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Background and Objective- Sarcopenia, characterized by progressive loss of skeletal muscle mass and function, is a public health concern among older adults. However there is a paucity of data regarding its determinants in Eastern India. Thus, study was conducted to explore this. Methodology: A community-based cross-sectional study was carried out over a span of 18 months where two distinct areas were selected: urban and rural. A total of 250 participants, equally divided between the two settings (125 urban and 125 rural), aged 60 years and above, were selected using simple random sampling. Sarcopenia was defined using Asian Working Group for Sarcopenia 2019 criteria. Data collection included sociodemographic variables, comorbidities, occupation and dietary intake. Results: The prevalence of sarcopenia was significantly higher in the rural population (25.2%) compared to the urban population (12%) (p < 0.05). The prevalence increased with advancing age, with the highest rate (81.8%) observed in participants aged 75 years and above. Significant gender disparity was evident, with a higher prevalence among males (66.7%) than females (42.9%) (p = 0.004). Illiterate individuals and those from lower-income households exhibited higher rates of sarcopenia (71.4% and 69.2%, respectively). Multivariate regression analysis identified age, male gender, low educational status, inadequate protein intake, and the presence of chronic disease as independent predictors of sarcopenia (p < 0.05). Interpretation and Conclusion:This study underscores a high burden of sarcopenia among the elderly, with a disproportionately higher prevalence in rural areas due to socioeconomically disadvantaged conditions, poor nutrition, and limited access to healthcare. Thus, targeted interventions are imperative for its prevention.
Sarcopenia is an age-related syndrome involving progressive loss of skeletal muscle mass, strength, and function. It is associated with adverse outcomes such as frailty, disability, falls, and mortality. Globally, its prevalence ranges from 10% to 27%, depending on diagnostic criteria and population characteristics. India is undergoing rapid demographic transition with a growing elderly population. However, data regarding sarcopenia, particularly in Eastern India, are limited. Understanding its prevalence and determinants is essential for developing targeted interventions.
Objectives
Study Design Community-based cross-sectional study Setting Urban (College Street) and rural (Banspool, Madhyamgram), Kolkata Duration June 2023 – December 2024 Participants 250 individuals aged ≥60 years Inclusion Criteria Participants were eligible for inclusion if they met the following criteria: 1. Age: Individuals aged 60 years and above were included. 2. Community-Dwelling: Participants had to have continuously resided in the selected urban or rural area for at least one year to ensure adequate exposure to local environmental and socioeconomic conditions. 3. Provided informed consent. Exclusion Criteria • Bedridden persons • Persons having severe illness • Severe Cognitive impairment Sample Size Calculation The sample size was calculated based on previous Indian studies reporting sarcopenia prevalence. In urban areas, sarcopenia prevalence was estimated at 14.2%, while in rural areas, it was 24.4%. Using the formula: N=(15.7×P×Q)/(P1−P2)2 where: • P1 (Prevalence in rural areas) = 24.4% • P2 (Prevalence in urban areas) = 14.2% • P (Average prevalence) = 19.3% • Q (100-P)=80.7% The sample size was calculated as 235 participants. To account for potential dropouts and non-responses, a 6% adjustment was made, resulting in a final sample size of 250 participants. Operational Definition for Sarcopenia- Sarcopenia was defined as Muscle Handgrip Strength < 28.0 kg in men and < 18.0 kg in women measured by hand dynamometer. Data Collection Participants underwent a comprehensive baseline assessment, which included face-to-face interviews to collect sociodemographic data (age, gender, education, occupation, income), lifestyle factors (physical activity level, smoking history, alcohol consumption), dietary history (24-hour dietary recall) to evaluate nutritional intake and malnutrition risk was done and medical history assessment including the presence of chronic diseases (hypertension, diabetes, cardiovascular disease, respiratory disorders). Muscle handgrip strength was measured using a hand dynamometer, following standardized procedures where participants were instructed to exert maximum force, and the best of three trials was recorded. Statistical Analysis Data were entered into SPSS version 28 and analyzed using appropriate statistical tests .Chi-square test for categorical variables. T-tests to compare means between groups. Pearson’s correlation to assess relationships between sarcopenia and independent variables. A significance level of P < 0.05 was considered for the results. Ethical Consideration This study adhered to ethical standards and practices. Each participant gave written informed consent. We kept all data confidential and used it only for research. The Institutional Ethics Committee of Medical College, Kolkata reviewed and approved the study protocol.
In this study, sarcopenia was present in 93 (37.2%), out of which 63 were from rural and 30 were from urban. Male were 147(58.8%). According to the education level 75 were illiterate, 85 had primary education, 35 had secondary education, 27 had higher secondary education and 28 were graduate and above. Of 250 individuals, 112(44.80 %) were employed in some form of work. Among the participants 134 were diabetic, 135 were hypertensive, 21 were hypothyroid, 6 were having chronic kidney disease, 29 had chronic obstructive airway disease. Classifying the participants according to socioeconomic class 58 participants were in upper class, 48 participants were in upper middle class, 41 participants were in middle class, 41 participants were in lower middle class, 62 participants were in lower class based on modified Kuppuswamy Sclae. In this aspect, lower income groups have increased prevalence of sarcopenia. It was seen that the prevalence of sarcopenia increased as age increased. It was seen that lower level of education was associated with higher prevalence of sarcopenia. In terms of nutritional deficieny, sarcopenia was present in 71.4% of protein deficient individuals.
The findings underscore the critical role of income, age, gender, education, occupation, and nutritional intake in the development of sarcopenia. The prevalence of sarcopenia significantly increased with advancing age, with the highest burden observed in participants aged ≥75 years (81.8%) due to the progressive decline in skeletal muscle mass, neuromuscular function, and hormonal imbalances. Aging leads to reduced anabolic hormone production (testosterone, growth hormone, and insulin-like growth factor-1), impaired mitochondrial function, and chronic low- grade inflammation, all of which contribute to muscle atrophy and strength reduction. A higher percentage of females were sarcopenic compared to males was found. It is probably due to sharp decrease in estrogen after menopause compared to gradual decline in testosterone in aging males, low peak muscle mass and more fat percentage in females. Sarcopenia was most prevalent in illiterate individuals (71.4%), with a significantly lower prevalence in those with higher education (16.7%) probably due to poorer dietary habits, reduced physical activity, and less access to preventive healthcare services in illiterate persons, all of which increase sarcopenia risk. Sarcopenia prevalence was significantly lower among employed individuals, particularly those in physically demanding occupations. In contrast, unemployed individuals had a higher prevalence of sarcopenia (p = 0.002) as occupational physical activity plays a protective role in preserving muscle mass and strength. The high prevalence of diabetes mellitus (53.6%) and hypertension (54.0%) among participants suggests a significant burden of metabolic disorders, which are known to exacerbate sarcopenia. Protein deficiency was significantly associated with sarcopenia (p =0.002), with 71.4% of protein-deficient individuals exhibiting muscle loss, compared to 44.4% among those with adequate protein intake. The findings of this study emphasize that sarcopenia is not solely an age-related condition but is influenced by multiple modifiable risk factors, including socioeconomic status, chronic disease burden, and nutritional intake. The study highlights the urgent need for targeted interventions, including nutritional support programs, education-based awareness campaigns, and employment-based health promotion strategies to mitigate sarcopenia risk. Given the rising prevalence of aging populations worldwide, sarcopenia prevention should be a global health priority, requiring collaborative efforts from healthcare providers, policymakers, and researchers to develop evidence-based interventions that promote healthy aging, physical activity, and nutritional sufficiency.
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