Original articleAssociations between dietary patterns at age 71 and the prevalence of sarcopenia 16 years later
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.
References (51)
- et al.
Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study
Clin Nutr
(2012) - et al.
Sarcopenia as a predictor of all-cause mortality among community-dwelling older people: a systematic review and meta-analysis
Maturitas
(2017) - et al.
Prevalence of sarcopenia in community-dwelling Japanese older adults
J Am Med Dir Assoc
(2013) - et al.
Diet and its relationship to sarcopenia in community dwelling Iranian elderly: a cross sectional study
Nutrition
(2015) - et al.
A prospective cohort study to examine the association between dietary patterns and sarcopenia in Chinese community-dwelling older people in Hong Kong
J Am Med Dir Assoc
(2016) - et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chronic Dis
(1987) - et al.
Mediterranean and carbohydrate-restricted diets and mortality among elderly men: a cohort study in Sweden
Am J Clin Nutr
(2010) - et al.
A higher adherence to a Mediterranean-style diet is inversely associated with the development of frailty in community-dwelling elderly men and women
J Nutr
(2012) - et al.
Mediterranean diet and functional indicators among older adults in non-Mediterranean and Mediterranean countries
J Nutr Health Aging
(2014) - et al.
Mediterranean diet and mobility decline in older persons
Exp Gerontol
(2011)