Background
Sarcopenia is defined as the loss of muscle mass and strength. Despite the seriousness of this disease, a single diagnostic criterion has not yet been established. Few studies have ...reported the prevalence of sarcopenia globally, and there is a high level of heterogeneity between studies, stemmed from the diagnostic criteria of sarcopenia and the target population. The aims of this systematic review and meta‐analysis were (i) to identify and summarize the diagnostic criteria used to define sarcopenia and severe sarcopenia and (ii) to estimate the global and region‐specific prevalence of sarcopenia and severe sarcopenia by sociodemographic factors.
Methods
Embase, MEDLINE, and Web of Science Core Collections were searched using relevant MeSH terms. The inclusion criteria were cross‐sectional or cohort studies in individuals aged ≥18 years, published in English, and with muscle mass measured using dual‐energy x‐ray absorptiometry, bioelectrical impedance, or computed tomography (CT) scan. For the meta‐analysis, studies were stratified by diagnostic criteria (classifications), cut‐off points, and instruments to assess muscle mass. If at least three studies reported the same classification, cut‐off points, and instrument to measure muscle mass, they were considered suitable for meta‐analysis. Following this approach, 6 classifications and 23 subgroups were created. Overall pooled estimates with inverse‐variance weights obtained from a random‐effects model were estimated using the metaprop command in Stata.
Results
Out of 19 320 studies, 263 were eligible for the narrative synthesis and 151 for meta‐analysis (total n = 692 056, mean age: 68.5 years). Using different classifications and cut‐off points, the prevalence of sarcopenia varied between 10% and 27% in the studies included for meta‐analysis. The highest and lowest prevalence were observed in Oceania and Europe using the European Working Group on Sarcopenia in Older People (EWGSOP) and EWGSOP2, respectively. The prevalence ranged from 8% to 36% in individuals <60 years and from 10% to 27% in ≥60 years. Men had a higher prevalence of sarcopenia using the EWGSOP2 (11% vs. 2%) while it was higher in women using the International Working Group on Sarcopenia (17% vs. 12%). Finally, the prevalence of severe sarcopenia ranged from 2% to 9%.
Conclusions
The prevalence of sarcopenia and severe sarcopenia varied considerably according to the classification and cut‐off point used. Considering the lack of a single diagnostic for sarcopenia, future studies should adhere to current guidelines, which would facilitate the comparison of results between studies and populations across the globe.
Aim
To investigate the joint associations of diabetes and obesity with all‐cause and cardiovascular disease (CVD) mortality in the Mexico City Prospective Study.
Materials and Methods
In total, 154 ...128 participants (67.2% women) were included in this prospective analysis. Diabetes was self‐reported, while body mass index was used to calculate obesity. Using diabetes and obesity classifications, six groups were created: (a) normal (no diabetes and normal weight); (b) normal weight and diabetes; (c) overweight but not diabetes (overweight); (d) overweight and diabetes (prediabesity); (e) obesity but not diabetes (obesity); and (f) obesity and diabetes (diabesity). Associations between these categories and outcomes were investigated using Cox proportional hazard models adjusted for confounder factors.
Results
During 18.3 years of follow‐up, 27 197 (17.6%) participants died (28.5% because of CV causes). In the maximally adjusted model, participants those with the highest risk {hazard ratio (HR): 2.37 95% confidence interval (CI): 2.24‐2.51}, followed by those with diabesity HR: 2.04 (95% CI: 1.94‐2.15). Similar trends of associations were observed for CVD mortality. The highest CV mortality risk was observed in individuals with diabesity HR: 1.80 (95% CI: 1.63‐1.99), followed by normal weight and diabetic individuals HR: 1.78 (95% CI: 1.60‐1.98).
Conclusion
This large prospective study identified that diabetes was the main driver of all‐cause and CVD mortality in all the categories studied, with diabesity being the riskiest. Given the high prevalence of both conditions in Mexico, our results reinforce the importance of initiating prevention strategies from an early age.
Summary
Considering the current prevalence in obesity and sarcopenia globally, this study aimed to summarize the development of sarcopenic obesity research to establish the topic's past, present, and ...future research direction using a bibliometric analysis. A comprehensive search for publications on sarcopenia and obesity was conducted in the Web of Science (WoS) database until the 31st of December 2023. We performed a detailed descriptive analysis, considering metrics like sources, authors, and documents, along with analyzing conceptual and social structures to map sarcopenic obesity research. Between 1993 and 2023, there were 4978 publications on sarcopenic obesity, representing 22.6% of the whole sarcopenia research (22070). Most published articles were originals (74.6%), and one of the highest increments in the fields was seen after 2010. The most significant contribution in this research area falls under the categories of Nutrition & Dietetics, Gerontology, and Geriatrics & Gerontology. Among regions, scientific production was located in 93 different countries. The United States, China, and South Korea had the highest contributions. The most relevant keywords were sarcopenia, obesity, and body composition. Research on sarcopenic obesity primarily focuses on epidemiology and identifying risk factors and outcome predictors. Yet, there is a shortage of research addressing prevention, early detection, and treatments to enhance the health of individuals with sarcopenia.
The current study aims to investigate the combined association of walking pace and grip strength with incident type 2 diabetes (T2D). A total of 205 738 participants (mean age 56.6 ± 8.1 years, 115 ...139 56.0% women) without diagnosed or unknown diabetes at baseline from the UK Biobank study were included in this prospective study. Walking pace was self‐reported as slow, average, or brisk. Grip strength was measured using a dynamometer and classified as weak, average, and strong. The combined association of walking pace and grip strength with incident T2D was investigated using Cox‐proportional hazards models with a 2‐year landmark analysis. The additive interaction was conducted by estimating relative excess risk due to interaction (RERI). After the median follow‐up period of 5.4 years (interquartile range: 4.8–6.5), 5082 (2.5%) participants were diagnosed with T2D. Compared to brisk‐strong individuals (reference group), people who were slow‐weak had a higher risk of T2D (hazard ratio: 1.64 95% CI, 1.42–1.89) after adjusting for all covariates. There were dose–response gradients across both walking pace and grip strength variables. There was a modest amount of negative additive interaction (RERI; −0.06 95% CI, −0.16; −0.01. To conclude, slower pace and weaker grip strength were associated with a higher risk of developing T2D, independent of sociodemographics, lifestyle, and adiposity. Combining walking pace and grip strength might be a practical approach to screening people who are at increased risk of developing T2D.
Combinations of lifestyle factors interact to increase mortality. Combinations of traditional factors such as smoking and alcohol are well described, but the additional effects of emerging factors ...such as television viewing time are not. The effect of socioeconomic deprivation on these extended lifestyle risks also remains unclear. We aimed to examine whether deprivation modifies the association between an extended score of lifestyle-related risk factors and health outcomes.
Data for this prospective analysis were sourced from the UK Biobank, a prospective population-based cohort study. We assigned all participants an extended lifestyle score, with 1 point for each unhealthy lifestyle factor (incorporating sleep duration and high television viewing time, in addition to smoking, excessive alcohol, poor diet low intake of oily fish or fruits and vegetables, and high intake of red meat or processed meats, and low physical activity), categorised as most healthy (score 0–2), moderately healthy (score 3–5), or least healthy (score 6–9). Cox proportional hazards models were used to examine the association between lifestyle score and health outcomes (all-cause mortality and cardiovascular disease mortality and incidence), and whether this association was modified by deprivation. All analyses were landmark analyses, in which participants were excluded if they had an event (death or cardiovascular disease event) within 2 years of recruitment. Participants with non-communicable diseases (except hypertension) and missing covariate data were excluded from analyses. Participants were also excluded if they reported implausible values for physical activity, sleep duration, and total screen time. All analyses were adjusted for age, sex, ethnicity, month of assessment, history of hypertension, systolic blood pressure, medication for hypercholesterolaemia or hypertension, and body-mass index categories.
328 594 participants aged 40–69 years were included in the study, with a mean follow-up period of 4·9 years (SD 0·83) after the landmark period for all-cause and cardiovascular disease mortality, and 4·1 years (0·81) for cardiovascular disease incidence. In the least deprived quintile, the adjusted hazard ratio (HR) in the least healthy lifestyle category, compared with the most healthy category, was 1·65 (95% CI 1·25–2·19) for all-cause mortality, 1·93 (1·16–3·20) for cardiovascular disease mortality, and 1·29 (1·10–1·52) for cardiovascular disease incidence. Equivalent HRs in the most deprived quintile were 2·47 (95% CI 2·04–3·00), 3·36 (2·36–4·76), and 1·41 (1·25–1·60), respectively. The HR for trend for one increment change towards least healthy in the least deprived quintile compared with that in the most deprived quintile was 1·25 (95% CI 1·12–1·39) versus 1·55 (1·40–1·70) for all-cause mortality, 1·30 (1·05–1·61) versus 1·83 (1·54–2·18) for cardiovascular disease mortality, and 1·10 (1·04–1·17) versus 1·16 (1·09–1·23) for cardiovascular disease incidence. A significant interaction was found between lifestyle and deprivation for all-cause and cardiovascular disease mortality (both pinteraction<0·0001), but not for cardiovascular disease incidence (pinteraction=0·11).
Wide combinations of lifestyle factors are associated with disproportionate harm in deprived populations. Social and fiscal policies that reduce poverty are needed alongside public health and individual-level interventions that address a wider range of lifestyle factors in areas of deprivation.
None.
Aim
To investigate the associations between types of diet and incident type 2 diabetes and whether adiposity mediated these associations.
Materials and Methods
In total, 203 790 participants from UK ...Biobank (mean age 55.2 years; 55.8% women) without diabetes at baseline were included in this prospective study. Using the dietary intake data self‐reported at baseline, participants were categorized as vegetarians (n = 3237), fish eaters (n = 4405), fish and poultry eaters (n = 2217), meat eaters (n = 178 004) and varied diet (n = 15 927). The association between type of diet and incident type 2 diabetes was investigated using Cox‐proportional hazards models with a 2‐year landmark analysis. The mediation role of adiposity was tested under a counterfactual framework.
Results
After excluding the first 2 years of follow‐up, the median follow‐up was 5.4 (IQR: 4.8‐6.3) years, during which 5067 (2.5%) participants were diagnosed with type 2 diabetes. After adjusting for lifestyle factors, fish eaters (HR 0.52 95% CI: 0.39‐0.69) and fish and poultry eaters (HR 0.62 95% CI: 0.45‐0.88) had a lower risk of incident type 2 diabetes compared with meat eaters. The association for vegetarians was not significant. Varied diet had a higher risk of type 2 diabetes. Obesity partially mediated the association of fish (30.6%), fish and poultry (49.8%) and varied (55.2%) diets.
Conclusions
Fish eaters, as well as fish and poultry eaters, were at a lower risk of incident type 2 diabetes than meat eaters, partially attributable to lower obesity risk.
Background
Depression and anxiety are the leading mental health problems worldwide; depression is ranked as the leading cause of global disability with anxiety disorders ranked sixth. Preventive ...strategies based on the identification of modifiable factors merit exploration. The aim of the present study was to investigate the associations of handgrip strength (HGS) with incident depression and anxiety and to explore how these associations differ by socio‐demographic, lifestyle, and health‐related factors.
Methods
The analytic sample comprised 162 167 participants (55% women), aged 38–70 years, from the UK Biobank prospective cohort study. HGS was assessed at baseline using dynamometry. Depression and anxiety were extracted from primary care and hospital admission records. Cox proportional models were applied, with a 2 year landmark analysis, to investigate the associations between HGS and incident depression and anxiety.
Results
Of the 162 167 participants included, 5462 (3.4%) developed depression and 6614 (4.1%) anxiety, over a median follow‐up period of 10.0 years (inter‐quartile range: 9.3–10.8) for depression and 9.9 (inter‐quartile range: 9.0–10.8) for anxiety. In the fully adjusted model, a 5 kg lower HGS was associated with a 7% (HR: 1.07 95% CI: 1.05, 1.10; P < 0.001) and 8% (HR: 1.08 95% CI: 1.06, 1.10; P < 0.001) higher risk of depression and anxiety, respectively. Compared with participants in the sex and age‐specific highest tertiles of HGS, those in the medium and lowest tertiles had an 11% (HR: 1.11 95% CI: 1.04, 1.19; P = 0.002) and 24% (HR: 1.24 95% CI: 1.16, 1.33; P < 0.001) higher risk of depression and 13% (HR: 1.13 95% CI: 1.06, 1.20; P < 0.001) and 27% (HR: 1.27 95% CI: 1.19, 1.35; P < 0.001) higher risk of anxiety, respectively. The association of HGS with depression was stronger among participants with average or brisk walking pace (vs. slow walking pace; Pinteraction < 0.001). The association with anxiety was stronger in those participants aged ≥58 years (vs. ≤58 years; Pinteraction = 0.002) and those living in more affluent areas (vs. deprived; Pinteraction = 0.001).
Conclusions
Handgrip strength was inversely associated with incident depression and anxiety. Because HGS is a simple, non‐invasive, and inexpensive measure, it could be easily used in clinical practice to stratify patients and identify those at elevated risk of mental health problems. However, future research should assess if resistance training aimed at increasing HGS can prevent the occurrence of mental health conditions.
Dementia is associated with a high burden of dependency and disability. Physical frailty (hereafter referred to as frailty) is a multisystem dysregulation that has been identified as a risk factor ...for dementia. The aim of this study was to examine the association of frailty and its individual components with all-cause dementia incidence in a cohort of UK adults.
Participants in UK Biobank with data available for dementia incidence and without any form of dementia at baseline were included in this prospective study. Frailty was defined using a modified version of the frailty phenotype based on five individual components (weight loss, tiredness, physical activity, gait speed, and grip strength), with participants classified as pre-frail if they fulfilled one or two criteria or frail if they fulfilled three or more. Associations between frailty and dementia incidence were investigated using Cox proportional hazard models adjusted for sociodemographic factors, lifestyle factors, and morbidity count. The population attributable fraction was also estimated.
Of 502 535 participants in UK Biobank, 143 215 met the inclusion criteria and were included in our analyses. 68 500 (47·8%) of the participants were pre-frail and 5565 (3·9%) were frail. During a median follow-up period of 5·4 years, 726 individuals developed dementia. Compared with non-frail individuals, the risk of dementia incidence was increased for individuals with pre-frailty (hazard ratio 1·21 95% CI 1·04–1·42) and frailty (1·98 1·47–2·67) in the fully adjusted model. Of the five components used to define frailty, weight loss (1·31 1·09–1·58), tiredness (1·48 1·18–1·86), low grip strength (1·38 1·17–1·63), and slow gait speed (1·55 1·22–1·96) were independently associated with incident dementia. Based on population attributable fraction analyses, in the study sample, pre-frailty and frailty accounted for 9·9% and 8·6% of dementia cases, respectively.
Individuals with pre-frailty and frailty were at a higher risk of dementia incidence even after adjusting for a wide range of confounding factors. Early detection and interventions for frailty could translate into prevention or delayed onset of dementia.
None.
Aim
This study aimed to contrast the associations of five common diet scores with severe non‐alcoholic fatty liver disease (NAFLD) incidence.
Materials and Methods
In total, 162 999 UK Biobank ...participants were included in this prospective population‐based study. Five international diet scores were included: the 14‐Item Mediterranean Diet Adherence Screener (MEDAS‐14), the Recommended Food Score (RFS), the Healthy Diet Indicator (HDI), the Mediterranean Diet Score and the Mediterranean‐DASH Intervention for Neurodegenerative Delay score. As each score has different measurements and scales, all scores were standardized and categorized into quartiles. Cox proportional hazard models adjusted for confounder factors investigated associations between the standardized quartiles and severe NAFLD incidence.
Results
Over a median follow‐up of 10.2 years, 1370 participants were diagnosed with severe NAFLD. When the analyses were fully adjusted, participants in quartile 4 using the MEDAS‐14 and RFS scores, as well as those in quartiles 2 and 3 using the HDI score, had a significantly lower risk of severe incident NAFLD compared with those in quartile 1. The lowest risk was observed in quartile 4 for the MEDAS‐14 score hazard ratio (HR): 0.76 (95% confidence interval (CI): 0.62‐0.94) and the RFS score HR: 0.82 (95% CI: 0.69‐0.96) and as well as in quartile 2 in the HDI score HR: 0.80 (95% CI: 0.70‐0.91).
Conclusion
MEDAS‐14, RFS and HDI scores were the strongest diet score predictors of severe NAFLD. A healthy diet might protect against NAFLD development irrespective of the specific approach used to assess diet. However, following these score recommendations could represent optimal dietary approaches to mitigate NAFLD risk.
Background
This study aimed to investigate the associations of grip strength with incidence and mortality from dementia and whether these associations differ by sociodemographic and lifestyle ...factors.
Methods
A total of 466 788 participants of the UK Biobank (median age 56.5 years, 54.5% women). The outcome was all‐cause dementia incidence and mortality and the exposure was grip strength. Grip strength was assessed using a Jamar J00105 hydraulic hand dynamometer.
Results
Excluding the first 2 years of follow‐up (landmark analysis), mean follow‐up was 9.1 years (inter‐quartile range: 8.3; 9.7) for incidence and 9.3 (inter‐quartile range: 8.7; 10.0) for mortality. During this time, 4087 participants developed dementia, and 1309 died from it. Lower grip strength was associated with a higher risk of dementia incidence and mortality independent of major confounding factors (P < 0.001). Individuals in the lowest quintile of grip strength had 72% 95% confidence interval (CI): 1.55; 1.92 higher incident dementia risk and 87% 95% CI: 1.55; 2.26 higher risk of dementia mortality compared with those in the highest quintile. Our PAF analyses indicate that 30.1% of dementia cases and 32.3% of dementia deaths are attributable to having low grip strength. The association between grip strength and dementia outcomes did not differ by lifestyle or sociodemographic factors.
Conclusions
Lower grip strength was associated with a higher risk of all‐cause dementia incidence and mortality, independently of important confounding factors.
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