Sarcopenia, Frailty and Locomotive Syndrome

Sarcopenia:

Sarcopenia refers to the age-related loss of muscle mass, strength, and function. It typically occurs in older adults and is associated with reduced physical performance, increased risk of falls, and decreased ability to perform daily activities. It is primarily a muscular condition driven by factors like aging, inactivity, poor nutrition, or chronic diseases. Diagnosis often involves assessing muscle mass (via imaging) and strength (grip strength).

1.  Reduced Muscle Strength:

•  Grip strength is a common measure of muscle strength. The AWGS 2019 criteria, for example, suggest cutoffs of <28 kg for men and <18 kg for women. The EWGSOP2 criteria use <27 kg for men and <16 kg for women. These values may vary based on the population and guideline used.

•  Low grip strength is often the first criterion assessed, as it’s a strong indicator of sarcopenia.

2.  Reduced Muscle Mass:

•  Muscle mass is typically measured using methods like dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), or CT/MRI. A decrease in muscle mass below a specific threshold (e.g., appendicular skeletal muscle mass adjusted for height or body weight) is required for diagnosis. The exact cutoff depends on the guideline and population (e.g., AWGS uses <7.0 kg/m² for men and <5.4 kg/m² for women via DXA).

3.  Reduced Physical Performance:

•  Walking speed (gait speed) is a common measure of physical performance. A speed of <0.8 m/s is often used as a cutoff in guidelines like EWGSOP (though AWGS uses <1.0 m/s in some cases). Other tests, like the Short Physical Performance Battery (SPPB) or Timed Up and Go (TUG) test, may also be used.

•  Low physical performance is not always required for diagnosis but helps classify the severity of sarcopenia (e.g., “severe sarcopenia” if all three criteria—strength, mass, and performance—are met).

Diagnostic Process:

•  According to EWGSOP2 (2019), sarcopenia is diagnosed if:

•  Low muscle strength (e.g., grip strength <27 kg men, <16 kg women) is present (probable sarcopenia).

•  Low muscle mass (confirmed via imaging or BIA) confirms the diagnosis.

•  Low physical performance (e.g., gait speed ≤0.8 m/s) indicates severity.

•  The AWGS 2019 criteria are similar but tailored for Asian populations, with slightly different cutoffs (e.g., grip strength <28 kg men, <18 kg women; gait speed <1.0 m/s).

The Finger Ring Test:

Procedure: You make a “ring” by touching the thumb and forefinger of both hands together (forming a circle with your hands). Then, you try to encircle the thickest part of your calf with this ring. If there’s a gap between the ring and your calf (meaning your calf is smaller than the ring), it may suggest reduced muscle mass, which could be a sign of sarcopenia.

Is the Finger Ring Test Valid for Sarcopenia?

•  Purpose:

The test is designed to estimate calf circumference, which correlates with muscle mass in the lower body. Low calf circumference ( <31 cm for men or <30 cm for women in some studies) is associated with sarcopenia, as it reflects muscle loss in the legs.

•  Limitations:

•  Not Diagnostic:

The Finger Ring Test is a rough screening tool, not a substitute for clinical diagnosis. Sarcopenia diagnosis requires assessing muscle mass (via DXA, BIA, or imaging), muscle strength (grip strength), and physical performance (e.g., gait speed), as outlined in guidelines like EWGSOP2 or AWGS.

•  Variability:

The size of a person’s hands and fingers varies, so the “ring” size isn’t standardized. This makes the test less reliable across individuals.

•  Other Factors:

A gap could result from naturally slim calves, low body fat, or other non-sarcopenic conditions, leading to false positives.

•  Usefulness:

It’s a quick, accessible way to prompt further evaluation, especially for older adults or in settings without advanced equipment. If a gap is present, it’s a cue to seek a proper assessment (grip strength, muscle mass measurement).

The Vicious Cycle of Sarcopenia

💥 I think low nutrition and lack of activity are critical contributors that create a vicious cycle.

•  Low Nutrition → Reduced Vitality, Muscle Strength, and Physical Function: Poor nutrition (especially low protein) reduces muscle mass and strength, leading to fatigue, weakness, and impaired physical performance (slower gait speed, difficulty standing from a chair).

•  Reduced Activity: Weakness and low vitality discourage physical activity, further accelerating muscle loss due to disuse.

•  Further Loss of Appetite: Reduced activity lowers energy expenditure, which can suppress appetite, leading to even lower nutrient intake. This perpetuates malnutrition and muscle decline.

•  This cycle increases the risk of falls, disability, frailty, and dependency, significantly impacting quality of life.

People at risk of or experiencing sarcopenia may exhibit the following tendencies:

• Frequent stumbling or tripping.

• Shorter or narrower stride when walking.

• Difficulty standing from a seated position.

• Tendency to hunch over or have poor posture.

• Feeling tired or fatigued easily.

• Being underweight or appearing too thin.

• Difficulty crossing a crosswalk before the pedestrian light turns red.

• Struggling to open plastic bottles due to weak grip strength.

• Lack of sustained weight loss or rebound weight gain after dieting.

• Extreme dietary restrictions or unbalanced nutrition.

• Swelling in the legs or other parts of the body (edema).

Frailty:

Frailty is a broader syndrome characterized by reduced physiological reserve and increased vulnerability to stressors, often seen in older adults. It involves multiple systems (not just muscles) and includes symptoms like unintentional weight loss, exhaustion, weakness, slow walking speed, and low physical activity. Frailty increases the risk of adverse outcomes like disability, hospitalization, or death. It’s more about overall health decline than just muscle loss.

Locomotive Syndrome:

Locomotive syndrome (or “locomo”) is a concept primarily used in Japan to describe a condition where mobility is impaired due to problems in the musculoskeletal system, such as muscles, bones, joints, or cartilage. It’s caused by conditions like sarcopenia, osteoporosis, or osteoarthritis and leads to difficulties in walking or other movements. Locomo focuses on maintaining mobility to prevent the need for long-term care and emphasizes early intervention.

Key Differences:

•  Scope:

Sarcopenia is specifically about muscle loss, frailty is a multi-system decline, and locomotive syndrome focuses on mobility issues due to musculoskeletal problems.

•  Focus:

Sarcopenia targets muscle mass/strength, frailty addresses overall vulnerability, and locomo emphasizes movement and independence.

•  Origin:

Sarcopenia and frailty are globally recognized medical terms, while locomotive syndrome is a term coined in Japan to promote preventive care for mobility.

⚠️The daily energy requirement for normally active adults aged 65–74 is approximately 2,400 kcal for men and 1,850 kcal for women. For independently living adults aged 75 and older, it decreases to about 2,100 kcal for men and 1,650 kcal for women, with a gradual decline as age increases. The recommended daily protein intake for men aged 65 and older is slightly reduced from 65 g to 60 g (equivalent to about three slices of ham), while for women, it remains 50 g, the same as for younger adults.

Simple Explanation:

How Much Protein Do You Need?

•  For older adults (65+ years) at risk of or with sarcopenia: You need 1.0 to 1.5 grams of protein per kilogram of body weight each day. This helps maintain or build muscle to prevent muscle loss.

•  Why? Sarcopenia reduces muscle mass and strength, and enough protein supports muscle repair and growth, especially when combined with exercise (like the resistance training we discussed earlier).

•  Example: If you weigh 70 kg (154 lbs), you need about 70–105 grams of protein daily.

How to Calculate Your Protein Needs

1.  Know Your Weight:

•  Weigh yourself in kilograms (kg). If you know your weight in pounds (lbs), divide by

2 to convert to kilograms.

•  Example: 154 lbs ÷ 2.2 = 70 kg.

2.  Multiply by Protein Range:

•  Multiply your weight in kg by 1.0 (minimum) and 1.5 (maximum) to get your daily protein range.

•  Example: For 70 kg, 70 × 1.0 = 70 g and 70 × 1.5 = 105 g. So, you need 70–105 g of protein per day.

3.  Adjust for Your Situation (optional):

•  If very active or doing resistance training: Aim for the higher end (1.2–1.5 g/kg).

•  If you have health issues (e.g., kidney disease): Consult a doctor, as protein needs may be lower.

•  If underweight or malnourished: You might need closer to 1.5 g/kg to rebuild muscle.

Practical Tips to Get Enough Protein

•  Spread it out: Aim for 20–30 g of protein per meal (e.g., breakfast, lunch, dinner) to maximize muscle building. A small protein snack (10–15 g) can help, too.

•  Examples of protein amounts:

•  100 g chicken breast = ~25 g protein.

•  1 cup Greek yogurt = ~20 g protein.

•  2 eggs = ~12 g protein.

•  1 scoop whey protein powder = ~20–25 g protein.

•  3 slices of ham (30 g) = ~5 g protein (as you mentioned earlier).

•  100 g tofu = ~10–15 g protein.

•  Easy foods: Include eggs, fish, chicken, dairy (yogurt, cheese), beans, lentils, or protein shakes if you struggle to eat enough.

Example Calculation

Let’s say you weigh 60 kg (132 lbs):

•  Minimum: 60 × 1.0 = 60 g protein/day.

•  Maximum: 60 × 1.5 = 90 g protein/day.

•  Daily goal: 60–90 g protein, spread across meals (e.g., 20 g at breakfast, 25 g at lunch, 25 g at dinner, 10 g snack).