As early as the age of 30, we tend to lose muscle mass and muscle strength at a gradual pace. However, some of us tend to lose it at a steeper rate.

This condition is called sarcopenia, unfortunately rather common among older adults.

Sarcopenia literally means “lack of flesh,” a disease of the skeletal muscles that makes them weaker over time.

This leads to muscle loss which can cause problems like weakness, frailty, memory loss and even death. Sarcopenia is now recognized as a disease.

As we get older, we tend to lose muscle, which can make it harder to do things like lift heavy things or walk long distances. Therefore, older adults with sarcopenia might notice that they have muscle weakness, slow walking speed, muscle shrinkage, falling, and difficulty performing normal daily activities.

Our study showed that one in 20, or 5% of older adults aged 60 years and above in Malaysia has sarcopenia, and 3.6% experience severe sarcopenia.

More concerning, we discovered that older adults with sarcopenia are 80% more likely to have cognitive impairment than those without sarcopenia.

Furthermore, those with severe sarcopenia are at a higher risk of cognitive impairment.. This means that having weak muscles makes it more likely that you will have trouble thinking and remembering, thus highlighting the importance of maintaining muscle mass and muscle strength.

While advancing age is a risk factor for sarcopenia, studies have shown that other factors may contribute to the condition as well. These include:

■ Inadequate calories and protein intake.

■ Immobility and muscle disuse, as this leads to accelerated muscle loss and increasing weakness. This could arise from prolonged bed rest or immobilization after an injury or illness.

■ Chronic inflammatory conditions such as rheumatoid arthritis, inflammatory bowel disease and chronic obstructive bowel disease. This is because inflammation disrupts the normal balance of muscle breakdown and muscle growth resulting in net muscle loss.

■ Other conditions such as obesity, smoking, diabetes and other non-communicable diseases (such as chronic kidney disease and chronic liver disease).

Although the link between sarcopenia and cognitive impairment is not yet fully understood, studies are ongoing to better understand the connection.

The “Common Cause Hypothesis” suggests that there is a common factor that affects both physical and cognitive function. This means that the decline in physical function that occurs in sarcopenia may also be linked to cognitive impairment.

As we age, our bodies go through many changes that can lead to muscle weakness and cognitive decline. These changes include changes in the brain, loss of neurons, and changes in the way muscles work.

Several studies have shown that sarcopenia often precedes cognitive impairment. This means that the loss of muscle mass, function and strength happens before the reduction of cognitive function. This is likely because the decline in physical function affects the brain and other cognitive processes.

Sarcopenia is preventable via common remedies such as exercise and adequate protein intake.

Regular exercise prevents sarcopenia while resistance exercise reverses sarcopenia.

The World Health Organization (WHO) recommends 150 minutes per week of moderate exercises such as brisk walking or 75 minutes per week of vigorous exercise such as jogging.

Resistance exercise includes the usage of the resistance band, weightlifting or performing exercise using own body weight such as squats, planks or push-ups. It is recommended to be conducted twice weekly, with 48 hours intervals, repeated 6-12 times for 1-3 sets with increasing weight load.

Protein intake is required for the signaling of muscle growth.

As age increases, our muscle becomes even more resistant to this signal requiring a greater amount of protein intake to stimulate muscle growth.

Therefore, an adequate protein intake of at least 1g per kg of body weight is recommended to prevent sarcopenia.

In addition, vitamin D is found to be protective against sarcopenia by increasing muscle strength.

As our population continues to age, it is becoming increasingly important to address the issue of sarcopenia and its impact on Malaysian older adults.

With a focus on promoting “Gaya Hidup Sihat” such as exercise and good nutrition, we can work towards preventing sarcopenia and ensuring that older adults in Malaysia continue to enjoy a high quality of life!

References:

1. Ramoo K, Hairi NN, Yahya A, Choo WY, Hairi FM, Peramalah D, Kandiben S, Bulgiba A, Ali ZM, Razak IA, Ismail N, Ahmad NS. Longitudinal Association between Sarcopenia and Cognitive Impairment among Older Adults in Rural Malaysia. Int J Environ Res Public Health. 2022 Apr 14;19(8):4723. doi: 10.3390/ijerph19084723. PMID: 35457592; PMCID: PMC9025848.
2. Lim WS, Cheong CY, Lim JP, Tan MMY, Chia JQ, Malik NA, Tay L. Singapore Clinical Practice Guidelines For Sarcopenia: Screening, Diagnosis, Management and Prevention. J Frailty Aging. 2022;11(4):348-369. doi: 10.14283/jfa.2022.59. PMID: 36346721.

(Dr. Karthikeyanathan Ramoo and Professor Dr. Noran Naqiah Hairi, Public Health Department, Universiti Malaya.)