Sarcopenia and the Worker – Is This the Next Epidemic Waiting to Happen?

Sarcopenia is defined as low muscle mass with loss of muscle strength and is often referred to as a muscle disease. (1, 4, 6) The loss of muscle strength is also referred to as dynapenia. (10)  Muscle mass and muscle strength are not synonymous.  The term sarcopenia is relatively new.  It was first coined in 1988 by Dr.  Irwin Rosenberg. (4, 5, 28, 29)

Is a sarcopenic worker costing the company more money than a non-sarcopenic worker?  What percentage of the work force might be sarcopenic?  Can this latest health disorder be reversed?

Although it is difficult to pinpoint the exact cost of sarcopenia, the research shows that sarcopenia in 2000 cost the United States $18.5 billion. (16)  MacEwan’s research shows the U.S. will spend up to $800 billion on sarcopenic people between 2010 and 2040 or on average $27 billion a year unless programs are put in place to reduce the risk of sarcopenia.  It is expected the cost will be even greater than $27 billion a year over the next 10 -15 years.  The cost for a hospitalized sarcopenic patient could vary from 18% up to 75% more than for a non-sarcopenic patient. (2, 11, 19)

The World Health Organization (WHO) and the CDC predict by the year 2050 there will be nearly 2 billion people worldwide over the age of 60 of which 25% or 500 million will be sarcopenic! (10, 20)  The percentage of sarcopenic people varies between 10% and 33% and sarcopenia is becoming more common after the age of 60. (19) The percent variance is mostly due to the lack of standardization on how sarcopenia is determined.  It was just recently in August 2023 that the U.S. Department of Health and Human Services launched an awareness campaign on sarcopenia.  (26)  The United States is far behind the European and Asian countries on standardizing an assessment tool for sarcopenia. (27) 

Currently, assessing for sarcopenia is timely and costly.  One of the most accurate and costly methods is using DEXA (dual-energy-X-ray-absorptiometry scan).  Other less expensive and easier to use methods and predictable models are coming to market and currently being validated.  For example, through predictive models, researchers are studying hand grip strength, calf leg circumference, gait speed, sit-to-stand and BIA (Bioelectric Impedance Assessment) or a combination of these as possible models.  The idea is to validate a model to screen people with less expense and in less time first and if the person appears to be sarcopenic then they can be screened by more accurate but costlier assessments. (1, 14, 15)

Why the concern about sarcopenia and dynapenia? 

1. Muscle health is related to the prevention and/or management of many lifestyle disorders and chronic illnesses such as Type 2 diabetes, hypertension, cardiovascular diseases, certain cancers, joint and bone health (as well as fracture risk) and mental health such as cognition, dementia, anxiety and depression. (4, 5, 12, 21, 22, 29)  The sarcopenic person has a greater frequency and costs associated with these disorders compared to a non-sarcopenic person.
2. Sarcopenia is one factor associated with an increased fall risk and musculoskeletal injuries. (3, 6, 20, 21, 25)
   1. With the increase in the number of workers today over the age of 60 years and that number continues to increase, sarcopenic workers will lead to increases in workers’ comp and healthcare costs.
   2. In addition, I have presented Data-Fit (IPCS) strength data showing that the industrial worker losing about 0.6 percent of their strength each year since 2014 across all age groups (20-70 years by decades), which increases the risk of the worker for sarcopenia. (8)
3. Sarcopenia has a negative impact on activities of daily living (ADL) – getting out a of chair, climbing stairs, carrying in a bag of groceries and so on. (6, 28)
4. Sarcopenia is also found in individuals as young as 40 years who have certain chronic diseases such as obesity, cancer, kidney dysfunction, liver disease and metabolic disorders. (28, 29)

The health and strength of muscle can be fixed – even if you are 90 years of age.  By why wait until your 90?  Resistance exercises (strength training) has been recommended by a number of health agencies including the American College of Sports Medicine for the last 15 years.

• It is recommended resistance exercise should be done 2 -3 times per week for 60 minutes each session to help prevent sarcopenia.
• Muscle is made to work and it must be stimulated through a great enough resistance to stay strong.

This becomes a serious concern as we age since the body naturally starts losing muscle at about age 30.  During our 40’s and 50’s, it is estimated we lose about 10-15% of our strength/muscle and then it goes downhill fast after 60 with up to a 25% loss. (1, 4, 6, 28)

But we should NOT accept this loss of muscle as part of aging because most of this can be prevented or delayed through resistance exercises!

Resistance exercise keeps the body strong and muscle healthy no matter what your age.  Before beginning any strength training, clear all activities first with your physician and start with a certified personal trainer.

Diet is critical too.  As we age, our bodies have greater difficulty processing protein.  This also contributes to muscle and strength loss.  After the age of 60, a protein supplement is recommended in addition to the daily protein intake. (21, 22)  The daily recommended protein intake after the age of 60 is about 1 gr per kilogram body weight.  This means a 200-pound (90.9 kg) person at age 60 or greater should be consuming at least 90 grams of protein each day. (21, 22)

Vitamin and mineral supplements are suggested too such as Vitamin D, antioxidant nutrients, long-chain poly-unsaturated fatty acids and dairy products. (21, 22)

Intuitively, it is conceivable, that the percentage of sarcopenic individuals/workers in the U.S. will increase dramatically by 2050 considering people today are:

• living longer,
• working to older ages (over 60),
• less physically actively compared to 30 years ago,
• gaining fat weight,
• losing muscle strength across all age groups, and
• long-term effects from the COVID lockdown.

Will these factors increase the risk of sarcopenia being diagnosed at an earlier age such as in the fifties instead of the sixties?  Therefore, should we expect more sarcopenic workers?

What can be done before sarcopenia becomes an epidemic?  If it does become an epidemic, it will be long lasting.  There is no quick fix.  It will take the work and cooperation of industry, occupational health, health and safety professionals, insurance companies with incentives, schools, parents, medical groups and others to implement strengthening and nutrition programs to slow the frequency of sarcopenia in the United States.  In a recent paper I wrote about the sad state of physical fitness in our children – the workers of tomorrow – which will result in an increase in the number of sarcopenic workers! (9, 13, 23)

About fifty years ago as a tenured faculty member at the University of Michigan, I received an N.I.H. grant to study heart disease risk in first graders.    My research demonstrated that when children were taught why physical activity and good nutrition were important to their health, they chose physical activity and healthy eating – they cared about their health.   We need to value our health before it is too late and quit relying on quick fixes!  I believe people want to be healthy and I believe with time this can happen. 

References

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