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Research Article

Prevalence of sarcopenia in an elderly population in rural South India: a cross-sectional study

[version 1; peer review: 2 not approved]
Nishat Shaikh1, R Harshitha2, Madhavi Bhargava
https://orcid.org/0000-0001-7480-566X
2,3
Nishat Shaikh1, R Harshitha2, Madhavi Bhargava
https://orcid.org/0000-0001-7480-566X
2,3
PUBLISHED 10 Mar 2020
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Abstract

Background: Sarcopenia is a condition common in the elderly characterized by progressive and generalized loss of skeletal muscle mass and strength leading to poor quality of life. According to a working definition proposed by the European Working Group on Sarcopenia in Older People (EWGSOP), the criteria for a diagnosis of sarcopenia is based on documentation of low muscle mass with either poor muscle strength or low physical performance. The objective of the present study was to determine the prevalence of sarcopenia in the rural elderly population of South India.
Methods: We conducted a cross-sectional survey of 240 elderly people, 60 years and above, 118 men and 122 women, in rural areas of Dakshina Kannada district. We measured their height, weight, gait speed (using an 8-feet walk test) and muscle strength (using a handgrip dynamometer). Appendicular skeletal mass was calculated using height and weight adjusted for sex and Asian people using the Lee formula.
Results: Sarcopenia was found in 34 (14.2%) participants. Of all those having sarcopenia, 27 (79.4%) were ≤75 years, 30 (88.2%) were women, 27 (79.4%) were married, 23 (67.6%) had below poverty line status.
Conclusions: The prevalence of sarcopenia found in the present study was 14.2% in an elderly population more than 60 years of age and was found to be more in women. Large-scale multi-centric community-based surveys will help determine the actual burden of sarcopenia in India.

Keywords

sarcopenia, muscle strength, muscle function, gait speed, grip strength, elderly

Corresponding author: Madhavi Bhargava
Competing interests: No competing interests were disclosed.
Grant information: The author(s) declared that no grants were involved in supporting this work.
Copyright:  © 2020 Shaikh N et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Shaikh N, Harshitha R and Bhargava M. Prevalence of sarcopenia in an elderly population in rural South India: a cross-sectional study [version 1; peer review: 2 not approved]. F1000Research 2020, 9:175 (https://doi.org/10.12688/f1000research.22580.1) First published: 10 Mar 2020, 9:175 (https://doi.org/10.12688/f1000research.22580.1) Latest published: 10 Mar 2020, 9:175 (https://doi.org/10.12688/f1000research.22580.1)

Introduction

There has been an increase in longevity globally. According to the United Nations, the proportion of people above the age of 60 years is 13% at a global level and 8.6% in India1,2. Sarcopenia is a condition that is common in elderly people and is characterized by progressive and generalized loss of skeletal muscle mass and strength3. It can lead to mobility problems, an increased risk of falls and fractures, impaired ability to perform activities of daily living, disability and loss of independence in the elderly. According to a working definition proposed by the European Working Group on Sarcopenia in Older People (EWGSOP), the criteria for diagnosis of sarcopenia is based on documentation of low muscle mass with either poor muscle strength or low physical performance4. Sarcopenia has been proposed to be primarily due to aging or secondary to reduced activity, such as bed rest, chronic diseases, malignancy, poor nutrition or endocrinal diseases5,6. The objective of the present study was to determine the prevalence of sarcopenia in the rural elderly population of South India.

Methods

Study setting

The present study was conducted in the coastal district of Dakshina Kannada in Karnataka. Karnataka is the 9th biggest state and according to the Census 2010, the geriatric population (>60 years) was 7.9%, 7th in India in terms of percentage of older persons.

Study population

Elderly persons >60 years of age2.

Study design and sample size

A cross sectional study was conducted between July 15 and September 15, 2018.

Prevalence of sarcopenia in India, according to a multi-continent study, was found to be 17.5%7. With a margin of error as 5% and 95% confidence level, the required sample size was 222. Considering a non-enrolment rate of 10%, a total of 240 participants were enrolled.

Sampling

Participants were approached using a door-to-door method. All family members above 60 years were approached for enrolment. The enrolment was started from the nearest village in the field practice area and it continued until the sample size was reached in the next contiguous village.

Inclusion and exclusion criteria

All individuals above 60 years of age were included. Participants who were unable to walk, very frail, had cardio-pulmonary problems, which can lead to restriction of examination of muscle function, were advised for a consultation in the nearby tertiary care hospital and excluded from the study.

Data collection

A survey was conducted for those enrolled in the study. Variables collected were age, sex, and socio-economic class based on availability of Below Poverty Line (BPL) card. Anthropometric assessment included height and weight measurements using a portable stadiometer (SECA 213) and digital weighing machine (SECA 803). Weight was measured to the nearest of 100 gm with minimum clothing, after removing belt, shoes and any heavy extra clothing. Height was measured with accuracy to the nearest 0.1cm with participant standing without footwear with weight borne evenly on both feet and head in Frankfurt plane.

Muscle function using gait speed. This was done using an 8-feet (2.4 meters) walking course with no obstructions for an additional two feet at either end. This was measured using a carpenter measuring tape. The participants were made to walk at their usual speed and time taken to cover the marked 8-feet distance was clocked using a stop-watch. A cut-off of <0.8m/s was considered as ‘slow’ performance5,9.

Appendicular muscle mass (ASM). This was calculated using the Lee formula:

ASM = (0.244 * body weight) + (7.8 * height) + (6.6 *gender) – (0.098 * age) + (race – 3.3). For Asian people this was calculated as -1.28.

Skeletal muscle index (SMI) was determined by dividing ASM with height in m2. With no reference values available from any large scale studies in India, the ASM cut-offs considered were <7.0kg/m2 in men and 5.7 in women based on previous study in Brazil9.

Muscle strength. Hand grip strength represented the muscle strength of the participant. We used Jamar® Plus+ Digital Hand Dynamometer (Patterson Medical, Cedarburg, WI, United Kingdom). A cut-off of <30 kg for men and <20 kg for women was considered ‘low’ muscle strength9.

Data analysis

Participants with sarcopenia were classified as those with poor ASM (using Lee’s equation) among all participants with either low muscle strength or slow gait speed (Figure 1). Data were analysed using Statistical Package for the Social Sciences (SPSS) for Windows, Version 23 Chicago, SPSS Inc. Data are presented as numbers (percentage).

7c2349e1-1df4-4a77-99d8-da45a4e247bc_figure1.gif

Figure 1. Study process for assessment of sarcopenia in the participants (>60 years).

SMI, skeletal muscle index. *Lee Equation: ASM = (0.244 * body weight) + (7.8 * height) + (6.6 *gender)–(0.098 * age)+ (race – 3.3) where for Asian race it is -1.2. Skeletal Muscle index(SMI) = ASM/(height in meter).

Ethical approval

Approval was obtained from Yenepoya University Ethics Committee - 1 before the commencement of the study (YEC-1; Protocol No: 2018/110). Written informed consent was obtained from all the study participants for voluntary participation and privacy and confidentiality of the participants were ensured.

Results

Figure 1 explains the methodology of deriving the number of participants with sarcopenia. All the participants were subjected to 8 feet walk test and a gait speed of <0.8m/sec was considered as slow. All those with normal gait speed (>0.8m/sec; 109, 45.4%) underwent hand grip dynamometry. Men with grip strength <30 kg and women with grip strength <20 kg were considered as having low grip strength. Those with normal grip strength (>30kg men, >20kg women) were considered non-sarcopenic (25, 10.4%). Those with poor grip strength were assessed for ASM using Lee’s formula, which was then converted to SMI. A value of <7.0kg/m2 in men and <5.7kg/m2 in women was considered as low SMI. The number of participants with normal gait speed, low muscle strength and low SMI were considered as having sarcopenia (12, 5%). Participants with normal gait speed, low grip strength and normal SMI were considered as non-sarcopenic (72, 30%).

Participants who had slow gait speed (131, 54.6%) also had their SMI determined (hand grip strength assessment was not used for determination of sarcopenia in the slow gait speed group). Those with slow gait speed and normal SMI were considered non-sarcopenic (109, 45.4%). Those with slow gait speed and low SMI were considered sarcopenic (22, 9.2%). Thus, overall 34 (14.2%) participants were found to have sarcopenia.

Table 1 describes the socio-demographic characteristics of the 240 participants enrolled in the study. Of all those having sarcopenia, 27 (79.4%) were ≤75 years, 30 (88.2%) were women, 23 (67.6%) had BPL status, and 27 (79.4%) were married.

Table 1. Demographic characteristics of study participants with and without sarcopenia.

Characteristic (n total)Sarcopenia
n= 34 (%)		No sarcopenia
n=206 (%)
Age group≤75 years (212)27 (79.4)185 (89.8)
>75 years (28)7 (20.6)21 (10.2)
SexMen (118)4 (11.8)114 (55.3)
Women(122)30 (88.2)92 (44.7)
Socioeconomic statusAbove poverty line (109)11 (32.4)98 (47.6)
Below poverty line (131)23 (67.6)108 (52.4)
Marital statusMarried (183)27 (79.4)156 (75.7)
Unmarried (5)05 (2.4)
Widowed (52)7 (20.6)45 (21.9)

Discussion

This study enrolled 240 rural elderly participants (>60 years) and found the prevalence of sarcopenia using gait speed, hand grip strength and skeletal muscle index as 14.2%. The prevalence of sarcopenia was 3.4% in men and 24.5% in women. According to a large multi-centric study conducted in nine countries, the overall prevalence of sarcopenia was 15.2% and in India this was 17.5%7. The higher prevalence in this study was probably because the age group included in the multi-centric study was ≥65 years. There are no other studies to estimate the prevalence of sarcopenia in India, to the best of our knowledge, for further comparison. In a study in Brazil, using a similar algorithm to EWGSOP, the prevalence of sarcopenia was found to be 16.1% in men and 14.4% in women9. In another study to estimate the functional measures of sarcopenia in six low and middle-income countries, India had the highest concomitant presence of poor grip strength and reduced gait speed, 33% as compared to 12.3% in South Africa10.

Strength and limitation

With no large scale surveys done so far in India, this study provides some insight into scale of problem of sarcopenia in community dwelling elderly persons. But the study has some important limitations. Firstly, the equation used to derive the appendicular skeletal mass has not been validated for the Indian population. Secondly, we do not have normative population level data on hand-grip strength in the Indian population, therefore we used the EWGSOP recommendations. Lastly, we did not validate our findings with body-composition analysis due to logistics involved in a community-based study.

Conclusion

The prevalence of sarcopenia found in the present study was 14.2% in an elderly population (<60 years of age) and was more likely to occur in women compared to men (24.5% vs 3.4%). Larger community-based surveys are required to determine the actual burden of the problem in India.

Data availability

Underlying data

Zenodo: Sarcopenia in elderly population of Karnataka, http://doi.org/10.5281/zenodo.369193911.

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

References

  • 1.  United Nations Department of Economic and Social Affairs Population Division: World Population Prospects: The 2017 Revision, Key Findings and Advance Tables. 2017; (accessed on 25 September 2019). Reference Source
  • 2.  Government of India: Elderly in India - Profile and Programmes 2016. Ministry of Statistics and Programme Implementation. Central Statistics Office. 2016; (accessed on 20 Sept 2019). Reference Source
  • 3.  Rosenberg IH: Sarcopenia: origins and clinical relevance. J Nutr. 1997; 127(5 Suppl): 990S–1S. PubMed Abstract | Publisher Full Text
  • 4.  Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al.: Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010: 39(4): 412–23. PubMed Abstract | Publisher Full Text | Free Full Text
  • 5.  Sayer AA, Syddall H, Martin H, et al.: The developmental origins of sarcopenia. J Nutr Health Aging. 2008; 12(7): 427–32. PubMed Abstract | Publisher Full Text | Free Full Text
  • 6.  Thompson DD: Aging and sarcopenia. J Musculoskelet Neuronal Interact. 2007; 7(4): 344–5. PubMed Abstract
  • 7.  Tyrovolas S, Koyanagi A, Olaya B, et al.: Factors associated with skeletal muscle mass, sarcopenia, and sarcopenic obesity in older adults: a multi-continent study. J Cachexia Sarcopenia Muscle. 2016; 7(3): 312–21. PubMed Abstract | Publisher Full Text | Free Full Text
  • 8.  Lee RC, Wang Z, Heo M, et al.: Total-body skeletal muscle mass: development and cross-validation of anthropometric prediction models. Am J Clin Nutr. 2000; 72(3): 796–803. PubMed Abstract | Publisher Full Text
  • 9.  Alexandre Tda S, Duarte YA, Santos JL, et al.: Prevalence and associated factors of sarcopenia among elderly in Brazil: findings from the SABE study. J Nutr Health Aging. 2014; 18(3): 284–90. PubMed Abstract | Publisher Full Text
  • 10.  Brennan-Olsen SL, Bowe SJ, Kowal P, et al.: Functional Measures of Sarcopenia: Prevalence, and Associations with Functional Disability in 10,892 Adults Aged 65 Years and Over from Six Lower- and Middle-Income Countries. Calcif Tissue Int. 2019; 105(6): 609–618. PubMed Abstract | Publisher Full Text
  • 11.  Bhargava M, Harshitha R, Shaikh N: Sarcopenia in elderly population of Karnataka. 2020. http://www.doi.org/10.5281/zenodo.3691939

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Shaikh N, Harshitha R and Bhargava M. Prevalence of sarcopenia in an elderly population in rural South India: a cross-sectional study [version 1; peer review: 2 not approved]. F1000Research 2020, 9:175 (https://doi.org/10.12688/f1000research.22580.1)
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Reviewer Report 04 Aug 2021
Harnish P. Patel, Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK 
Not Approved
VIEWS 19
https://doi.org/10.5256/f1000research.24926.r87833
Thank you for this manuscript. The authors are to be commended for making the effort to conduct this study. Sarcopenia is and remains a burden for many of our older population, irrespective of ethnicity so studies like these are very ... Continue reading
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Patel HP. Reviewer Report For: Prevalence of sarcopenia in an elderly population in rural South India: a cross-sectional study [version 1; peer review: 2 not approved]. F1000Research 2020, 9:175 (https://doi.org/10.5256/f1000research.24926.r87833)
The direct URL for this report is:
https://f1000research.com/articles/9-175/v1#referee-response-87833
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Reviewer Report 24 Jul 2020
Min Yang, National Clinical Research Center for Geriatrics (West China Hospital of SCU), Sichuan University, Sichuan, China 
Not Approved
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https://doi.org/10.5256/f1000research.24926.r67830
Thank you for inviting me to review this manuscript. It addressed an old topic in the research field of sarcopenia and did not provide any valuable information for our readers. Here are my considerations.
  1. This work
... Continue reading
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Yang M. Reviewer Report For: Prevalence of sarcopenia in an elderly population in rural South India: a cross-sectional study [version 1; peer review: 2 not approved]. F1000Research 2020, 9:175 (https://doi.org/10.5256/f1000research.24926.r67830)
The direct URL for this report is:
https://f1000research.com/articles/9-175/v1#referee-response-67830
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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  1. Min Yang, Sichuan University, Sichuan, China
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    Alongside their report, reviewers assign a status to the article:
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