Exploring muscle mass measurements that predict functional outcomes - PowerPoint PPT Presentation

SIG Symposium IMPROVING PREVENTIVE SCREENING FOR SARCOPENIA Exploring muscle mass measurements that predict functional outcomes Gulistan Bahat, MD Istanbul Medical School Division of Geriatrics EUGMS Congress 2017-Nice, September 21

CONFLICT OF INTEREST DISCLOSURE • I have no potential conflict of interest to report.

OBJECTIVE

Background Low • differs among the muscle consensus groups in mass regard to “ muscle mass adjustment (LMM) method ” definition

Adjusting skeletal muscle mass (SMM) Height Weight Body mass index (BMI)

Adjusting by Height* • First and most used adjustment method* • SMM/height 2 † – kg/m 2 • Young mean-2SD *Baumgartner R, et al. Am J Epidemiol. 1998;147:755-63. † Appendicular SMM by DXA

Adjusting by Weight* • SMM/ body weight – % • Young mean-2SD *Janssen I, et al. J Am Geriatr Soc 2002;50:889-96 †Total SMM by BIA

Adjusting by BMI* • SMM/ BMI – kg/(kg/m 2 ) • Young mean-2SD (BMIa) • SMM threshold that best predict the low grip strength (BMIb) (FNIH) *Studenski et al. J Gerontol A Biol Sci Med Sci 2014;69:547-58. † Appendicular SMM by DXA

Association of Prevalence of sarcopenia with adverse sarcopenia health outcomes differ among different definitions

AIM Which LMM adjustment method reveals better efficacy in relation to functional outcomes?

Association of SMMI with sarcopenia related outcomes Hand grip strength Usual gait speed (UGS) Activities of daily living (ADL) Instrumental ADL (IADL) Frailty

Secondary output Prevalence by different adjustment methods Low muscle mass Sarcopenia

MATERIALS AND METHODS

• Participants – Community-dwelling – 60-99 years of age – Outpatient clinic of a university hospital

Body composition • - bioimpedance analysis (BIA) (Tanita-BC532) LMM was evaluated according to our national data • SMM index (SMMI) by height* • females<7.4 kg/m 2 , males<9.2 kg/m 2 • SMMI by weight • females <%33.6, males<%37.4 • SMMI by BMIa • females <0.823 males<1.049 • SMMI by BMIb • females<0.677 kg/BMI males <1.017 kg/BMI *Bahat G et al. 2016 Dec;35(6):1557-1563.

• Muscle strength – hand grip strength (Jamar hydraulic hand dynamometer)

• Usual gait speed (UGS) (4m) • Activities of daily living (ADL) – Katz* • Instrumental ADL (IADL) – Lawton** * Cho et al. Am Geriatr Soc 1998; 46: 677 – 682. **Lawton et al. J Gerontol 1982; 37: 91 – 99.

• Frailty – FRAIL scale

Statistical analysis • Descritive data: % or mean, SD or median • Correlation analyses (Pearson or Spearman Rho) • Independent sample t test or Mann Whitney-U

RESULTS

• n= 1307 – 421 male (32.2%) – 886 female (67.8%) • Age: 78.5 (5.7)

Prevalences Low Muscle Low Grip Low Gait Sarcopenia Mass Strength Speed • 2.1% (H) • 39.4% • 36.1% • 1.3% (H) • 47.2% (W) • 23.9% (W) • 63.4% (BMIa) • 35.2% (BMIa) • 21% (BMIb) • 13.2% (BMIb ) Low Muscle Performance 54.5 %

Association of SMMI with sarcopenia related outcomes Hand grip strength Usual gait speed (UGS) Activities of daily living (ADL) Instrumental ADL (IADL) Frailty

Association of SMMI with sarcopenia related outcomes Hand grip strength correlated with all SMMIs (p<0.001) BMI Height Weight r=0.286 r=0.298 r=0.548

Association of SMMI with sarcopenia related outcomes Usual Gait Speed Height Weight BMI (p=0.267) (r=0.08, p=0.009) (r=0.22, p<0.001)

Association of SMMI with sarcopenia related outcomes ADL Height Weight BMI (p=0.71) (r= 0.08, p=0.008) (r=0.17, p<0.001)

Association of SMMI with sarcopenia related outcomes IADL Height Weight BMI (p=0.49) (r= -0.06, p=0.04) (r=0.07, p=0.03)

Association of SMMI with sarcopenia related outcomes FRAIL Height Weight BMI (p=0.61) (r= -0.06, p=0.04) (r= -0.18, p<0.001)

Association of SMMI with sarcopenia related outcomes

Sarcopenia diagnoses defined by different SMMI vs Functional Outcomes Sarcopenia- Sarcopenia- Sarcopenia- SMMI- BMIa or SMMI-Height SMMI-Weight BMIb Hand grip All functional ADL strength measures (p=0.002) (p<0.001) (p<0.001)

Association of sarcopenia diagnoses defined by different SMMI vs Functional Outcomes

DISCUSSION

• Prevalence of sarcopenia – 3.3% (SMMI-height)** • 6.7% (male) vs 0.4% (female)(kg/m2) – 7.6% (SMMI-weight)** • 4% (male) vs 10.7% (female) (%) • κ coefficient: 0.17 (Agreement) – 0.39 (male) – 0.03 (female) *Han et al. Sci Rep. 2016 Jan 20;6:19457. **Young mean-2SD

Association of functionality between different SMMI adjustment methods • SSMI (height) correlated with – Grip strength ( r = 0.171 ), gait speed ( r = 0.109 ) • SSMI (weight) correlated with – grip strength (r = 0.105) , gait speed (r = 0.098) * Han et al. Sci Rep. 2016 Jan 20;6:19457.

Association of functionality between different SMMI adjustment methods • SSMI (height) correlated with – Grip strength ( r = 0.171 ), gait speed ( r = 0.109 ) • SSMI (weight) correlated with – grip strength (r = 0.105) , gait speed (r = 0.098)  SMMI-Height correlated better than SMMI-Weight  Grip strength  Gait speed  More muscular functions * Han et al. Sci Rep. 2016 Jan 20;6:19457.

• SMMI- height, SMMI-weight (%), SMMI-BSA, SMMI-BMI • Prevalence of LMM(8-32%) – SMMI- height • Lowest (esp. in F) – SMMI-BSA • highest – SMMI-weight, SMMI-BMI • classified more overweight and obese patients as LMM *Kittiskulnam et al. J Cachexia Sarcopenia Muscle. [e-pub ahead of print].

• Prevalence of LMM • Prevalence of LMM (M/F) – 8.1% (SMMI-height) – 12.2% vs 2.3% – 25.3% (SMMI-weight) – 27.8% vs 21.7% – 32.4% (SMMI-BSA) – 37.3% vs 25.5% – 25% (SMMI-BMI) – 24.9% vs 25.1% *Kittiskulnam J Cachexia Sarcopenia Muscle. [e-pub ahead of print].

Association of functionality between different SMMI adjustment methods • Hand grip strength • LMM Not associated with low hand – SMMI-height grip strength – SMMI-weight • LMM – SMMI-BSA Associated • OR: 1.9 with low hand – SMMI-BMI grip strength • OR: 1.8 *Kittiskulnam J Cachexia Sarcopenia Muscle. [e-pub ahead of print].

Association of functionality between different SMMI adjustment methods • Hand grip strength • LMM Not associated with low hand – SMMI-height grip strength – SMMI-weight • LMM  SMMI-BMI and SMMI-BSA correlated better than – SMMI-BSA SMMI-Height and SMMI-Weight Associated • OR: 1.9  Grip strength with low hand – SMMI-BMI grip strength • OR: 1.8 *Kittiskulnam J Cachexia Sarcopenia Muscle. [e-pub ahead of print].

Association of functionality between different SMMI adjustment methods • Gait speed • Gait speed vs SMMI (correlation) (less robust) – SMMI-height (-) – SMMI-weight (+) – SMMI-BSA (+) – SMMI-BMI (+) *Kittiskulnam et al. J Cachexia Sarcopenia Muscle. [e-pub ahead of print].

Association of functionality between different Gait speed SMMI adjustment methods • Gait Speed • LMM Not associated – SMMI-Height with low gait – SMMI-BSA speed • LMM – SMMI-Weight Associated • OR: 2.1 with low gait – SMMI-BMI speed • OR: 1.6 *Kittiskulnam et al. J Cachexia Sarcopenia Muscle. [e-pub ahead of print]

Association of functionality between different Gait speed SMMI adjustment methods • Gait Speed • LMM Not associated – SMMI-height with low gait – SMMI-BSA speed • LMM  SMMI-BMI and SMMI-Weight correlated better than – SMMI-weight SMMI-Height and SMMI-BSA Associated • OR: 2.1  Gait speed with low gait – SMMI-BMI speed • OR: 1.6 *Kittiskulnam et al. J Cachexia Sarcopenia Muscle. [e-pub ahead of print]

Association of functionality between different Gait speed SMMI adjustment methods • Gait Speed • LMM Not associated – SMMI-height with low gait – SMMI-BSA speed • LMM – SMMI-weight Associated • OR: 2.1  SMMI-BMI seems most valid with low gait – SMMI-BMI  Hand grip strength and gait speed speed • OR: 1.6 *Kittiskulnam et al. J Cachexia Sarcopenia Muscle. [e-pub ahead of print]

Bahat et al. Aging Male. 2010 Sep;13(3):211-4.

*Tufan et al. Aging Male. 2016 Sep;19(3):182-186.

2010 STUDY 2016 STUDY

 SMMI-Height associated better than the SMMI-BSA  ADL/IADL

• SMMI-Height or SMMI-Weight • Prevalence – 5.7% (SMMI-Height) – 9.7% (SMMI-Weight) Meng et al.Geriatr Gerontol Int. 2015 Jan;15(1):45-53.

Association of functionality between different SMMI adjustment methods • Falls – SMMI-Weight Sarcopenia (+) – SMMI-Height Sarcopenia (-) Meng et al.Geriatr Gerontol Int. 2015 Jan;15(1):45-53.

Association of functionality between different SMMI adjustment methods • Falls – SMMI-Weight Sarcopenia (+) – SMMI-Height Sarcopenia (-)  SMMI-Weight is better associated than SMMI-Height  for Falls Meng et al.Geriatr Gerontol Int. 2015 Jan;15(1):45-53.

Liu et al. Geriatr Gerontol Int. 2013 Oct;13(4):964-71.