Introduction

Frailty, sarcopenia and fragility fractures are closely related to epidemiologically, biologically and clinical impactions. Fragility fracture is observed more frequently in sarcopenic older adults. Older persons who have had a fragility fracture should be assessed for sarcopenia to better develop prevention and recovery after fractures. For these reasons global consensuses tried to create the definition of sarcopenia that best predicts clinical outcomes in the recent years.

Objectives

There is no global consensus definition of sarcopenia despite the great efforts in the recent years. We aimed to study the longitudinal associations of different sarcopenia definitions with functional outcomes.

Methods

We recruited participants admitted to geriatrics outpatient clinics of a university hospital. The patients that have follow-up evaluation for usual gait speed (UGS), activities of daily living (ADL) and instrumental ADL and frailty included. Body composition was assessed by bioimpedance analysis (TANITA BC532). HGS, UGS, ADL, IADL were assessed by Jamar hydraulic hand dynamometer, gait speed at 4m course, Katz and Lawton scales, respectively. Frailty was screened by FRAIL questionnaire. Sarcopenia was defined by EWGSOP1, EWGSOP2 and the two alternative FNIH definitions. EWGSOP2-sarcopenia was evaluated by universally suggested cut-offs (i.e. 27 and 16 kg). EWGSOP2-probable sarcopenia was assessed also by Turkish cut-offs (i.e. 32 and 22 kg) as an additional parameter alternatively. The patients were assessed for detoriation in UGS, ADL, IADL, FRAIL scores and also for decrease in UGS to <= 0.8 m/s and detoriation to frailty.

Results

Among a total of 1881 patients, 264 patients had follow-up data for functional measures and included in the study. The mean age was 75.3+6.3, 195 (73.9%) patients were female with a mean and median follow-up days of 600 and 511 days (Table 1a, 1b). In the first evaluation, the prevalence of sarcopenia ranged between 0.8%-6.1% with standard definitions while it increased to 37% when EWGSOP2-probable sarcopenia was assessed by Turkish cut-offs (probable sarcopenia EWGSOP2-Turkish) (Table 1). The EWGSOP1 or EWGSOP2-confirmed/probable sarcopenia was not associated with adverse outcomes. The EWGSOP2-probable sarcopenia by Turkish cut-offs was associated with detoriation in IADL and decrease in UGS to <= 0.8 m/s (p=0.049 and pearson chi square=3.9; p=0.044 and pearson chi square=4.1, respectively) (Table 2). The FNIH sarcopenia definition including slow UGS was associated with detoriation in IADL (p=0.045, pearson chi square=5.0) (Table 2). In the regression analysis including age, MNA-SF, number of chronic diseases and drugs, dementia and diabetes none of the regression parameters were associated with adverse outcomes.

Conclusions

In this follow-up study of about 1.5 years, the adverse outcomes associated with sarcopenia were decrease in UGS to <= 0.8 m/s and detoriation in IADL. The sarcopenia definitions associated with adverse functional outcomes were EWGSOP2-probable sarcopenia by Turkish cut-offs and FNIH sarcopenia definition including the slow gait speed. EWGSOP2-probable sarcopenia by Turkish cut-offs came forward as having more extensive association with adverse functional outcomes.

中文翻译：

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肌肉减少症定义与不良结局的纵向关联：一项比较研究

介绍

衰弱、肌肉减少和脆性骨折与流行病学、生物学和临床影响密切相关。在肌肉减少的老年人中更频繁地观察到脆性骨折。应该对患有脆性骨折的老年人进行肌肉减少症评估，以更好地进行骨折预防和康复。由于这些原因，近年来全球共识试图创建最能预测临床结果的肌肉减少症的定义。

目标

尽管近年来做出了巨大努力，但肌肉减少症的定义尚无全球共识。我们旨在研究不同肌肉减少症定义与功能结果的纵向关联。

方法

我们招募了一家大学医院老年科门诊的参与者。包括对通常步态速度（UGS）、日常生活活动（ADL）和工具性ADL和虚弱进行随访评估的患者。通过生物阻抗分析（TANITA BC532）评估身体成分。HGS、UGS、ADL、IADL 分别通过 Jamar 液压手测力计、4m 路线的步态速度、Katz 和 Lawton 量表进行评估。通过 FRAIL 问卷筛选虚弱。肌肉减少症由 EWGSOP1、EWGSOP2 和两个可供选择的 FNIH 定义定义。EWGSOP2-肌肉减少症通过普遍建议的临界值（即 27 和 16 公斤）进行评估。EWGSOP2 可能的肌肉减少症也通过土耳其临界值（即 32 和 22 公斤）作为附加参数进行评估。评估患者在 UGS、ADL、IADL、

结果

在总共 1881 名患者中，264 名患者有功能测量的随访数据并被纳入研究。平均年龄为 75.3+6.3，195 名（73.9%）患者为女性，平均和中位随访天数分别为 600 天和 511 天（表 1a、1b）。在第一次评估中，按照标准定义，肌肉减少症的患病率在 0.8%-6.1% 之间，而当通过土耳其临界值（可能的肌肉减少症 EWGSOP2-土耳其语）评估 EWGSOP2 可能的肌肉减少症时，它增加到 37%（表 1）。EWGSOP1 或 EWGSOP2 确认/可能的肌肉减少症与不良结局无关。土耳其临界值的 EWGSOP2 可能的肌肉减少症与 IADL 的恶化和 UGS 下降到 <= 0.8 m/s 相关（p=0.049 和 pearson 卡方=3.9；p=0.044 和 pearson 卡方=4.1，分别） （表 2）。包括缓慢 UGS 在内的 FNIH 肌肉减少症定义与 IADL 的恶化相关（p=0.045，pearson chi square=5.0）（表 2）。在包括年龄、MNA-SF、慢性病和药物数量、痴呆和糖尿病在内的回归分析中，没有一个回归参数与不良结果相关。

结论

在这项约 1.5 年的随访研究中，与肌肉减少症相关的不良结果是 UGS 降低至 <= 0.8 m/s 和 IADL 恶化。与不良功能结果相关的肌肉减少症定义是土耳其临界值的 EWGSOP2 可能的肌肉减少症和 FNIH 肌肉减少症的定义，包括慢步态速度。土耳其临界值的 EWGSOP2 可能的肌肉减少症与不良功能结果有更广泛的关联。