General characteristics of participants
Study participants comprised 324 individuals living in six rural villages, and research was conducted at senior and welfare centers. All participants aged 65 years who lived in villages and were able to move to senior and welfare centers were surveyed. Of a population of 351 elderly people, 341 responded that they did not suffer from cognitive impairment, cancer, stroke, or myocardial infarction. A total of 324 participants was finally included in the investigation (341 healthy respondents, excepting 17, who declined to consent to participation).
The median (percentile 25 and 75) age of study subjects was 72.0 (68.3, 78.0) years, with women comprising 283 (87.3%) of total subjects. Of the elderly subject sample, 47.5% lived alone and 31.2% had depression. Skeletal muscle mass, calf circumference, grip strength, and TUG decreased in 11.1%, 43.5%, 21.9%, and 30.9% of all subjects, respectively. In terms of nutritional assessment, the low-risk group comprised 42.6%, the moderate-risk group comprised 29.3%, and the high-risk group comprised 28.1% of the sample. The overall (median (percentile of 25, 75)) of SarQoL was 70.2 (56.0, 81.8), among the sub-domains, physical and mental health had the lowest quality of life scores (62.2 (51.4, 76.6)), and fears were the highest (87.5 (75.0, 100.0)) (Table 1).
Table 1. General characteristics of participants
Variables
|
|
N (%)
|
Sex
|
Male
|
41 (12.7)
|
|
Female
|
283 (87.3)
|
Age
|
Median (25%,75%)
|
72.0(68.3, 78.0)
|
Living alone
|
No
|
170 (52.5)
|
|
Yes
|
154 (47.5)
|
Education level
|
≤ 6 years
|
196 (60.5)
|
|
≥ 7 years
|
128 (39.5)
|
Smoking
|
No
|
314 (96.9)
|
|
Yes
|
10 (3.1)
|
Depression
|
No
|
223 (68.8)
|
|
Yes
|
101 (31.2)
|
SARC_F
|
< probable not sarcopenia
|
256 (79.0)
|
|
≥ probable sarcopenia
|
68 (21.0)
|
SMI
|
Robust
|
288 (88.9)
|
|
Low
|
36 (11.1)
|
Calf circumference
|
Robust
|
183 (56.5)
|
|
Low
|
141 (43.5)
|
Grip strength
|
Robust
|
253 (78.1)
|
|
Low
|
71 (21.9)
|
TUG
|
Robust
|
224 (69.1)
|
|
Low
|
100 (30.9)
|
Determine (range: 0-21)
|
0-2
|
138 (42.6)
|
|
3-5
|
95 (29.3)
|
|
≥ 6
|
91 (28.1)
|
SalQoL
|
Physical and mental health
|
Median (25%,75%)
|
62.2(51.4, 76.6)
|
Locomotion
|
Median (25%,75%)
|
66.7(50.0, 91.7)
|
Body composition
|
Median (25%,75%)
|
62.5(50.0, 79.2)
|
Functionality
|
Median (25%,75%)
|
73.2(57.7, 86.5)
|
Activities of daily living
|
Median (25%,75%)
|
70.0(55.4, 85.0)
|
Leisure activities
|
Median (25%,75%)
|
66.5(33.3, 66.5)
|
Fears
|
Median (25%,75%)
|
87.5(75.0, 100.0)
|
Overall
|
Median (25%,75%)
|
70.2(56.0 81.8)
|
Total
|
|
324 (100.0)
|
Abbreviations: TUG, timed up and go, SMI, skeletal muscle index, DETERMINE: Disease, Eating poorly, Tooth loss, Mouth pain, Economic hardship, Reduced social contact, Multiple medicines, Involuntary weight loss or gain, Need for assistance in self-care, and Elderly, SarQoL: Sarcopenia-specific Quality of Life
Association between SARC-F and nutritional status
To evaluate the association between SARC-F and sarcopenia assessment, nutritional status, logistic regression analysis was performed. Among the assessment tools for evaluating sarcopenia, calf circumference (OR = 2.150, 95% C.I. = 1.057-4.376, p = 0.037) and TUG (OR = 3.414, 95% C.I. = 1.710-6.816, p = 0.001) showed statistically significant (Table 2). SARC-F and nutritional status (Determine ≥6 vs. <3) were statistically associated (OR = 3.703, 95% C.I. = 1.580-8.682, p = 0.003).
Table 2. Association between SARC_F (suspected sarcopenia (≥4) vs not suspected sarcopenia (<4)) and nutritional status
Dependent variable: SARC_F
|
OR
|
95% CI for OR
|
P value
|
Lower
|
upper
|
SMI (ref: robust)
|
1.218
|
0.470
|
3.156
|
0.685
|
Calf circumference (ref: robust)
|
2.150
|
1.057
|
4.376
|
0.035
|
Grip strength (ref: robust)
|
1.944
|
0.957
|
3.950
|
0.066
|
TUG (ref: robust)
|
3.414
|
1.710
|
6.816
|
0.001
|
Determine (score: 3-5)
|
1.798
|
0.768
|
4.206
|
0.176
|
Determine (score≥ 6)
|
3.703
|
1.580
|
8.682
|
0.003
|
Adjusted for demographic characteristics (sex, age, living alone, education level, smoking) and depressive symptoms.
Abbreviations: OR, odds ratio, TUG, timed up and go, SMI, skeletal muscle index, Determine: Disease, Eating poorly, Tooth loss, Mouth pain, Economic hardship, Reduced social contact, Multiple medicines, Involuntary weight loss or gain, Need for assistance in self-care, and Elderly
Relationship between SarQoL domain and nutritional status
Total score of SarQoL was significant in relationship to SARC-F (B = -13.314, p < 0.001), grip strength (B = -3.866, p = 0.034), and TUG (B = -5.459, p = 0.001). The relationship between total score of SarQoL and nutritional status was significant in the moderate-risk group (B = -5.542, p = 0.001) and in the high-risk group (B = - 8.136, p < 0.001) in comparison to the low-risk group. (Table 3)
Table 3. The relationship between overall score of SarQoL and nutritional status
Dependent variable:
overall score of SarQoL
|
B
|
SE
|
95% CI for B
|
P value
|
Lower
|
Upper
|
SARC_F (ref: <4)
|
-13.314
|
1.900
|
-17.053
|
-9.575
|
<.001
|
SMI (ref: robust)
|
.002
|
2.335
|
-4.593
|
4.597
|
.999
|
Calf circumference (ref: robust)
|
.411
|
1.532
|
-2.603
|
3.425
|
.789
|
Grip strength (ref: robust)
|
-3.866
|
1.820
|
-7.448
|
-.285
|
.034
|
TUG (ref: robust)
|
-5.459
|
1.682
|
-8.768
|
-2.150
|
.001
|
Determine (score: 3-5)
|
-5.542
|
1.666
|
-8.821
|
-2.264
|
.001
|
Determine (score:≥ 6)
|
-8.136
|
1.882
|
-11.839
|
-4.433
|
<.001
|
Adjusted for demographic characteristics (sex, age, living alone, education level, smoking) and depressive symptoms.
Abbreviations: OR, odds ratio, TUG, timed up and go, SMI, skeletal muscle index, Determine: Disease, Eating poorly, Tooth loss, Mouth pain, Economic hardship, Reduced social contact, Multiple medicines, Involuntary weight loss or gain, Need for assistance in self-care, and Elderly, SarQoL: Sarcopenia-specific Quality of Life
Relationships between physical and mental health and nutritional status were statistically significant in the moderate-risk group (B = -4.353, p = 0.033) and in the high-risk group (B = -7.013, p = 0.002) in comparison to the low-risk group. Trends were shown in locomotion (moderate-risk group (B = -6.127, p = 0.026) and high-risk group (B= -14.801, p < 0.001)), body composition (moderate-risk group (B = -4.924, p = 0.019) and high-risk group (B = -5.670, p = 0.017)), functionality (moderate-risk group (B = -5.542, p = 0.012) and high-risk group (B = -7.480, p = 0.003)), activities of daily living (moderate-risk group (B = -5.857, p = 0.002) and high-risk group (B = -5.287, p = 0.014)), and leisure activities (moderate-risk group (B = -8.662, p = 0.004) and high-risk group (B = -14.943, p < 0.001)). In particular, leisure activities were only significantly related to nutritional status. However, SARC-F was significantly related to physical and mental health (B = -11.741, p < 0.001), locomotion (B = -16.935, p < 0.001), body composition (B = -9.124, p < 0.001), functionality (B = -13.897, p < 0.001), and activities of daily living (B = -14.336, p < 0.001). Findings from TUG tests were significantly related to locomotion (B = -8.010, p = 0.001), functionality (B = -6.869, p = 0.002), and activities of daily living (B = -7.210, p < 0.001). In addition, grip strength was significantly related to activities of daily living (B = -5.103, p = 0.014) and feelings of fear (B = -7.243, p = 0.001). However, there were no SarQoL domains related to limb muscle mass or calf circumference. (Supplementary table)
Supplementary table. Relationships between sub-domains of SarQoL and nutritional status
Dependent variable
Physical, mental health of SarQoL
|
B
|
SE
|
95% CI for B
|
P value
|
Lower
|
Upper
|
SARC_F (ref: <4)
|
-11.741
|
2.313
|
-16.293
|
-7.189
|
<.001
|
SMI (ref: robust)
|
-1.537
|
2.843
|
-7.131
|
4.057
|
.589
|
Calf circumference (ref: robust)
|
-3.102
|
1.865
|
-6.771
|
.568
|
.097
|
Grip strength (ref: robust)
|
-2.879
|
2.216
|
-7.240
|
1.481
|
.195
|
TUG (ref: robust)
|
-1.298
|
2.048
|
-5.327
|
2.731
|
.527
|
Determine (score: 3-5)
|
-4.353
|
2.029
|
-8.345
|
-.361
|
.033
|
Determine (score: ≥ 6)
|
-7.013
|
2.291
|
-11.522
|
-2.504
|
.002
|
Locomotion of SarQoL
|
|
|
|
|
|
SARC_F (ref: <4)
|
-16.935
|
3.128
|
-23.089
|
-10.781
|
<.001
|
SMI (ref: robust)
|
.104
|
3.844
|
-7.459
|
7.667
|
.978
|
Calf circumference (ref: robust)
|
3.820
|
2.521
|
-1.141
|
8.781
|
.131
|
Grip strength (ref: robust)
|
-4.174
|
2.996
|
-10.069
|
1.721
|
.165
|
TUG (ref: robust)
|
-8.010
|
2.768
|
-13.457
|
-2.563
|
.004
|
Determine (score: 3-5)
|
-6.127
|
2.743
|
-11.523
|
-.730
|
.026
|
Determine (score: ≥ 6)
|
-14.801
|
3.098
|
-20.896
|
-8.705
|
<.001
|
Body composition of SarQoL
|
|
|
|
|
|
SARC_F (ref: <4)
|
-13.009
|
2.389
|
-17.710
|
-8.308
|
<.001
|
SMI (ref: robust)
|
-2.282
|
2.936
|
-8.060
|
3.495
|
.438
|
Calf circumference (ref: robust)
|
-1.770
|
1.926
|
-5.559
|
2.020
|
.359
|
Grip strength (ref: robust)
|
-2.756
|
2.289
|
-7.260
|
1.747
|
.229
|
TUG (ref: robust)
|
-.603
|
2.115
|
-4.765
|
3.558
|
.776
|
Determine (score: 3-5)
|
-4.924
|
2.095
|
-9.047
|
-.802
|
.019
|
Determine (score: ≥ 6)
|
-5.670
|
2.367
|
-10.327
|
-1.013
|
.017
|
Functionality of SarQoL
|
|
|
|
|
|
SARC_F (ref: <4)
|
-13.897
|
2.500
|
-18.815
|
-8.979
|
<.001
|
SMI (ref: robust)
|
1.964
|
3.072
|
-4.080
|
8.008
|
.523
|
Calf circumference (ref: robust)
|
-.806
|
2.015
|
-4.770
|
3.159
|
.690
|
Grip strength (ref: robust)
|
-3.818
|
2.394
|
-8.529
|
.894
|
.112
|
TUG (ref: robust)
|
-6.869
|
2.212
|
-11.223
|
-2.516
|
.002
|
Determine (score: 3-5)
|
-5.542
|
2.192
|
-9.855
|
-1.229
|
.012
|
Determine (score: ≥ 6)
|
-7.480
|
2.476
|
-12.352
|
-2.609
|
.003
|
Activities of daily living of SarQoL
|
|
|
|
|
|
SARC_F (ref: <4)
|
-14.336
|
2.166
|
-18.597
|
-10.075
|
<.001
|
SMI (ref: robust)
|
-.660
|
2.661
|
-5.897
|
4.577
|
.804
|
Calf circumference (ref: robust)
|
1.885
|
1.746
|
-1.550
|
5.320
|
.281
|
Grip strength (ref: robust)
|
-5.103
|
2.075
|
-9.185
|
-1.021
|
.014
|
TUG (ref: robust)
|
-7.210
|
1.917
|
-10.981
|
-3.438
|
<.001
|
Determine (score: 3-5)
|
-5.857
|
1.899
|
-9.594
|
-2.121
|
.002
|
Determine (score: ≥ 6)
|
-5.287
|
2.145
|
-9.508
|
-1.067
|
.014
|
Leisure activities of SarQoL
|
|
|
|
|
|
SARC_F (ref: <4)
|
-1.996
|
3.399
|
-8.683
|
4.692
|
.558
|
SMI (ref: robust)
|
-2.400
|
4.177
|
-10.618
|
5.819
|
.566
|
Calf circumference (ref: robust)
|
.469
|
2.740
|
-4.921
|
5.860
|
.864
|
Grip strength (ref: robust)
|
2.923
|
3.256
|
-3.483
|
9.330
|
.370
|
TUG (ref: robust)
|
-1.193
|
3.008
|
-7.112
|
4.727
|
.692
|
Determine (score: 3-5)
|
-8.662
|
2.981
|
-14.527
|
-2.797
|
.004
|
Determine (score: ≥ 6)
|
-14.943
|
3.367
|
-21.567
|
-8.319
|
<.001
|
Fears of SarQoL
|
|
|
|
|
|
SARC_F (ref: <4)
|
-3.935
|
2.234
|
-8.330
|
.461
|
.079
|
SMI (ref: robust)
|
2.397
|
2.745
|
-3.005
|
7.799
|
.383
|
Calf circumference (ref: robust)
|
.977
|
1.801
|
-2.566
|
4.520
|
.588
|
Grip strength (ref: robust)
|
-7.243
|
2.140
|
-11.454
|
-3.032
|
.001
|
TUG (ref: robust)
|
2.299
|
1.977
|
-1.592
|
6.190
|
.246
|
Determine (score: 3-5)
|
-2.227
|
1.959
|
-6.082
|
1.628
|
.257
|
Determine (score: ≥ 6)
|
-4.275
|
2.213
|
-8.629
|
.079
|
.054
|
|
|
|
|
|
|
|
Adjusted for demographic characteristics (sex, age, living alone, education level, smoking) and depressive symptoms.
Abbreviations: OR, odds ratio, TUG, timed up and go, SMI, skeletal muscle index, Determine: Disease, Eating poorly, Tooth loss, Mouth pain, Economic hardship, Reduced social contact, Multiple medicines, Involuntary weight loss or gain, Need for assistance in self-care, and Elderly, SarQoL: Sarcopenia-specific Quality of Life