Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Clinical nutrition

Sarcopenia as a mortality predictor in community-dwelling older adults: a comparison of the diagnostic criteria of the European Working Group on Sarcopenia in Older People

European Journal of Clinical Nutrition volume 74, pages 573–580 (2020)Cite this article

Subjects

Abstract

Background/objectives

The definition of sarcopenia remains a matter of discussion and there is no globally accepted consensus for its diagnosis. The aim of this study was to assess the effect of sarcopenia diagnostic components on mortality, as well as to compare the associations between sarcopenia diagnosed via the 2010 and 2018 Consensuses of the European Working Group on Sarcopenia in Older People (EWGSOP) and mortality.

Methods

Prospective cohort study involving noninstitutionalized older adults aged ≥ 60 years. For the diagnosis of sarcopenia, the definitions proposed by the 2010 (EWGSOP) and 2018 (EWGSOP2) Consensuses were used. The diagnostic components corresponded to muscle mass, muscular strength, and physical performance. The associations of sarcopenia and its components with mortality were investigated using Cox proportional hazard regression models.

Results

The sample consisted of 1291 older adults. After an average of 2.6 years of follow-up, 88 (6.8%) participants had died. The diagnosis of severe sarcopenia by both Consensuses was associated with an increased risk of mortality. Severe sarcopenia was associated with an increased risk of death compared with that in people without sarcopenia when using EWGSOP (hazard ratio (HR) 3.15, 95% confidence interval (CI) 1.44–6.90) and EWGSOP2 (HR 4.11, 95% CI 1.88–9.00). Older adults with decreased gait speed had a 76% higher risk of dying (p = 0.033). There was no statistically significant association between the other sarcopenia components and mortality risk.

Conclusions

Older adults with severe sarcopenia and those with changes in physical performance had an increased risk of death in the short term.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Hughes VA, Frontera WR, Roubenoff R, Evans WJ, Singh MAF. Longitudinal changes in body composition in older men and women: role of body weight change and physical activity. Am J Clin Nutr. 2002;76:473–81.

    Article  CAS  Google Scholar 

  2. Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr. 1997;127:994–7.

    Article  Google Scholar 

  3. Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, et al. Epidemiology of Sarcopenia among the Elderly in New Mexico. Am J Epidemiol. 1998;147:755–63. https://doi.org/10.1093/oxfordjournals.aje.a009520.

    Article  CAS  PubMed  Google Scholar 

  4. Janssen I, Heymsfield SB, Ross R. Is associated with functional impairment and physical disability. J Am Geriatr. 2002;50:889–96.

    Article  Google Scholar 

  5. Cawthon PM, Blackwell TL, Cauley J, Kado DM, Barrett-Connor E, Lee CG, et al. Evaluation of the usefulness of consensus definitions of sarcopenia in older men: results from the observational osteoporotic fractures in men cohort study. J Am Geriatr Soc. 2015;63:2247–59.

    Article  Google Scholar 

  6. Woo J, Leung J, Morley JE. Defining sarcopenia in terms of incident adverse outcomes. J Am Med Dir Assoc. 2015;16:247–52. https://doi.org/10.1016/j.jamda.2014.11.013.

    Article  PubMed  Google Scholar 

  7. Kim H, Hirano H, Edahiro A, Ohara Y, Watanabe Y, Kojima N, et al. Sarcopenia: prevalence and associated factors based on different suggested definitions in community-dwelling older adults. Geriatr Gerontol Int. 2016;16:110–22. https://doi.org/10.1111/ggi.12723.

    Article  PubMed  Google Scholar 

  8. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis. Age Ageing. 2010;39:412–23.

    Article  Google Scholar 

  9. Cruz-Jentoft, AJ, Bahat, G, Bauer, J, Boirie Y, Bruyère O, Cederholm T, et al. Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48, 16–31.

  10. Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, 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;12:249–56.

    Article  Google Scholar 

  11. Barbosa-Silva TG, Bielemann RM, Gonzalez MC, Menezes AMB. Prevalence of sarcopenia among community-dwelling elderly of a medium-sized South American city: Results of the COMO VAI? study. J Cachexia Sarcopenia Muscle. 2016;7:136–43.

    Article  Google Scholar 

  12. Barros AJD, Menezes AMB, Santos IS, Assunção MCF, Gigante D, Fassa AG, et al. O Mestrado do Programa de PósGraduação em epidemiologia da UFPel baseado em consórcio de pesquisa: Uma experiência inovadora. Rev Bras Epidemiol. 2008;11:133–44.

    Article  Google Scholar 

  13. Lauretani F, Russo CR, Bandinelli S, Bartali B, Cavazzini C, Di Iorio A, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol. 2003;95:1851–60. https://doi.org/10.1152/japplphysiol.00246.2003.

    Article  PubMed  Google Scholar 

  14. Bielemann RM, Gigante DP, Horta BL. Birth weight, intrauterine growth restriction and nutritional status in childhood in relation to grip strength in adults: from the 1982 Pelotas (Brazil) birth cohort. Nutrition. 2016;32:228–35. https://doi.org/10.1016/j.nut.2015.08.014.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dodds RM, Syddall HE, Cooper R, Benzeval M, Deary IJ, Dennison EM, et al. Grip strength across the life course: normative data from twelve British studies. PLoS ONE. 2014;9:e113637.

    Article  Google Scholar 

  16. Associação Brasileira de Empresas de Pesquisa (ABEP). Alterações na aplicação do Critério Brasil, válidas a partir de 2013. 2013. http://www.abep.org/novo/Content.aspx?ContentID=835.

  17. Hellwig N, Munhoz TN, Tomasi E. Sintomas depressivos em idosos: estudo transversal de base populacional. Cien Saude Colet. 2016;21:3575–84. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232016001103575&lng=pt&tlng=pt.

  18. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–95.

    Article  Google Scholar 

  19. Buchner DM, Bishop J, Brown DR, Fulton JE, Galuska DA, Gilchrist J, et al. 2008 physical activity guidelines for Americans. 2008. www.health.gov/paguidelines. Accessed 2 Nov 2014.

  20. Regina S, Pereira M. Independência em Atividades da Vida Diária (Escala de Katz). Cross-cultural adaptation of the Independence in Activities of Daily Living Index (Katz Index). Caderno de Saúde Pública 2008;24:103–12.

  21. Beaudart C, Zaaria M, Pasleau F, Reginster J-Y, Bruyère O. Health outcomes of sarcopenia: a systematic review and meta-analysis. PLoS ONE. 2017;12:e0169548. https://doi.org/10.1371/journal.pone.0169548.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Kelley GA, Kelley KS. Is sarcopenia associated with an increased risk of all-cause mortality and functional disability? Exp Gerontol. 2017;96:100–3. https://doi.org/10.1016/j.exger.2017.06.008.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Landi F, Calvani R, Tosato M, Martone AM, Bernabei R, Onder G, et al. Impact of physical function impairment and multimorbidity on mortality among community-living older persons with sarcopaenia: results from the ilSIRENTE prospective cohort study. BMJ Open. 2016;6:e008281. https://doi.org/10.1136/bmjopen-2015-008281.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kim JH, Lim S, Choi SH, Kim KM, Yoon JW, Kim KW, et al. Sarcopenia: an independent predictor of mortality in community-dwelling older Korean men. J Gerontol A Biol Sci Med Sci. 2014;69:1244–52.

    Article  Google Scholar 

  25. Bianchi L, Ferrucci L, Cherubini A, Maggio M, Bandinelli S, Savino E, et al. The predictive value of the EWGSOP definition of sarcopenia: results from the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2016;71:259–64.

    Article  Google Scholar 

  26. Cesari M, Pahor M, Lauretani F, Zamboni V, Bandinelli S, Bernabei R, et al. Skeletal muscle and mortality results from the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2009;64:377–84.

    Article  Google Scholar 

  27. Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH, Kritchevsky SB, et al. K V. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci. 2006;61:72–7.

    Article  Google Scholar 

  28. Alexandre T, Duarte Y, Wong R, Lebrao M. Sarcopenia according to the European Working group on sarcopenia in older people versus Dynapenia as a risk factor for disability in elderly. J Nutr Health Aging. 2014;18:547–53.

    Article  Google Scholar 

  29. Locquet M, Beaudart C, Hajaoui M, Petermans J, Reginster JY, Bruyère O. Three-year adverse health consequences of sarcopenia in community-dwelling older adults according to 5 diagnosis definitions. J Am Med Dir Assoc. 2019;20:43–46. https://doi.org/10.1016/j.jamda.2018.06.004.

    Article  PubMed  Google Scholar 

  30. Liu P, Hao Q, Hai S, Wang H, Cao L, Dong B. Sarcopenia as a predictor of all-cause mortality among community-dwelling older people: a systematic review and meta-analysis. Maturitas. 2017;103:16–22.

    Article  Google Scholar 

  31. Sim M, Prince RL, Scott D, Daly RM, Duque G, Inderjeeth CA, et al. Sarcopenia definitions and their associations with mortality in older Australian women. J Am Med Dir Assoc. 2019;20:76–82. https://doi.org/10.1016/j.jamda.2018.10.016.

    Article  PubMed  Google Scholar 

  32. Santos LP, Gonzalez MC, Orlandi SP, Bielemann RM, Barbosa-Silva TG, Heymsfield SB. New predictions equations to estimate appendicular skeletal muscle mass using calf-circumfernce: results from NHANES 1999–2006. JPEN J Parenter Enteral Nutr. 2019. https://doi.org/10.1002/jpen.1605.

  33. Asai C, Akao K, Adachi T, Iwatsu K, Fukuyama A, Ikeda M, et al. Maximal calf circumference reflects calf muscle mass measured using magnetic resonance imaging. Arch Gerontol Geriatr 2019;83:175–8.

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) and the the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) for the financial support, and all the colleagues who collaborated on the COMO VAI? study.

Funding

First phase (2014) was funded by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) from Brazil and also by individual financial resources of the students. The second phase was partially funded by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

Authors’ contributions

NPB and MCG planned the study. RMB and MCG performed the statistical analyses. NPB, RMB, AMBM, ET, TGBS and MCG wrote the paper. All authors approved the final version of the paper.

Author information

Authors and Affiliations

  1. Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil

    Nathalia Perleberg Bachettini & Maria Cristina Gonzalez

  2. Post-Graduate Program in Nutrition and Foods, Federal University of Pelotas, Pelotas, Brazil

    Renata Moraes Bielemann & Maria Cristina Gonzalez

  3. Post-Graduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil

    Renata Moraes Bielemann

  4. Post-Graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil

    Renata Moraes Bielemann, Thiago Gonzalez Barbosa-Silva, Ana Maria Baptista Menezes, Elaine Tomasi & Maria Cristina Gonzalez

  5. Department of Surgery, School of Medicine, Federal University of Pelotas, Pelotas, Brazil

    Thiago Gonzalez Barbosa-Silva

Authors
  1. Nathalia Perleberg Bachettini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Renata Moraes Bielemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thiago Gonzalez Barbosa-Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ana Maria Baptista Menezes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elaine Tomasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Cristina Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nathalia Perleberg Bachettini.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bachettini, N.P., Bielemann, R.M., Barbosa-Silva, T.G. et al. Sarcopenia as a mortality predictor in community-dwelling older adults: a comparison of the diagnostic criteria of the European Working Group on Sarcopenia in Older People. Eur J Clin Nutr 74, 573–580 (2020). https://doi.org/10.1038/s41430-019-0508-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-019-0508-8

This article is cited by

Search

Advanced search

Quick links