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Impact of Malnutrition on Low Muscle Mass in Community-Dwelling Older People in Singapore: Findings from the SHIELD study

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Abstract

Objectives Malnutrition contributes to loss of muscle mass. There is limited information on the prevalence of low muscle mass in community-dwelling older people who are (not) at risk of malnutrition. Factors associated with muscle mass are also not well characterized. This cross-sectional study aimed to determine the prevalence of low appendicular skeletal muscle mass index (ASMI; ASM/height2) in older people with normal nutritional status (Malnutrition Universal Screening Tool, MUST risk category = low) and those at risk of malnutrition (MUST risk category = medium or high), and to determine factors associated with ASMI. Methods Strengthening Health In ELDerly through nutrition (SHIELD) is a study involving 1211 (400 with normal nutritional status and 811 at risk of malnutrition) community-dwelling older people aged ≥65 years in Singapore. Low ASMI was determined by bioelectrical impedance analysis (Asian Working Group for Sarcopenia, 2014). Results One in five (20.6%) nourished participants had low ASMI vs. four in five (81.3%) participants at risk of malnutrition had low ASMI (P < 0.0001). Older people with low ASMI were more likely to be admitted to the hospital, had longer length of stay, 25-hydroxyvitamin D deficiency, and lower education level, compared to those with normal ASMI (all P ≤ 0.0472). In the multiple linear regression model, age (coefficient, b = −0.013 kg/m2; P < 0.001), gender (female: b = −0.963 kg/m2; P < 0.001), calf circumference (b = 0.042 kg/m2; P < 0.001), bone mass (b = 0.593 kg/m2; P < 0.001), BMI (b = 0.129 kg/m2; P < 0.001), and Physical Activity Scale for the Elderly (PASE) score (b = 0.001 kg/m2; P = 0.048) were associated with ASMI. Conclusions Community-dwelling older people at risk of malnutrition had four-fold greater risk of having low ASMI as compared to nourished counterparts. Increasing age was associated with lower ASMI, whereas calf circumference, bone mass, BMI, PASE score, and being male were positively associated with ASMI. These findings highlight the importance of screening for low muscle mass and maintaining muscle health as part of the overall malnutrition management in this population group. Funding Sources The Economic Development Board of Singapore, Abbott Nutrition, and Changi General Hospital funded this study.
80 Aging and Chronic Disease
Impact of Malnutrition on Low Muscle Mass in Community-
Dwelling Older People in Singapore: Findings from the SHIELD
study
Siew Ling Tey1, Samuel Teong Huang Chew2, Yatin Berde3,
Geraldine Baggs4,ChoonHowHow
2, Magdalin Cheong2,Yen
Ling Low1,NgiapChuanTan
5,andDieuThiThuHuynh
1
1Abbott Nutrition Research and Development; 2Changi General
Hospital; 3Cognizant Technologies Solution Pvt. Ltd.; 4Abbott Labora-
tories; and 5SingHealth Polyclinics
Objectives: Malnutrition contributes to loss of muscle mass. There
is limited information on the prevalence of low muscle mass in
community-dwelling older people who are (not) at risk of malnutrition.
Factorsassociatedwithmusclemassarealsonotwellcharacterized.
This cross-sectional study aimed to determine the prevalence of low
appendicular skeletal muscle mass index (ASMI; ASM/height2)in
older people with normal nutritional status (Malnutrition Universal
Screening Tool, MUST risk category =low) and those at risk of
malnutrition (MUST risk category =medium or high), and to
determine factors associated with ASMI.
Methods: Strengthening Health In ELDerly through nutrition
(SHIELD) is a study involving 1211 (400 with normal nutritional
status and 811 at risk of malnutrition) community-dwelling older
people aged 65 years in Singapore. Low ASMI was determined by
bioelectrical impedance analysis (Asian Working Group for Sarcopenia,
2014).
Results: One in ve (20.6%) nourished participants had low ASMI
vs. four in ve (81.3%) participants at risk of malnutrition had
low ASMI (P<0.0001). Older people with low ASMI were more
likely to be admitted to the hospital, had longer length of stay, 25-
hydroxyvitamin D deciency, and lower education level, compared
to those with normal ASMI (all P0.0472). In the multiple linear
regression model, age (coecient, b =−0.013 kg/m2;P<0.001),
gender (female: b =−0.963 kg/m2;P<0.001), calf circumference
(b =0.042 kg/m2;P<0.001), bone mass (b =0.593 kg/m2;P<0.001),
BMI (b =0.129 kg/m2;P<0.001), and Physical Activity Scale for the
Elderly (PASE) score (b =0.001 kg/m2;P=0.048) were associated with
ASMI.
Conclusions: Community-dwelling older people at risk of malnu-
trition had four-fold greater risk of having low ASMI as compared
to nourished counterparts. Increasing age was associated with lower
ASMI, whereas calf circumference, bone mass, BMI, PASE score, and
being male were positively associated with ASMI. These ndings high-
light the importance of screening for low muscle mass and maintaining
muscle health as part of the overall malnutrition management in this
population group.
Funding Sources: TheEconomicDevelopmentBoardofSingapore,
Abbott Nutrition, and Changi General Hospital funded this study.
CURRENT DEVELOPMENTS IN NUTRITION
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... The contribution of physiotherapists is often overlooked, but nutrition and physical therapy have synergistic effects in improving health and function [61]. Malnutrition affects muscle health; data from the SHIELD study show that four in five community-dwelling older adults in Singapore who were at risk of malnutrition had low muscle mass [62], and 76% were sarcopenic based on the Asian Working Group for Sarcopenia (AWGS) 2019 cut-offs [63]. Therefore, physiotherapists play an important role in educating patients on physical rehabilitation and exercises for bone and muscle health, which will lead to an overall improvement in appetite and function. ...
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The nutritional status of hospitalised patients is often at risk or compromised and predisposed to further deterioration after discharge, leading to poor clinical outcomes, high healthcare costs, and poor quality of life. This paper aims to provide evidence-based best-practice recommendations to address this, supported by a national survey of healthcare professionals in Singapore and reviewed by a multidisciplinary expert panel under the Sarcopenia Interest Group of Society of Parenteral and Enteral Nutrition Singapore (SingSPEN). We advocate screening all patients with a validated tool which includes a disease activity/burden component, an easily accessible dietitian referral pathway for patients at risk of malnutrition, and an individualised nutrition care plan formulated and delivered using a multidisciplinary team approach for patients at risk or with malnutrition. A comprehensive team would include not only dietitians but also physicians, nurses, physiotherapists, speech therapists, and medical social workers working together towards a common goal. Information on why nutrition is important for good health and how it can be achieved should also be provided to all patients and their caregivers before and after hospital discharge. With the above recommendations, we seek to improve upon the current nutrition care processes at discharge for healthcare institutions in Singapore.
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