Prevalence and coexistence of malnutrition, sarcopenia, frailty and sarcopenic obesity among older adults in the community: Results from a prospective cohort study

Summary: Background &amp; aims: Advanced age is an independent risk factor for malnutrition, sarcopenia, frailty and sarcopenic obesity (MSFSO), and each condition is associated with adverse outcomes, such as higher risk of morbidity and mortality, higher incidence of hospitalization, increased risk of falls and disability, poorer quality of life (QOL), and greater use of health and social care resources. Some characteristics overlap between MSFSO, yet there is a lack of research into the coexistence of these conditions currently. Therefore, this study aimed to explore the prevalence and coexistence of MSFSO among older adults in different community settings, to identify potential associated factors, and to examine its associations with mortality, QOL and contacts with health and social care professionals (HSCPs). Methods: Data were retrieved from a prospective cohort study, recruiting older adults (≥60 years of age) from community settings. Baseline characteristics from two settings, general practice (GP) and intermediate care (IC), were analyzed in this study. Results: 347 participants were analyzed (57% females, mean age 77 ± 9 years, mean body mass index 25.8 ± 5.7 kg/m2), with 52% from GP and 48% from IC. The prevalence rates were 21.6% for malnutrition, 50.1% for sarcopenia, 49.3% for frailty, and 12.1% for sarcopenic obesity. More than half of the subjects (53.8%) experienced at least one of the above conditions, with 4 participants (1.3%) suffering from all four conditions simultaneously. The IC cohort was older and had a poorer health status compared to the GP population, resulting in a significantly higher prevalence of malnutrition (41.5% vs. 7.9%, P < 0.001), sarcopenia (85.7% vs. 16.8%, P < 0.001), frailty (91.1% vs. 10.0%, P < 0.001), sarcopenic obesity (17.9% vs. 7.3%, P = 0.006) and coexisting MSFSO (83.7% vs. 12.4%, P < 0.001). In addition, strong associations were observed between higher coexistence of MSFSO conditions and participants from the IC setting (IRR 4.12, 95%CI 3.06–5.56, P < 0.001) or with more comorbidities (IRR 1.55, 95%CI 1.13–2.12, P = 0.007). The majority of participants (90.3%, P < 0.001) who subsequently died during the study had at least two conditions of MSFSO. Subjects with coexistence of MSFSO also had poorer perceived QOL (EQ-5D Visual Analogue Scale: none vs. ≥2 conditions = 85 scores vs. 56 scores, P < 0.001) and generally more contacts with HSCPs. Conclusion: Coexistence of MSFSO was associated with a greater risk of mortality, a poorer perceived QOL and an increased contact with health and social care services. Furthermore, people in the IC setting or with more comorbidities were more likely to experience a higher coexistence of MSFSO. The differences in characteristics and MSFSO prevalence rates between GP and IC cohorts suggest that different strategies may be needed across different community settings. For example, the IC setting should focus on screening, assessment and treatment of affected individuals, while multidisciplinary population-based health promotion or primary prevention strategies might be more suitable among the older GP population, where people might present early signs of these conditions.