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

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.

Full text

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 P≤0.0472). 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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