Abstract
Objectives
Following the concept of a metabolic load-capacity model, we propose the use of appendicular
skeletal muscle mass (ASM) to total body fat (TBF) ratio in predicting 4-year physical
limitations, physical performance measures, 6-year incident diabetes and cardiovascular
diseases, and 12-year mortality.
Design
Cross-sectional and prospective cohort study.
Setting and participants
4000 men and women aged 65 years and older living in the community.
Measures
At baseline, information regarding physical limitation was obtained. Measurements
included height, weight, body composition using dual-energy x-ray absorptiometry,
grip strength, and walking speed. Total ASM was calculated as the sum of appendicular
lean mass minus bone mineral content of both arms and legs. Gait speed was measured
using the best time in seconds to complete a walk along a straight line 6 m long.
The mean ASM/TBF ratio was estimated for the combination categories of (1) no sarcopenia
and TBF less than top quartile (by sex), (2) sarcopenia and TBF less than top quartile,
and (3) sarcopenia and TBF larger than top quartile. Association of quintiles of ASM/TBF
with mortality was analyzed using Cox regression; logistic regressions were applied
to examine other outcomes. Cutoff values of ASM/TBF were identified by Classification
and Regression Tree (CART) analysis for different outcomes.
Results
Compared with those with the highest quintile of ASM/TBF, men in the lowest quintile
had a 79% increase in risk of physical limitations, 66% increase in risk of slow walking
speed, and 80% increase in incident cardiovascular diseases. In women, increased risk
was only observed for physical limitation and slow walking speed. CART analysis identified
different cutoff values for different outcomes and also between men and women.
Conclusions/Implications
ASM/TBF may be used in geriatric screening to detect sarcopenic obesity, to guide
implementation of weight control, as well as in muscle-strengthening programs.
Keywords
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Article info
Publication history
Published online: April 17, 2018
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
