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Journal ArticleDOI

Sarcopenia: Revised European consensus on definition and diagnosis

TL;DR: An emphasis is placed on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarc Openia diagnosis, and provides clear cut-off points for measurements of variables that identify and characterise sarc openia.
Abstract: 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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01 Jun 2011

618 citations

Journal ArticleDOI
TL;DR: Evidence is provided to support recommendations for successful resistance training in older adults related to 4 parts: program design variables, physiological adaptations, functional benefits, and considerations for frailty, sarcopenia, and other chronic conditions.
Abstract: Fragala, MS, Cadore, EL, Dorgo, S, Izquierdo, M, Kraemer, WJ, Peterson, MD, and Ryan, ED. Resistance training for older adults: position statement from the national strength and conditioning association. J Strength Cond Res 33(8): 2019-2052, 2019-Aging, even in the absence of chronic disease, is associated with a variety of biological changes that can contribute to decreases in skeletal muscle mass, strength, and function. Such losses decrease physiologic resilience and increase vulnerability to catastrophic events. As such, strategies for both prevention and treatment are necessary for the health and well-being of older adults. The purpose of this Position Statement is to provide an overview of the current and relevant literature and provide evidence-based recommendations for resistance training for older adults. As presented in this Position Statement, current research has demonstrated that countering muscle disuse through resistance training is a powerful intervention to combat the loss of muscle strength and muscle mass, physiological vulnerability, and their debilitating consequences on physical functioning, mobility, independence, chronic disease management, psychological well-being, quality of life, and healthy life expectancy. This Position Statement provides evidence to support recommendations for successful resistance training in older adults related to 4 parts: (a) program design variables, (b) physiological adaptations, (c) functional benefits, and (d) considerations for frailty, sarcopenia, and other chronic conditions. The goal of this Position Statement is to a) help foster a more unified and holistic approach to resistance training for older adults, b) promote the health and functional benefits of resistance training for older adults, and c) prevent or minimize fears and other barriers to implementation of resistance training programs for older adults.

505 citations

Journal ArticleDOI
TL;DR: 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) are presented.
Abstract: 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.

466 citations


Cites methods from "Sarcopenia: Revised European consen..."

  • ...Of importance, the task force did consider grip strength as a screening tool for sarcopenia, but this was voted out in the consensus process for two main reasons: (i) the new EWGSOP guidelines for sarcopenia [EWGSOP-2 (59)] recommend that grip strength is a diagnostic assessment rather than a screening test; and (ii) the specific feedback we received from the primary care members of our external reviewing group, most of whom stated that they would prefer not to perform grip strength measurement in their primary care clinics....

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Journal ArticleDOI
TL;DR: The positive association between sarcopenia with falls and fractures in older adults strengthens the need to invest in sarc Openia prevention and interventions to evaluate its effect on falls and fracture.
Abstract: Sarcopenia is a potentially modifiable risk factor for falls and fractures in older adults, but the strength of the association between sarcopenia, falls, and fractures is unclear. This study aims to systematically assess the literature and perform a meta-analysis of the association between sarcopenia with falls and fractures among older adults. A literature search was performed using MEDLINE, EMBASE, Cochrane, and CINAHL from inception to May 2018. Inclusion criteria were the following: published in English, mean/median age ≥ 65 years, sarcopenia diagnosis (based on definitions used by the original studies' authors), falls and/or fractures outcomes, and any study population. Pooled analyses were conducted of the associations of sarcopenia with falls and fractures, expressed in odds ratios (OR) and 95% confidence intervals (CIs). Subgroup analyses were performed by study design, population, sex, sarcopenia definition, continent, and study quality. Heterogeneity was assessed using the I2 statistics. The search identified 2771 studies. Thirty-six studies (52 838 individuals, 48.8% females, and mean age of the study populations ranging from 65.0 to 86.7 years) were included in the systematic review. Four studies reported on both falls and fractures. Ten out of 22 studies reported a significantly higher risk of falls in sarcopenic compared with non-sarcopenic individuals; 11 out of 19 studies showed a significant positive association with fractures. Thirty-three studies (45 926 individuals) were included in the meta-analysis. Sarcopenic individuals had a significant higher risk of falls (cross-sectional studies: OR 1.60; 95% CI 1.37-1.86, P < 0.001, I2 = 34%; prospective studies: OR 1.89; 95% CI 1.33-2.68, P < 0.001, I2 = 37%) and fractures (cross-sectional studies: OR 1.84; 95% CI 1.30-2.62, P = 0.001, I2 = 91%; prospective studies: OR 1.71; 95% CI 1.44-2.03, P = 0.011, I2 = 0%) compared with non-sarcopenic individuals. This was independent of study design, population, sex, sarcopenia definition, continent, and study quality. The positive association between sarcopenia with falls and fractures in older adults strengthens the need to invest in sarcopenia prevention and interventions to evaluate its effect on falls and fractures.

421 citations

References
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Journal ArticleDOI
TL;DR: In this article, a review aimed to determine the relation between different body composition measures and muscle strength measures and functional decline in older men and women, and revealed that BMI ≥30 and low muscle strength were associated with functional decline.
Abstract: Aging is associated with changes in body composition and muscle strength. This review aimed to determine the relation between different body composition measures and muscle strength measures and functional decline in older men and women. By use of relevant databases (PubMed, Embase, and CINAHL) and keywords in a search from 1976 to April 2012, 50 articles were reviewed that met the inclusion criteria (written in English, a prospective, longitudinal design, involving older persons aged 65 years or more, and at least one of the measures that follow: body mass index (BMI), waist circumference, waist/hip ratio, midarm circumference, fat mass, muscle fat infiltration, muscle mass, or strength as independent variables and a measure of functional decline as outcome measure). Meta-analyses were performed and revealed that BMI ≥30 and low muscle strength were associated with functional decline (pooled odds ratio (OR) = 1.60, 95% confidence interval (CI): 1.43, 1.80, for BMI ≥30 and OR = 1.86, 95% CI: 1.32, 2.64, for muscle strength). Low muscle mass was not significantly associated with functional decline (pooled OR = 1.19, 95% CI: 0.98, 1.45). Future intervention research should focus on positive changes in body composition to prevent onset or worsening of functional decline in old age.

291 citations


"Sarcopenia: Revised European consen..." refers background in this paper

  • ...In these revised guidelines, muscle strength comes to the forefront, as it is recognised that strength is better than mass in predicting adverse outcomes [11, 28, 29, 37]....

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Journal ArticleDOI
TL;DR: ALM cutpoints derived from a large, diverse sample of older adults identified lean mass thresholds below which older adults had a higher likelihood of weakness.
Abstract: Early efforts to create an operational definition of sarcopenia (including the creation of cutpoints) have relied on distributional definitions of lean mass (1), with sarcopenia defined as a value of appendicular lean mass (ALM)/height2 (derived from whole-body dual-energy x-ray absorptiometry [DXA]) below the young adult mean level of lean mass or was based on definitions that further account for body size or fatness (2–4). More recent efforts have added functional and/or strength measures to lean mass to define sarcopenia (5,6), but no approaches thus far have proposed and validated cutpoints and definitions based on discriminative and predictive ability using a data-driven approach from a variety of cohort studies. The overarching goal of this set of concurrent reports from the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project was to determine preliminary data-driven criteria for clinically relevant weakness and low lean mass. The conceptual framework was based on a clinician making a “differential diagnosis” of mobility impairment, defined as slow gait speed. The clinician understands that there are many causes of slow walking, one of which is weakness. Similarly, low lean mass may be considered a potential contributing factor to the development of weakness (7). Data from multiple large cohort studies of aging were pooled for this effort (7). The first stage of analyses identified sex-specific cutpoints for weakness that discriminated slow participants (walking speed <0.8 m/s) from those who walked faster (8). In the second stage of the analyses, reported herein, we aimed to identify cutpoints in lean mass that discriminated those who were weak (grip strength <16kg in women or <26kg in men) from those who were stronger. The findings from this work were used to address subsequent goals of the Project, so it is important to consider these results within the context of all other articles in this series.

285 citations

Journal ArticleDOI
TL;DR: A systematic review and meta-analysis of cross-sectional and cohort studies exploring the relationship between PA and sarcopenia in older people confirmed the beneficial influence of PA in general for the prevention of sarc Openia.
Abstract: Physical activity (PA) has been identified as beneficial for many diseases and health disorders, including sarcopenia The positive influence of PA interventions on sarcopenia has been described previously on many occasions Current reviews on the topic include studies with varied PA interventions for sarcopenia; nevertheless, no systematic review exploring the effects of PA in general on sarcopenia has been published The main aim of this study was to explore the relationship between PA and sarcopenia in older people on the basis of cross-sectional and cohort studies We searched PubMed, Scopus, EBSCOhost, and ScienceDirect for articles addressing the relationship between PA and sarcopenia Twenty-five articles were ultimately included in the qualitative and quantitative syntheses A statistically significant association between PA and sarcopenia was documented in most of the studies, as well as the protective role of PA against sarcopenia development Furthermore, the meta-analysis indicated that PA reduces the odds of acquiring sarcopenia in later life (odds ratio [OR] =045; 95% confidence interval [CI] 037-055) The results of this systematic review and meta-analysis confirm the beneficial influence of PA in general for the prevention of sarcopenia

267 citations


"Sarcopenia: Revised European consen..." refers background in this paper

  • ...Treatment options for physical frailty and for sarcopenia likewise overlap—provision of optimal protein intake, supplementation of vitamin D, and physical exercise [19, 144, 145]....

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Journal ArticleDOI
TL;DR: In this article, the authors investigated the associations of sarcopenia as defined by European Working Group on Sarcopenia in Older People (EWGSOP) and Foundation for the National Institutes of Health (FNIH) Sarc Openia Project, and their underlying components, with the incidence of recurrent falling and fractures.
Abstract: Background: The aim was to investigate the associations of sarcopenia as defined by European Working Group on Sarcopenia in Older People (EWGSOP) and Foundation for the National Institutes of Health (FNIH) Sarcopenia Project, and their underlying components, with the incidence of recurrent falling and fractures. Methods: In 498 older men and women (mean age = 75.2 [SD = 6.4]) from the Longitudinal Aging Study Amsterdam (LASA), the sarcopenia components lean mass (DXA), handgrip strength (handheld dynamometer), and gait speed were measured. Data on falls (3-year follow-up) and fractures (10-year follow-up) were collected. Cox regression analyses were performed, adjusting for age, sex, and total body fat. Results: Recurrent falling occurred in 130 persons and 60 persons experienced a fracture during follow-up. Participants who were identified as sarcopenic based on the FNIH definitions had a more than 2-fold increased risk to become a recurrent faller. There was no association between sarcopenia based on the EWGSOP definition and incidence of recurrent falling. When the sarcopenia components were examined individually, only a low grip strength was associated with incidence of recurrent falling, independent of a low lean mass or a slow gait speed. Sarcopenia according to both definitions was not associated with incident fractures, which may be caused by low statistical power. Conclusion: Sarcopenia according to the FNIH definitions, but not according to the EWGSOP definition was associated with recurrent falling. When examining the individual components, only a low grip strength was independently associated with recurrent falling. No associations between sarcopenia with incidence of fractures were found.

261 citations

Journal ArticleDOI
TL;DR: Sarcopenia was independently associated with cognitive impairment, and different target populations and sex specificity did not significantly modify the association, whereas the tools for evaluating cognitive function and modalities for measuring body composition did.

259 citations


"Sarcopenia: Revised European consen..." refers background in this paper

  • ...In terms of human health, sarcopenia increases risk of falls and fractures [10, 11]; impairs ability to perform activities of daily living [12]; is associated with cardiac disease [13], respiratory disease [14] and cognitive impairment [15]; leads to mobility disorders [2]; and contributes to lowered quality of life [16], loss of independence or need for long-term care placement [17–19], and death [20]....

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