Volume 207 - Issue 2
Sarcopenia: a potential cause and consequence of type 2 diabetes in Australia’s ageing population?
Authors: David Scott, Barbora de Courten and Peter R Ebeling
Med J Aust 2017; 207 (2): 89. || doi: 10.5694/mja16.01243
Published online: 17 July 2017
Published online: 17 July 2017
In reply
In reply:
We thank Li and colleagues for their comments on our article,1 and for sharing their interesting data on associations of lean mass and muscle strength with incident type 2 diabetes mellitus in middle-aged Australian men. The low observed prevalence of sarcopenia according to the Foundation for the National Institutes of Health (FNIH) definition2 is likely attributable in part to the relatively young age of their cohort (mean age 54 years).3 However, the finding also highlights that the FNIH cut-points for low lean mass and hand grip strength may be overly conservative. Indeed, a United Kingdom study including over 1500 adults aged 60–64 years revealed a similarly low prevalence of sarcopenia according to the FNIH definition (1.1% in men and 2.0% in women).4 It has been recently noted that the low prevalence associated with current multicomponent definitions of sarcopenia may limit opportunities for its early identification and treatment.5 This is particularly relevant in the middle-aged adult population, who potentially should be the primary target for sarcopenia prevention.
We also agree with the authors’ statement that greater loss of muscle mass and function over time may be a more relevant indicator of functional and metabolic risks than low muscle mass and function according to distribution-based cut-points. We previously showed that declines in gait speed over several years — rather than baseline values — are predictive of increased risk of incident falls in older women.6 As such, we encourage clinicians to consider ongoing monitoring of body composition and muscle function in older patients and particularly those with type 2 diabetes, in whom such declines may be accelerated. Nevertheless, the absence of any cut-points for excessive loss of both muscle mass and function with ageing will limit the ability of clinicians to interpret such repeated measurements. It is therefore clear that further research into operational definitions of sarcopenia is required. We believe that less conservative cut-points are needed in order to assist clinicians to identify sarcopenia and initiate treatment before its functional and metabolic consequences manifest in older Australians.
Competing interests
No relevant disclosures.
References
- Scott D, de Courten B, Ebeling PR. Sarcopenia: a potential cause and consequence of type 2 diabetes in Australia’s ageing population? Med J Aust 2016; 205: 329-333.
- Studenski SA, Peters KW, Alley DE, et al. The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci 2014; 69: 547-558.
- Li JJ, Wittert GA, Vincent A, et al. Muscle grip strength predicts incident type 2 diabetes: population-based cohort study. Metabolism 2016; 65: 883-892.
- Cooper R, Bann D, Wloch EG, et al. “Skeletal muscle function deficit” in a nationally representative British birth cohort in early old age. J Gerontol A Biol Sci Med Sci 2015; 70: 604-607.
- Dawson-Hughes B, Bischoff-Ferrari H. Considerations concerning the definition of sarcopenia. Osteoporos Int 2016; 27: 3139-3144.
- Scott D, McLaughlin P, Nicholson GC, et al. Changes in gait performance over several years are associated with recurrent falls status in community-dwelling older women at high risk of fracture. Age Ageing 2015; 44: 287-293.