Have you ever met with a patient and wondered if the assessment findings related not to malnutrition but to the aging process? Many dietitians have at some point reflected on this subject. Today we will discuss the difference between sarcopenia and malnutrition.

First, let’s start with the definitions for each. Sarcopenia is defined as the age-related reduction in skeletal muscle mass in the elderly. (1) This is a natural part of the aging process. Sarcopenia has two categories. Primary Sarcopenia has no specific etiologic cause that can be identified. Secondary Sarcopenia is where the natural process is aggravated by an extrinsic factor, such as lack of physical activity, malnutrition, chronic inflammation and comorbidity. (3) Sarcopenia is diagnosed by looking at the muscle mass, muscle strength, and physical performance. (4)

Malnutrition is defined as a condition that develops when the body doesn’t get the right amount of the vitamins, minerals, and other nutrients it needs to maintain healthy tissues and organ function. (2) Aging is an independent factor of malnutrition. (3) Malnutrition is nutritionally diagnosed using the characteristics from Academy of Nutrition and Dietetics (AND) and American Society of Parenteral and Enteral Nutrition (ASPEN), assessing muscle wasting, body fat loss, energy intake, weight loss, edema, and hand grip strength all over specific time periods.

The presence of both:

These diseases can exist independently or together. To assess the difference, we must look at the big picture. Is the patient eating well? Has the patient lost weight? Is the patient diagnosed with malnutrition? Although, currently dietitians as a profession are not nutritionally diagnosing sarcopenia, we need to be aware of it. When we assess older adults, we need to keep in mind that some muscle loss is natural, and if that person hasn’t lost a significant amount of weight and is eating well, then they MAY have sarcopenia, but are not malnourished. We need to use our best clinical judgment, and the more patients that are assessed, the better the clinician gets in diagnosing malnutrition. Another example would be if a patient is not eating well, and had significant weight loss, and had muscle loss, that patient could be malnourished with secondary sarcopenia, but none the less is malnourished.

The nutrition intervention:

The nutrition interventions for sarcopenia and malnutrition can be similar. For malnutrition, dietitians would create a tailored nutritional intervention to stop the cause and progression of malnutrition, including adequate protein, calories, vitamins, and minerals. For those with sarcopenia, the recommendations are for patients to meet their nutritional needs in protein (1.0-1.5g/kg) and vitamin D. (5 &6) Dietitians should provide recommendations to their patient meet their macronutrient and micronutrient needs.

Brooke May, MS, RD, LRD
Executive Success Coach
DM&A Nutrition Division
February 2015

Citations:

  1. Sarcopenia. (n.d.). In Medical Dictionary online. Retrieved from
    http://medical-dictionary.thefreedictionary.com/sarcopenia
  2. Malnutrition. (n.d.). In Medical Dictionary online. Retrieved from
    http://medical-dictionary.thefreedictionary.com/malnutrition
  3. Vandewoude, M.F., Alish, C.J., Sauer, A.C., Hegazi, R.A. (2012). Malnutrition-sarcopenia syndrome: is this the future of nutrition screening and assessment for older adults? Journal of Aging Research, 2012. http://dx.doi.org/10.1155/2012/651570
  4. Cruz-Jentoft, A.J., & Baeyens, J.P. (2010). Sarcopenia: European consensus on definition and diagnosis. Age and Ageing, 39: 412-423. Doi: 10.1093/ageing/afq034
  5. Dorner, B., & Posthauer, M.E. (2012). Nutrition’s role in sarcopenia prevention. Today’s Dietitian, 14. Retrieved from: http://www.todaysdietitian.com/newarchives/090112p62.shtml
  6. Morley, J.E., & Argiles, J.M. (2010). Nutritional recommendations for the management of sarcopenia. Journal of the American Medical Directors Association, 11. Retrieved from: http://www.stuurgroepondervoeding.nl/fileadmin/inhoud/eerstelijn_thuiszorg/literatuur_en_achtergrondinformatie/voedingsinterventie_bij_sarcopenie.pdf