Sarcopenia in older people with chronic airway diseases: the Rotterdam study

Elizabeth Benz; Katerina Trajanoska; Josje D. Schoufour; Lies Lahousse; Emmely W. de Roos; Natalie Terzikhan; Carolina Medina-Gomez; Katia Verhamme; Ross Williams; Bruno H. Stricker; Oscar H. Franco; M. Arfan Ikram; Fernando Rivadeneira; Guy Brusselle

doi:10.1183/23120541.00522-2020

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FIGURE 1
Flow chart of the study population. DXA: dual-energy X-ray absorptiometry; ACO: Asthma and COPD Overlap.
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FIGURE 2
Prevalence of probable sarcopenia and confirmed sarcopenia according to a) sex and b) the presence or absence of chronic airway diseases.

TABLE 1

Definition of sarcopenia and cut-off values based on the revised and updated EWGSOP2 consensus

Definition	Outcome	Cut-off values
		Male	Female
Probable sarcopenia	Low muscle strength: measured by hydraulic hand dynamometer	<27 kg	<16 kg
Sarcopenia	Low muscle strength AND
	Low lean mass: measured by DXA	<7.0 kg·m⁻²	<5.5 kg·m⁻²
Severe sarcopenia	Low muscle strength AND low lean mass AND
	Low physical performance: measured by gait speed or	≤0.8 m·s⁻¹	≤0.8 m·s⁻¹
	Timed Up and Go Test	≥20 s	≥20 s

EWGSOP2: European Working Group of Sarcopenia in Older People 2; DXA: dual-energy X-ray absorptiometry.

TABLE 2

Main characteristics of the study population according to presence or absence of chronic airway diseases

Participants	Total population	No chronic airway diseases	Chronic airway diseases	p-value
Subjects n	5082	3836	1246
Age years	69.0±8.8	68.6±8.5	70.1±9.1	<0.001
Age groups				<0.001
<70 years	2873 (56.5)	2234 (58.2)	639 (51.3)
≥70 years	2209 (43.5)	1602 (41.8)	607 (48.7)
Sex				<0.001
Male	2219 (43.7)	1620 (42.2)	599 (48.1)
Female	2863 (56.3)	2216 (58.8)	647 (51.9)
BMI kg·m⁻²	27.5±4.2	27.5±4.1	27.2±4.4	0.061
Overweight	2446 (48.1)	1897 (49.4)	549 (44.1)	<0.0029
Obese	1168 (23.0)	882 (23.0)	286 (22.9)
Smoking				<0.05
Never	1717 (33.8)	1436 (37.4)	281 (22.5)
Past	2749 (54.1)	2041 (53.2)	708 (56.8)
Current	616 (12.1)	359 (9.4)	257 (20.6)
Lung function
FEV₁/FVC %	76.0±7.7	78.8±4.6	67.5±8.9	<0.001
FVC predicted %	99.5±14.6	101.5±13.3	93.3±16.5	<0.001
FEV₁ predicted %	98.5±17.8	103.7±13.9	82.5±19.1	<0.001
Total body fat %
Male	31.0±5.5	30.9±5.3	31.2±6.1	0.292
Female	40.1±6.1	40.1±6.0	39.9±6.5	0.595
HGS kg
Male	37.1±8.8	37.4±8.6	36.2±9.2	<0.05
Female	22.1±5.7	22.3±5.7	21.5±6.0	<0.05
ASMI kg·m⁻²
Male	8.3±0.9	8.4±0.9	8.0±0.9	<0.001
Female	6.9±0.9	6.9±0.8	6.8±0.9	<0.05
Walking speed^# m·s⁻¹	1.2 (1.1–1.3)	1.2 (1.1–1.4)	1.2 (1.1–1.3)
PA MET^# h·week⁻²	42.6 (17.3–81.3)	44.5 (18.0–83.9)	36.8 (15.0–73.7)
Protein intake^# %	15.7±2.9	15.7±2.8	15.5±3.0
OCS^#				<0.001
Never	3364 (66.2)	2749 (71.7)	615 (49.3)
Past	1592 (31.3)	1029 (26.8)	563 (45.2)
Current	126 (2.5)	58 (1.5)	68 (5.5)
Comorbidities
Type 2 diabetes	699 (13.8)	489 (12.7)	210 (16.8)	<0.001
Hypertension	3656 (71.9)	2715 (70.8)	941 (75.5)	<0.05
Cancer	524 (10.3)	389 (10.1)	135 (10.8)	0.484
CHD	434 (8.5)	286 (7.5)	148 (11.9)	<0.001
Sarcopenia status
Probable sarcopenia	506 (10.0)	356 (9.3)	150 (12.0)	<0.001
Confirmed sarcopenia	82 (1.6)	46 (1.2)	36 (3.0)

Data are presented as mean±sd, n (%) or median (interquartile range), unless otherwise stated. BMI: body mass index (overweight: BMI 25–30 kg·m⁻², obese: BMI ≥30 kg·m⁻²); FEV₁/FVC: forced expiratory volume in 1 s/forced vital capacity ratio; HGS: handgrip strength; ASMI: appendicular skeletal muscle mass index; PA: physical activity; MET: metabolic equivalent of task; OCS: oral corticosteroids use; CHD: coronary heart diseases. ^#: n (%) of missing values per variable. Walking speed: 1428 (28.1); physical activity: 601 (11.8); protein intake: 1041 (20.5); diabetes mellitus: 92 (1.8); hypertension: 1 (0.0); CHD: 53 (1.0). Original data without imputations.

TABLE 3

Association between chronic airway diseases and sarcopenia (EWGSOP2)

Sarcopenia status	Chronic airway diseases	Model 1	Model 2
Sarcopenia status	Chronic airway diseases	OR (95% CI)	OR (95% CI)
Probable sarcopenia (n=506)	No (n=356)	Ref.	Ref.
Probable sarcopenia (n=506)	Yes (n=150)	1.20 (0.96–1.49)	1.28 (1.02–1.60)
Confirmed sarcopenia (n=82)	No (n=46)	Ref.	Ref.
Confirmed sarcopenia (n=82)	Yes (n=36)	2.03 (1.29–3.21)	2.13 (1.33–3.43)

EWGSOP2: European Working Group of Sarcopenia in Older People 2; Ref.: no chronic airway diseases. Model 1 was adjusted for age and sex; model 2 was model 1 plus total body fat (%), height (cm) and smoking status.

TABLE 4

Association between chronic airway diseases and handgrip muscle strength (HGS) and appendicular skeletal muscle index (ASMI)

Individual components of sarcopenia	Chronic airway diseases	Model 1		Model 2
Individual components of sarcopenia	Chronic airway diseases	β (se)	95% CI	β (se)	95% CI
HGS kg^#	No (n=3836)	Ref.		Ref.
HGS kg^#	Yes (n=1246)	−0.356 (0.203)	−0.753−0.041	−0.506 (0.199)	−0.898−−0.114
ASMI kg·m⁻²	No (n=3836)	Ref.		Ref.
ASMI kg·m⁻²	Yes (n=1246)	−0.209 (0.029)	−0.265−−0.153	−0.190 (0.028)	−0.245−−0.136

Ref.: no chronic airway diseases. Model 1 was adjusted for age and sex; model 2 was model 1 plus total body fat (%), height (cm) and smoking status. ^#: height is only included in the HGS model due to ASMI already being calculated based on height (m²).

TABLE 5

Association between FEV₁ (≥80% and <80%) and the components of sarcopenia in participants with chronic airway diseases (n=1246)

Components of sarcopenia	FEV₁ % pred.	Model 1		Model 2
Components of sarcopenia	FEV₁ % pred.	β (se)	95% CI	β (se)	95% CI
HGS kg^#	≥80% (n=725)	Ref.		Ref.
HGS kg^#	<80% (n=521)	−1.246 (0.373)	−1.978−−0.514	−1.03 (0.368)	−1.749−−0.307
ASMI kg·m⁻²	≥80% (n=725)	Ref.		Ref.
ASMI kg·m⁻²	<80% (n=521)	−0.245 (0.054)	−0.351−−0.139	−0.252 (0.053)	−0.356−−0.148

FEV₁: forced expiratory volume in 1 s; HGS: handgrip strength; ASMI: appendicular skeletal muscle mass index. Model 1 was adjusted for age and sex; model 2 was model 1 plus total body fat (%), height and smoking status. ^#: height is only included in the HGS model due to ASMI already being calculated based on height (m²).

TABLE 6

Odds ratio for chronic airway diseases according to sarcopenia status (EWGSOP2)

	Probable sarcopenia	Confirmed sarcopenia
	OR (95% CI)	OR (95% CI)
No additional adjustment	1.28 (1.02–1.60)	2.13 (1.33–3.43)
Additionally, adjusted for
FEV₁/FVC	1.33 (1.01–1.77)	1.40 (0.73–2.66)
Oral corticosteroids use	1.16 (0.92–1.46)	1.94 (1.18–3.16)
Number of comorbidities	1.25 (1.00–1.56)	2.08 (1.29–3.35)
Physical activity^#	1.27 (1.01–1.58)	2.07 (1.29–3.33)
Protein intake %^#	1.28 (1.02–1.60)	2.15 (1.33–3.45)

EWGSOP2: European Working Group of Sarcopenia in Older People 2; FEV₁/FVC: forced expiratory volume in 1 s/forced vital capacity ratio. All odds are adjusted for age, sex, height, % total body fat and smoking status. ^#: based on imputed data, n (%) of missing values: physical activity: 601 (11.8 protein intake: 1041 (20.5).

Supplementary Materials

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