Prevalence And Risk Factors Of Sarcopenia Among Older People In Suburban Using Different Screening And Diagnosis Methods And An Exploration Of Intervention Methods For Sarcopenia

1 ObjectiveSarcopenia,a progressive disease associated with increasing age,characterized by decreased muscle mass,muscle strength,and/or physical performance.It has many adverse outcomes,such as falls,fractures,and increased risk of premature death.With the increasing aging of Chinese population,the Chongming District of Shanghai suburban area is one of the most aging areas in Shanghai,but there has been no studies on sarcopenia.Therefore,exploring the risk factors for sarcopenia,identifying sarcopenia in a timely and effective method and taking effective interventions to prevent and treat sarcopenia among older people in this area are essential for healthy aging.At present,the criteria most used for diagnosing sarcopenia in Asia is the Asian Working Group for Sarcopenia(AWGS)2019 consensus guidelines,but this diagnostic method requires the use of professional and expensive measurement equipment,and the high difficulty of operation,that cannot be used in primary settings(especially in the suburbs)for large-scale identification of sarcopenia in older people.And there are many methods for screening sarcopenia,and the equipment required is more readily available and inexpensive,but its accuracy in identifying sarcopenia is not clear.However,there is a lack of study comparing the prevalence and diagnostic efficacy of sarcopenia in older people under different screening and diagnosis methods,to determine the most suitable method for primary institutions to identify sarcopenia conveniently and effectively.For older people with risk factors of sarcopenia or already suffering from sarcopenia,it is necessary to be identified and take an education as soon as possible,and recommend them appropriate and effective intervention methods to prevent and treat sarcopenia,reduce adverse effects of sarcopenia in older people,and actively promote healthy aging.Thus,the aim of this study is to explore the prevalence and diagnostic efficacy of sarcopenia among Chinese community-dwelling older people under different screening and diagnosis methods,to explore the best methods of large-scale screening for sarcopenia in community,and further to investigate the risk factors for sarcopenia,so as to provide a favorable basis for the effective identification and prevention of sarcopenia in the future.Then through a systematic review and meta-analysis,the effects of different exercise interventions(resistance training[RT],whole-body vibration training[WBVT]and mixed training[MT])on muscle function,physical performance and the risk factors of sarcopenia in older people with sarcopenia are further explored,which provides a theoretical basis for subsequent studies.2 MethodsThe study consists of two sub-studies,of which Study 1 is a cross-sectional study which has been ethically approved,and Study 2 is a systematic review and meta-analysis which has completed trial registration.Study 1:Prevalence and risk factors of sarcopenia among community-dwelling older people under different screening and diagnosis methods.A total of 1407participants≥65 years were included,with a mean age of 71.91±5.59 years old and a mean body mass index(BMI)of 24.65±3.32kg/m~2.The SARC-F questionnaire,calf circumference measurement,SARC-Cal F questionnaire,and AWGS 2019 consensus guidelines were used to define sarcopenia,and calculate the prevalence of sarcopenia.The receiver operator characteristic curve was analyzed,and the diagnostic effect for sarcopenia was judged according to the area under curve(AUC).Univariate and multivariate logistic regression analysis were used to explore the risk factors for sarcopenia.Study 2:Effects of different exercise interventions on sarcopenia in older people.A systematic search was conducted with the following six electronic databases from January 2010 to March 2021:Pubmed,Cochrane Library,Embase,Web of Science,the China National Knowledge Infrastructure,and Wanfang Database.Studies met the inclusion and exclusion criteria were extracted and assessed.Review Manager 5.4software was used for data analysis,and mixed and random-effects models were used to calculate weighted mean differences and standardized mean differences(SMDs),and comprehensive analysis of pre-and post-intervention measurement results.P<0.05 was considered statistically significant.3 ResultsA total of 1407 participants were included in Study 1,and the prevalence of sarcopenia using SARC-F questionnaire,calf circumference measurement,SARC-Cal F questionnaire,and AWGS 2019 consensus were 3.84%,40.80%,20.11%,and 19.69%,respectively.Compared with AWGS 2019 consensus guideline,calf circumference measurement had the highest diagnostic value(AUC=0.843,p<0.001;sensitivity=0.751,specificity=0.794).This was followed by the use of SARC-Cal F questionnaire(AUC=0.792,p<0.001;sensitivity=0.895,specificity=0.649),while SARC-F questionnaire had the lowest diagnostic value(AUC=0.601,p<0.001;sensitivity=0.361,specificity=0.813).In addition,logistic regression analysis was used to explore the risk factors for sarcopenia and it was found that increased age,sex(male),BMI<18.5kg/m~2,increased body fat percentage,excessive sleep duration(>9hours),malnutrition,and increased levels of high-density lipoprotein cholesterol were independent risk factors for sarcopenia in older people.And BMI≥24.0kg/m~2,increased hip circumference and waist-hip ratio has a protective effect on older people from sarcopenia.Study 2 included a total of 26 studies,and involving 1191 older people with sarcopenia(mean age 60.6±2.3 to 89.5±4.4).Compared with control group,RT and MT significantly improved knee extension strength in older people with sarcopenia(RT,SMD=1.36,95%CI:0.71-2.02,p<0.0001,I~2=72%;MT,SMD=0.62,95%CI:0.29-0.95,p=0.0002,I~2=56%),gait speed(RT,SMD=2.01,95%CI:1.04-2.97,p<0.0001,I~2=84%;MT,SMD=0.69,95%CI:0.29-1.09,p=0.008,I~2=81%)and percent of body fat(RT,SMD=-0.63,95%CI:-0.98--0.27,p=0.0005,I~2=0%;MT,SMD=-0.28,95%CI:-0.53--0.03,p=0.03,I~2=12%).Under three intervention methods,the time of Timed-up and go test in older people with sarcopenia was significantly improved(SMD=-0.66,95%CI:-0.94--0.38,p<0.00001,I~2=60%).4 ConclusionsThe prevalence of sarcopenia among community older people was significantly different under different screening and diagnosis methods,and the prevalence of sarcopenia measured by the SARC-Cal F questionnaire was closest to the AWGS consensus guidelines.Compared with AWGS 2019 consensus guidelines,the diagnostic value of calf circumference measurement and SARC-Cal F questionnaire were relatively higher,but the latter had higher sensitivity and less specificity for identifying sarcopenia than the former.Therefore,the SARC-Cal F questionnaire is more recommended for screening sarcopenia in the community.In addition,for older people with risk factors of sarcopenia or already have sarcopenia,RT and MT can not only improve muscle strength and physical performance,but also reduce percentage of body fat,that decrease the risk of sarcopenia in older people;while WBVT can only improve physical performance.So,all of these exercises have a positive effect on sarcopenia.Therefore,it is recommended that ordinary older people can use RT and MT to prevent and treat sarcopenia,while frail older people can choose WBVT to improve sarcopenia,if they are hard to perform medium-high intensity active exercises such as RT and MT.