Predictive Values of the New Sarcopenia Index by the Foundation for the National Institutes of Health Sarcopenia Project for Mortality among Older Korean Adults

<div><p>Objective</p><p>We evaluated the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project’s recommended criteria for sarcopenia’s association with mortality among older Korean adults.</p><p>Methods</p><p>We conducted a community-based prospective cohort study which included 560 (285 men and 275 women) older Korean adults aged ≥65 years. Muscle mass (appendicular skeletal muscle mass-to-body mass index ratio (ASM/BMI)), handgrip strength, and walking velocity were evaluated in association with all-cause mortality during 6-year follow-up. Both the lowest quintile for each parameter (ethnic-specific cutoff) and FNIH-recommended values were used as cutoffs.</p><p>Results</p><p>Forty men (14.0%) and 21 women (7.6%) died during 6-year follow-up. The deceased subjects were older and had lower ASM, handgrip strength, and walking velocity. Sarcopenia defined by both low lean mass and weakness had a 4.13 (95% CI, 1.69–10.11) times higher risk of death, and sarcopenia defined by a combination of low lean mass, weakness, and slowness had a 9.56 (3.16–28.90) times higher risk of death after adjusting for covariates in men. However, these significant associations were not observed in women. In terms of cutoffs of each parameter, using the lowest quintile showed better predictive values in mortality than using the FNIH-recommended values. Moreover, new muscle mass index, ASM/BMI, provided better prognostic values than ASM/height² in all associations.</p><p>Conclusions</p><p>New sarcopenia definition by FNIH was better able to predict 6-year mortality among Korean men. Moreover, ethnic-specific cutoffs, the lowest quintile for each parameter, predicted the higher risk of mortality than the FNIH-recommended values.</p></div

Hazard Ratios for 6-year Mortality by Sarcopenia Parameters.

<p>Hazard Ratios for 6-year Mortality by Sarcopenia Parameters.</p

Survival Curve by Sarcopenia in Each Gender.

<p>Cumulative survival according to Sarcopenia_{mass/strength}and Sarcopenia_{mass/strength/performance} is presented by the Cox proportional hazard model in men (A) and women (B). The model was adjusted for age, BMI, smoking, alcohol, exercise, systolic blood pressure, fasting glucose, total cholesterol, creatinine, alanine transaminase, free T4, and the cumulative illness rating scale.</p

Logistic model for EQ-5D dimensions of polio survivors (n = 120).

<p>*<i>P</i> < 0.05;</p><p>**<i>P</i> < 0.001</p><p>Values are odds ratios (95% confidence intervals) after adjusting for age, education, income, region, comorbidity.</p><p>PS = polio survivor group; CG = control group; AL = activity limitation group.</p><p>Sex, male (reference), female; age, <50 years (reference), 50 ≤ age <60, ≥60 years; education, middle school or less (reference), high school or more; marital status, married (reference), other; income, lower 50% (reference), upper 50%; place of residence, city or country (reference), metropolitan area; smoking, non-smoker (reference), smoker; drinking, non-drinker (reference), drinker; comorbidity, no comorbidity (reference), comorbidity.</p><p>^a Includes single, living separately, divorced, and separated by death.</p><p>^b Income: monthly household income ($1 = 1020 KRW, based on the mean exchange rate at July, 2014.</p><p>Each dimension of the EQ5D scale served as a dependent variable; responses were grouped into two categories: no problem and problem.</p><p>Logistic model for EQ-5D dimensions of polio survivors (n = 120).</p

Characteristics of the polio survivors (PS), the general population, and the group with activity limitations.

<p>¹ Income: monthly household income ($1 = 1020 KRW based on the mean exchange rate at July, 2014.</p><p>Characteristics of the polio survivors (PS), the general population, and the group with activity limitations.</p

Schematic representation of data collection for the study.

<p>Outpatient Clinic at Seoul National University Bundang Hospital and at National Rehabilitation Center. K-MBI = Korean version of Modified Barthel Index; SPPB = Short Physical Performance Battery; BPI = Brief Pain Inventory; BFI = Brief Fatigue Inventory; BDI = Beck Depression Inventory; EQ-5D = Euro QoL Questionnaire 5-Dimensional Classification</p

Proportion of participants who reported problems on each of the five EQ-5D dimensions.

<p>Proportion of participants who reported problems on each of the five EQ-5D dimensions.</p

Comparisons of demographic, anthropometric, and laboratory data in examinees between dead or alive during the follow-up period.

<p>Abbreviations: ASM/ht²-appendicular skeletal muscle mass per square meter height, BP-blood pressure, HDL-cholesterol-high density lipoprotein cholesterol, ESR-erythrocyte sedimentation rate, ALT-alanine aminotransferase, AST-aspartate aminotransferase, ALP-alkaline phosphatase, SPPB-Short Physical Performance Battery, K-ADL score-Korean Activity of Daily Living score, K-IADL score-Korean Instrumental Activity of Daily Living score, GDS-K score-Korean version of the Geriatric Depression Scale score, K-MMSE score- the Korean Mini-Mental State Examination score, CHS-Cardiovascular Health Study, SOF-Study of Osteoporotic Fracture, KLoSHA-Korean Longitudinal Study on Health and Aging.</p><p>Data are presented as the mean (SD) or number (%).</p

Comparisons of predictability for mortality by frailty status from each frailty index.

*<p>Bootstrapped 1000 times.</p><p>†p-value for C-index difference.</p><p>Abbreviations: 95% CI-95% confidence interval, KLoSHA-Korean Longitudinal Study on Health and Aging, CHS-Cardiovascular Health Study, SOF-Study of Osteoporotic Fracture.</p

The distributions of KFI by age and fractional polynomial prediction plots plotted by sex, (A) female, (B) male.

<p>The shaded area denotes a 95% confidence interval for the prediction curve.</p