Elsevier

Clinical Nutrition

Volume 39, Issue 4, April 2020, Pages 1077-1084
Clinical Nutrition

Original article
Associations between dietary patterns at age 71 and the prevalence of sarcopenia 16 years later

https://doi.org/10.1016/j.clnu.2019.04.009Get rights and content

Summary

Background & aims

The growing recognition of the significance of sarcopenia has highlighted the need to understand etiologic factors, where food intake likely plays a role. The aim was to investigate the association between dietary patterns at mean age 71 and the prevalence of sarcopenia at mean age 87 in a Swedish cohort of community dwelling men.

Methods

Dietary habits were assessed using a 7-day food record. Adherences to official dietary guidelines, defined by the World Health Organization (WHO) by using the Healthy Diet Indicator, and Mediterranean-like dietary habits by using the Mediterranean Diet Score, were calculated. Sarcopenia was determined using the definition from the European Working Group on Sarcopenia in Older People (EWGSOP) and associations to each dietary pattern were analyzed using logistic regression, adjusted for potential confounders.

Results

Our study population included 254 men, mean age 71 at baseline, and 53 (21%) were defined as sarcopenic 16 years later. There was no linear relationship between increased adherence to WHO dietary guidelines and future prevalence of sarcopenia, although those with medium adherence seemed to be protected (crude OR = 0.41, 95% CI 0.19–0.92). On the other hand, an inverse relationship to sarcopenia was found for each SD increment in the Mediterranean diet score (crude OR = 0.68, 95% CI 0.46–0.99), which remained after adjusting for potential confounders. Sensitivity analysis indicated relationships to be independent of changes in physical activity and dietary misreporting.

Conclusions

In this prospective study of elderly men, using a single measure of diet at age 71 as a reflection of habitual dietary habits, healthy dietary patterns tended to protect against the development of sarcopenia over 16 years. In particular, we found indications that increased adherence to a Mediterranean dietary pattern might be advantageous.

Introduction

Sarcopenia is a geriatric syndrome consisting of age-related decline in both muscle mass and muscle function. Accumulating evidence suggests this condition to be associated with many adverse health outcomes, such as disability [1], falls [2], physical and cognitive impairment [3], poor quality of life [1] and mortality [4], with significant impact on social care costs [5], [6].

Although the loss of muscle mass is a physiological part of aging, the term sarcopenia is used if muscle mass and muscle function fall below defined thresholds. Sarcopenia has been defined by the European Working Group on Sarcopenia in Older People (EWGSOP) as a progressive and general loss of muscle mass and muscle function (either low muscle strength or low physical performance) [7]. The prevalence of sarcopenia increases steeply with age, especially after the age of 75, with a prevalence of 1–6% reported among men <74 years, and 17–75% among men >80 years, depending on age stratum and choice of definition [8], [9], [10].

The growing recognition of sarcopenia as a geriatric syndrome has highlighted the need to understand its etiology. As of today, established risk factors include hormonal changes, neurodegeneration, low-grade inflammation and physical inactivity (including bed rest) [7]. Physical inactivity is clearly linked to the loss of muscle mass and muscle strength. Several intervention studies have shown that physical activity has positive effects on muscle mass and muscle strength improving overall physical function [11], [12]. The role of diet is less clear, and studies examining the role of diet in sarcopenia have predominantly focused on single food components. A growing body of evidence indicate that sufficient intakes of protein, vitamin D, antioxidant nutrients, and long-chain n-3 polyunsaturated fatty acids, may improve or maintain muscle function [13]. Furthermore, several studies suggest that an overall healthy diet contributes to maintained physical performance, but there is limited evidence when it comes to healthy diets in relation to muscle mass and muscle strength, as reviewed [14]. To our knowledge, only four studies have assessed dietary patterns in relation to sarcopenia, defined as low muscle mass with either low muscle strength and/or low muscle performance [15], [16], [17], [18]. These four studies used different methodologies to assess the role of dietary patterns, but they all indicate a relationship between diet and the development of sarcopenia.

The aim of the present study was to evaluate the association between the adherence of two pre-defined dietary patterns at mean age 71 years and the prevalence of sarcopenia at mean age 87 in a Swedish cohort of community dwelling men. The dietary patterns assessed were: 1) official dietary guidelines, as defined by WHO by using the Healthy Diet Indicator (HDI) and 2) Mediterranean-like dietary habits by using the Mediterranean Diet Score (MDS).

Section snippets

Study population

The present study was performed using the Uppsala Longitudinal Study of Adult Men (ULSAM), a population-based cohort study that started in 1970 and invited all men at age 50, born 1920-24 and living in Uppsala County (described in detail at http://www.pubcare.uu.se/ulsam). At the first investigation cycle a total of 2322 men agreed to participate, which corresponds to a participation rate of 82%. Several re-examinations have been carried out, see Fig. 1. Baseline in this study is the third

Results

Among the 254 participants included in this study, 53 men (21%) were defined as sarcopenic at age 87. As depicted in Table 1, participants defined as sarcopenic had a lower body weight (73.1 ± 9.9 SD vs. 81.3 ± 9.2 SD) and BMI (24.4 ± 2.9 SD vs. 26.3 ± 2.7 SD) at baseline compared to non-sarcopenic individuals (both p < 0.001). There were no corresponding differences at baseline in the reported intakes of energy (kcal/d) or protein (g/d), self-reported education or level of physical activity.

Discussion

In this population of 254 71-year-old men, adherence to healthy dietary patterns was associated with lower prevalence of sarcopenia 16 years later. The odds of having sarcopenia at mean age 87 decreased by >30% with a continuous increase in the Mediterranean Diet Score. There were also indications that the odds of having sarcopenia at mean age 87 was more than halved in individuals with medium, but not high, adherence to the WHO dietary guidelines (mHDI). These relationships seemed to be

CRediT author statement

Mikael Karlsson: Conceptualization, Methodology, Formal Analysis, Data Curation, Writing – Original draft.

Wulf Becker: Conceptualization, Methodology, Writing – Review & Editing, Supervision.

Karl Michaëlsson: Conceptualization, Methodology, Writing – Review & Editing.

Tommy Cederholm: Conceptualization, Methodology, Writing – Review & Editing, Supervision, Funding Acquisition.

Per Sjögren: Conceptualization, Methodology, Writing – Original draft, Review & Editing, Supervision, Project

Conflict of interest

MK participates in educational activites organized by Nutricia and Fresenius Kabi, TC has received unconditional research funding from Nutricia, Nestle and Fresenius Kabi, and participates in educational activities organized by Nutricia, Nestle, Fresenius Kabi and Abbott.

Acknowledgments

The authors would like to acknowledge the Swedish Medical Research Council 2015-02338, Uppsala University, Uppsala County.

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