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CHAPTER 7 Adverse Outcomes and Functional Consequences of Sarcopenia
Jean Woo
Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China
INTRODUCTION
Since the publication of the first edition of this book, major changes have occurred in the definition of sarcopenia, to include some are the consequences of sarcopenia previously described in the chapter of adverse outcomes and functional consequences.
This chapter provides a summary of the current state of research on these topics, to cover mortality, functional decline, rate of falls, fracture incidence, quality of life, metabolic consequences, and use of health services. The chapter will also cover the term “secondary sarcopenia” associated with disuse, malnutrition, and inflammation.
MORTALITY
Systematic reviews on prospective studies of people aged 60 years and over as well as individual population studies have shown that sarcopenia increases the odds ratio of mortality between 1.6 and 3.6 [1–3], and that the effect was higher in people aged 79 years or older [1]. Individual constituent definition of sarcopenia, such as grip strength, and body composition among community‐living older people aged 65 years and over also predicted all‐cause mortality [4, 5], while grip strength and other physical performance measures in mid‐life predicted late‐life mortality [6–8].
With respect to secondary sarcopenia in the clinical setting, other than increased mortality (with odds ratio much higher than those for community‐living older people), depleted muscle mass is also associated with infection, increased duration of mechanical ventilation, longer hospitalization, readmission rates, and rehabilitation needs [9]. Worse outcomes are observed among patients with liver failure.
MOBILITY LIMITATIONS
Functional decline, or mobility limitations, initially classified as one of the adverse consequences, has been incorporated into the definition and diagnosis of sarcopenia. For example, a prospective study of Hong Kong Chinese older people proposed that sarcopenia may be defined in terms of risk of physical limitations [10] and other adverse outcomes [11], and anthropometric cut points based on incident mobility and physical limitation have been proposed [12]. Similarly, the Foundation of National Institute of Health (FNIH) also proposed a data‐driven approach in deriving cut points that is associated with slow walking speed (<0.8 m/s) [13]. Other consensus panel definitions used a combination of muscle mass, muscle strength, and physical performance measures in the diagnosis of sarcopenia [14, 15]. Systematic reviews show that sarcopenia is associated with increased odds ratio of functional decline between 2.5 and 3.0 [1, 3].
FALLS AND FRACTURES
Sarcopenia has been reported to increase the rate of falls in two community‐living populations, with an hazard ratio (HR) between 2.38 and 3.23 [16, 17]. Reduced strength and poor balance would contribute directly to occurrence of falls. As expected, there is also an association between sarcopenia and fractures, not only mediated by occurrence of falls, but also through the hormonal interaction between muscle and bone, with a common factor giving rise to both muscle weakness and low bone mineral density, giving rise to the term osteosarcopenia [18]. The use of sarcopenia screening tool SARC‐F [19] combined with the fracture risk prediction tool FRAX improves fracture risk prediction in older Chinese men aged 65 years and over at 10 years [20] and in both men and women at 14 years [21].
QUALITY OF LIFE
Quality of life represents an important patient‐related outcome measure in the management of sarcopenia. Generic quality‐of‐life instruments such as the Medical Outcomes Study 36‐item Short Form Health Survey (SF‐36) have been widely used, and association examined in relationship to individual components included in the diagnosis of sarcopenia. A decline in these components is associated with poorer physical component of health‐related quality of life. Physical, psychological, and social factors may all contribute to poorer quality of life [22]. Specific tools for musculoskeletal health have also been proposed, including one
