We frequently see that our elderly people tend to be more fearful when walking, slow down their gait, and perform activities with greater physical and cognitive difficulty, and many even tend to fall into bed as a result of fractures due to falls, losing thus, the independence that we would all like to maintain until the last day of our lives.
We think that osteoporosis leads to bone fractures when the individual falls, but we must also think about the reason why the individual falls, such as muscle weakness, cognitive disability, joint problems, among others. One of the main protagonists of this problem is sarcopenia.
This loss of muscle mass does not always begin in old age, in fact, muscle production slows down when we reach the age of 30 If we do not stimulate with resistance exercises and we manage nutritional habits with a good supply of protein. In fact, the loss of muscle mass often goes unnoticed because it is supplanted by increased fat mass, even within the muscles becoming a marbling muscle.
Definition
Since 1997 where sarcopenia was defined based in a combination of two Greek words: sarx (meat) and penia (loss), it has been changed or better to say, modified based on the disease by itself and not based on just the age as before was consider.
In 2020, the Asian Working Group of Sarcopenia (AWGS) updated its Expert Consensus on the Diagnosis and Treatment of Sarcopenia Asia (AWGS2019), which defines sarcopenia as low muscle mass, low muscle strength, and/or low physical function. Currently, there is no internationally accepted diagnostic standard for the definition of sarcopenia”.
Is sarcopenia popular in the elderly?
Talking about the prevalence of sarcopenia in the elderly can be very non-specific and this is because research studies are carried out in different parts of the world and use different tools to measure fat or muscle mass.
So, how can we assess sarcopenia?
The European Working Group on Sarcopenia in Older People (EWGSOP) proposed cutoff points
• To evaluate muscle strength, the grip strength, “the grip strength of men with sarcopenia is less than 27 kg, and that of women is less than 16 kg (Cruz-Jentoft et al., 2019)”.
• Muscle mass measurement, “AWGS2019 recommends using DXA or DSM-BIA combined with the height-corrected appendicular skeletal muscle mass (ASM) index (ASM/height2).” Based on these, the cutoff to determine sarcopenia is a ratio less than 7 in men and 5.5 in women.
•To check physical function, it is necessary not just evaluate muscle function, but central and peripheral nerve function to analyze the cooperation of individual tissues and organs
Causes
The causes are variables that depend on several factors:
• AGE: After 35 years of age, muscle production not only decreases, but muscle mass is lost annually.
Over the years there is a decrease in satellite cells, which are the promoter cells of muscle cells.
• EXERCISES: From here lies the importance of doing routines with resistance (leagues, weights, machines) to avoid muscle loss and improve muscle tone.
• SLEEP: Muscle repair occurs at night while we sleep and our body enters a deep sleep. In old age, sleep in some cases ceases to be constant or deep
• STRESS: This factor increases the production of hormones that help muscle loss, not to mention that when we are stressed, we tend to prefer carbohydrates instead of proteins.
• NUTRITION: In the elderly, the general consumption of food decreases with preference for foods rich in carbohydrates and protein consumption decreases.
• PROTEIN CONSUMPTION: There is something between the microbiota and the taste palate that makes the elderly reduce the consumption of proteins (chicken, fish, eggs), commonly hearing the annoyance that this produces.
• ASSOCIATED DISEASES: Any chronic and/or inflammatory disease causes loss of muscle mass, either due to increased protein energy expenditure or the change in habit that this brings (sedentary lifestyle, decreased intake, chronic stress).
Sarcopenia is multifactorial and it is important to emphasize that one factor can drag down other factors and make it a cycle that is difficult to break. Likewise, it is important to note that the loss of muscle mass begins shortly after 30, when we feel more agile and independent, but we will really see the drawbacks years later. It is never too late to start removing triggers.
Recomendations
• Increase physical activity with resistance exercise combined with cardio and balance.
• Combining resistance exercise with increased protein intake helps build muscle
• Consume more protein intake or protein powder supplementation. Studies show better results with animal protein than plant-based protein
• In particular, branched-chain amino acids (including leucine, valine, and isoleucine) can increase muscle mass by directly promoting protein synthesis.
• Supplements that help reduce inflammation in the body such as Omega 3, Polyphenols and Vitamin D
• In some cases and depending on the individual, supplementation with testosterone and melatonin stimulators can work effectively on muscle synthesis.
• Autophagy has been studied in the recovery of muscle cell proliferation, but it should be practiced as prevention in adulthood or under medical supervision.