Longitudinal Deterioration in Nutritional Status Associated With Increased Risk of Sarcopenia in Community-Dwelling Aged Adults: A Prospective Cohort Study.

BACKGROUND

The association between changes in nutritional status over time and the risk of sarcopenia in older adults is unclear. This study investigated the impact of baseline nutritional status and its 4-year changes on the development of sarcopenia and severe sarcopenia.

METHODS

We conducted a prospective, multicentre longitudinal cohort study and 1661 community-dwelling adults aged 70-84 years without baseline sarcopenia were included for analysis. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), categorized as normal, at risk of malnutrition or malnutrition (24-30, 17-23.5 and < 17 points, respectively). Changes in nutritional status were classified as improved, unchanged or deteriorated. Primary outcomes were new-onset sarcopenia and severe sarcopenia. Sarcopenia was defined by the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Cox regression models using changes in nutritional status as a time-varying covariate were used to estimate hazard ratios (HRs), adjusted for age, sex, body mass index, smoking, alcohol use, fall history, education, comorbidities and activities of daily living. In sensitivity analyses, the Fine and Gray subdistribution hazard model was performed to estimate subdistribution HRs (sHRs), which accounts for death as a competing risk.

RESULTS

The mean age of participants was 76.3 ± 3.6 years, and 46.9% were male. At baseline, 77.3% had normal nutritional status, 21.8% were at risk of malnutrition, and 0.9% were malnourished. After mean follow-up of 6.8 years, deterioration in nutritional status was associated with increased risk of sarcopenia (HR 1.77 [95% confidence interval, 1.25-2.51], p = 0.001) and severe sarcopenia (HR 1.97 [1.23-3.16], p = 0.005) compared to those with unchanged nutritional status among total participants. Among those with normal nutritional status at baseline, deterioration in nutritional status was also associated with increased risk of sarcopenia (HR 2.07 [95% confidence interval, 1.37-3.12], p = 0.001) and severe sarcopenia (HR 1.95 [1.08-3.53], p = 0.028). Prevalence of low muscle mass differed significantly by measurement device (Hologic 64.8%, GE Lunar 37.2%, BIA 24.2%, p < 0.001); however, the longitudinal association between nutritional status and sarcopenia risk remained consistent in sensitivity analysis.

CONCLUSION

Baseline nutritional risk and deterioration in nutritional status are robust predictors of future sarcopenia and severe sarcopenia in community-dwelling older adults. Improving nutritional status over time may significantly reduce the risk of progressing to severe sarcopenia. Clinical strategies to monitor and enhance nutrition are essential for preventing sarcopenia.