On the Definition of Sarcopenia in the Presence of Aging and Obesity-Initial Results from UK Biobank

Jennifer Linge, Steven B Heymsfield, Olof Dahlqvist Leinhard, Jennifer Linge, Steven B Heymsfield, Olof Dahlqvist Leinhard

Abstract

Background: Current consensus is to combine a functional measure with muscle quantity to assess/confirm sarcopenia. However, the proper body size adjustment for muscle quantity is debated and sarcopenia in obesity is not well described. Further, functional measures are not muscle-specific or sensitive to etiology, and can be confounded by, for example, fitness/pain. For effective detection/treatment/follow-up, muscle-specific biomarkers linked to function are needed.

Methods: Nine thousand six hundred and fifteen participants were included and current sarcopenia thresholds (EWGSOP2: DXA, hand grip strength) applied to investigate prevalence. Fat-tissue free muscle volume (FFMV) and muscle fat infiltration (MFI) were quantified through magnetic resonance imaging (MRI) and sex-and-body mass index (BMI)-matched virtual control groups (VCGs) were used to extract each participant's FFMV/height2 z-score (FFMVVCG). The value of combining FFMVVCG and MFI was investigated through hospital nights, hand grip strength, stair climbing, walking pace, and falls.

Results: Current thresholds showed decreased sarcopenia prevalence with increased BMI (underweight 8.5%/normal weight 4.3%/overweight 1.1%/obesity 0.1%). Contrary, the prevalence of low function increased with increasing BMI. Previously proposed body size adjustments (division by height2/weight/BMI) introduced body size correlations of larger/similar magnitude than before. VCG adjustment achieved normalization and strengthened associations with hospitalization/function. Hospital nights, low hand grip strength, slow walking pace, and no stair climbing were positively associated with MFI (p < .05) and negatively associated with FFMVVCG (p < .01). Only MFI was associated with falls (p < .01). FFMVVCG and MFI combined resulted in highest diagnostic performance detecting low function.

Conclusions: VCG-adjusted FFMV enables proper sarcopenia assessment across BMI classes and strengthened the link to function. MFI and FFMV combined provides a more complete, muscle-specific description linked to function enabling objective sarcopenia detection.

Keywords: Dual-energy x-ray absorptiometry; Imaging biomarkers; Magnetic resonance imaging; Muscle fat infiltration; Sarcopenic obesity.

© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America.

Figures

Figure 1.
Figure 1.
Fraction of participants with low appendicular lean mass and/or low hand grip strength for sarcopenia detection (EWGSOP2), and fraction of participants reporting low functional performance across BMI classes. Hand grip strength thresholds: 16/27 kg (females/males), appendicular lean mass/height2 (ALM/height2, assessed by DXA) thresholds: 6.0/7.0 kg/m2 (females/males).
Figure 2.
Figure 2.
Sex-specific associations between fat-tissue free muscle volumeVCG (FFMVVCG) and BMI in comparison to other body size adjustments. BMIbins with less than 25 participants removed. ALM = Appendicular lean mass (assessed by dual-energy x-ray absorptiometry [DXA]); F = Females; FFMV = Fat-tissue free muscle volume; M = Males; SD = Standard deviation; VCG = Virtual control group.

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