COPD is associated with a progressive loss of muscle mass and function. However, there is an unmet need to define and standardise methods to estimate the prevalence of sarcopenia in COPD patients.We performed a systematic review and meta-analysis of the prevalence of this extrapulmonary manifestation in COPD patients. We searched Embase, Medline (Ovid), CINAHL (EBSCO), Web of Science, Scopus and Google Scholar for studies published up to January 17, 2019, assessing sarcopenia in COPD patients based on low muscle mass and decreased muscle function. Interventional studies, in vitro experiments, protocols or reviews and meta-analyses were excluded. We estimated heterogeneity (I2) and assessed significance (Q) using a Chi-squared test for estimates obtained from random-effects models.4465 articles were initially identified. After removing the duplicates and applying the selection criteria, we reviewed 62 full-text articles. Finally, 10 articles (n=2565 COPD patients) were included in this systematic review and meta-analyses. Overall, the prevalence of sarcopenia in patients with COPD was 21.6% (95% CI 14.6–30.9%, I2=94%), ranging from 8% in population-based to 21% in clinic-based studies, and 63% in COPD patients residing in nursing homes.Sarcopenia is frequently observed in COPD patients, with varying prevalence across population settings. Sarcopenia in COPD should be assessed using standardised tests and cut-off points from sarcopenia consensus criteria for clinical practice and international comparisons.

Sarcopenia, a complex multifactorial condition, is characterized by loss of muscle mass and function, which increases progressively with age. The existence of different definitions has contributed to the large variation in the prevalence estimates of sarcopenia. We aimed to estimate the prevalence of sarcopenia in the general population using the European Working Group on Sarcopenia in Older People (EWGSOP) proposed definition and compared baseline demographic and clinical characteristics between the nonsarcopenia, presarcopenia, and sarcopenia individuals, with particular emphasis on the overlap with osteoporosis and fracture risk. We studied 5911 subjects at a mean age of 69.2 years (55.8% female) with data on sarcopenia participating in the Rotterdam Study, a prospective population-based cohort study in Rotterdam, the Netherlands. Presarcopenia was defined as having only low muscle mass, whereas sarcopenia was defined based on the presence of low muscle mass, plus either low muscle strength or low physical performance. The prevalence of presarcopenia and sarcopenia was 5.9% and 4.4%, respectively. Individuals with sarcopenia were older, more often males, smokers, with less optimal dietary intake, and more often disabled with lower physical activity. Although the prevalence of fractures was higher in individuals with low lean mass (presarcopenic [16.6%] and sarcopenic [23.5%]) compared with the no sarcopenic group (15.5%), the differences were not present after correcting for age and sex. There were no statistical differences in the prevalence of chronic diseases, with the exception of a higher prevalence of COPD in presarcopenic (29.1%) and sarcopenic (26.9%) individuals compared with nonsarcopenic (13.4%) individuals. Osteoporotic individuals with (odds ratio [OR] = 2.59, 95% confidence interval [CI] 1.41-4.45) and without sarcopenia (OR = 2.75, 95% CI 2.01-3.75) had similar elevated risk of nonvertebral fractures. The presence of sarcopenia appears to be independent of chronic diseases with the exception of COPD and more related to lifestyle factors and disabilities. Sarcopenic individuals in the general population are at no greater risk of fracture than what is determined by their low bone mineral density. © 2018 American Society for Bone and Mineral Research.

BackgroundIncreasing evidence suggests that sarcopenia and a higher systemic immune-inflammation index (SII) are linked with morbidity in patients with chronic obstructive pulmonary disease (COPD). However, whether these two conditions contribute to all-cause mortality in middle-aged and older patients with COPD or asthma is unclear. Therefore, we investigated the association between sarcopenia, SII, COPD, or asthma and all-cause mortality in a large-scale population-based setting.MethodsBetween 2009 and 2014, 4482 participants (aged>55 years, 57.3% female) from the population-based Rotterdam Study were included. COPD and asthma patients were clinically and spirometry-based diagnosed. Six study groups were defined according to the presence or absence of COPD or asthma and sarcopenia. Cox regression models were used to assess all-cause mortality in the study groups, adjusted for sex, age, BMI, SII, smoking, oral corticosteroid use and comorbidities. In addition, all participants were categorised into sex-specific quartiles of SII and mortality in these groups was compared.ResultsOver a median follow-up of 6.1 years (IQR 5.0–7.2), 466 (10.4%) persons died. Independent of the presence of sarcopenia, participants with COPD had a higher risk of all-cause mortality (HR: 2.13 [95% CI: 1.46 to 3.12], and HR: 1.70 [95% CI: 1.32 to 2.18]). Compared to lower SII levels, higher SII levels increased mortality risk even in people without sarcopenia, COPD or asthma.ConclusionMiddle-aged and older people with COPD, higher SII levels or sarcopenia had an independently increased mortality risk. Our study suggests prognostic usefulness of routinely evaluating sarcopenia and SII in older people with COPD or asthma.

IntroductionSarcopenia is a heterogeneous skeletal muscle disorder involving the loss of muscle mass and function. However, the prevalence of sarcopenia based on the most recent definition remains to be determined in older people with chronic airway diseases.ObjectiveTo evaluate sarcopenia prevalence and association with chronic airway diseases and its lung function in an older population, using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria.MethodsWe performed a cross-sectional analysis in 5082 participants (mean age, 69.0±8.8 years, 56% females) from the Rotterdam Study. Participants with interpretable spirometry and an available assessment of sarcopenia were included. The appendicular skeletal muscle mass index (ASMI) and handgrip strength (HGS) were assessed using dual-energy X-ray absorptiometry (DXA) and a hydraulic hand dynamometer, respectively. We analysed the association between sarcopenia and chronic airway diseases by using regression models adjusted for age, sex, smoking status, total fat percentage and other relevant confounders.ResultsParticipants with chronic airway diseases had higher prevalence of probable sarcopenia (12.0%, 95% CI 10.2; 13.8) and confirmed sarcopenia (3.0%, 95% CI 2.1; 3.9) than without. Chronic airway diseases were associated with “probable sarcopenia” (OR=1.28, 95%CI 1.02, 1.60), “confirmed sarcopenia” (OR=2.13, 95%CI 1.33, 3.43), reduced HGS (β=−0.51 [−0.90; −0.11]) and reduced ASMI (β=−0.19 [−0.25; −0.14]). FEV1<80% was associated with lower HGS (β=−1.03 [−1.75; −0.31]) and lower ASMI (β=−0.25 [−0.36; −0.15]) than FEV1≥80%.ConclusionSarcopenia was prevalent and associated with chronic airway diseases among older population. These results suggest the need for early diagnosis of sarcopenia in older people with chronic airway diseases by applying EWGSOP2 recommendations.

Background The ageing population and its burden on health-care systems warrant early detection of patients at risk of functional decline and mortality. We aimed to assess frailty transitions and its accuracy for mortality prediction in subjects with impaired spirometry (Preserved Ratio Impaired Spirometry [PRISm] or Chronic Obstructive Pulmonary Disease [COPD]). Methods In participants from the population-based Rotterdam Study (mean age 69.1±8.9 years), we examined whether PRISm (Forced Expiratory Volume in 1 second [FEV1]/Forced Vital Capacity [FVC]≥70% and FEV1&lt;80%) or COPD (FEV1/FVC&lt;70%) affected frailty transitions (progression/recovery between frailty states [robust, prefrailty and frailty], lost to follow-up or death) using age-, sex- and smoking state-adjusted multinomial regression models yielding odd’s ratios (OR). Second, we assessed diagnostic accuracy of frailty score for predicting mortality in subjects with COPD using c-statistics. Results Compared to subjects with normal spirometry, subjects with PRISm were more likely to transit from robust (OR 2.2[1.2-4.2], p&lt;0.05) or prefrailty (OR 2.6[1.3-5.5], p&lt;0.01) towards frailty. Subjects with PRISm (OR 0.4[0.2-0.8], p&lt;0.05) and COPD (OR 0.6[0.4-1.0], NS) were less likely to recover from their frail state, and were more likely to progress from any frailty state towards death (OR between 1.1 and 2.8, p&lt;0.01). Accuracy for predicting mortality in subjects with COPD significantly improved when adding frailty score to age, sex and smoking status (90.5[82.3-89.8] vs 77.9[67.2-88.6], p&lt;0.05). Conclusion Participants with PRISm or COPD more often developed frailty with poor reversibility. Assessing physical frailty improved risk stratification for subjects with impaired spirometry for predicting increased life years.