Criteria for clinically relevant weakness and low lean mass and their longitudinal association with incident mobility impairment and mortality: the foundation for the National Institutes of Health (FNIH) sarcopenia project

Robert R McLean, Michelle D Shardell, Dawn E Alley, Peggy M Cawthon, Maren S Fragala, Tamara B Harris, Anne M Kenny, Katherine W Peters, Luigi Ferrucci, Jack M Guralnik, Stephen B Kritchevsky, Douglas P Kiel, Maria T Vassileva, Qian-Li Xue, Subashan Perera, Stephanie A Studenski, Thuy-Tien L Dam, Robert R McLean, Michelle D Shardell, Dawn E Alley, Peggy M Cawthon, Maren S Fragala, Tamara B Harris, Anne M Kenny, Katherine W Peters, Luigi Ferrucci, Jack M Guralnik, Stephen B Kritchevsky, Douglas P Kiel, Maria T Vassileva, Qian-Li Xue, Subashan Perera, Stephanie A Studenski, Thuy-Tien L Dam

Abstract

Background: This analysis sought to determine the associations of the Foundation for the National Institutes of Health Sarcopenia Project criteria for weakness and low lean mass with likelihood for mobility impairment (gait speed ≤ 0.8 m/s) and mortality. Providing validity for these criteria is essential for research and clinical evaluation.

Methods: Among 4,411 men and 1,869 women pooled from 6 cohort studies, 3-year likelihood for incident mobility impairment and mortality over 10 years were determined for individuals with weakness, low lean mass, and for those having both. Weakness was defined as low grip strength (<26kg men and <16kg women) and low grip strength-to-body mass index (BMI; kg/m(2)) ratio (<1.00 men and <0.56 women). Low lean mass (dual-energy x-ray absorptiometry) was categorized as low appendicular lean mass (ALM; <19.75kg men and <15.02kg women) and low ALM-to-BMI ratio (<0.789 men and <0.512 women).

Results: Low grip strength (men: odds ratio [OR] = 2.31, 95% confidence interval [CI] = 1.34-3.99; women: OR = 1.99, 95% CI 1.23-3.21), low grip strength-to-BMI ratio (men: OR = 3.28, 95% CI 1.92-5.59; women: OR = 2.54, 95% CI 1.10-5.83) and low ALM-to-BMI ratio (men: OR = 1.58, 95% CI 1.12-2.25; women: OR = 1.81, 95% CI 1.14-2.87), but not low ALM, were associated with increased likelihood for incident mobility impairment. Weakness increased likelihood of mobility impairment regardless of low lean mass. Mortality risk patterns were inconsistent.

Conclusions: These findings support our cut-points for low grip strength and low ALM-to-BMI ratio as candidate criteria for clinically relevant weakness and low lean mass. Further validation in other populations and for alternate relevant outcomes is needed.

Keywords: Impairment.; Mobility; Muscle; Sarcopenia.

Figures

Figure 1.
Figure 1.
Age-adjusted odds ratios (OR) for incident mobility impairment (gait speed ≤ 0.8 m/s) after approximately 3 years of follow-up for proposed low grip strength criteria (weak) among men (A) and women (B) in the FNIH Sarcopenia Project.
Figure 2.
Figure 2.
Age-adjusted odds ratios (OR) for incident mobility impairment (gait speed ≤ 0.8 m/s) after approximately 3 years of follow-up for proposed low grip strength-to-BMI ratio criteria (weakBMI) among men (A) and women (B) in the FNIH Sarcopenia Project.
Figure 3.
Figure 3.
Age-adjusted odds ratios (OR) for incident mobility impairment (gait speed ≤ 0.8 m/s) after approximately 3 years of follow-up for proposed low appendicular lean mass criteria (ALM) among men (A) and women (B) in the FNIH Sarcopenia Project.
Figure 4.
Figure 4.
Age-adjusted odds ratios (OR) for incident mobility impairment (gait speed ≤ 0.8 m/s) after approximately 3 years of follow-up for proposed low appendicular lean mass-to-BMI ratio criteria (ALMBMI) among men (A) and women (B) in the FNIH Sarcopenia Project.

References

    1. Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr. 1997;127:990S–991S
    1. Baumgartner RN, Koehler KM, Gallagher D, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998;147:755–763
    1. Melton LJ, 3rd, Khosla S, Crowson CS, O’Connor MK, O’Fallon WM, Riggs BL. Epidemiology of sarcopenia. J Am Geriatr Soc. 2000;48:625–630
    1. Lauretani F, Russo CR, Bandinelli S, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol. 2003;95:1851–1860
    1. Visser M, Goodpaster BH, Kritchevsky SB, et al. Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol A Biol Sci Med Sci. 2005;60:324–333
    1. Fielding RA, Vellas B, Evans WJ, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc. 2011;12:249–256. :10.1016/j.jamda.2011.01.003
    1. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412–423. :10.1093/ageing/afq034
    1. Muscaritoli M, Anker SD, Argilés J, et al. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr. 2010;29:154–159. :10.1016/j.clnu.2009.12.004
    1. Morley JE, Abbatecola AM, Argiles JM, et al. Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc. 2011;12:403–409. :10.1016/j.jamda.2011.04.014
    1. Alley DE, Shardell MD, Peters KW, et al. Grip strength cutpoints for the identification of clinically relevant weakness. J Gerontol A Biol Sci Med Sci. 2014;5:559–566
    1. Cawthon PM, Peters KW, Shardell MD, et al. Cut-points for low appendicular lean mass that identify older adults with clinically significant weakness. J Gerontol A Biol Sci Med Sci. 2014;5:567–575
    1. Studenski SA, Peters KW, Alley DE, et al. The FNIH sarcopenia project: rationale and study description. J Gerontol A Biol Sci Med Sci. 2014;5:547–558
    1. Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1995;332:767–773
    1. Cauley JA, Lui LY, Ensrud KE, et al. Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA. 2005;293:2102–2108
    1. Orwoll E, Blank JB, Barrett-Connor E, et al. Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study–a large observational study of the determinants of fracture in older men. Contemp Clin Trials. 2005;26:569–585
    1. Blank JB, Cawthon PM, Carrion-Petersen ML, et al. Overview of recruitment for the Osteoporotic Fractures in Men Study (MrOS). Contemp Clin Trials. 2005;26:557–568
    1. Dam TT, Ewing S, Ancoli-Israel S, Ensrud K, Redline S, Stone K. Association between sleep and physical function in older men: the osteoporotic fractures in men sleep study. J Am Geriatr Soc. 2008;56:1665–1673. :10.1111/j.1532-5415.2008.01846.x
    1. Koster A, Visser M, Simonsick EM, et al. Association between fitness and changes in body composition and muscle strength. J Am Geriatr Soc. 2010;58:219–226. :10.1111/j.1532-5415.2009.02681.x
    1. Kannel WB, Feinleib M, McNamara PM, Garrison RJ, Castelli WP. An investigation of coronary heart disease in families. The Framingham offspring study. Am J Epidemiol. 1979;110:281–290
    1. Ferrucci L, Bandinelli S, Benvenuti E, et al. Subsystems contributing to the decline in ability to walk: bridging the gap between epidemiology and geriatric practice in the InCHIANTI study. J Am Geriatr Soc. 2000;48:1618–1625
    1. Härkönen R, Piirtomaa M, Alaranta H. Grip strength and hand position of the dynamometer in 204 Finnish adults. J Hand Surg Br. 1993;18:129–132
    1. Guralnik JM, Ferrucci L, Pieper CF, et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000;55:M221–M231
    1. Hedges LV, Olkin I. Statistical Methods for Meta-analysis. Orlando, FL: Academic Press; 1985
    1. Newman AB, Kupelian V, Visser M, et al. Sarcopenia: alternative definitions and associations with lower extremity function. J Am Geriatr Soc. 2003;51:1602–1609
    1. Manini TM, Clark BC. Dynapenia and aging: an update. J Gerontol A Biol Sci Med Sci. 2012;67:28–40. :10.1093/gerona/glr010
    1. Goodpaster BH, Carlson CL, Visser M, et al. Attenuation of skeletal muscle and strength in the elderly: The Health ABC Study. J Appl Physiol (1985). 2001;90:2157–2165
    1. Visser M, Kritchevsky SB, Goodpaster BH, et al. Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: the health, aging and body composition study. J Am Geriatr Soc. 2002;50:897–904
    1. Delbono O. Regulation of excitation contraction coupling by insulin-like growth factor-1 in aging skeletal muscle. J Nutr Health Aging. 2000;4:162–164
    1. Vandervoort AA. Aging of the human neuromuscular system. Muscle Nerve. 2002;25:17–25
    1. Arango-Lopera VE, Arroyo P, Gutiérrez-Robledo LM, Pérez-Zepeda MU, Cesari M. Mortality as an adverse outcome of sarcopenia. J Nutr Health Aging. 2013;17:259–262. :10.1007/s12603-012-0434-0
    1. Landi F, Cruz-Jentoft AJ, Liperoti R, et al. Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing. 2013;42:203–209. :10.1093/ageing/afs194
    1. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59:255–263
    1. Riley RD, Lambert PC, Abo-Zaid G. Meta-analysis of individual participant data: rationale, conduct, and reporting. BMJ. 2010;340:c221. :10.1136/bmj.c221

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