| Objective:To improve the understanding of sarcopenia assessing techniques, mobility and influencing factors of elderly hospitalized patients in cardiovascular department of internal medicine.Methods:The study enrolled 400 patients with aged 60 years among hospitalized patients in department of cardiology, form November 2015 to January 2016, the first Hospital of Jilin University. According to the European Working Group on Sarcopenia in Older People(EWGSOP), sarcopenia was defined as the presence of both low muscle mass and low muscle function. Muscle mass was evaluated using mid-arm muscle circumference(MAMC) and using bioelectrical impedance analysis(BIA). MAMC was calculated from mid-arm circumference(MAC) and triceps skinfold thickness(TSF) with the formula(Landi 2012). Muscle mass assessed by BIA, adjusted for height or weight, had three formula, Janssen 2002, Janssen 2004 and Baumgartner1998. Muscle function was evaluated by HGS. Motality of sarcopenia were counted from diffrent reference formula, according to the cut-off points respectively. The degree of agreement between the four reference formula of sarcopenia was evaluated using kappa. Association between muscle mass measured by BIA or estimated by MAMC was assessed using Spearman’s correlation coefficient. The patients were divided into two groups of sarcopenia and non-sarcopenia, according to Janssen 2004 recommended by EWGSOP 2004. Clinical data, biochemical indicators and echocardiographic of patients were collected. Nutritional status was evaluated by Scored Patient-Generated Subjective Global Assessment(PG-SGA), all patients were divided into non-undernourished, moderate undernourished and severe undernourished. According to body mass index(BMI) divided into underweight,normal weight and obesity. Stage A, stage B, stage C and stage D represent the development of heart failure. T test and chi-square test were used to assess the differences indicators between sarcopenic and non-sarcopenic groups, including gender, age, smoking history, drinking history, hypertension, diabetes mellitus, MAC,TSF, height, weight, waist circumference, creatinine, albumin, hemoglobin, blood lipid, B-type natriuretic peptide(BNP), left ventricular end-diastolic diameter(LVEDd) and left ventricular ejection fraction(LVEF). Multivariable logistic regression models were used in order to identify factors associated with sarcopenia.ROC curve was drawn from the measurement data to determine the incidence of sarcopenia. Its sensitivity and specificity were analyzed.Statistical significance was set at P < 0.05.Results:Depending on reference criteria of Janssen 2002, Janssen 2004, Baumgartner1998 and Landi 2012, frequency of sarcopenia have a large gap varied from 19.29%to 35.40% for men and from 7.21% to 13.5% for women. According to EWGSOP’s criteria, 22.8% patients were sarcopenic. There was a good agreement(k=0.907,P<0.001) between reference formula Janssen 2004 and Baumgartner 1998 that estimated muscle mass by BIA. Agreement for Janssen 2002 versus Janssen 2004 and Baumgartner 1998 formula was moderate,(k=0.541,P<0.001)and(k=0.514,P<0.001), respectively. Agreement for Landi 2012 versus Baumgartner 1998, Janssen2002 and Janssen 2004 formula was lower,(k=0.473,P<0.001),(k=0.426,P<0.001)and(k=0.468,P<0.001), respectively. There was moderate correlation between BIA and MAMC(r=0.579). Compared with the non-undernourished group, the incidence of sarcopenia in moderate undernourished and severe undernourished group was higher(z=92.984,P<0.001). And approximately 6.25% of non-undernourished patients were sarcopenic. 64.29% of underweight patients were sarcopenic.Furthermore, 19.78% of overweight and obese patients were sarcopenic.According to heart failure staging, 65.09% patients of Stage C and D were sarcopenia, higher than Stage A and B(z=147.140,P < 0.001). Factors associated with sarcopenia were gerontism, male gender, underweight, undernourished, LVEDd increased, heart failure Stage C and D. The incidence of sarcopenia will increase when more than the age of68.5 and LVEDd greater than 55 mm.Conclusions:(1) Sarcopenia is frequent among hospitalized patients in department of cardiology and varies widely depending on the applied reference criteria.(2) There is a good consistency between Janssen 2004 recommended by EWGSOP and Baumgartner et al 1998, and both can be used to evaluat muscle mass.In spite of the fact that MAMC is more feasible than BIA, it is not recommended to evaluate muscle mass.(3)Independent risk factors associated with sarcopenia are male gender,underweight, being undernourished, LVEDd increased, heart failure Stage C and D.(4)Sarcopenia is identified in non-undernourished and among overweight and obese. |
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