Cavdar Sibel, Kayhan Kocak Fatma Ozge, Savas Sumru
Department of Internal Medicine, Division of Geriatrics, Ege University Hospital, Izmir, Turkey.
Department of Internal Medicine, Division of Geriatrics, Izmir City Hospital, Izmir, Turkey.
BMC Geriatr. 2025 Apr 15;25(1):250. doi: 10.1186/s12877-025-05897-7.
Studies comparing different operational definitions of sarcopenia (S) and sarcopenic obesity (SO) defined according to the ''European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity'' (ESPEN/EASO) criteria with functionality are scarce. Our aim is to investigate whether SO or S with different skeletal muscle mass (SMM) adjustments is better associated with functional disability.
This retrospective study was carried out in older individuals ≥ 65 years of age in a geriatric outpatient clinic. Probable and confirmed sarcopenia were evaluated with the revised European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, and SO with ESPEN/EASO consensus steps. For SMM component for both S and SO, different adjustments (weight, body mass index, and height square (W, BMI, H respectively)) were used. Functional disability was examined with activities of daily living (ADL), and instrumental ADL (IADL). Receiver operating characteristic (ROC) curves were drawn and area under ROC curve (AUC) were calculated to find which operational definition best predicts disability.
Data from 1477 older adults were screened. 408 participants (median age; 73 (65-101), 65% female) were included. Prevelance of SO was 6.9%. Probable sarcopenia, confirmed sarcopenia BMI-adjusted and confirmed sarcopenia W-adjusted were significantly associated with impaired IADL (p < 0.001), and showed fair accuracy for predicting IADL disability. Sarcopenic obesity did not show significant associations with ADL and IADL disability and didn't predict ADL and IADL disability. Only confirmed sarcopenia by BMI predicted ADL disability with poor accuracy. Among operational definitions of sarcopenia, probable sarcopenia had the highest sensitivity (83.6%) and negative predictive value (NPV) (94.2%) for predicting IADL disability.
We found that probable sarcopenia (with the highest sensitivity and NPV) and confirmed sarcopenia (BMI-adjusted with higher sensitivity and NPV than W-adjusted) were the most relevant for predicting IADL disability, but their diagnostic accuracy was limited. Confirmed sarcopenia by BMI predicted ADL disability with poor accuracy. Other operational definitions, including SO did not predict functional disability in our study. Future studies need to refine the definitions of SO and investigate its distinct impact on functional impairment compared to sarcopenia alone.
比较根据“欧洲临床营养与代谢学会和欧洲肥胖研究协会”（ESPEN/EASO）标准定义的肌肉减少症（S）和肌肉减少性肥胖症（SO）的不同操作定义与功能之间关系的研究很少。我们的目的是研究不同骨骼肌质量（SMM）调整下的SO或S与功能残疾的关联是否更强。
这项回顾性研究在一家老年门诊诊所中≥65岁的老年人中进行。采用修订后的欧洲老年人肌肉减少症工作组（EWGSOP2）标准评估可能的和确诊的肌肉减少症，采用ESPEN/EASO共识步骤评估SO。对于S和SO的SMM成分，使用了不同的调整方法（体重、体重指数和身高平方（分别为W、BMI、H））。通过日常生活活动（ADL）和工具性ADL（IADL）来检查功能残疾情况。绘制受试者工作特征（ROC）曲线并计算ROC曲线下面积（AUC），以找出哪种操作定义最能预测残疾。
筛选了1477名老年人的数据。纳入了408名参与者（中位年龄；73（65-101）岁，65%为女性）。SO的患病率为6.9%。可能的肌肉减少症、BMI调整后的确诊肌肉减少症和W调整后的确诊肌肉减少症与IADL受损显著相关（p<0.001）且在预测IADL残疾方面显示出一定准确性。肌肉减少性肥胖症与ADL和IADL残疾无显著关联，也无法预测ADL和IADL残疾。只有BMI确诊的肌肉减少症在预测ADL残疾方面准确性较差。在肌肉减少症的操作定义中，可能的肌肉减少症在预测IADL残疾方面具有最高的敏感性（83.6%）和阴性预测值（NPV）（94.2%）。
我们发现可能的肌肉减少症（敏感性和NPV最高）和确诊的肌肉减少症（BMI调整后的敏感性和NPV高于W调整后的）与预测IADL残疾最相关，但其诊断准确性有限。BMI确诊的肌肉减少症在预测ADL残疾方面准确性较差。在我们的研究中，包括SO在内的其他操作定义无法预测功能残疾。未来的研究需要完善SO的定义，并研究其与单独的肌肉减少症相比对功能损害的独特影响
