo N, Biritwum R, Fan W, Ridaura RL, Maximova T, Arokiasamy P, Phaswana-Mafuya N, Williams S, Snodgrass JJ, Minicuci N, E’Este C, Peltzer K, Boerma JT, the SAGE collaborators (2012) Data resource profile: the World Health Organization Study on global AGEing and adult health (SAGE). Int J Epidemiol 41:1639–1649CrossRefGoogle Scholar
- 17.World Health Organization (2010) World Health Organization Disability Assessment Schedule II (WHO-DAS II). WHO. http://www.who.int/classifications/icf.en/ Accessed Aug 2018
- 18.World Health Organization (2010) Measuring health and disability: manual for WHO disability assessment schedule (WHODAS 2.0). In: Ustun TB, Kostanjsek N, Chatterji S, Rehm J (ed). WHO, GenevaGoogle Scholar
- 19.World Health Organization (2018) WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). https://www.who.int/classifications/icf/more_whodas/en/) Accessed Feb 2019
- 20.World Health Organization (2000) The Asia-Pacific perspective: redefining obesity and its treatment. WHO Western Pacific Region, GenevaGoogle Scholar
- 21.Brennan-Olsen SLSS, Viikari-Juntura E, Ackerman IN, Bowe SJ, Kowal P, Naidoo N, Chatterji S, Wluka AE, Leech MT, Page RS, Sanders KM, Gomez F, Duque G, Green D, Mohebbi M (2018) Arthritis diagnosis and symptoms are positively associated with specific physical job exposures in lower- and middle-income countries: cross-sectional results from the World Health Organization’s Study on global AGEing and adult helath (SAGE). BMC Public Health 8:1Google Scholar
- 27.World Health Organization (2010) Global recommendations on physical activity for health. WHO, GenevaGoogle Scholar
- 31.Alley DE, Shardell MD, Peters KW, McLean RR, Dam T-TL, Kenny AM, Fragala MS, Harris TB, Kiel DP, Guralnik JM, Ferrucci L, Kritchevsky SB, Studenski SA, Vassileva MT, Cawthon PM (2014) Grip strength cutpoints for the identification of clinically relevant weakness. J Gerontol Ser A 69:559–566CrossRefGoogle Scholar
- 33.Cesari M, Kritchevsky SB, Newman AB, Simonsick EM, Harris TB, Penninx BW, Brach JS, Tylavsky FA, Satterfield S, Bauer DC, Rubin SM, Visser M, Pahor M, for the Health ABC Study (2009) Added value of physical performance measures in predicting adverse health-related events: results from the Health, Aging, and Body Composition Study. J Am Geriatr Soc 57:251–259CrossRefGoogle Scholar
- 36.World Health Organization (2015) Health and human rights. In: WHO (ed) GenevaGoogle Scholar