Predictive Values of the New Sarcopenia Index by the Foundation for the National Institutes of Health Sarcopenia Project for Mortality among Older Korean Adults

November Predictive Values of the New Sarcopenia Index by the Foundation for the National Institutes of Health Sarcopenia Project for Mortality among Older Korean Adults Joon Ho Moon 0 1 2 3 Kyoung Min Kim 1 2 3 Jung Hee Kim 0 1 2 3 Jae Hoon Moon 1 2 3 Sung Hee Choi 1 2 3 Soo Lim 1 2 3 Jae-Young Lim 1 3 Ki Woong Kim 1 3 Kyong Soo Park 0 1 2 3 Hak Chul Jang 1 2 3 0 Department of Internal Medicine, Seoul National University Hospital , Seoul , Korea , 3 Department of Internal Medicine, Seoul National University Bundang Hospital , Seongnam , Korea , 4 Department of Rehabilitation Medicine, Seoul National University Bundang Hospital , Seongnam , Korea , 5 Department of Neuropsychiatry, Seoul National University Bundang Hospital , Seongnam , Korea 1 Research Foundation Grant by Ministry of Education , Science, and Technology , Republic of Korea (2006±2005410, URL: 2 Department of Internal Medicine, Seoul National University College of Medicine , Seoul , Korea 3 Editor: Stephen E Alway, West Virginia University School of Medicine , UNITED STATES - Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Objective Methods We evaluated the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project's recommended criteria for sarcopenia's association with mortality among older Korean adults. We conducted a community-based prospective cohort study which included 560 (285 men and 275 women) older Korean adults aged 65 years. Muscle mass (appendicular skeletal muscle mass-to-body mass index ratio (ASM/BMI)), handgrip strength, and walking velocity were evaluated in association with all-cause mortality during 6-year follow-up. Both the lowest quintile for each parameter (ethnic-specific cutoff) and FNIH-recommended values were used as cutoffs. Results Forty men (14.0%) and 21 women (7.6%) died during 6-year follow-up. The deceased subjects were older and had lower ASM, handgrip strength, and walking velocity. Sarcopenia defined by both low lean mass and weakness had a 4.13 (95% CI, 1.69±10.11) times higher risk of death, and sarcopenia defined by a combination of low lean mass, weakness, and slowness had a 9.56 (3.16±28.90) times higher risk of death after adjusting for covariates in men. However, these significant associations were not observed in women. In terms of cutoffs of each parameter, using the lowest quintile showed better predictive values in Competing Interests: The authors have declared that no competing interests exist. mortality than using the FNIH-recommended values. Moreover, new muscle mass index, ASM/BMI, provided better prognostic values than ASM/height2 in all associations. Conclusions New sarcopenia definition by FNIH was better able to predict 6-year mortality among Korean men. Moreover, ethnic-specific cutoffs, the lowest quintile for each parameter, predicted the higher risk of mortality than the FNIH-recommended values. Introduction Populations are rapidly aging and this has become a global health burden [ 1 ]. Aging is accompanied by body composition changes, and Rosenberg first proposed the term ‘sarcopenia’ to describe age-related pathologic loss of skeletal muscle mass [ 2 ]. Skeletal muscles play a crucial role in humans, and therefore sarcopenia has resulted in various adverse health outcomes including fracture, fall, disability, and mortality [ 3, 4 ]. Sarcopenia was initially defined as relative appendicular skeletal muscle mass (ASM) less than 2 standard deviations below the mean values of healthy young adults or the lowest quintile of study populations [ 4, 5 ]. ASM divided by height squared (ASM/ht2) was first proposed by Baumgartner as a representative method to estimate relative ASM [4]. Recent studies, however, indicated that decline in muscle strength or physical performance may be more important in health outcomes related to sarcopenia [ 6 ]. Based on this, the criteria combining ‘reduced muscle mass with either muscle weakness or poor physical performance’ has been proposed by study groups including the European Working Group for Sarcopenia in Older People and the Asian Working Group for Sarcopenia (AWGS) [ 7, 8 ]. These criteria demonstrated better associations with various outcomes than the definitions driven only by muscle mass [ 9, 10 ]. A number of working groups have suggested different criteria for sarcopenia, but each has different clinical implications [ 11 ] and no consensus has been achieved for ‘gold standard’ criteria for sarcopenia. The Foundation for the National Institutes of Health (FNIH) Biomarkers Consortium initiated ‘The FNIH Sarcopenia Project’ to derive, using the best available data, criteria for clinically relevant low lean mass and weakness that correspond to incident mobility impairment [ 12 ]. A total of 26,625 participants from nine large community-based cohorts were pooled for the analysis, and the new FNIH criteria were proposed in 2014, the cutof (...truncated)