1

A Case Study on
Sarcopenia

Table of Contents
Introduction.......3
Methods5
Results...6
Discussion...8
References..........................................................................................................10

INTRODUCTION
There is no definite and accepted definition for Sarcopenia. Definitions slightly differ
among sources, but overall, they all conclude that Sarcopenia is a condition characterized
by loss of skeletal muscle and function that is associated with aging.1 Sarcopenia can lead
to other morbid factors such as the frailty syndrome, mobility disabilities, and even death.2
The risk of developing the factors mentioned previously increase significantly if the
individual gains excess fat.3 As an individual loses muscle mass, they often gain fat, so if
they do not follow nutritional recommendations, excessive fat gain can lead to obesity,
which leads to the diagnosis of obese Sarcopenia.3
When an individual reaches the age of 40, the loss of muscle mass begins. It is
estimated that each decade, an individual loses 8% percent of their muscle mass until the
individual reaches the age of 70. At the age of 70, the loss accelerates to 15% per decade.2
A total of approximately $18.5 billion per year is spent on treating individuals with
Sarcopenia.4 This cost can be reduced by $1.1 billion if the prevalence of Sarcopenia is
reduced by 10%.4
Physical inactivity is stated as the primary cause of Sarcopenia. When an individual
exercises, they break down muscle fibers, causing the release of muscle growth factors to
activate satellite cells and protein synthesis, leading to muscle regeneration.3 As an
individual gets older, physical activity declines, so the activation of these satellite cells and
protein synthesis does not occur.3 A decline in testosterone and inadequate intake of
protein and vitamin D have also been associated with causing Sarcopenia. Testosterone
also activates the protein synthesis/degeneration pathway as well as channeling
mesenchymal stem cells to satellite cells and inhibiting the pathway to pre-adipocyte

progenitor cells.3 As an individual ages, the decline of testosterone is inevitable, and with
this decline, protein synthesis slows down; therefore, maintaining muscle mass becomes
more difficult. Older individuals do not consume enough protein or even the Recommended
Daily Allowance of 0.8 g/kg/day, thus, protein synthesis is unable to be activated.5
Furthermore, a deficient of vitamin D decreases muscle strength.5
Diagnostic criteria that can be used to determine if an individual has Sarcopenia is
by measuring usual gait speed, measuring muscle mass, and measuring muscle strength. It
is recommended that the gait speed be measured first before proceeding to the next
measures. If an individual has a gait speed of less than 0.8m/s, they may be at risk for
muscle loss; therefore, measurements of muscle mass and muscle strength are taken to
come to a final diagnosis.6 Recently, in the year 2014, the National Institutes of Health
Biomarkers Consortium Sarcopenia Project proposed standardize criteria to diagnose
Sarcopenia. In addition to the gait speed, measurement of muscle mass in the arms and legs
(ALM), as well as measurement of grip strength were specifically identified. A weak grip
was identified to be less than 26 kg for men and 16 kg for women while a low lean mass
were ALM of less than 19.75 kg in men and less than 15.02 kg in women.7 However, the
criteria is not official since more research has to been conducted on people that are at risk
for disabilities and diseases.
All the factors that were mentioned as the primary cause of Sarcopenia should be
incorporated back into an individuals lifestyle in order to combat Sarcopenia. Resistance
training in addition to strength training has been shown to improve muscle strength in
older individuals as well as decrease fraility.4 It is recommended that exercising be done at
a minimum of three times per week. Protein is also essential in developing and maintaining

muscle. For older individuals, it is recommended that they consume between 1.0-1.5 g of
protein/kg/d in addition to equally spreading the protein throughout the day.5 However,
Bismarck, Andersen, Olsen, Richter, Mizuno, and Kjaer found that protein intake after
resistance training is best since immediate intake activates protein synthesis and
hypertrophy of skeletal muscle.8 Furthermore, Vitamin D intake will need to be increased
to reach a level above 100 nmol/L.4 In a study conducted by Hughes, Harris, Krall, and
Dallal, they found that dietary supplementation with calcium and vitamin D reduced bone
loss moderately in men and women 65 years of age or older who were living in the
community.9 Therefore, supplementation in doses, but in low levels, is recommended
because not only will supplementation reduce bone loss, but it will also help increase
muscle strength.4 Lastly, testosterone therapy may help increase muscle mass, however, it
may not improve functional performance.4 Due to the potential risks that testosterone
therapy may implicate, it is recommended that an increase in physical activity, vitamin D,
and protein intake be implemented first.
The patient interviewed may have developed Sarcopenia due to the lack of
resistance training at a younger age and now in her elderly years. Additionally, low level
intakes of protein and vitamin D may have also contributed to her loss of muscle mass.
Methods
A 49, 120 pound, 73 year old Mexican female who has Sarcopenia was interviewed.
To gather information from the patient, a phone interview was conducted. The phone
interview was conducted in one day and was approximately an hour long. The information
gathered during the phone interview was in regards to how the patient felt Sarcopenia has
affected her life and what may have led to the development of Sarcopenia by analyzing a

24-hour recall diet obtained from the patient. The analysis of the 24-hour recall diet was
done by using the SuperTracker program on the www.choosemyplate.gov website. Figure 1
lists the series of questions asked to the patient.
Figure 1. List of questions asked
What is your weight and height?
How much did you used to weigh?
How has Sarcopenia affected your life?
Did your strength significantly decrease?
Are you or have you ever been physically active?
Have you been diagnosed with any other disease?
Do you take medications and if so, what kind and for what?
Do you take supplements and if so, what kind?

Results
Throughout her life, my patient was always moderately active. In her younger years,
she went for long walks every day. She still takes walks occasionally, but not as often as she
used to. Additionally, the walks she takes now last a shorter period of time than before due
to the fact that she gets tired more quickly. Walking was the only form of exercise she did;
she never did any resistance or strength training. The patient has also felt that her strength
has decreased. She cannot lift the same heavy items she could several years ago.
Concerning her food intake, she does not consume enough calories that her body needs.
Most of her food consists of carbohydrates with little fat and protein. The patient reports
that she usually only eats two full meals a day with rare moments of snacking. She states

that she does not feel hungry very often. Her physician has told her to eat more and better
food in order to control her blood pressure. The patient has high blood pressure, therefore,
she takes Hydrochlorothiazide. She takes no supplements of any kind.
Figure 2 shows the meals the patient consumed in a 24 hour period while Figure 3
shows the food groups she consumed and whether she achieved the minimum
requirement. Lastly, figure 4 shows the nutrient breakdown associated with Sarcopenia
that she consumed from her meals in the 24 hour period.
Figure 2. Patients Food intake and serving size in a typical 24 hour day.
Food

Serving Size

Coffee w/sugar

8 oz w/ 1 T

Pinto beans

1 C

Corn tortilla

Eggs, scrambled and fried

Potatoes

White rice, fried

Figure 3. Daily Food Group Targets

Grains
Vegetables
Target
Eaten
Status

5 oz
4 oz
Under

2 cup(s)
1 cup(s)
Under

Fruits

Dairy

1 cup(s)
0 cup(s)
-

3 cup(s)
0 cup(s)
-

Protein
Foods
5 oz
2 oz
Under

Figure 4. Nutrient breakdown of food consumed in the 24 hour recall.
Nutrients

Target

Average Eaten

Status

Total Calories

1200 Calories

738 Calories

Under

Protein (g)***

46 g

32 g

Under

Protein (% Calories)***

10 - 35%
Calories

17% Calories

OK

Carbohydrate (g)***

130 g

107 g

Under

Carbohydrate (%
Calories)***

45 - 65%
Calories

58% Calories

OK

Total Fat

20 - 35%
Calories

26% Calories

OK

Cholesterol

<300 mg

415 mg

Over

Calcium

1200 mg

192 mg

Under

Vitamin D

15 ug

1 ug

Under

Discussion
The interview with the patient and analysis of her food intake reinforced the
hypothesis. Based on the nutrient analysis of the 24 hour recall, the patient does not
consume enough calories and protein and does not get enough vitamin D, which are all
essential for muscle mass maintenance. On average, the patient consumes a little under
1000 calories. This is under the minimum 1200 calories her body needs to function well.
Due to her low calorie intake, she also did not gain weight, which often accompanies
muscle mass loss.
Additionally, her protein intake is 14 g under the 46 g of protein recommended for
her bodyweight. However, since she is 73 years old, it is recommended that she consume a
little bit more than 0.8 g/kg/d in order to maintain and possibly gain muscle mass. Her
vitamin D intake is also critically low. She barely gets one ug of vitamin D, whereas, her

recommended intake is 15 ug. As stated previously, vitamin D is essential for muscle

strength, therefore, if the patient does not get enough vitamin D, her muscle strength
decreases. In order to reach the recommended vitamin D level, it would be best for the
patient to take a supplement.
Furthermore, the lack of resistance and strength training in her life may have
contributed to her inability to walk as far as she used to and to lift heavy items as she used
to. However, she can still gradually incorporate this type of exercise in her life to slow
down the loss of muscle mass. Since her calorie, protein, and vitamin D intake are low and
she hardly ever did any strength/resistance training, she was not able to maintain her
muscle mass and therefore, possibly developed Sarcopenia. To combat this disease, she
must increase her calorie, protein, and vitamin D intake and incorporate some form of
resistance/strength training in her life.

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REFERENCES
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Metab. 2013 April; 20:1-10.
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2012 Sept; 14(9):62.
5. Morley JE, Argiles JM, et al. Nutritional recommendations for the management of
Sarcopenia. J. Am. Med. Dir. Assoc. 2010; 11: 391-396.
6. Jentoft AC. Sarcopenia: a clinical review. Rev. Clin. Gerontol. 2013 Oct; 23: 267-274.
7. National Institute on Aging. Research consortium including NIH proposes diagnostic
criteria for Sarcopenia. Bethesda, Maryland: National Institutes of Health.
2014 April 15. Available from:
http://www.nih.gov/news/health/apr2014/nia-15.htm

8. Bismarck B, Andersen JL, Olsen S, Richter EA, Mizuno M, Kjaer M. Timing of

postexercise protein intake is important for muscle hypertrophy with
resistance training in elderly humans. J. Physiol. 2001 Aug; 535:301-311.
9. Hughes BD, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D
Supplementation on bone density in men and women 65 years of age or older.
N. Engl. J. Med. 1997 Sept; 337:670-676.