Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

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Sarcopenia: Revised European consensus on definition and diagnosis

Sarcopenia

Are designed landscapes conceived as geometric compositions or abstractions of nature incompatible with sustainable design? Does mimesis result in the only truly sustainable form in the landscape? This paper attempts to answer these questions by drawing on the observations of practitioners and educators in the field as well as investigating a range of built work for sustainable qualities. The built work is categorized according to four approaches to form genesis, geometric composition, abstractions of nature, mimesis, and combinations of the three. It is suggested here that there is no single formal strategy that must be used in order to achieve sustainability.

Summary comments

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. 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. 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). 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.

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

Sarcopenia, defined as an age-associated loss of skeletal muscle function and muscle mass, occurs in approximately 6 - 22 % of older adults. This paper presents evidence-based clinical practice guidelines for screening, diagnosis and management of sarcopenia from the task force of the International Conference on Sarcopenia and Frailty Research (ICSFR). To develop the guidelines, we drew upon the best available evidence from two systematic reviews paired with consensus statements by international working groups on sarcopenia. Eight topics were selected for the recommendations: (i) defining sarcopenia; (ii) screening and diagnosis; (iii) physical activity prescription; (iv) protein supplementation; (v) vitamin D supplementation; (vi) anabolic hormone prescription; (vii) medications under development; and (viii) research. The ICSFR task force evaluated the evidence behind each topic including the quality of evidence, the benefitharm balance of treatment, patient preferences/values, and cost-effectiveness. Recommendations were graded as either strong or conditional (weak) as per the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Consensus was achieved via one face-to-face workshop and a modified Delphi process. We make a conditional recommendation for the use of an internationally accepted measurement tool for the diagnosis of sarcopenia including the EWGSOP and FNIH definitions, and advocate for rapid screening using gait speed or the SARC-F. To treat sarcopenia, we strongly recommend the prescription of resistance-based physical activity, and conditionally recommend protein supplementation/a protein-rich diet. No recommendation is given for Vitamin D supplementation or for anabolic hormone prescription. There is a lack of robust evidence to assess the strength of other treatment options.

International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management

Quality of life and physical components linked to sarcopenia: The SarcoPhAge study

The health economics burden of sarcopenia: a systematic review.

This study aims to explore the association between malnutrition diagnosed according to both the Global Leadership Initiative of Malnutrition (GLIM) and the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria and the onset of sarcopenia/severe sarcopenia, diagnosed according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criterion, in the sarcopenia and physical impairment with advancing age (SarcoPhAge) cohort during a four-year follow-up. Adjusted Cox-regression and Kaplan-Meier curves were performed. Among the 534 community-dwelling participants recruited in the SarcoPhAge study, 510 were free from sarcopenia at baseline, of whom 336 had complete data (186 women and 150 men, mean age of 72.5 ± 5.8 years) to apply the GLIM and ESPEN criteria. A significantly higher risk of developing sarcopenia/severe sarcopenia during the four-year follow-up based on the GLIM [sarcopenia: Adjusted hazard ratio (HR) = 3.23 (95% confidence interval (CI) 1.73–6.05); severe sarcopenia: Adjusted HR = 2.87 (95% CI 1.25–6.56)] and ESPEN [sarcopenia: Adjusted HR = 4.28 (95% CI 1.86–9.86); severe sarcopenia: Adjusted HR = 3.86 (95% CI 1.29–11.54)] criteria was observed. Kaplan-Meier curves confirmed this relationship (log rank p < 0.001 for all). These results highlighted the importance of malnutrition since it has been shown to be associated with an approximately fourfold higher risk of developing sarcopenia/severe sarcopenia during a four-year follow-up.

https://www.mdpi.com/2072-6643/11/12/2883/pdf

Malnutrition as a Strong Predictor of the Onset of Sarcopenia.

Background Sarcopenia leads to serious adverse health consequences. There is a dearth of screening tools for this condition, and performances of these instruments have rarely been evaluated. Our aim was to compare the performance of five screening tools for identifying elders at risk of sarcopenia against five diagnostic definitions. Subjects and methods We gathered cross-sectional data of elders from the SarcoPhAge ("Sarco"penia and "Ph"ysical Impairment with Advancing "Age") study. Lean mass was measured with X-ray absorptiometry, muscle strength with a dynamometer and physical performance with the Short Physical Performance Battery (SPPB) test. Performances of screening methods were described using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC), according to five diagnostic definitions of sarcopenia. For each screening tool, optimal cutoff points were computed using two methods. Results A total of 306 subjects (74.8±5.9 years, 59.5% women) were included. The prevalence of sarcopenia varied from 5.7% to 16.7% depending on the definition. The best sensitivity (up to 100%) and the best NPV (up to 99.1%) were obtained with the screening test of Ishii et al, regardless of the definition applied. The highest AUC (up to 0.914) was also demonstrated by the instrument of Ishii et al. The most specific tool was the algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP; up to 91.1%). All NPVs were above 87.0%, and all PPVs were below 51.0%. New cutoffs related to each screening instrument were also proposed to better discriminate sarcopenic individuals from non-sarcopenic individuals. Conclusion Screening instruments for sarcopenia can be relevantly used in clinical practice to make sure to identify individuals who do not suffer from the syndrome. The screening test of Ishii et al showed better properties in terms of distinguishing those at risk of sarcopenia from those who were not at risk.

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Comparison of the performance of five screening methods for sarcopenia.

Introduction: In the definition of the European Working Group on Sarcopenia in Older People (EWGSOP), different cut-off limits are proposed for appendicular lean mass, muscle strength and gait speed. Therefore we aimed to examine the variation in prevalence of sarcopenia obtained with these cut-off limits. Materials and Methods: Subjects aged 65 years and older were re - cruited in an outpatient clinic in Belgium and screened for sarcopenia using the EWGSOP definition. Appendicular lean mass was measured by Dual Energy X-Ray Absorptiometry, muscle strength by a hydraulic handgrip dynamometer and gait speed was measured on a 4-meter distance. Two different cut-off points proposed by the EWGSOP were examined for each variable and 8 diagnostic methods were thereby established. Results: 400 subjects were recruited for this study. Prevalence of sarcopenia varied from 9.25% to 18% depending on the cut-offs applied. When stratified by sex, it seems that the variation in prevalence of sar - copenia was mainly attributable to women. This prevalence ranged from 6.58% to 20.2% for women and only from 13.4% to 14.7% for men. Conclusion: Prevalence of sarcopenia varies widely depending on the EWGSOP cut-off points applied for women. This may limit clinical researches and development of therapeutic strategies in the field of sarcopenia.

Médéa Locquet

Papers

Quality of life and physical components linked to sarcopenia: The SarcoPhAge study

The health economics burden of sarcopenia: a systematic review.

Malnutrition as a Strong Predictor of the Onset of Sarcopenia.

Comparison of the performance of five screening methods for sarcopenia.

Prevalence of sarcopenia: the impact of different diagnostic cut-off limits.