Association between pain and sarcopenia among adults aged ≥65 years from low- and middle-income countries

Lee Smith, Guillermo F López Sánchez, Nicola Veronese, Pinar Soysal, Karel Kostev, Louis Jacob, Masoud Rahmati, Agnieszka Kujawska, Mark A Tully, Laurie Butler, Jae Il Shin, Ai Koyanagi

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Background Pain may increase the risk for sarcopenia, but existing literature is only from high-income countries, while the mediators of this association are largely unknown. Thus, we aimed to investigate the association between pain and sarcopenia using nationally representative samples of older adults from six low- and middle-income countries (LMICs), and to identify potential mediators. Methods Cross-sectional data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Sarcopenia was defined as having low skeletal muscle mass and weak handgrip strength, while presence and severity of pain in the last 30 days was self-reported. Multivariable logistic regression and mediation analyses were performed. The control variables included age, sex, education, wealth, and chronic conditions, while affect, sleep/energy, disability, social participation, sedentary behavior, and mobility were considered potential mediators. Results Data on 14,585 adults aged ≥65 years were analyzed [mean (SD) age 72.6 (11.5) years; 55.0% females]. Compared to no pain, mild, moderate, severe, and extreme pain were associated with 1.42 (95%CI=1.05-1.94), 1.43 (95%CI=1.02-2.00), 1.92 (95%CI=1.09-3.37), and 2.88 (95%CI=1.10-7.54) times higher odds for sarcopenia, respectively. Disability (mediated percentage 18.0%), sedentary behavior (12.9%), and low mobility (56.1%) were significant mediators in the association between increasing levels of pain and sarcopenia. Conclusions Higher levels of pain were associated with higher odds for sarcopenia among adults aged ≥65 years in six LMICs. Disability, sedentary behavior, and mobility problems were identified as potential mediators. Targeting these factors in people with pain may decrease future risk of sarcopenia onset, pending future longitudinal research.
Original languageEnglish
JournalJournals of Gerontology, Series A
Early online date5 Jan 2023
Publication statusPublished online - 5 Jan 2023


  • Pain
  • Sarcopenia
  • Low and middle-income countries
  • older
  • Disability
  • Low- and middle-income countries
  • Older adults

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