Hirani Vasant, Blyth Fiona, Naganathan Vasi, Le Couteur David G, Seibel Markus J, Waite Louise M, Handelsman David J, Cumming Robert G
Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia; School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Australian Research Council Centre of Excellence in Population Ageing Research, University of Sydney, Sydney, New South Wales, Australia.
Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia.
J Am Med Dir Assoc. 2015 Jul 1;16(7):607-13. doi: 10.1016/j.jamda.2015.02.006. Epub 2015 Mar 26.
Sarcopenia is associated with an increased risk of adverse outcomes. The aim of this study was to explore the relationship between severity of sarcopenia and incident activities of daily living (ADL) disability, institutionalization, and all-cause mortality among community-dwelling older men participating in the Concord Health and Ageing in Men Project (CHAMP).
Longitudinal analysis of 1705 participants aged 70 years or older at baseline (2005-2007) living in the community in Sydney, Australia.
The main outcome measures were incident ADL disability, institutionalization, and mortality. Of the 1705 participants who completed the baseline assessments, a total of 1678 men (mean age 77 years) had complete measures by dual-energy x-ray absorptiometry, to assess sarcopenia in terms of low appendicular lean mass (ALM), using the Foundation for the National Institutes of Health (FNIH) criteria. To differentiate between severity of sarcopenia we used low ALM alone (sarcopenia I), low ALM with weakness (sarcopenia II), and sarcopenia with weakness and poor gait speed (sarcopenia III). Cox proportional hazard models and logistic regression models were used to assess the risk of mortality and institutionalization, and incidence of ADL disability.
From baseline to follow-up, 103 (11.3%) men had incident ADL disability, 191 (11.2%) men were institutionalized, and 535 (31.9%) had died. At baseline, 14.2% had sarcopenia I, 5.3% had sarcopenia II, and 3.7% had sarcopenia III. Fully adjusted analysis (adjusted for demographics, lifestyle factors, comorbidities and health conditions, and blood measures) showed that sarcopenia I, II, and III were associated with increased risk of disability, institutionalization, and mortality. Associations between sarcopenia I, II, and III and risk of incident disability were as follows: odds ratio (OR) 2.77 95% confidence interval (CI) 1.30-5.87, OR 3.78 95% CI 1.23-11.64, and OR 4.53 95% CI 0.90-22.72; associations with institutionalization were hazard ratio (HR) 1.96 95% CI 1.14-3.35, HR 2.53 95% CI 1.31-4.90, and HR 2.27 95% CI 1.08-4.80; and with mortality were HR 1.65 95% CI 1.30-2.09, HR 1.50 95% CI 1.08-2.08, and HR 1.69 95% CI 1.17-2.44.
This study shows that, in community-dwelling older men, sarcopenia defined by the FNIH criteria is associated with increased risk of incident disability, institutionalization, and mortality.
肌肉减少症与不良后果风险增加相关。本研究旨在探讨参与康科德男性健康与老龄化项目（CHAMP）的社区居住老年男性中，肌肉减少症严重程度与日常生活活动（ADL）能力丧失、入住养老院及全因死亡率之间的关系。
对1705名基线时（2005 - 2007年）年龄在70岁及以上、居住在澳大利亚悉尼社区的参与者进行纵向分析。
主要结局指标为ADL能力丧失、入住养老院及死亡率。在完成基线评估的1705名参与者中，共有1678名男性（平均年龄77岁）通过双能X线吸收法进行了完整测量，以根据美国国立卫生研究院基金会（FNIH）标准，通过低四肢瘦体重（ALM）评估肌肉减少症。为区分肌肉减少症的严重程度，我们单独使用低ALM（肌肉减少症I）、伴有虚弱的低ALM（肌肉减少症II）以及伴有虚弱和步态速度慢的肌肉减少症（肌肉减少症III）。采用Cox比例风险模型和逻辑回归模型评估死亡风险、入住养老院风险以及ADL能力丧失发生率。
从基线到随访，103名（11.3%）男性出现ADL能力丧失，191名（11.2%）男性入住养老院，535名（31.9%）男性死亡。基线时，14.2%有肌肉减少症I，5.3%有肌肉减少症II，3.7%有肌肉减少症III。完全调整分析（针对人口统计学、生活方式因素、合并症和健康状况以及血液指标进行调整）显示，肌肉减少症I、II和III与残疾、入住养老院及死亡风险增加相关。肌肉减少症I、II和III与ADL能力丧失风险之间的关联如下：比值比（OR）2.77，95%置信区间（CI）1.30 - 5.87；OR 3.78，95% CI 1.23 - 11.64；OR 4.53，95% CI 0.9 ->22.72；与入住养老院的关联为风险比（HR）1.96，95% CI 1.14 - 3.35；HR 2.53，95% CI 1.31 - 4.90；HR 2.27，95% CI 1.08 - 4.80；与死亡的关联为HR 1.65，95% CI 1.30 - 2.09；HR 1.50，95% CI 1.08 - 2.08；HR 1.69，95% CI 1.17 - 2.44。
本研究表明，在社区居住的老年男性中，根据FNIH标准定义的肌肉减少症与ADL能力丧失、入住养老院及死亡风险增加相关。
