Large overlap between sarcopaenia, malnutrition calls for joint screening, holistic intervention

Malnutrition and sarcopenia are highly interrelated and have overlapping presentations in adults, according to a recent Singapore study.

“Nutrition assessment should be integrated with sarcopenia [screening] to adequately address these interrelated nutritional issues,” the researchers said. “Examining the entirety of an individual’s nutritional and functional status will enable healthcare professionals to better target intervention to fit the individual’s needs.”

A total of 541 randomly sampled Singaporean adults (age 21–90 years, 313 women) participated in the community-based, cross-sectional study. Dual-energy x-ray absorptiometry was used to detect sarcopenia, while nutritional status was evaluated using the Mini Nutritional Assessment (MNA). Muscle strength was also included in the analysis, measured through handgrip strength.

Overall, the population-adjusted prevalence of malnutrition was only 0.1 percent, but 18.5 percent were at risk. The mean MNA score in the study sample was 12.8. In terms of body composition and functional performance, the mean appendicular lean mass index (ALMI) was 6.20 kg/m², and the average handgrip strength was 28.3 kg. A total of 137 participants were deemed sarcopenic. [J Nutr Health Aging 2021;25:374-381]

When the participants were classified according to MNA status, 100 percent (n=2) of those who were malnourished were also sarcopenic. On the other hand, the prevalence of sarcopenia among at-risk adults was 35 percent. Taken together, 36.3 percent of participants who were either at-risk or malnourished had sarcopenia.

Conversely, 27.0 percent of adults with sarcopenia were at risk or malnourished, 25.5 percent were at risk of malnutrition, while 1.5 percent were malnourished.

Fully adjusted logistic regression analysis showed that those who were at risk or malnourished were more than twice as likely to be sarcopenic vs comparators who had normal nutrition (odds ratio [OR], 2.31, 95 percent confidence interval [CI], 1.22–4.37; p<0.05).

Moreover, higher MNA scores, indicative of better nutrition and lower malnutrition risk, were significantly and positively correlated with both muscle mass and strength (p<0.001 for both).

“These findings indicated several important implications and practices for community health,” the researchers said. The substantial and significant co-occurrence of sarcopenia and malnutrition, for instance, “highlights the importance of early screening and detection even during young adulthood and more so among the older age group.”

“[W]e propose that screening of nutritional status should be integrated with the screening of muscle health even among well-nourished, community-dwelling adults,” they added.

In addition, implementing better diet education to encourage diets rich in high-quality protein could also help to promote healthy ageing.

“Future research should attempt to further understand the cause-effect relationship between malnutrition and sarcopenia, prospectively investigate the efficacy of a combination of nutrition and sarcopenia screening in the community, and interventional studies to evaluate the use of specific dietary components that can improve both nutritional and muscle health status,” the researchers said.