Prevalence of Sarcopenia and Its Association with Malnutrition in Hospitalized Elderly Patients

Öz

Objective: To investigate the prevalence of sarcopenia and evaluate the nutritional status in geriatric patients hospitalized at the Internal Medicine Clinic. Material and Method: A total of 105 patients (54 female and 51 male) aged ≥ 65 years (mean age: 74 ± 6 years) hospitalized between November 2015 and January 2016 were consecutively enrolled in this prospective and observational clinical study. Muscle mass was evaluated by bioelectrical impedance device, muscle function by walking test, and strength by hand grip test. Patients were diagnosed with sarcopenia, pre-sarcopenia, and nonsarcopenic. Mini nutritional assessment (MNA) test was used to define malnutrition. Results: The number of patients diagnosed with sarcopenia and pre-sarcopenia was 49 (46.7%) and 5 (4.8%), respectively. The prevalence of sarcopenia was higher in female patients than male patients (61.1% vs. 31.4%; p=0.006). The prevalence of malnutrition in patients with sarcopenia and without sarcopenia were 51%, 10%, and the rate of patients at risk of malnutrition with sarcopenia and without sarcopenia was 37%, 49%, respectively. The prevalence of malnutrition was significantly higher in patients with sarcopenia (p<0.001). 40.8% of sarcopenic patients were overweight or obese. In the logistic regression analysis, female gender (OR=3.3, CI=1.35-8.04) and malnutrition (OR=9.41, CI=3.06-28.95) were significant risk factors for the development of sarcopenia. Conclusion: Approximately half of the hospitalized geriatric patients were sarcopenic or pre-sarcopenic, and 88% of patients with sarcopenia had malnutrition or at risk of malnutrition. Sarcopenia and malnutrition should be evaluated together in geriatric inpatients and sarcopenic obesity should not be ignored.

Anahtar Kelimeler

• Bioelectrical Impedance Analysis
• Malnutrition
• Obesity
• Sarcopenia.

Etik Beyan

Approval for the study was obtained from the İstanbul Medeniyet University Göztepe Research and Training Hospital Clinical Research Ethics Committee on 12/10/2015. Decision no: 2015/0136.

Hastanede Yatan Yaşlı Hastalarda Sarkopenı̇ Prevalansı Ve Malnütrı̇syon ı̇le İlı̇şkı̇sı̇

Öz

Amaç: İç Hastalıkları Kliniğinde yatan geriatrik hastalarda sarkopeni prevalansını araştırmak ve beslenme durumunu değerlendirmek. Gereç ve Yöntem: Hastanede yatan 65 yaş üstü toplam 105 hasta (54 kadın ve 51 erkek) (ortalama yaş: 74 ± 6 yıl) ardışık olarak çalışmaya dahil edildi. Kas kütlesi biyoelektrik empedans cihazı ile, kas fonksiyonu yürüme testi ile ve kas gücü el kavrama testi ile değerlendirildi. Hastalar sarkopeni, pre-sarkopeni ve sarkopenik olmayan olarak teşhis edildi. Malnütrisyonu tanımlamak için mini nütrisyonel değerlendirme (MNA) testi kullanılmıştır. Bulgular: Sarkopeni ve pre-sarkopeni tanısı konan hasta sayısı sırasıyla 49 (%46,7) ve 5 (%4,8) idi. Sarkopeni prevalansı kadın hastalarda erkek hastalara göre daha yüksekti (%61,1’ e karşı %31,4; p=0,006). Sarkopenisi olan hastalarda malnütrisyon prevalansı %51 ve malnütrisyon riski taşıyan hastaların oranı %37; sarkopenisi olmayan hastalarda malnütrisyon prevalansı %10 ve malnütrisyon riski taşıyan hastaların oranı %49 idi. Malnütrisyon prevalansı, sarkopenik olmayan katılımcılara kıyasla sarkopenili hastalarda anlamlı derecede yüksekti (p<0,001). Sarkopenik hastaların %40,8’ i obez veya kiloluydu. Lojistik regresyon analizinde kadın cinsiyet (OR=3.3, CI=1.35- 8.04) ve malnütrisyon (OR=9.41, CI=3.06-28.95) sarkopeni gelişimi için önemli risk faktörleriydi. Sonuç: Hastanede yatan geriatrik hastaların yaklaşık yarısı sarkopenik veya pre-sarkopenikti ve sarkopenisi olan hastaların %88’ inde malnütrisyon vardı veya malnütrisyon riski altındaydı. Yatan geriatrik hastalarda sarkopeni ve malnütrisyon birlikte değerlendirilmeli ve sarkopenik obezite göz ardı edilmemelidir.

Anahtar Kelimeler

• Biyoelektrik Empedans Analizi
• Malnütrisyon
• Obezite
• Sarkopeni.

Etik Beyan

: Çalışma için 12/10/2015 tarihinde İstanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi Klinik Araştırmaları Etik Kurulu’ndan onay alınmıştır. Karar no: 2015/0136.

Kaynakça

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.
2. Meng S, He X, Fu X, et al. The prevalence of sarcopenia and risk factors in the older adult in China: a systematic review and meta-analysis. Front Public Health 2024;12:1415398.
3. Cruz-Jentoft AJ, Landi F, Schneider SM, et al. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing 2014;43:748-759.
4. Gariballa S, Alessa A. Sarcopenia: prevalence and prognostic significance in hospitalized patients. Clin Nutr 2013;32:772-776.
5. Sousa AS, Guerra RS, Fonseca I, Pichel F, Amaral TF. Sarcopenia among hospitalized patients - A cross-sectional study. Clin Nutr 2015;34:1239-1244.
6. Martone AM, Bianchi L, Abete P, et al. The incidence of sarcopenia among hospitalized older patients: results from the Glisten study. J Cachexia Sarcopenia Muscle 2017;8:907-914.
7. Beaudart C, McCloskey E, Bruyère O, et al. Sarcopenia in daily practice: assessment and management. BMC Geriatr. 2016;16:170.
8. Lochs H, Allison SP, Meier R, et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics. Clin Nutr. 2006;25(2):180-186.

9. Ligthart-Melis GC, Luiking YC, Kakourou A, Cederholm T, Maier AB, De van der Schueren MAE. Frailty, Sarcopenia, and Malnutrition Frequently (Co-)occur in Hospitalized Older Adults: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2020;21:1216-1228.
10. Sieber CC. Malnutrition and sarcopenia. Aging Clin Exp Res 2019;31:793-798.
11. Cruz-Jentoft AJ, Kiesswetter E, Drey M, Sieber CC. Nutrition, frailty, and sarcopenia. Aging Clin Exp Res 2017;29:43-48.
12. Vellas B, Guigoz Y, Garry PJ, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999;15:116-122.
13. Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001;56:366–372.
14. Walston JD. Sarcopenia in older adults. Curr Opin Rheumatol 2012;24:623-627.
15. Hu X, Zhang L, Wang H, Hao Q, Dong B, Yang M. Malnutrition-sarcopenia syndrome predicts mortality in hospitalized older patients. Sci Rep 2017;7:3171.
16. Thomas DR. Sarcopenia. Clin Geriatr Med 2010;26:331-346.
17. Ozer FF, Akin S, Tasci İ, et al. Risk of sarcopenia in hospitalized patients and related clinical factors: a multicenter study from Turkey. Eur Geriatr Med 2021;12:863-870.
18. Janssen I, Steven B, Heymsfield SB, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 2002;50:889-896.
19. Tanimoto Y, Watanabe M, Sun W, et al. Sarcopenia and falls in community-dwelling elderly subjects in Japan: Defining sarcopenia according to criteria of the European Working Group on Sarcopenia in Older People. Arch Gerontol Geriatr 2014;59:295-299.
20. Wei S, Nguyen TT, Zhang Y, Ryu D, Gariani K. Sarcopenic obesity: epidemiology, pathophysiology, cardiovascular disease, mortality, and management. Front Endocrinol (Lausanne) 2023;14:1185221.
21. Prado CM, Batsis JA, Donini LM, Gonzalez MC, Siervo M. Sarcopenic obesity in older adults: a clinical overview. Nat Rev Endocrinol 2024;20:261-277.
22. Batsis JA, Mackenzie TA, Barre LK, Lopez-Jimenez F, Bartels SJ. Sarcopenia, sarcopenic obesity and mortality in older adults: results from the National Health and Nutrition Examination Survey III. Eur J Clin Nutr 2014;68:1001-1007.
23. Wu PY, Huang KS, Chen KM, Chou CP, Tu YK. Exercise, Nutrition, and Combined Exercise and Nutrition in Older Adults with Sarcopenia: A Systematic Review and Network Meta-analysis. Maturitas 2021;145:38-48.
24. Zhao H, Cheng R, Song G, et al. The Effect of Resistance Training on the Rehabilitation of Elderly Patients with Sarcopenia: A Meta-Analysis. Int J Environ Res Public Health 2022;19(23):15491.