Skip to main content

Revisiting: “prevalence of and factors associated with sarcopenia among multi-ethnic ambulatory older Asians with type 2 diabetes mellitus in a primary care setting”

Abstract

Background

Sarcopenia is an age-related clinical syndrome characterized by loss of muscle mass and reduced muscle function. Diseases that contribute to sarcopenia include type 2 diabetes mellitus (T2DM), chronic obstructive pulmonary disease (COPD), heart failure, chronic kidney disease, and cancer and others. Fung FY et al. (BMC Geriatrics. 2019;19(1):122) conducted a single-center study aimed to determine the prevalence of sarcopenia among older patients with T2DM and to identify factors which mitigate sarcopenia. Their study entitled “Prevalence of and factors associated with sarcopenia among multi-ethnic ambulatory older Asians with type 2 diabetes mellitus in a primary care setting” suggested that the prevalence of sarcopenia in older patients with T2DM was 27.4%, and that Chinese ethnicity was associated with a greater risk of sarcopenia in the study population.

Discussion

Deficiency in scientific research and analysis of other diseases associated with sarcopenia such as COPD, may contribute to misestimation of the prevalence of sarcopenia in older patients with T2DM. We are concerned that the conclusions of this single-center study with a small study population might be unreliable.

Summary

The prevalence of sarcopenia in older patients with T2DM in a single-center study with a small sample size may be misestimated due to the lack of strict exclusion criteria and detailed analysis of other diseases that contribute to sarcopenia. In addition, it is inappropriate to draw the conclusion that Chinese ethnic group was associated with a greater risk of sarcopenia among the study population.

Peer Review reports

Main text

We read the article “Prevalence of and factors associated with sarcopenia among multi-ethnic ambulatory older Asians with type 2 diabetes mellitus in a primary care setting” with great interest [1]. This study reported that the prevalence of sarcopenia in unassisted ambulatory older, community-dwelling patients with type 2 diabetes mellitus (T2DM) in Singapore was 27.4%, and that Chinese ethnicity was associated with a greater risk of sarcopenia among the study population.

Chronic obstructive pulmonary disease (COPD) can lead to malnutrition, weight loss and induce the development of sarcopenia [2]. The prevalence of sarcopenia in patients with COPD is up to 15–40% [3,4,5,6]. In addition to COPD and T2DM, sarcopenia has previously been reported to be associated with various diseases, such as chronic heart failure, chronic kidney disease and cancer. We cannot find the strict exclusion or detailed analysis of the diseases related to sarcopenia in this study. Since this was a single-center research with a small study population, the prevalence of sarcopenia in older patients with T2DM may be largely affected by other diseases such as COPD, among whom the prevalence of sarcopenia is also considerable. Did the authors analyze whether the patients in the sarcopenia and severe sarcopenia groups have complicating COPD or other diseases contributing to sarcopenia? Furthermore, the morbidities of sarcopenia in different ethnicities may be influenced by many factors, and it is inappropriate to draw the conclusion that Chinese ethnic groups were associated with a greater risk of sarcopenia among older patients with T2DM. For example, genetic background plays an important role in the development of COPD, and the morbidity of COPD differs in ethnicities. Did the authors analyze whether the prevalence of COPD in patients of Chinese ethnicity was higher than that in other ethnicities among the study population? Inappropriate and unscientific research design can lead to unreliable results. Did Fung FY et al. take all these questions into consideration? The ignorance of these above issues could affect the results and interpretation of the study. Further studies and analyses should be performed taking into consideration the concerns we have mentioned.

Availability of data and materials

Not applicable.

Abbreviations

T2DM:

Type 2 diabetes mellitus

COPD:

Chronic obstructive pulmonary disease

References

  1. 1.

    Fung FY, Koh YLE, Malhotra R, Ostbye T, Lee PY, Shariff Ghazali S, et al. Prevalence of and factors associated with sarcopenia among multi-ethnic ambulatory older Asians with type 2 diabetes mellitus in a primary care setting. BMC Geriatr. 2019;19(1):122.

    Article  Google Scholar 

  2. 2.

    Wagner PD. Possible mechanisms underlying the development of cachexia in COPD. Eur Respir J. 2008;31(3):492–501.

    CAS  Article  Google Scholar 

  3. 3.

    Jones SE, Maddocks M, Kon SS, Canavan JL, Nolan CM, Clark AL, et al. Sarcopenia in COPD: prevalence, clinical correlates and response to pulmonary rehabilitation. Thorax. 2015;70(3):213–8.

    Article  Google Scholar 

  4. 4.

    Byun MK, Cho EN, Chang J, Ahn CM, Kim HJ. Sarcopenia correlates with systemic inflammation in COPD. Int J Chron Obstruct Pulmon Dis. 2017;12:669–75.

    CAS  Article  Google Scholar 

  5. 5.

    de Blasio F, Di Gregorio A, de Blasio F, Bianco A, Bellofiore B, Scalfi L. Malnutrition and sarcopenia assessment in patients with chronic obstructive pulmonary disease according to international diagnostic criteria, and evaluation of raw BIA variables. Respir Med. 2018;134:1–5.

    Article  Google Scholar 

  6. 6.

    Limpawattana P, Inthasuwan P, Putraveephong S, Boonsawat W, Theerakulpisut D, Sawanyawisuth K. Sarcopenia in chronic obstructive pulmonary disease: a study of prevalence and associated factors in the southeast Asian population. Chron Respir Dis. 2018;15(3):250–7.

    Article  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

None.

Author information

Affiliations

Authors

Contributions

XL conceived the idea and was a major contributor in writing the manuscript. FX, LH, and HF re-analyzed the published study, interpreted and reported the final conclusion. YA critically revised the manuscript. All authors reviewed and finalized the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yi An.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The correspondence article is a response to BGTC-D-18-00596 / https://doi.org/10.1186/s12877-019-1137-8

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Li, X., Xu, F., Hu, L. et al. Revisiting: “prevalence of and factors associated with sarcopenia among multi-ethnic ambulatory older Asians with type 2 diabetes mellitus in a primary care setting”. BMC Geriatr 20, 415 (2020). https://doi.org/10.1186/s12877-020-01727-0

Download citation

Keywords

  • Sarcopenia
  • Diabetes
  • COPD