Saving money is not as good as saving muscles! Elderly people should be wary of this disease

Tang Dynasty poet Du Fu wrote in "A Hundred Worries" that "When I was fifteen, I was still a child at heart, as vigorous as a yellow calf. In August, pears and dates ripened in front of the yard, and I could climb the tree a thousand times a day. Now I am fifty, and I only sit and lie down a little, and walk and stand a little."

Coincidentally, poets Bai Juyi and Liu Yuxi also expressed their feelings of "staying at home all day" and "losing weight and taking off their belts frequently".

Similar scenes are constantly happening in the daily lives of ordinary people like us.

Perhaps, one day you will suddenly discover that your father's strong body seems to have shrunk a size. He, who used to have amazing arm strength, now does not have the strength to carry heavy objects such as rice and flour upstairs; and your mother, who used to walk briskly, now has thinner limbs and can hardly keep up with your pace, and often has to stop and walk.

At this time, you need to pay attention that in addition to the weakness of their limbs caused by aging, they may also suffer from a disease -

Sarcopenia

Sarcopenia, also known as muscle wasting syndrome, skeletal muscle reduction, and sarcopenia, is often manifested as weakness, difficulty walking, easy falls, slow gait, thin and weak limbs, etc.

So, what is sarcopenia? And how should we deal with it? Let us unveil the mystery of sarcopenia together.

1. Is sarcopenia just a lack of muscle?

The International Sarcopenia Working Group defines sarcopenia as a disease that is associated with aging and is characterized by a progressive, widespread loss of muscle mass, strength, and function, leading to limited activity, falls, fractures, and even death.

Sarcopenia is not just a loss of muscle mass; low muscle strength is the key feature for the diagnosis of sarcopenia.

"Sarcopenia" is when there is a decrease in muscle strength or physical dysfunction, but only a decrease in muscle volume is called pre-sarcopenia.

The advantage of using muscle strength as the basis for diagnosing sarcopenia is that it can effectively identify sarcopenic obesity.

Many people associate sarcopenia with emaciation, but obesity and sarcopenia often coexist. Obesity also increases the risk of sarcopenia because these patients have excessive body fat accumulation and reduced muscle mass, leading to an imbalance in the ratio of lean body mass to fat. Increased intramuscular fat infiltration also affects muscle strength and function, further aggravating sarcopenia.

2. What are the dangers of sarcopenia?

Sarcopenia seriously affects the physical and mental health of elderly patients.

The reduction of muscle mass and strength will lead to a decrease in the patient's mobility, which in turn increases the risk of falls, fractures, disability and even death. In addition, sarcopenia is also associated with a variety of diseases such as diabetes, osteoporosis, heart disease, respiratory diseases and cognitive impairment, which is simply worse for many frail elderly people.

At the same time, sarcopenia can also cause mental damage to the elderly . Some elderly people are afraid of falling and become fearful and uneasy, and even dare not move. They lack confidence in social activities, have reduced desires, and even become depressed.

Bai Juyi once expressed a similar pessimistic and decadent mood in a letter to an old friend: "I am too lazy to look in the newly polished mirror, and I don't want to read books with small characters. I have deep feelings for old friends, but we are no longer friends since we were young." The damage caused by sarcopenia to individual health will inevitably lead to an increase in nursing and medical costs, bringing a huge economic burden to families and society.

3. What is the prevalence of sarcopenia?

It was not until 2016 that the World Health Organization officially defined sarcopenia as a disease, and my country's understanding and research on sarcopenia was also relatively late.

So we rarely heard the term sarcopenia in the past, but sarcopenia is actually not uncommon .

Currently, the global prevalence of sarcopenia is about 6% to 12%. About 50 million people worldwide suffer from sarcopenia, and it is estimated that the number of people suffering from this disease will reach 500 million by 2050 .

In China, the prevalence of sarcopenia among the elderly aged 60 and above is 5.7%-23.9%, with significant differences in prevalence among different regions and genders, and increases significantly with age. The prevalence of sarcopenia among the elderly aged 80 and above can be as high as 67.1%.

4. Can young people also suffer from sarcopenia?

All elderly people are at risk of developing sarcopenia. As they age, changes in organ functions and hormone levels in the elderly can lead to decreased exercise capacity, loss of muscle mass and muscle strength.

The muscle mass of the human body reaches its peak at around 30 years old, and begins to gradually decrease at around 50 years old. Thereafter, the loss is about 1% to 2% each year, and by the age of 80, the loss can be more than half. Therefore, sarcopenia is most common among the elderly. This type of sarcopenia that is only related to aging is called primary sarcopenia.

In addition, some exercise, nutrition, and disease-related factors, such as long-term bed rest, long-term sitting, long-term alcoholism and smoking, malnutrition, pre-existing chronic diseases, surgery, malignant tumors, endocrine diseases, multiple organ failure, and multiple medications can also lead to the occurrence of sarcopenia.

Therefore, if young people do not have a good diet, exercise habits and health, sarcopenia will come to them without mercy. Only by storing more muscle while young can we calmly face the muscle decline after aging.

5. Do I need to go to the hospital for sarcopenia screening?

Currently, the European Sarcopenia Working Group recommends that all people aged 65 years and over should be screened for sarcopenia every year or after a major health event (such as a fall leading to hospitalization).

In addition, if any of the following conditions exist, screening for sarcopenia should be performed, such as chronic diseases (heart failure, chronic obstructive pulmonary disease, diabetes, kidney disease), functional decline or limitation, involuntary weight loss, depression, cognitive impairment, repeated falls, malnutrition, etc., to detect sarcopenia early.

Sarcopenia screening does not necessarily require going to the hospital . Using some small tools, you can also do sarcopenia screening at home.

Screening using calf circumference or questionnaires is recommended.

Calf circumference should be measured using a non-elastic tape to measure the maximum circumference of the calves on both sides. The cutoff value is <34 cm for men and <33 cm for women.

If you don't have a tape measure, an effective alternative to calf circumference is the "finger-ring test," where people use their index fingers and thumbs to circle the thickest part of their non-dominant calf. If the measured calf is exactly the right size or smaller than the circle formed by their fingers, they are at increased risk for sarcopenia.

Ring test

The recommended questionnaire is the SARC-F or SARC-CalF self-assessment questionnaire. The SARC-F questionnaire includes five items: strength, assisted walking, standing up, climbing stairs, and falling. A total score of ≥4 is considered a positive screening. SARC-CalF increases the sensitivity of SARC-F by adding calf circumference. A SARC-CalF score of ≥11 is considered a positive screening.

Self-Assessment Questionnaire

Individuals who screen positive need to go to a medical institution for further muscle strength, muscle mass measurement and muscle function assessment to confirm the presence of sarcopenia.

6. How to prevent and treat sarcopenia?

Du Fu died at the age of 59. From today's perspective, he is not old, but Du Fu experienced separation, escape, danger, and frustration in his life. He often drank to drown his sorrows. After going to Shu, he became even more sick and suffered from all kinds of diseases. His activities were greatly affected. In addition, his life was difficult and nutrition was difficult to guarantee. He had all the risk factors related to exercise, nutrition, and disease for sarcopenia.

Although these are preventable and controllable risk factors, unfortunately, under the circumstances at that time, Du Fu had no awareness or conditions for preventive health care, so how could he not age quickly?

The health concept of preventing illness before it occurs has been around since ancient times. More than a thousand years later, will we repeat Du Fu's mistakes? This depends on our own choices and changes in our concepts.

How much can surgery, drugs, and doctors really help people's health? "Prevention is ultimately the most economical and effective health strategy." Of course, prevention is better than cure for sarcopenia.

The prevention and treatment measures for sarcopenia mainly include improving unhealthy lifestyles (quitting smoking and drinking, avoiding sitting for long periods of time, eating a healthy diet, etc.), nutrition, exercise and drug treatment .

Secondary sarcopenia is mainly the treatment of the underlying disease. Exercise is one of the most effective means to gain and maintain muscle mass and strength.

Most elderly people do not have adequate intake of calories and protein. Therefore, it is recommended that the elderly maintain a balanced diet and adequate nutrition in their daily lives, and consider protein or essential amino acid nutritional supplementation when necessary.

Currently, there is no drug for sarcopenia. Some drugs used to treat other diseases may benefit muscles and thus be used for sarcopenia, including anabolic steroids, β-adrenergic receptor stimulants, angiotensin-converting enzyme inhibitors, growth hormone, etc.

Pursuing the highest level of health is everyone’s basic right. In the future aging society, staying away from sarcopenia is what every elderly person needs for their health.

●Advocate healthy eating habits, good living habits, regular participation in physical activities, good chronic disease management, and regular physical examinations;

● Understand sarcopenia, take the initiative to prevent it, and change what we can change;

●Early identification, early screening, and early intervention.

In this way, we will get closer and closer to the goal of "preventing sarcopenia before it occurs, preventing complications after illness, and preventing recurrence after recovery", and the quality of life in old age can be guaranteed.

At the same time, we should maintain an optimistic attitude in the face of aging, as the saying goes, "Don't say it's too late, the sky is still full of rosy clouds." I also wish all elderly friends to be strong and healthy!

References:

1． Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European consensus on definition and diagnosis[J]. Age Ageing, 2019, 48(1): 16-31.

2. Cui Hua, Wang Zhaohui, Wu Jianqing, et al. Chinese expert consensus on prevention, control and intervention of sarcopenia in the elderly (2023) [J]. Chinese Journal of Geriatrics, 2023, 42(2): 144-153.

3. Liu Haixia, Zhou Ping, Zhang Yina. Diagnosis and treatment of sarcopenia. Chinese Journal of Osteoporosis and Bone Mineral Diseases, 2021, 14 (4): 434-439.

4. Chinese expert consensus on oral nutritional supplementation for sarcopenia in the elderly (2019), Chinese Journal of Geriatrics [J] 2019.11(38): 1193-1197

Author: Chen Zhifang

Unit: Community Health Department, Beijing Jishuitan Hospital