Sarcopaenia which is not discussed much, is a disease that occurs as one gets older due to the wasting of members and organs. This phenomenon is also observed in muscles. It is estimated however that  1 in 4 adults over  65 years have  Sarcopaenia. We had a chat with Dr. Shehan Silva, Consultant Physician/ Geriatrician on Sarcopaenia.

Q WHAT IS SARCOPAENIA? With the advancement of age, there is a loss of body functions as well as a wasting of members and organs. This phenomenon is also observed in muscles. The disease entity of Sarcopaenia was described in the 1990’s and remains an undetected and unappreciated entity. The word sarx in Greek means flesh, while paenia denotes loss. In Sarcopaenia one would observe the loss of muscle mass(quantity) along with strength (quality) leading to poor performance and reduced exercise endurance.

Q HOW COMMON IS IT? It is estimated that 1 in 4 adults older than 65 years of age have Sarcopaenia. Sarcopaenia increases with age. Three out of 5 adults endure its effects by 80 years of age. Q WHAT CAUSES IT? Sarcopaenia is caused by age-related abnormalities in hormones and body chemicals. As one ages there is general wear and tear of muscles just like all organs. However, it is accentuated by diseases such as ischaemic heart disease, diabetes, chronic infections, nutritional deficiencies etc. This results in harmful chemicals that are produced by the body resulting in inflammation. (i.e. ‘inflammageing’)

Q WHAT ARE THE SYMPTOMS OF SARCOPAENIA AND HOW IS IT DIAGNOSED? ANY PARTICULAR TESTS THAT CAN BE DONE TO DIAGNOSE IT? One would observe the wasting away of the body's lean muscle mass with reduced muscle mass. This will be accompanied by poor strength, fatigue and reduced exercise tolerance. It should however be noted that certain obese individuals although their weight may be at a higher level, may in fact have excess fat deposition with reduced muscle mass. This paradoxical condition is called ‘sarcobesity’. Sarcopaenic patients are also prone to unsteadiness in standing and walking, resulting in recurrent falls and their consequences. Furthermore, it reduces exercise endurance and affects walking speed and stride causing immobility. Ultimately it leads to poor quality of life. Sarcopaenia is detected by clinical examination by a physician or a geriatrician by a conscientious screening of older adults. This includes assessment of strength, assessment of walking, rising from a chair, and climbing a flight of stairs. The timed up-and-go test (TUG test) is also a useful bedside test. A person who takes more than 10 seconds to stand up from a chair, walk a distance of 10 metres, turn around and return to seat reflects the possible existence of Sarcopaenia. This simple screening test can be used by you as well to self-detect frailty. Confirmation of Sarcopaenia ideally requires high fidelity tests such as bioimpedance analysers and DEXA scanners.
 

Q WHAT IS THE BEST TREATMENT FOR IT? The best treatment is a combination of physical exercise complemented with good nutrition. Most adults in this day and age engage in aerobic or endurance exercise such as walking, jogging, running and swimming. In a similar level of zeal, engagement in resistance or strength training exercises should be encouraged. These include stretching muscles and maintaining states in the form of resistance bands, simple weights etc. One need not go to a gym to do such activities. All that is needed is some improvisation by engaging in lifting sandbags, sacks of cereals/ cans of water etc. Exercise prescription is also done by trained sports physicians. Nutrition goes hand in hand as well. It is advised that patients consume adequate quantities of proteins with sparing levels of carbohydrates and fats. In particular, proteins that have the essential amino acid leucine is encouraged. Food items such as dairy products, cereals, pulses meats and fish are rich sources of leucine. It is noteworthy that whey: the protein in milk after curdling is a rich source of leucine. Whey protein can be prescribed in a judicious manner for some individuals as a nutritional enhancement.

Q CAN YOU REVERSE SACROPAENIA AND  IF SO, HOW? Sarcopaenia can be reversed by the gradual introduction of exercise/ physiotherapy along with nutrition as mentioned before. It is also essential that underlying active as well as chronic medical conditions are cured or controlled well. These include diabetes, nutritional deficiencies, certain cancers etc.

Q WHO IS MOST AT RISK OF SARCOPAENIA? Advancing age is highly associated with Sarcopaenia. However, it may even manifest in young patients if they are suffering from a poorly controlled illness. Furthermore, individuals who are sedentary couch potatoes and those having meagre diets may be at risk of developing Sarcopaenia or even having it undetected.

Q WHAT VITAMINS IF ANY PREVENT AGE-RELATED MUSCLE LOSS? Fortification of Vitamin D and calcium in the diet as well as via supplements have shown promising results in counteracting sarcopaenia. These ensure maintaining the integrity of healthy and efficient muscles.

Q WHAT ARE SOME OF THE MISCONCEPTIONS OF SARCOPAENIA? Sarcopaenia can be misconceived as a wasting disease such as tuberculosis or cancer. Although those illnesses may be accompanied and influenced by Sarcopaenia, it is important that a sedentary life and poor nutrition are considered as influencers of primary Sarcopaenia. As stated above, do not assume that obese individuals have higher levels of muscles due to their body composition. In fact, they may be falsely seen with greater amount of fat tissue as opposed to much required lean mass.

Q ARE PEOPLE WITH SARCOPENIA AT RISK OF ANY OTHER ILLNESSES? As individuals with low muscle mass have poor strength, they may be afflicted by mobility issues and falls. These may result in serious repercussions such as fractures, soft tissue trauma such as lacerations, bruising and blood boils(haematoma). Muscle integrity is required to maintain a steady state of body functions. This is known as physiological reserve. As muscles become depleted and inefficient, patients may be at risk and poor or later recovery of critical illnesses (such as heart attacks) and infections.

Q ANYTHING ELSE YOU WOULD LIKE TO ADD  ON SARCOPAENIA? If you or your loved one overtly fatigues or feels weak along with a poor appetite, these may be subtle musings of Sarcopaenia. Furthermore, a change in body composition to wasting or significant obesity (accompanied by muscle weakness) may also point towards this disease. If so, please seek the advice of a physician who has interest in elderly care (geriatric medicine). One should remember that they need to be active (especially with resistance exercise) and consume nutritious food to reverse or prevent Sarcopaenia.

By Kshalini Nonis