title: Sarcopenia Is Associated With Incident Disability, Institutionalization, and Mortality in Community-Dwelling Older Men: The Concord Health and Ageing in Men Project.
abstract: BACKGROUND
  Sarcopenia is associated with an increased risk of adverse outcomes. The aim of this study was to explore the relationship between severity of sarcopenia and incident activities of daily living (ADL) disability, institutionalization, and all-cause mortality among community-dwelling older men participating in the Concord Health and Ageing in Men Project (CHAMP).
  
  
  METHODS
  Longitudinal analysis of 1705 participants aged 70 years or older at baseline (2005-2007) living in the community in Sydney, Australia.
  
  
  METHODS
  The main outcome measures were incident ADL disability, institutionalization, and mortality. Of the 1705 participants who completed the baseline assessments, a total of 1678 men (mean age 77 years) had complete measures by dual-energy x-ray absorptiometry, to assess sarcopenia in terms of low appendicular lean mass (ALM), using the Foundation for the National Institutes of Health (FNIH) criteria. To differentiate between severity of sarcopenia we used low ALM alone (sarcopenia I), low ALM with weakness (sarcopenia II), and sarcopenia with weakness and poor gait speed (sarcopenia III). Cox proportional hazard models and logistic regression models were used to assess the risk of mortality and institutionalization, and incidence of ADL disability.
  
  
  RESULTS
  From baseline to follow-up, 103 (11.3%) men had incident ADL disability, 191 (11.2%) men were institutionalized, and 535 (31.9%) had died. At baseline, 14.2% had sarcopenia I, 5.3% had sarcopenia II, and 3.7% had sarcopenia III. Fully adjusted analysis (adjusted for demographics, lifestyle factors, comorbidities and health conditions, and blood measures) showed that sarcopenia I, II, and III were associated with increased risk of disability, institutionalization, and mortality. Associations between sarcopenia I, II, and III and risk of incident disability were as follows: odds ratio (OR) 2.77 95% confidence interval (CI) 1.30-5.87, OR 3.78 95% CI 1.23-11.64, and OR 4.53 95% CI 0.90-22.72; associations with institutionalization were hazard ratio (HR) 1.96 95% CI 1.14-3.35, HR 2.53 95% CI 1.31-4.90, and HR 2.27 95% CI 1.08-4.80; and with mortality were HR 1.65 95% CI 1.30-2.09, HR 1.50 95% CI 1.08-2.08, and HR 1.69 95% CI 1.17-2.44.
  
  
  CONCLUSIONS
  This study shows that, in community-dwelling older men, sarcopenia defined by the FNIH criteria is associated with increased risk of incident disability, institutionalization, and mortality.
authors.affiliation: Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia; School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Australian Research Council Centre of Excellence in Population Ageing Research, University of Sydney, Sydney, New South Wales, Australia. Electronic address: vasant.hirani@sydney.edu.au.
authors.forename: Vasant
authors.initials: V
authors.lastname: Hirani
authors.affiliation: Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Blyth
authors.affiliation: Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Vasi
authors.initials: V
authors.lastname: Naganathan
authors.affiliation: ANZAC Research Institute and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: David G
authors.initials: DG
authors.lastname: Le Couteur
authors.affiliation: Bone Research Program, ANZAC Research Institute, and Department of Endocrinology and Metabolism, Concord Hospital, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Seibel
authors.affiliation: Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Waite
authors.affiliation: Department of Andrology, Concord Hospital and ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Handelsman
authors.affiliation: Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia; School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Australian Research Council Centre of Excellence in Population Ageing Research, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007326:Institutionalization; D008137:Longitudinal Studies; D008297:Male; D051346:Mobility Limitation; D009517:New South Wales / Q000453:epidemiology; D016016:Proportional Hazards Models; D012112:Residential Facilities; D055948:Sarcopenia / Q000453:epidemiology*
keywords: Sarcopenia; incident disability; institutionalization; mortality; older men; population study