Sarcopenia: Understand Muscle Loss, Risk Factors and Prevention

What Causes Sarcopenia?

Sarcopenia can develop through a combination of biological, lifestyle and medical factors. The primary factors are as follows:

Ageing

Ageing is the most important context for sarcopenia. Changes in muscle protein metabolism, hormonal signalling, physical activity, nutrition and neuromuscular function can contribute to progressive loss of muscle strength and quantity. This does not mean that everyone begins developing clinically significant sarcopenia in their 30s or 40s. Muscle mass and strength can change throughout adulthood, but sarcopenia is primarily an age-associated condition, particularly relevant in older adults.

Physical Inactivity

Periods of inactivity, prolonged bed rest and idle behaviour can contribute to loss of muscle strength and physical function. Regular resistance and other forms of physical activity help maintain muscle strength and function.

Inadequate Nutrition

Insufficient energy or protein intake can contribute to muscle loss, particularly in older adults or people affected by illness. Nutritional needs vary between individuals. Adequate overall nutrition, including sufficient protein where appropriate, helps maintain muscle health.

Chronic Disease

Several chronic conditions can contribute to secondary muscle loss.

Here are a few examples:

• Chronic obstructive pulmonary disease or COPD
• Diabetes
• Chronic kidney disease
• Cancer
• Heart failure
• Chronic inflammatory conditions
• Neurological disorders

However, the presence of one of these conditions does not automatically mean that a person has sarcopenia.

Medications and Other Factors

Certain treatments, including prolonged exposure to corticosteroids, may contribute to muscle weakness or loss in some people. Consider medication effects alongside the person’s underlying disease, activity level, and nutritional status.

Can Sarcopenia Affect Younger Adults?

Sarcopenia is predominantly associated with ageing, but muscle weakness or muscle loss can occur at younger ages.

In younger adults, possible contributors include:

• Prolonged physical inactivity
• Severe or chronic illness
• Long duration of hospitalisation
• Inadequate nutritional intake
• Certain medications
• Neurological or muscular disorders
• Other medical conditions affecting muscle

Therefore, unexplained muscle weakness or loss in a younger person should not automatically be labelled sarcopenia.

5 Primary Symptoms of Sarcopenia

Sarcopenia does not have one symptom that can confirm the condition. Possible indicators of reduced muscle function include the following:

• Reduced Muscle Strength: Difficulty lifting objects, opening containers, and climbing stairs can indicate reduced strength. Grip strength and chair-stand performance are commonly used during functional assessment.
• Difficulty With Mobility: A person may notice difficulty walking, climbing stairs or completing everyday physical tasks. Reduced walking speed can indicate physical performance issues, but slow walking speed alone does not establish a diagnosis of sarcopenia.
• Reduced Physical Function: Difficulty with activities such as dressing, bathing, shopping or getting out of a chair may indicate functional decline. However, these difficulties can have many causes, including arthritis, neurological disease, cardiovascular problems, pain or general deconditioning.
• Fatigue or Reduced Exercise Capacity: Fatigue can accompany reduced physical fitness or muscle function, but it is nonspecific. Do not attribute constant fatigue to sarcopenia; it may require evaluation for other medical or lifestyle causes.

Diagnosis for Sarcopenia

Diagnosis requires more than simply looking at a person’s body shape or measuring muscle size. Contemporary approaches generally place muscle strength at the centre of assessment, with evaluation of muscle quantity or quality and physical performance helping to further characterise the condition.

Here is a summary of the assessments performed:

Treatments to Manage Sarcopenia

Management depends on whether sarcopenia is present, how severe it is and whether an underlying condition is contributing to muscle loss.

A few sarcopenia management treatment measures are stated below:

Step 1: Resistance Exercise

Resistance training is an important component of maintaining and improving muscle strength. Exercises can include:

• Squats or sit-to-stand exercises
• Resistance-band exercises
• Weight training
• Leg-strengthening exercises
• Other supervised strength exercises

The appropriate programme depends on age, fitness, existing medical conditions and physical ability. Older adults or people with significant weakness may benefit from professional supervision when beginning a resistance programme.

Step 2: Adequate Nutrition

Adequate energy and protein intake are important to maintain muscle; however, protein requirements vary. People with kidney disease, liver disease or other medical conditions may require individualised dietary advice. A dietitian can help determine appropriate nutritional intake when muscle loss, poor appetite or chronic illness is present.

Step 3: Treat Underlying Conditions

If muscle weakness or loss is related to another condition, management should also address the underlying problem.

This may involve the following treatments:

• Chronic disease
• Nutritional deficiencies
• Endocrine disorders
• Medication-related problems
• Reduced mobility
• Other conditions affecting physical function

Step 4: HMB and Other Supplements

Some nutritional supplements, including beta-hydroxy-beta-methylbutyrate (HMB), have been studied for muscle health, particularly in older adults and certain clinical settings [1]. Evidence varies by population, nutritional status, exercise programme, and clinical context. Before using HMB, protein supplements or other products, particularly if you have kidney disease or take multiple medicines, discuss their suitability with a healthcare professional or dietitian

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