Sarcopenia in older people

Transcription

1 Sarcopenia in older people Timothy Kwok/Ruth Chan Department of Medicine and Therapeutics / Centre for Nutritional Studies

2 Outline What is sarcopenia? How common is sarcopenia? Risk factors of sarcopenia Health consequences of sarcopenia Interventions for sarcopenia

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4 What is sarcopenia? Sarco = Flesh Penia = Loss Newly recognized geriatric syndrome Complex clinical conditions in older persons Do not fit into traditional disease categories Highly prevalent, multifactorial and associated with multiple comorbidities & poor outcomes Cruz Jentoft AJ, et al. Curr Opin Clin Nutr Metab Care 2010;13:1e7. Rosenberg IH. Am J Clin Nutr 1989;50:1231Se1233S.

5 ll. hk Past Current w w w.n ofa Age related decline of skeletal muscle plus low muscle strength and/or physical performance Cruz Jentoft AJ, et al. Curr Opin Clin Nutr Metab Care 2010;13:1e7. Rosenberg IH. Am J Clin Nutr 1989;50:1231Se1233S. Photos and graph from Google search

6 Sarcopenia Reduced gait speed Reduced hand grip strength Reduced muscle mass (appendicular lean mass /Ht 2 )

7 Dual X-ray Densitometry measurement

8 How common is sarcopenia in HK? Definition does matter

9 Criteria US Foundation National Institutes of Health (FNIH) Physical performance (gait speed, m/s) Muscle strength (grip strength, kg) <26 (men) <16 (women) US FNIH (slowness) <0.8 <26 (men) <16 (women) European Working Group on Sarcopenia in Older Persons (EWGSOP) International Working Group on Sarcopenia (IWGS) Asian Working Group on Sarcopenia (AWGS) <0.8 OR <=28 (men) <=18 (women) Skeletal muscle mass* ALM BMI <0.789 (men) <0.512 (women) ALM BMI <0.789 (men) <0.512 (women) ALM/Ht 2 <=6.52 (men) <=5.44 (women) <1.0 ALM/Ht 2 <=7.23 (men) <=5.67 (women) <0.8 OR <26 (men) <18 (women) ALM/Ht 2 <7 (men) <5.4 (women) Men (MrOs) Prevalence (%) Women (MsOs) Woo J, et al. J Am Med Dir Assoc 2015;16(3):

10 Age related changes in Relative Appendicular mass in Chinese Women kg/m 2 A S M H T SEX= Female N = AGEGP 207 =< yrs

11 Age related changes in Relative Appendicular mass in Chinese Men kg/m 2 A S M H T SEX= Male N = AGEGP 27 =< yrs

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13 SARC-F Simple community screening tool for sarcopenia 5 questions Potentially sarcopenic if total score >4 Woo J, et al. J Am Med Dir Assoc. 2014;15(9):630 4.

14 SARC-F Low Sensitivity = Poor in identifying true positive persons (i.e. true sarcopenic patients) >=4 Quite likely that the patients may or may not be true sarcopenic <4 Very likely to be non sarcopenia but still have a chance of missing out true sarcopenic patients High Specificity = Good in identifying true negative persons (i.e. true non sarcopenic individuals) Woo J, et al. J Am Med Dir Assoc. 2014;15(9):630 4.

15 w w ll. hk w.n ofa Risk factors Cruz Jentoft AJ, et al. Curr Opin Clin Nutr Metab Care 2010;13:1e7.

16 Consequences Adopted from Cruz Jentoft AJ, et al. Curr Opin Clin Nutr Metab Care 2010;13:1e7.

17 Treatment Nonpharmacological approach

18 Nutrition and exercise intervention studies were included if the outcome measures reported for the interventions included muscle mass and at least one measure of muscle strength or physical performance, even when the population studied was not defined as sarcopenic. Exercise intervention n=7 Most exercise trials showed improved muscle strength and physical performance, but only three of seven studies found increased muscle mass. 1 Jan 2000 to May 2013 Pubmed n=2715, Dialog search n=2095 Nutrition intervention n=12 Studies failed to show a consistent effect of protein supplementation on muscle mass and function Very limited evidence on essential amino acid (EAA) supplementation seems to show some effects on muscle mass and function β hydroxy β methylbutyrate (HMB) showed some effects on muscle mass and function, but sample sizes were small Combined exercise and nutrition interventions n=17 Muscle strength and physical performance improved with exercise training in all studies. Mixed effects of exercise training and supplementation on muscle mass. Only one Japanese women study got 0.8kg more muscle mass by HMB Cruz Jentoft AJ, et al. Age Ageing 2014 Nov;43(6):748 59

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21 A randomized controlled trial assessing the role of exercise program and nutrition supplement Aim: To compare the effectiveness of exercise program +/- nutrition supplement on improving muscle mass, strength and power, physical performance in Chinese sarcopenic older adults.

22 Study Design

23 33 outreach screening cases (SARC F<4) haven t been invited for DEXA even meeting criteria for gait speed/handgrip (4 not yet contacted; 29 being OW & given lower priority) 77 cases attended DEXA appt 315 cases approached during 1 Apr 18 Sep cases identified as sarcopenia (12 cases with SARC F>=4) 28 cases randomized to: Exercise (M:2, F:7) Exercise + suppl. (M:2, F:8) Control (M:2, F:7) Drop out: Exercise (2 doctor s advice; 1 other reasons) Exercise + suppl. (1 Hosp adm) 164 cases SARC F > 4 / potentially at risk 1 case will start intervention later 6 cases will attend coming DEXA appt 5 cases did not join the study Unwilling to join control group (3) Pass away (1) Time clash (1) 11 cases haven t been invited for DEXA even SARF >4 (being OW & given lower priority) 37 cases refused further Ax Living too far (11) Physically unwell (5) Program too intensive (7) Not specified (9) Not interested (5)

24 Exercise program 3 sessions/week (2 x 1-hr group sessions + 1 x >= 15-min home exercise) Duration (mins) Rundown 5 10 Warm up stretching Chair based resistance exercises using Thera Bands for muscle groups in both the upper and lower body 5 Rest Aerobic exercises, such as dancing or Taichi 5 10 Cool down stretching

25 Combined exercise program and nutrition supplement Same exercise program Two sachets of Ensure NutriVigor per day Return any unused packets at 4-week interval for compliance check Nutrient Amount per sachet (54.1g powder) Energy (kcal) 231 Protein (g) 8.61 HMB (g) 1.21 Vitamin D (IU) 130 Omega 3 fatty acid (g) 0.29

26 Future directions in research Definition of Sarcopenia Novel imaging for Muscle quality Sarcopenic obesity Drug treatment Adverse effect of Statin

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