Is Sarcopenia Unavoidable As We Age?

By Jody Bergeron, RN, BSN, MS, CEN

As we age, our bodies are constantly changing from the time we are born up into our “golden years.”   How can we best maintain our bodies for optimum health and performance?  The overall life expectancy in the U.S. continues to increase due to increased longevity and advanced medical care treatments. Preventative measures can help maintain physical functioning as we age (1).

Over time there is a progressive loss of tissue and organ function as we get older. Unfortunately, this starts at the young age of 30 years!  There is a decline of .1% to .5 % loss of skeletal muscle mass per year.  This rapidly accelerates after the age of 65 years old and is accompanied by a decrease in strength (1).   This age-related phenomenon of reduced muscular mass and function is called Sarcopenia.   There is no widely accepted meaning for Sarcopenia (Greek, Sarx for “flesh” and Penia for “loss”) and therefore it remains under recognized and inadequately managed due to lack of diagnostic testing and criteria (2). Sarcopenia treatment includes healthy food choices and exercise that helps build muscle and support healthy aging.

Making the Sarcopenia Diagnosis

In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) defined the syndrome as progressive and generalized loss of skeletal muscle mass and strength with an increased risk of adverse outcomes (physical disability, poor quality of life and death) (1, 2).

Approximately 36.5% of U.S. adults with an average age of 70.1 years have sarcopenia.  Sarcopenia is diagnosed through assessment of multiple factors including handgrip strength, calf circumference, gait/walking speed, DEXA (dual energy X-ray absorptiometry, BIA (bioelectrical impedance analysis, ultrasound, MRI and CT (1,2).

Sarcopenia can predispose seniors to:

• Osteopenia
• Frailty
• Insulin resistance
• Type 2 diabetes
• Metabolic syndrome (high glucose, dyslipidemia, hypertension, and increased waist circumference)

These conditions contribute to an increased risk of stroke and cardiovascular disease. (3)

Sarcopenia Symptoms

The development of Sarcopenia has many factors, and the severity is also highly variable depending on risk factors.  The stages of Sarcopenia include pre-sarcopenia, sarcopenia and severe sarcopenia depending upon the severity of muscle mass and strength loss and performance (2).  One of the most significant risk factors for Sarcopenia is lack of exercise and physical activity.   Neuromuscular degeneration characterized by an atrophy of type II muscle fibers leads to muscle being replaced by fat and connective tissue (1,2).  Reduced hormone concentrations (growth hormone, sex hormones, thyroid hormone, insulin like growth factor) also contributes to an increase in visceral fat and decrease in lean body mass and bone mineral density (1,2).

Increased inflammatory markers and cortisol in addition to oxidative stress associated with aging can all contribute to chronic low-grade inflammation.  Low vitamin D levels and insulin resistance are also key factors to consider.  Seniors may also have inadequate caloric and protein intake.  This issue is multidimensional due to: diminished appetite, altered sense of taste/smell, poor dentition, gastrointestinal changes, medication side effects, depression, dementia and lack of social interactions especially in this current pandemic with social distancing.

Sarcopenia Treatment

Preventative measures along with early recognition and intervention are critical to keep seniors functioning at optimum level and keep Sarcopenia at bay.  Increasing awareness in the general public and with all health care providers should be a priority.  Exercise (strength and resistance training), proper nutrition, stress management and adequate rest/sleep are key measures in the development of a preventative action plan.   Consulting with primary care physicians to inquire about physical therapy consults, vitamin D optimization, increasing protein intake and other possible therapeutics if needed.

Food First Focus

A higher than Recommended Daily Allowance protein intake from the recommended .8g/kg/day to (1.2 to 1.6g/kg/day) has been suggested for Sarcopenia prevention (2).   Specific nutrients to focus on increasing in meal planning include: carotenoids (carotene, lycopene, xanthophyll, lutein, and zeaxanthin), selenium, vitamins C and E and omega-3 fatty acids or long chain polyunsaturated fatty acids (PUFAs).  In addition to meeting protein needs, attention to the human gut microbiota or microbiome should also be optimized as alterations can have inflammatory effects (1).

Focus on high quality proteins or complete proteins which contain essential amino acids:

• Eggs
• Dairy
• Fish/Seafood (Salmon, Tuna, Sardines)-also high in omega-3 fatty acids Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)
• Seafood (Shrimp, Crab, Scallops)
• Poultry
• Lean Beef
• Quinoa
• Soy (Edamame, Tofu, Tempeh, Miso)

Carotenoids are what give fruits and vegetables the deep yellow, orange and red hues. These colorful carotenoids are best absorbed when consumed with a small amount of fat.

Sources of Carotenoids:

• Pumpkins, Sweet Potatoes, Carrots, Squash
• Papaya, Cantaloupe, Corn, Spinach, Kale
• Red Pepper, Tomato Paste, Watermelon
• Tangerine, Nectarine, Red Grapefruit

Selenium is a trace element that serves as an antioxidant.  As we age our selenium concentrations decrease.  Sources of Selenium:

• Brazil Nuts, Mushrooms, Seafood (Tuna, Oysters, Clams, Halibut, Crab)

Vitamin C or ascorbic acid is a water-soluble vitamin and functions as the primary circulating antioxidant of the body.

Sources of this multi functional stress vitamin include:

• Citrus- Oranges, Grapefruit, Lemons, Limes
• Kiwis
• Strawberries
• Asparagus
• Red Peppers

Vitamin E is a fat-soluble vitamin with antioxidant properties.   Sources of Vitamin E:

• Sunflower seeds
• Almonds
• Hazelnuts
• Safflower Oil, Olive Oil

What Does the Future Hold To Prevent Sarcopenia?

Further research is needed in these areas, but some of the following components are being investigated for their possible role in reducing muscle loss with aging.

• Nutrition/Herbal Supplements (Curcumin, Catechins, Proanthocyanidin, Gingerols, Creatine Monohydrate)
• β –hydroxy β –methylbutyrate (HMB)
• Ornithine α –ketoglutarate (OKG)
• Testosterone
• Selective Androgen Receptor Modulators (SARMs)
• Growth Hormone/IGF-1
• Ghrelin and Ghrelin Receptor Agonists
• Agiotensin-Converting Enzyme Inhibitors (ACEIs)
• Anti-Inflammatory Agents/Monoclonal Antibodies (Infliximab, Tocilizumab)

Active strength training exercises and optimum nutrition are cornerstone strategies in avoiding Sarcopenia in older individuals.  An active lifestyle is essential; activities like walking, swimming, biking, and gardening are great ways to keep moving.  In addition to staying active, a restful night sleep, stress management, and Vitamin D optimization are important. Include a nutrient dense diet rich in fruits, vegetables, whole grains, high quality protein, healthy fats, nuts and seeds. These foods will not only decrease the risk of sarcopenia, but will benefit other chronic conditions such as hypertension, diabetes, metabolic syndrome, osteoporosis, cardiovascular disease and stroke. Physical activity can also help to combat feelings of depression and social isolation.

Jody Bergeron, RN, BSN, MS, CEN, works in critical care for Cape Cod Healthcare. She obtained her master’s in human nutrition from the University of Bridgeport and was enrolled at the University of Alabama’s College of Human Environmental Sciences Online Dietetics program. Jody has 30 years of experience working in healthcare with the past 20 years in critical care nursing. She served 9 years in the Army Reserve as a military officer in a Combat Support Hospital as a critical care RN.

References

1. Liguori I, Russo G, Aran L, et al. Sarcopenia: assessment of disease burden and strategies to improve outcomes. Clin Interv Aging. 2018;13:913-927. Published 2018 May 14. doi:10.2147/CIA.S149232\
2. Dhillon RJ, Hasni S. Pathogenesis and Management of Sarcopenia. Clin Geriatr Med. 2017;33(1):17-26. doi:10.1016/j.cger.2016.08.002
3. Sullivan, J, et al. Strength training for health in adults:  Terminology, principles, benefits and risks.  2020; 1-50.