Advertisement

Sarc-frailty: towards an integrated view of ageing

  • Shou-En Wu
    Affiliations
    Department of Dermatology, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei City, Taiwan, ROC
    Search for articles by this author
  • Wei-Liang Chen
    Correspondence
    Corresponding author at: Division of Geriatric Medicine, Department of Family Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Number 325, Section 2, Chang-gong Rd, Nei-Hu District, 114, Taipei, Taiwan, ROC.
    Affiliations
    Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei City, Taiwan, ROC

    Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei City, Taiwan, ROC

    Department of Biochemistry, National Defense Medical Center, Taipei City, Taiwan, ROC
    Search for articles by this author

      Highlights

      • “Sarc-frailty” combines the six diagnostic elements of sarcopenia and frailty.
      • “Sarc-frailty” demonstrated greater power than sarcopenia or frailty singly to predict mortality.
      • A scoring classification which counts the sum of diagnostic elements fulfilled provides a comprehensive evaluation of sarc-frailty.

      Abstract

      Objectives

      Sarcopenia and frailty have both been related to adverse events in ageing, but have long been studied in parallel. The purpose of this study was to provide a better depiction of ageing by taking the advantages of both entities.

      Study design

      2532 participants were enrolled from the National Health and Nutrition Examination Survey 1999–2002. A new diagnostic entity, sarc-frailty, was established by merging the diagnostic elements of both sarcopenia and frailty.

      Main outcome measures

      Cox proportional hazard models, Kaplan-Meier curve, and receiver operating characteristic (ROC) curve analysis were utilized to compare the hazard ratios and predictive power in relation to mortality of sarcopenia, frailty, and sarc-frailty. Two different classification strategies, categorical and scoring, were used as alternative assessment methods.

      Results

      The median follow-up duration was 67.49 months, and no participants were lost to follow-up. ROC analysis revealed the highest area under curves (AUC) in sarc-frailty by both categorical and scoring classification (AUC = 0.660, p value <0.001 and AUC = 0.697, p value <0.001, respectively), indicating the best predictive ability in relation to mortality. Kaplan-Meier analysis also demonstrated the shortest overall survival for sarc-frailty with both classifications (p value both <0.001). In addition, hazard ratios (HRs) of sarc-frailty with both classifications were higher than their counterparts for sarcopenia and frailty (HR = 12.599, 95 % CI = 7.780 to 20.403, p < 0.001 by categorical method, and HR = 20.121, 95 % CI = 8.101 to 49.973, p < 0.001 by scoring classification). Moreover, the scoring classification revealed a more delicate hierarchical structure of mortality levels than the categorical classification.

      Conclusions

      Sarc-frailty had a better predictive ability in relation to mortality. Considering that ageing well is a holistic health-care issue, our new entity, along with the scoring method, provides clinicians with more effective tools in geriatric assessment.

      Abbreviations:

      AUC (area under curves), AWGS (Asian Working Group for Sarcopenia), CDC (Disease Control and Prevention), CV (cardiovascular), EWGSOP2 (European working Group on Sarcopenia in Older People in 2019), HR (hazard ratio), MEC (mobile examination center), NCHS (National Center for Health Statistics), NHANES (National Health and Nutrition Examination Survey), ROC (receiver operating characteristic)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Organization W.H.
        Global Strategy And Action Plan on Ageing And Health.
        2017
        • Cruz-Jentoft A.J.
        • Bahat G.
        • Bauer J.
        • Boirie Y.
        • Bruyère O.
        • Cederholm T.
        • Cooper C.
        • Landi F.
        • Rolland Y.
        • Sayer A.A.J.A.
        Ageing, sarcopenia: revised European consensus on definition and diagnosis.
        Age Ageing. 2019; 48: 16-31
        • Chen L.K.
        • Woo J.
        • Assantachai P.
        • Auyeung T.W.
        • Chou M.Y.
        • Iijima K.
        • Jang H.C.
        • Kang L.
        • Kim M.
        • Kim S.
        • Kojima T.
        • Kuzuya M.
        • Lee J.S.W.
        • Lee S.Y.
        • Lee W.J.
        • Lee Y.
        • Liang C.K.
        • Lim J.Y.
        • Lim W.S.
        • Peng L.N.
        • Sugimoto K.
        • Tanaka T.
        • Won C.W.
        • Yamada M.
        • Zhang T.
        • Akishita M.
        • Arai H.
        Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment.
        J. Am. Med. Dir. Assoc. 2020; 21: 300-307.e2
        • Von Haehling S.
        • Morley J.E.
        • Anker S.D.
        An Overview of Sarcopenia: Facts And Numbers on Prevalence And Clinical Impact.
        Springer, 2010
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • Newman A.B.
        • Hirsch C.
        • Gottdiener J.
        • Seeman T.
        • Tracy R.
        • Kop W.J.
        • Burke G.
        • McBurnie M.A.
        Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
        • Clegg A.
        • Young J.
        • Iliffe S.
        • Rikkert M.O.
        • Rockwood K.J.T.l.
        Frailty in elderly people.
        Lancet. 2013; 381: 752-762
        • Xue Q.L.
        The frailty syndrome: definition and natural history.
        Clin Geriatr Med. 2011; 27: 1-15
        • Bauer J.M.
        • Sieber C.C.J.E.g
        Sarcopenia and frailty: a clinician's controversial point of view.
        Exp.Gerontol. 2008; 43: 674-678
        • Reijnierse E.M.
        • Trappenburg M.C.
        • Blauw G.J.
        • Verlaan S.
        • de van der Schueren M.A.
        • Meskers C.G.
        • Maier A.B.
        Common ground? The concordance of sarcopenia and frailty definitions.
        J. Am. Med. Dir. Assoc. 2016 Apr 1; 17: 371.e7-371.e12
        • Cooper C.
        • Dere W.
        • Evans W.
        • Kanis J.A.
        • Rizzoli R.
        • Sayer A.A.
        • Sieber C.
        • Kaufman J.-M.
        • Van Kan G.A.
        • Boonen S.J.O.I.
        Frailty and sarcopenia: definitions and outcome parameters.
        Osteoporos. Int. 2012; 23: 1839-1848
        • Cesari M.
        • Landi F.
        • Vellas B.
        • Bernabei R.
        • Marzetti E.
        Sarcopenia and physical frailty: two sides of the same coin.
        Front Aging Neurosci. 2014 Jul 28; 6: 192
        • Centers for Disease Control and Prevention
        National Center for Health Statistics. National health and nutrition examination survey.
        • Centers for Disease Control and Prevention (US)
        National Center for Health Statistics. National Death Index.
        • Rosenberg I.H.
        Sarcopenia: origins and clinical relevance.
        J. Nutr. 1997 May; 127: 990S-991S
        • Nishiguchi S.
        • Yamada M.
        • Fukutani N.
        • Adachi D.
        • Tashiro Y.
        • Hotta T.
        • Morino S.
        • Shirooka H.
        • Nozaki Y.
        • Hirata H.
        • Yamaguchi M.
        • Arai H.
        • Tsuboyama T.
        • Aoyama T.
        Differential association of frailty with cognitive decline and sarcopenia in community-dwelling older adults.
        J. Am. Med. Dir. Assoc. 2015 Feb; 16: 120-124
        • Morley J.E.
        Frailty and Sarcopenia: The New Geriatric Giants.
        Rev. Invest. Clin. 2016 Mar-Apr; 68: 59-67
        • Moreh E.
        • Jacobs J.M.
        • Stessman J.
        Fatigue, function, and mortality in older adults.
        J. Gerontol. A Biol. Sci. Med. Sci. 2010 Aug; 65: 887-895
        • Basu N.
        • Yang X.
        • Luben R.N.
        • Whibley D.
        • Macfarlane G.J.
        • Wareham N.J.
        • Khaw K.-T.
        • Myint P.K.J.B.m
        Fatigue is associated with excess mortality in the general population: results from the EPIC-Norfolk study.
        BMC Med. 2016; 14: 122
        • Stenholm S.
        • Harris T.B.
        • Rantanen T.
        • Visser M.
        • Kritchevsky S.B.
        • Ferrucci L.
        Sarcopenic obesity: definition, cause and consequences.
        Curr. Opin. Clin. Nutr. Metab. Care. 2008 Nov; 11: 693-700
        • Hamer M.
        • O'Donovan G.
        Sarcopenic obesity, weight loss, and mortality: the English Longitudinal Study of Ageing.
        Am. J. Clin. Nutr. 2017 Jul; 106: 125-129
        • Sanada K.
        • Chen R.
        • Willcox B.
        • Ohara T.
        • Wen A.
        • Takenaka C.
        • Masaki K.J.N.
        Association of sarcopenic obesity predicted by anthropometric measurements and 24-y all-cause mortality in elderly men: the Kuakini Honolulu Heart Program.
        Nutrition. 2018; 46: 97-102
        • Montano-Loza A.J.
        • Angulo P.
        • Meza-Junco J.
        • Prado C.M.
        • Sawyer M.B.
        • Beaumont C.
        • Esfandiari N.
        • Ma M.
        • Baracos V.E.
        Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis.
        J. Cachexia. Sarcopenia Muscle. 2016 May; 7: 126-135
        • Shi G.P.
        • Ma T.
        • Zhu Y.S.
        • Wang Z.D.
        • Chu X.F.
        • Wang Y.
        • Chen Z.K.
        • Xu W.D.
        • Wang X.F.
        • Guo J.H.
        • Jiang X.Y.
        Frailty phenotype, frailty index and risk of mortality in Chinese elderly population- Rugao longevity and ageing study.
        Arch. Gerontol. Geriatr. 2019 Jan-Feb; 80: 115-119
        • Lohman M.C.
        • Sonnega A.J.
        • Resciniti N.V.
        • Leggett A.N.
        Frailty Phenotype and Cause-Specific Mortality in the United States.
        J. Gerontol. A Biol. Sci. Med. Sci. 2020 Sep 25; 75: 1935-1942
        • Landi F.
        • Cruz-Jentoft A.J.
        • Liperoti R.
        • Russo A.
        • Giovannini S.
        • Tosato M.
        • Capoluongo E.
        • Bernabei R.
        • Onder G.J.A.
        ageing, Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study.
        Age Ageing. 2013; 42: 203-209
        • Batsis J.A.
        • Mackenzie T.A.
        • Barre L.K.
        • Lopez-Jimenez F.
        • Bartels S.J.
        Sarcopenia, sarcopenic obesity and mortality in older adults: results from the National Health and Nutrition Examination Survey III.
        Eur. J. Clin. Nutr. 2014 Sep; 68: 1001-1007
        • Cawthon P.M.
        • Marshall L.M.
        • Michael Y.
        • Dam T.T.
        • Ensrud K.E.
        • Barrett-Connor E.
        • Orwoll E.S.
        Osteoporotic Fractures in Men Research Group. Frailty in older men: prevalence, progression, and relationship with mortality.
        J. Am. Geriatr. Soc. 2007 Aug; 55: 1216-1223
        • Chang S.F.
        • Lin P.L.
        Systematic Literature Review and Meta-Analysis of the Association of Sarcopenia With Mortality.
        Worldviews Evid. Based Nurs. 2016 Apr; 13: 153-162
        • Tosato M.
        • Marzetti E.
        • Cesari M.
        • Savera G.
        • Miller R.R.
        • Bernabei R.
        • Landi F.
        • Calvani R.J.A.c.
        e. research, Measurement of muscle mass in sarcopenia: from imaging to biochemical markers.
        Aging Clin. Exp. Res. 2017; 29: 19-27
        • Sousa A.S.
        • Guerra R.S.
        • Fonseca I.
        • Pichel F.
        • Ferreira S.
        • Amaral T.F.
        Financial impact of sarcopenia on hospitalization costs.
        Eur. J. Clin. Nutr. 2016 Sep; 70: 1046-1051
        • Robinson T.N.
        • Wu D.S.
        • Stiegmann G.V.
        • Moss M.
        Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults.
        Am. J. Surg. 2011 Nov; 202: 511-514
        • Landi F.
        • Cesari M.
        • Calvani R.
        • Cherubini A.
        • Bari M.Di
        • Bejuit R.
        • Mshid J.
        • Andrieu S.
        • Sinclair A.J.
        • Sieber C.C.J.A.c.
        e. research, The “Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies”(SPRINTT) randomized controlled trial: design and methods.
        Aging Clin. Exp. Res. 2017; 29: 89-100
        • Calvani R.
        • Picca A.
        • Marini F.
        • Biancolillo A.
        • Gervasoni J.
        • Persichilli S.
        • Primiano A.
        • Coelho-Junior H.J.
        • Cesari M.
        • Bossola M.
        • Urbani A.
        • Onder G.
        • Landi F.
        • Bernabei R.
        • Marzetti E.
        Identification of biomarkers for physical frailty and sarcopenia through a new multi-marker approach: results from the BIOSPHERE study.
        Geroscience. 2021 Apr; 43: 727-740
        • Malmstrom T.K.
        • Miller D.K.
        • Simonsick E.M.
        • Ferrucci L.
        • Morley J.E.
        SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes.
        J. Cachexia. Sarcopenia Muscle. 2016 Mar; 7: 28-36
        • Yu Zhuowei
        • et al.
        From sarcopenia to frailty: the pathophysiological basis and potential target molecules of intervention.
        Frailty Sarcopenia Onset Dev. Clin. Chall. 2017; 3: 55-69
        • Ruan Q.
        • D’Onofrio G.
        • Sancarlo D.
        • Greco A.
        • Lozupone M.
        • Seripa D.
        • Panza F.
        • Yu Z.J.A.c
        e. research, Emerging biomarkers and screening for cognitive frailty.
        Aging Clin. Exp. Res. 2017; 29: 1075-1086
        • Fulop T.
        • Larbi A.
        • Witkowski J.M.
        • McElhaney J.
        • Loeb M.
        • Mitnitski A.
        • Pawelec G.J.B.
        Aging, frailty and age-related diseases.
        Biogerontology. 2010; 11: 547-563
        • Cesari M.
        • Gambassi G.
        • Abellan van Kan G.
        • Vellas B.J.A.
        ageing, The frailty phenotype and the frailty index: different instruments for different purposes.
        Age Ageing. 2014; 43: 10-12