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

  • Sharon L. Brennan-OlsenEmail author
  • Steven J. Bowe
  • Paul Kowal
  • Nirmala Naidoo
  • Nekehia T. Quashie
  • Geeta Eick
  • Sutapa Agrawal
  • Catherine D’Este
Original Research


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.


Grip 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.

Supplementary material

223_2019_609_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 14 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medicine-Western HealthThe University of MelbourneSt AlbansAustralia
  2. 2.Australian Institute for Musculoskeletal Science (AIMSS)The University of Melbourne and Western HealthMelbourneAustralia
  3. 3.Deakin Biostatistics Unit, Faculty of HealthDeakin UniversityGeelongAustralia
  4. 4.Chiang Mai University Research Institute for Health SciencesChiang MaiThailand
  5. 5.Research Centre for Generational Health and AgeingUniversity of NewcastleNewcastleAustralia
  6. 6.World Health Organization (WHO) SAGEGenevaSwitzerland
  7. 7.Department of AnthropologyUniversity of OregonEugeneUSA
  8. 8.College of Population StudiesChulalongkorn UniversityBangkokThailand
  9. 9.Public Health Foundation of IndiaNew DelhiIndia
  10. 10.National Centre for Epidemiology and Population Health, Research School of Population HealthAustralian National UniversityCanberraAustralia
  11. 11.School of Medicine and Public Health, Faculty of Health and MedicineThe University of NewcastleNewcastleAustralia

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