Prevalence and associated factors of sarcopenia in older adults with intellectual disabilities
Highlights
► Sarcopenia is prevalent in older people with ID. ► Sarcopenia in people with ID starts at an early age. ► Risk groups for sarcopenia in people with ID: low BMI, mobility impairment.
Introduction
Sarcopenia was originally described in the late 1980s as the age-related loss of skeletal muscle mass. Parallel to the increasing knowledge, the definition of sarcopenia has evolved (Rolland, van Kan, Gillette-Guyonnet, & Vellas, 2011). Nowadays, combining both muscle mass and muscle function to define sarcopenia is the recommended approach. In 2009 the European Working Group on Sarcopenia in Older People (EWGSOP) defined sarcopenia as a syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability (Cruz-Jentoft et al., 2010).
The underlying pathophysiological pathways of sarcopenia are complex. There are several internal and external processes that contribute to its development (Muscaritoli et al., 2010). With regard to internal processes, inflammation (expressed as increased levels of C-reactive protein), reductions of anabolic hormones, accumulation of free radicals and increases of apoptotic activities play a central role in sarcopenia (Hamer and Molloy, 2009, Muscaritoli et al., 2010, Schaap et al., 2006). External processes leading to sarcopenia are disuse (including immobility and physical inactivity) and a deficient intake of energy and proteins (Ferrando et al., 1996, Muscaritoli et al., 2010, Paddon-Jones, 2006).
Prevalences of sarcopenia vary between 3% and 52% depending on the study population, the criteria used to define sarcopenia and the instruments used to measure it (Fielding et al., 2011). In subsequent studies in the same population, it was shown that prevalences of sarcopenia increased from 12% when people were aged 60–70 years to nearly 30% when they were older than 80 years (Baumgartner et al., 1998, Morley et al., 2001).
In most studies, men are more likely to be sarcopenic than women (Castillo et al., 2003, Gillette-Guyonnet et al., 2003, Iannuzzi-Sucich et al., 2002, Melton et al., 2000, Tanko et al., 2002). People with a low body mass index (BMI) (Iannuzzi-Sucich et al., 2002), or with low serum vitamin D levels (Kim et al., 2011) or low serum albumin levels (Baumgartner et al., 1996, Visser et al., 2005) are also at greater risk for sarcopenia.
In the general population sarcopenia is a risk factor for frailty (Bauer and Sieber, 2008, Frisoli et al., 2011). Both sarcopenia and frailty are highly relevant conditions with regard to functionality and independence in old age (Bauer and Sieber, 2008, Delmonico et al., 2007, Janssen et al., 2002, Lauretani et al., 2003, Melton et al., 2000). It is known that these conditions overlap; most frail older people exhibit sarcopenia and some older people with sarcopenia are also frail (Bauer & Sieber, 2008). Looking at the criteria for sarcopenia in accordance with the EWGSOP (Cruz-Jentoft et al., 2010) and the criteria for frailty in accordance with the Cardiovascular Health Study (CHS) (Fried et al., 2001), this overlap can partly be explained by the similarity in parameters for both muscle strength and muscle performance.
In people with intellectual disabilities (ID) sarcopenia has hardly been studied before. As far as we know, the only study in this population was executed by Carmeli, Imam, and Merrick (2012). They studied the correlation between sarcopenia and physical ability in a small group of healthy, older participants with a relatively high level of independency (Carmeli et al., 2012). They found that loss of muscle mass and loss of muscle strength were associated with early onset of physical and functional decline.
We expected that sarcopenia is frequent in older people with ID, due to high levels of physical inactivity (Hilgenkamp, Reis, van Wijck, & Evenhuis, 2012) and a high prevalence of (lifelong) mobility impairments (Evenhuis, 1997). Therefore, we set up a study into sarcopenia, in accordance with the EWGSOP-criteria, in a nearly representative older client population of Dutch ID care provider services. The aims of the current study were (1) to determine the prevalence of sarcopenia in older adults with ID, (2) to identify the association of sarcopenia with participant characteristics (gender, age, level of ID, Down syndrome, residential status) and mobility, physical activity, intake of energy and proteins, BMI and levels of C-reactive protein (CRP), albumin and vitamin D in serum, and (3) to determine the overlap between sarcopenia and frailty in accordance with the CHS-criteria in this group.
Section snippets
Study design and participants
This study was part of a large cross-sectional study, called “Healthy Ageing in people with Intellectual Disability” (HA-ID). The recruitment and selection process of the HA-ID study has been outlined in detail by Hilgenkamp et al. (2011). The study population consisted of clients, aged 50 years and over, in three Dutch care provider services in The Netherlands. Informed consent was obtained from 1069 clients, aged 50 years and over, and/or their legal representatives and 1050 clients actually
Participants
For 929 out of 1050 participants in the total cohort, a valid result for CC was obtained. Due to missing data for muscle strength or muscle performance 45 persons with a low CC could not be categorized into presarcopenia, sarcopenia or severe sarcopenia and therefore they were excluded. Of the remaining 884 participants, data of 103 persons on comfortable walking speed were missing, largely due to physical impairments, and data of 173 persons on grip strength were missing, largely due to
Discussion
This is the first study into prevalence and associated factors of sarcopenia in a large near-representative older population with intellectual disabilities. The prevalence of sarcopenia in this group is 14.3%. Sarcopenia is positively associated with mobility impairment and inflammation and negatively with BMI. Sarcopenia and frailty partly overlap, but less than we expected based on the similarity in criteria. With a prevalence of 12.7%, sarcopenia is already remarkably present in the age
Conflict of interest
None declared.
Acknowledgements
This project was financed by ZonMw, The Netherlands Organization for Health Research and Development (nr. 57000003), Erasmus Medical Center Rotterdam, and three Dutch care provider services for people with intellectual disabilities: Abrona (Huis ter Heide), Amarant (Tilburg) and Ipse de Bruggen (Zwammerdam).
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