Malnutrition and Associated Sarcopenia - Episode 4
Nicolaas Deutz, MD, PhD: Sarcopenia of aging, that’s the situation in which older people slowly are losing muscle mass. This has been studied for many years and was found that about 10% to 15% of muscle will be lost between 65 and 80 years old. But, that really depends on how people are doing. If they do a lot of exercise every day, they will not lose muscle mass. If they keep their protein intake high, they will not lose muscle mass. Or, even if they’re not getting sick that much, they will stay in better health. So, although, on average, older people will lose muscle mass, it really depends on the person.
Older people will be affected in their daily living if they become weaker. It becomes harder to go to the shop; it becomes harder to go outside. It has a major implication. And, if people are doing more exercise and moving around more, they will be more active, can do things outside, can go to other older people, and do things together. So, the effect of loss of muscle mass is severe.
Peter A. McCullough, MD: Lean body mass can be measured through a variety of techniques. One of the simplest is the doctor’s physical examination. Doctors get a very good sense of what a normal muscle mass is, including the large muscle masses in the body of the deltoids, the gluteus, and the quadriceps. But, it can be quantitated by a whole-body densitometry, which divides the body into a fat mass and a lean mass. The lean mass will include both the bones and the muscles. It’s most important to understand that each one of us has our intrinsically mass, that this peaks at about age 40, and then after age 40; all of us undergo a decline in lean muscle mass that’s part of normal aging.
One of the things that all elderly patients seem to remark about so much, whether it be in the office or in the hospital, is the importance of their physical constitution as they get older. Why is one 75-year-old in the hospital with weakness and can barely walk down the hall, and another 75-year-old is skiing the downhill blue runs out in Colorado? In fact, I’ve seen both. What separates these two 75-year-olds? Well, what separates them is really their physical constitution. And the elderly grew up in a time where there really was no emphasis at all. There was really no such thing as sports science or exercise science. There was no effort or thought at all with respect to voluntary exercise. Now, they’re in their 70s or 80s, and voluntary exercise becomes really a must in terms of their activities of daily living. It’s very important for all elderly individuals to have a strength training program so they can function in the house, so they can function in terms of going outside the house, shopping, and interacting with family and loved ones. It’s very important. So, the physical constitution in terms of the capabilities of walking, lifting, sitting, standing, if falling on the ground, and getting up, these important capabilities really should be tested and retested. They should be inquired by nurses, healthcare providers, but should also be tested and retested by family members who are working with this individual.