Luo Ya-Xi, Zhou Xiao-Han, Heng Tian, Yang Ling-Ling, Zhu Ying-Hai, Hu Peng, Yao Xiu-Qing
Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Chongqing Municipality Clinical Research Center for Geriatric Medicine, Chongqing, China.
J Cachexia Sarcopenia Muscle. 2024 Oct;15(5):1915-1929. doi: 10.1002/jcsm.13541. Epub 2024 Jul 12.
Sarcopenia, the age-related loss of muscle mass and function, brings multiple adverse outcomes including disability and death. Several sarcopenia consensuses have newly introduced the premorbid concept of possible sarcopenia and recommended early lifestyle interventions. Bidirectional transitions of premorbid states have been revealed in several chronic diseases yet not clarified in sarcopenia. This study aims to investigate the underlying transition patterns of sarcopenia states.
The study utilized three waves of data from a nationally representative survey, the China Health and Retirement Longitudinal Study (CHARLS), and included community-dwelling individuals aged 60 years and older with at least two sarcopenia states assessments based on the Asian Working Group for Sarcopenia criteria 2019 (AWGS2019) between 2011 and 2015. The estimated transition intensity and probability between non-sarcopenia, possible sarcopenia, sarcopenia, and death were investigated using multi-stage Markov (MSM) models.
The study comprised 4395 individuals (49.2% female, median age 67 years) with a total of 10 778 records of sarcopenia state assessment, and the mean follow-up period was 3.29 years. A total of 24.5% of individuals with a current state of possible sarcopenia returned to non-sarcopenia, 60.3% remained possible sarcopenia, 6.7% progressed to sarcopenia, and 8.5% died by the next follow-up. The transition intensity of recovery to non-sarcopenia (0.252, 95% CI 0.231-0.275) was 2.8 times greater than the deterioration to sarcopenia (0.090, 95% CI 0.080-0.100) for individuals with possible sarcopenia. For individuals with possible sarcopenia, the estimated probabilities of recovering to non-sarcopenia, progressing to sarcopenia, and transitioning to death within a 1-year observation were 0.181, 0.066, and 0.035, respectively. For individuals with sarcopenia, the estimated probabilities of recovering to non-sarcopenia, recovering to possible sarcopenia, and transitioning to death within 1-year observation were 0.016, 0.125, and 0.075, respectively. In covariables analysis, age, sex, body mass index, physical function impairment, smoking, hypertension, and diabetes are important factors influencing bidirectional transitions.
The findings highlight the bidirectional transitions of sarcopenia states among older adults and reveal a notable proportion of possible sarcopenia show potential for recovery in the natural course. Screening and intensifying interventions based on risk factors may facilitate a recovery transition.
肌肉减少症是与年龄相关的肌肉量和功能丧失，会带来包括残疾和死亡在内的多种不良后果。多项肌肉减少症共识最近引入了可能存在肌肉减少症的病前概念，并建议尽早进行生活方式干预。在几种慢性疾病中已经揭示了病前状态的双向转变，但在肌肉减少症中尚未阐明。本研究旨在调查肌肉减少症状态的潜在转变模式。
该研究利用了来自具有全国代表性的中国健康与养老追踪调查（CHARLS）的三轮数据，纳入了年龄在60岁及以上、居住在社区、在2011年至2015年间根据2019年亚洲肌肉减少症工作组标准（AWGS2019）至少进行过两次肌肉减少症状态评估的个体。使用多阶段马尔可夫（MSM）模型研究了非肌肉减少症、可能存在肌肉减少症、肌肉减少症和死亡之间的估计转变强度和概率。
该研究包括4395名个体（49.2%为女性，中位年龄67岁），共有10778条肌肉减少症状态评估记录，平均随访期为3.29年。目前处于可能存在肌肉减少症状态的个体中，共有24.5%恢复到非肌肉减少症状态，60.3%仍处于可能存在肌肉减少症状态，6.7%进展为肌肉减少症，8.5%在下一次随访时死亡。对于可能存在肌肉减少症的个体，恢复到非肌肉减少症的转变强度（0.252，95%CI 0.231-0.275）是恶化到肌肉减少症（0.090，95%CI 0.080-0.100）的2.8倍。对于可能存在肌肉减少症的个体，在1年观察期内恢复到非肌肉减少症、进展为肌肉减少症和转变为死亡的估计概率分别为0.181、0.066和0.035。对于患有肌肉减少症的个体，在1年观察期内恢复到非肌肉减少症、恢复到可能存在肌肉减少症和转变为死亡的估计概率分别为0.016、0.125和0.075。在协变量分析中，年龄、性别、体重指数、身体功能损害、吸烟、高血压和糖尿病是影响双向转变的重要因素。
研究结果突出了老年人肌肉减少症状态的双向转变，并揭示了相当比例的可能存在肌肉减少症者在自然病程中显示出恢复的潜力。基于风险因素进行筛查和强化干预可能有助于恢复转变。
