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Longitudinal Changes in Sarcopenia Criteria in Older Men with Low Skeletal Muscle Mass Index: A 2-Year Observational Study

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Abstract

Purpose

Declines in muscle mass and function are inevitable during the aging process. However, what is the “normal age appropriate” decline of muscle mass and function? Further, is this decline uniform for muscle mass versus functions or between different functional abilities? Using recognized Sarcopenia criteria [i.e. skeletal muscle mass index (SMI) defined as appendicular skeletal muscle mass/height (kg/m2), handgrip strength, gait velocity], the aim of the present project was to determine corresponding changes in community-dwelling men 70 years+ with low SMI over a 2-year period.

Methods

One hundred and seventy-seven (177) men within the lowest SMI quartile of a recent epidemiologic study (n = 965) were included in the 2-year follow-up analysis. Muscle mass was determined via direct-segmental, multi-frequency Bio-Impedance-Analysis, handgrip strength was tested with a Jamar hand-dynamometer and habitual gait speed was assessed with photo sensors applying the 10 m protocol.

Results

SMI, handgrip strength and gait velocity all declined significantly ( P< 0.001; effect size, d′ 0.39–1.17), however, with significantly higher reductions (P< 0.001) in functional compared with morphologic Sarcopenia criteria (P ≤ 0.006). Less expected, handgrip strength featured a fourfold higher decline compared with gait velocity (− 12.8 ± 10.9% versus − 3.5 ± 9.0%).

Conclusion

We provided evidence for significant non-uniform changes of Sarcopenia criteria in a cohort of community dwelling men 70 years+ with low SMI. We doubt that this result might be a particularity of the selected cohort; however, studies with other (older) cohorts should address this issue in more depth. Of practical relevance, our data further give implications for the prioritization of interventions that address Sarcopenia criteria in older community-dwelling men.

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Notes

  1. Changes of total FFM < appendicular skeletal muscle mass < lower extremity FFM [4, 21, 37, 38].

  2. …considering its relevance for resting metabolic rate and thermoregulation [33, 34].

  3. SMI was calculated as fat free mass of the upper and lower extremities (= appendicular skeletal muscle mass) divided by square body height (kg/m2) [5].

  4. T-Score based approach of SMI (ASMM/height2) based on 2 SD below the mean value of a young reference cohort of 1189 healthy Caucasian men 18–35 years old [28].

  5. …along with baseline values close to the cut-off value of 30 kg [13].

  6. The FNIH [64] recommended grip strength as the sole functional criteria; the EWGSOP-I algorithm [13] applied grip strength after gait velocity > 0.8 m/s.

  7. …correspondingly non-significant changes would result when applying the AWGS approach [10], that is however not suitable for this Caucasian cohort.

  8. Smallest meaningful change (ES 0.2) was calculated to be 0.05 m/s.

  9. i.e. Cross sectional area of the triceps surae, quadriceps and hamstrings as assessed by MRI.

  10. Nasciemiento et al. [50] reported significant differences in maximum gait speed after different instructions. Considering that instructions for habitual, i.e. “normal” gait speed have to be even more sophisticated, the importance of standardized and consistently identical test instructions is obvious.

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Acknowledgements

This study was exclusively funded by resources of the Institute of Medical Physics, University of Erlangen-Nürnberg, Germany. All the authors state that they have no conflicts of interest.

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Authors and Affiliations

  1. Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany

    Wolfgang Kemmler, Simon von Stengel & Stephanie Kast

  2. Institute of Biomedicine of Aging, University of Erlangen-Nürnberg, 90408, Nürnberg, Germany

    Cornel Sieber & Ellen Freiberger

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  1. Wolfgang Kemmler
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Wolfgang Kemmler (WK), Simon von Stengel, Stephanie Kast, Cornel Sieber and Ellen Freiberger designed the study, completed data analysis and/or interpretation and drafted the manuscript. WK accepts full responsibility for the integrity of the data sampling, analysis and interpretation.

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Correspondence to Wolfgang Kemmler.

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Kemmler, W., von Stengel, S., Kast, S. et al. Longitudinal Changes in Sarcopenia Criteria in Older Men with Low Skeletal Muscle Mass Index: A 2-Year Observational Study. J. of SCI. IN SPORT AND EXERCISE 1, 59–68 (2019). https://doi.org/10.1007/s42978-019-0006-7

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