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Cited by 1,076Nutrition and Health in AgingFrailty in Older AdultsMuscle Physiology and Disorders

Prevalence of sarcopenia in the world: a systematic review and meta- analysis of general population studies

Open access
Shafiee, Gita, Keshtkar, Abbasali, Soltani, Akbar, Ahadi, Zeinab, Larijani, Bagher, Heshmat, Ramin·2017·Journal of Diabetes & Metabolic Disorders
DOI 10.1186/s40200-017-0302-xPMC PMC5434551
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Abstract

BACKGROUND: Sarcopenia, an age-related decline in muscle mass and function, is one of the most important health problems in elderly with a high rate of adverse outcomes. However, several studies have investigated the prevalence of sarcopenia in the world, the results have been inconsistent. The current systematic review and meta- analysis study was conducted to estimate the overall prevalence of sarcopenia in both genders in different regions of the world. METHODS: Electronic databases, including MEDLINE (via PubMed), SCOPUS and Web of Science were searched between January 2009 and December 2016. The population- based studies that reported the prevalence of sarcopenia in healthy adults aged ≥ 60 years using the European Working Group on Sarcopenia in Older People (EWGSOP), the International Working Group on Sarcopenia (IWGS) and Asian Working Group for Sarcopenia (AWGS) definitions, were selected. According to these consensual definitions, sarcopenia was defined by presence of low muscle mass (adjusted appendicular muscle mass for height) and muscle strength (handgrip strength) or physical performance (the usual gait speed). The random effect model was used for estimation the prevalence of sarcopenia. The sex-specific prevalence of sarcopenia and 95% confidence interval (CI) were calculated using the Binomial Exact Method. Heterogeneity was assessed by subgroup analysis. RESULTS: Thirty- five articles met our inclusion criteria, with a total of 58404 individuals. The overall estimates of prevalence was 10% (95% CI: 8-12%) in men and 10% (95% CI: 8-13%) in women, respectively. The prevalence was higher among non- Asian than Asian individuals in both genders especially, when the Bio-electrical Impedance Analysis (BIA) was used to measure muscle mass (19% vs 10% in men; 20% vs 11% in women). CONCLUSION: Despite the differences encountered between the studies, regarding diagnostic tools used to measure of muscle mass and different regions of the world for estimating parameters of sarcopenia, present systematic review revealed that a substantial proportion of the old people has sarcopenia, even in healthy populations. However, sarcopenia is as a consequence of the aging progress, early diagnosis can prevent some adverse outcomes.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis estimated the global prevalence of sarcopenia in community-dwelling adults aged ≥60 years at 10% in men and 10% in women. Prevalence varied by region and muscle-mass assessment method, with higher estimates when BIA was used and among non-Asian populations.

Key findings

  • Across 35 studies and 58,404 individuals (32,642 men; 25,762 women), the overall pooled prevalence of sarcopenia was 10% in men (95% CI 8–12%) and 10% in women (95% CI 8–13%).
  • Prevalence differed by muscle-mass measurement tool: BIA gave 13% in men (95% CI 7–19%) and 13% in women (95% CI 9–19%), while DXA gave 8% in men (95% CI 7–9%) and 8% in women (95% CI 6–11%).
  • Non-Asian individuals had higher prevalence than Asian individuals in both genders; with BIA, the reported estimates were 19% vs 10% in men and 20% vs 11% in women. The text also reports non-Asian vs Asian as 11% vs 10% in men and 13% vs 9% in women (data not shown), and with DXA as 9% in Asian men vs 6% in non-Asian men and 10% vs 6% in women.
  • Heterogeneity was substantial in men (I² = 98.11%, P = 0.00) and women (I² = 98.07%, P = 0.00); Begg’s test showed no evidence of substantial publication bias (men: Z = 1.79, p = 0.08; women: Z = 0.31, p = 0.76).

Methods

  • Systematic review and meta-analysis searching MEDLINE (via PubMed), SCOPUS, and Web of Science from January 2009 to December 2016, without language restriction. Included population-based studies of community-dwelling healthy adults aged ≥60 years that used EWGSOP, IWGS, or AWGS definitions based on muscle mass plus muscle strength or physical performance; excluded clinical/hospital/care-setting studies and those using only muscle mass.
  • Thirty-five articles met inclusion criteria, totaling 58,404 individuals; 21 studies were from Asia and 14 from non-Asian countries. Eighteen studies used DXA for muscle mass, 16 used BIA, and one used both methods.
  • Random-effects model was used for pooled prevalence; sex-specific prevalence and 95% CIs were calculated with the Binomial Exact Method. Subgroup analyses examined gender, region, and muscle-mass measurement method; heterogeneity was assessed, and Begg’s test evaluated publication bias using STATA 12.

Limitations

  • The paper states that not all studies presented data by age group, so prevalence for each age subgroup could not be estimated.
  • The paper states that grouping by different cut-off points and definitions led to reader confusion, so analyses were limited to sex, region, and muscle-mass measurement tool.
  • The paper states that characteristics of residents (e.g., rural or urban) could not be assessed due to insufficient data from most publications. Evident from the text: substantial heterogeneity remained (I² ≈ 98% in both genders), and prevalence estimates varied by diagnostic tool and region, limiting interpretability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s40200-017-0302-x

Cites

61 of 61 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 19 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In women, when DXA was used, the prevalence of sarcopenia was higher in non-Asian than Asian countries (10% vs 6%).

    “Women in non-Asian countries were more likely to be sarcopenic than their counterparts in Asia in both tools for measurement of muscle mass [20 vs 11% with BIA method; 10 vs 6% with DXA method) (Fig. 5).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The prevalence estimates from studies using different diagnostic definitions and cut-off points can be pooled into a single overall prevalence.
    • Rests on an assumption: The included studies are representative of the world's general older population.
  • Findingown data

    In women, when BIA was used, the prevalence of sarcopenia was higher in non-Asian than Asian countries (20% vs 11%).

    “Women in non-Asian countries were more likely to be sarcopenic than their counterparts in Asia in both tools for measurement of muscle mass [20 vs 11% with BIA method; 10 vs 6% with DXA method) (Fig. 5).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The prevalence estimates from studies using different diagnostic definitions and cut-off points can be pooled into a single overall prevalence.
    • Rests on an assumption: The included studies are representative of the world's general older population.
  • Findingown data

    The overall pooled prevalence of sarcopenia in men was 10% (95% CI 8-12%).

    “The overall estimates of prevalence was 10% (95% CI: 8–12%) in men and 10% (95% CI: 813%) in women, respectively.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The prevalence estimates from studies using different diagnostic definitions and cut-off points can be pooled into a single overall prevalence.
    • Rests on an assumption: The included studies are representative of the world's general older population.
  • Findingown data

    In women, the pooled prevalence was higher among non-Asian individuals than in the Asian population (12% vs 9%).

    “The pooled prevalence was higher among non-Asian individuals than in the Asian population in both genders (11 vs 10% in men, 12 vs 9% in women).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The prevalence estimates from studies using different diagnostic definitions and cut-off points can be pooled into a single overall prevalence.
    • Rests on an assumption: The included studies are representative of the world's general older population.
  • Findingown data

    In women, individuals in non-Asian countries were more likely to be sarcopenic than those in Asian countries (13% vs 9%).

    “Individuals in non-Asian countries were more likely to be sarcopenic than Asian countries among both genders (11% vs 10% in men, 13% vs 9% in women) (Data not shown).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The prevalence estimates from studies using different diagnostic definitions and cut-off points can be pooled into a single overall prevalence.
    • Rests on an assumption: The included studies are representative of the world's general older population.
  • Classified as probably not a substantial claim. 8
  • May combine two claims. 12

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Twenty-one included studies were from Asia and 14 from non-Asian countries.

    “Twenty one studies were distributed in Asia and there were also 14 studies from non-Asian countries.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In men, when DXA was used, the prevalence of sarcopenia was 9% in Asian and 6% in non-Asian populations.

    “However, in the studies that DXA was used, the prevalence of sarcopenia was 9% in Asian men and 6% in non-Asian men (Fig. 4).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The prevalence estimates from studies using different diagnostic definitions and cut-off points can be pooled into a single overall prevalence.
    • Rests on an assumption: The included studies are representative of the world's general older population.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Eighteen included studies used DXA to assess muscle mass and 16 used BIA.

    “A total of 18 studies used the Dual Energy X-Ray Absorptiometry (DXA) to assess muscle mass and 16 studies used the Bio-electrical Impedance Analysis (BIA).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    One study used both DXA and BIA to assess muscle mass.

    “In a study were used both methods to assess of muscle mass [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Pagotto V, Silveira EA. Applicability and agreement of different diagnostic criteria for sarcopenia estimation in the elderly. Arch Gerontol Geriatr. 2014;59(2):288–94. Epub 2014/06/18. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Of the included individuals, 32,642 (55.9%) were men and 25,762 (44.1%) were women.

    “A total of 58404 individuals, 32642 (55.9%) men and 25762 (44.1%) women; respectively, from the general population were examined through these studies.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The included studies are representative of the world's general older population.

  • Classified as probably not a substantial claim.

    Findingown data

    Thirty-five studies were eligible for the meta-analysis.

    “After reviewing the full texts, thirty five studies were eligible for the meta- analysis (Fig. 1).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The search strategy and inclusion criteria identified all relevant studies on sarcopenia prevalence.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Sarcopenia is a major clinical problem in public health of older people, with adverse outcomes such as disability, poor quality of life, and increased risk of death.

    “In addition, sarcopenia is a major clinical problem in public health of older people; with some adverse outcomes such as disability, poor quality of life, and increased risk of death [2–4].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [2] Lauretani F, Russo CR, Bandinelli S, Bartali B, Cavazzini C, Di Iorio A, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol. 2003;95(5):1851–60. Epub 2003/10/14. source

      Not checked in the free run.

    • cites [3] Rizzoli R, Reginster JY, Arnal JF, Bautmans I, Beaudart C, Bischoff-Ferrari H, et al. Quality of life in sarcopenia and frailty. Calcif Tissue Int. 2013;93(2):101–20. Epub 2013/07/06. source

      Not checked in the free run.

    • cites [4] Rantanen T. Muscle strength, disability and mortality. Scand J Med Sci Sports. 2003;13(1):3–8. Epub 2003/01/22. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Not all studies presented data according to age group; therefore, the prevalence for each age subgroup could not be estimated.

    “First, not all studies presented data according to age group; therefore, we could not estimate the prevalence for each age subgroup.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The use of different measurement tools, cut-off points and definitions may lead to different prevalence of sarcopenia and make results difficult to interpret.

    “Therefore, the use of different measurement tools, cut- off points and definitions may lead to different prevalence of sarcopenia and the results may be difficult to interpret.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    BIA is known to underestimate fat mass and overestimate muscle mass.

    “BIA is known to underestimate fat mass and overestimate muscle mass [24].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Janssen I, Heymsfield SB, Baumgartner RN, Ross R. Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol. 2000;89(2):465–71. Epub 2000/08/05. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    Grouping according to different cut-off points and definitions led to reader's confusion, so analyses were based on sex, region and tool of muscle mass measurement.

    “Second, grouping according to different cut-off points for parameters of sarcopenia and different definitions were led to reader’s confusion. So, analyses were based on sex, region and tool of muscle mass measurement.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The similar prevalence of sarcopenia in both genders in this review may be due to subgrouping by gender, exclusion of studies enrolling only participants above 70 years, and lack of pooled analysis of different age groups due to inadequate data.

    “In present review, we just have sub grouped the studies according to gender, and the studies that had enrolled only participants in the age group above 70 years, were excluded. Also, a pooled analysis of different age groups was not conducted due to inadequate data in each subgroup. Therefore, it seems similar prevalence of sarcopenia in both genders is due to these items.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    Sarcopenia is a consequence of the aging progress.

    “However, sarcopenia is as a consequence of the aging progress, early diagnosis can prevent some adverse outcomes.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998;147(8):755–63. Epub 1998/04/29. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Begg's test showed no evidence of substantial publication bias in men (Z = 1.79, p = 0.08) and women (Z = 0.31, p = 0.76).

    “According to Begg’s test the value for Z equaled 1.79 (p = 0.08) in men and 0.31 (p = 0.76) in women, that showed no evidence of substantial publication bias.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Most excluded articles either had low quality based on STROBE quality assessment and did not present reliable data, or lacked information required for the review.

    “Most of the excluded articles either had a low quality based on STROBE quality assessment forms and therefore did not present reliable data, or lacked information required for the review, such as adequate descriptive information about the population of their study, or a separate sarcopenia prevalence in different sex, which can make it difficult to use in a meta-analysis.”
    Quote in the paperSubstantial claim
15 of 15

  • The paper relies on this without support.

    The prevalence estimates from studies using different diagnostic definitions and cut-off points can be pooled into a single overall prevalence.

    “Despite the differences encountered between the studies, regarding diagnostic tools used to measure of muscle mass and different regions of the world for estimating parameters of sarcopenia, present systematic review revealed that a substantial proportion of the old people has sarcopenia, even in healthy populations.”

  • The paper relies on this without support.

    The included studies are representative of the world's general older population.

    “A total of 58404 individuals, 32642 (55.9%) men and 25762 (44.1%) women; respectively, from the general population were examined through these studies.”

  • The paper relies on this without support.

    The search strategy and inclusion criteria identified all relevant studies on sarcopenia prevalence.

    “The search was carried out in three electronic databases, MEDLINE (via PubMed), SCOPUS and Web of Science between January 2009 and December 2016.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Htun study's female prevalence does not match its count and sample

    Minor

    The reported 147 cases among 945 women give a prevalence of about 15.56%, not 16.56%.

    Reported 16.56 · recomputed 15.555556

  • Htun study's total prevalence does not match its count and sample

    Minor

    The reported 248 cases among 1,921 participants give a prevalence of about 12.91%, not 13.3%.

    Reported 13.3 · recomputed 12.909943

  • Two pooled prevalence values are given for non-Asian women

    Minor

    The Results give 13% for non-Asian women, while the Discussion gives 12% for the same regional and sex subgroup.

  • Jung study's male prevalence does not match its count and sample

    Minor

    The reported 46 cases among 167 men give a prevalence of about 27.54%, not 28.10%.

    Reported 28.1 · recomputed 27.54491

  • Brown study's total prevalence does not match its count and sample

    Minor

    The reported 1,618 cases among 4,425 participants give a prevalence of about 36.56%, not 36.0%.

    Reported 36 · recomputed 36.564972

5 of 5

Cites

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Related

Authors
Shafiee, G., Keshtkar, A., Soltani, A., Ahadi, Z., Larijani, B., & Heshmat, R.
Affiliations
  • Endocrinology and Metabolism Population Sciences Institute (IR)
  • Tehran University of Medical Sciences (IR)
  • Endocrinology and Metabolism Clinical Sciences Institute (IR)
  • Shariati Hospital (IR)
Corresponding author
Heshmat, Ramin
ORCID
Venue
Journal of Diabetes & Metabolic Disorders
Publisher
Springer Science and Business Media LLC
Published
2017-05-16
Volume
16
Issue
1
Pages
21-21
ISSN
2251-6581 (ISSN-L)
DOI
10.1186/s40200-017-0302-x
PMC
PMC5434551
OpenAlex
W2614428059
Semantic Scholar
5b96013919bca517ba3f3173442ab00cb29b47e1
Cited by
1,076
References
61
Citations by year
2026: 85 · 2025: 147 · 2024: 121 · 2023: 144 · 2022: 173 · 2021: 164 · 2020: 111 · 2019: 70 · 2018: 54 · 2017: 6
FWCI
8.08
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Diabetes & Metabolic Disorders (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Muscle Physiology and Disorders
Keywords
sarcopenia, prevalence, older adults, muscle mass, muscle strength, grip strength, walking speed, appendicular skeletal muscle mass, sex differences, Asian populations, bioelectrical impedance analysis, aging

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