Sarcopenia: Revised European consensus on definition and diagnosis
Istanbul University1, Heidelberg University2, University of Liège3, Karolinska University Hospital4, University of Southampton5, Catholic University of the Sacred Heart6, University of Toulouse7, Newcastle upon Tyne Hospitals NHS Foundation Trust8, University of Erlangen-Nuremberg9, First Faculty of Medicine, Charles University in Prague10, University of Antwerp11, Public Health Research Institute12, University of Verona13
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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National Yang-Ming University1, The Chinese University of Hong Kong2, Mahidol University3, University of Tokyo4, Seoul National University Bundang Hospital5, Peking Union Medical College Hospital6, Kyung Hee University7, Nagoya University8, Seoul National University9, Taipei Veterans General Hospital10, Ajou University11, Tan Tock Seng Hospital12, Osaka University13, University of Tsukuba14, Chinese Ministry of Health15
TL;DR: The Asian Working Group for Sarcopenia 2019 introduces "possible sarcopenia," defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions.
2,287 citations
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
The Heart Research Institute1, Saint Louis University2, Wake Forest University3, University of Maryland, Baltimore4, Heidelberg University5, University of Florida6, University of Milan7, University of Miami8, University of Erlangen-Nuremberg9, Université du Québec à Montréal10, University of Otago11, University of Adelaide12, Agostino Gemelli University Polyclinic13, United States Department of Veterans Affairs14, Tufts University15, Kyung Hee University16, Dalhousie University17, King's College London18, Sichuan University19, The Chinese University of Hong Kong20, University of Western Australia21, National Institutes of Health22, National University of Singapore23, Uppsala University24, University of São Paulo25, Memorial Hospital of South Bend26, Vrije Universiteit Brussel27, Maastricht University28, Universidad Pública de Navarra29, Centre Hospitalier Universitaire de Toulouse30
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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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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TL;DR: The details of the final consensus methodology suggested for SARC-F validation are explained, thereby guiding and helping the research teams in their studies.
33 citations
"Sarcopenia: Revised European consen..." refers background in this paper
...A project is underway to translate and validate SARC-F in multiple different world languages [60]....
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TL;DR: A sarcopenia-specific HRQoL questionnaire was developed and validated in a population of sarcopenic subjects to more accurately assess the impact of sarc Openia on QoL and a new specific HRQOL questionnaire is introduced, the SarZoL®.
Abstract: Sarcopenia, defined by a progressive and generalized loss of muscle mass and muscle function, is associated with many harmful clinical consequences. Several studies have reported the impact of sarcopenia on health-related quality of life (HRQoL) using generic quality of life (QoL) questionnaires. The results of these observational studies are quite heterogenous. Indeed, generic tools may not be able to detect subtle effects of sarcopenia on QoL. Recently, a sarcopenia-specific HRQoL questionnaire was developed and validated in a population of sarcopenic subjects to more accurately assess the impact of sarcopenia on QoL. Areas covered: The purpose of this review is to present evidence regarding the impact of sarcopenia on QoL and to introduce a new specific HRQoL questionnaire, the SarQoL®. Expert commentary: The self-administered SarQoL®, initially developed in French, comprises 55 items translated into 22 questions. The questionnaire has been shown to be understandable, valid, consistent, and reliable and can therefore be recommended for clinical and research purposes. The questionnaire is now available in 11 different languages with another 20 translations in progress. The instrument's sensitivity to change still needs to be assessed in future longitudinal studies.
32 citations
TL;DR: This tutorial for nutrition support clinicians is presented, in order to understand and perform muscle measurements by this reliable, accessible, low-cost, and easy-to-use technique.
Abstract: Intensive care unit acquired weakness is a long-term consequence after critical illness; it has been related to muscle atrophy and can be considered as one of the main nutritional support challenges at the intensive care unit. Measuring muscle mass by image techniques has become a new area of research for the nutritional support field, extending our knowledge about muscle wasting and the impact of nutritional approaches in the critical care setting, although currently there is no universally accepted technique to perform muscle measurements by ultrasound. Because of this, we present this tutorial for nutrition support clinicians, in order to understand and perform muscle measurements by this reliable, accessible, low-cost, and easy-to-use technique. Reviewing issues such as quadriceps muscle anatomy, correct technique (do's and don'ts), identification of structures, and measurement of the rectus femoris and vastus intermedius muscles helps to acquire the basic concepts of this technique and encouraging more research in this field.
29 citations
"Sarcopenia: Revised European consen..." refers background in this paper
...Assessment of pennate muscles such as the quadriceps femoris can detect a decrease in muscle thickness and cross-sectional area within a relatively short period of time, thus suggesting potential for use of this tool in clinical practice, including use in the community [112, 113]....
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...Ultrasound is accurate with good intra- and inter-observer reliability, even in older subjects [112]....
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08 Apr 2019
TL;DR: Evaluating the availability and use of dual energy X-ray absorptiometry and bio-impedance analysis in clinical practice of Belgian and Latin American geriatricians found that the use of BIA in the screening for sarcopenia was negligible and search for inexpensive and readily available detection tools should continue.
Abstract: Dear Editor,
Sarcopenia is the age-associated progressive loss of skeletal muscle mass and function, with higher risk of adverse outcomes [1, 2]. The cause of sarcopenia is still unclear, but the determinants are likely to be a combination of genetic and environmental factors [2–4]. Computed tomography and magnetic resonance imaging are considered the gold standard to estimate muscle mass. However, their high cost and limited availability preclude their routine use in clinical settings [5, 6]. Dual energy X-ray absorptiometry (DXA) and bio-impedance analysis (BIA) are alternative methods for research and clinical use to measure skeletal muscle mass [7]. In the last years, BIA and DXA have been used frequently in the field of research, but it is not known to what extent the recommendations for screening and diagnosis are followed nor to what extent the suggested techniques are available in clinical practice [8]. Therefore, the aim of this study was to evaluate the availability and use of these techniques in clinical practice of Belgian and Latin American geriatricians.
Geriatricians were asked four questions by a web-based survey system in order to determine availability and use of both techniques. The questions were: “Does your hospital have a BIA system?” and “Does your hospital have a DXA scanner for measuring muscle mass?” If one or both of the questions were affirmative, it was asked whether they had used the respective technique during the last month.
As shown in Fig. 1 in the group of Latin Americans, 170 geriatricians were contacted of whom 94 (55.0 %) responded (Mexico, Brazil, and Costa Rica responded most frequent). In Belgium, 133 geriatricians were contacted and 50 (37.6 %) responded. The Latin American geriatricians had greater availability of both techniques (BIA and DXA) than their Belgian counterparts (22 vs 35 and 35 vs 30 %, respectively). In Latin American, BIA was more available than DXA (35 vs 30 %). In Belgium, BIA was less available than DXA (22 vs 34 %). The overall use of these techniques for measuring muscle mass was 10.0 % for DXA and 4.0 % for BIA among Belgian geriatricians. In Latin America, the reported use of both techniques was higher than in Belgium, specifically for DXA (12 vs 10 %; p < 0.0001). For BIA, the difference was less pronounced (17 vs 4 %; p = 0.18). Centers that had DXA were more likely to also have BIA available (p < 0.001); this was true in Belgium as well as in Latin America (see Table 1).
Fig. 1
Flowchart of the study
Table 1
Comparison of availability and use of DXA/BIA between Belgium and Latin American countries
Availability of the techniques recommended for the measurement of muscle mass is not very broad. In Belgium, excluding university hospitals, general hospitals use only 28 % for DXA and even less for BIA (10 %). The overall availability in Latin America is comparable with the situation in Belgium with a reversed preponderance of BIA over DXA availability. Regardless from the availability, the actual use of these studies was lower for DXA with only about 10 % in both regions. In Belgium, the use of BIA in the screening for sarcopenia was negligible. Nevertheless, interpretation should be careful. Sarcopenia remains still a relatively new concept, and it can be expected that in the years to come, the knowledge of this condition will improve along with the detection of this condition. In addition, search for inexpensive and readily available detection tools should continue in fields such as anthropometry (calf circumference). Easy and available clinical indicators could provide valuable information on muscle-related disability and physical function and have a preponderant role in screening, leaving BIA and DXA for intervention decisions and follow-up.
28 citations
"Sarcopenia: Revised European consen..." refers background in this paper
...Because of technological limits, muscle quantity and muscle quality remain problematic as primary parameters to define sarcopenia [31, 32, 34]....
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TL;DR: Five PEs showed ASM values that correlated strongly with ASMDXA and the Sergi equation is applicable in adult Australians (Caucasian) whereas the Kyle equation can be considered in males, the need remains to validate PEs in other ethnicities and to develop equations suitable for multi-frequency BIA.
Abstract: Appendicular skeletal muscle mass (ASM) is a diagnostic criterion for sarcopenia. Bioelectrical impedance analysis (BIA) offers a bedside approach to measure ASM but the performance of BIA prediction equations (PE) varies with ethnicities and body composition. We aim to validate the performance of five PEs in estimating ASM against estimation by dual-energy X-ray absorptiometry (DXA). We recruited 195 healthy adult Australians and ASM was measured using single-frequency BIA. Bland-Altman analysis was used to assess the predictive accuracy of ASM as determined by BIA against DXA. Precision (root mean square error (RMSE)) and bias (mean error (ME)) were calculated according to the method of Sheiner and Beal. Four PEs (except that by Kim) showed ASM values that correlated strongly with ASMDXA (r ranging from 0.96 to 0.97, p < 0.001). The Sergi equation performed the best with the lowest ME of −1.09 kg (CI: −0.84–−1.34, p < 0.001) and the RMSE was 2.09 kg (CI: 1.72–2.47). In men, the Kyle equation performed better with the lowest ME (−0.32 kg (CI: −0.66–0.02) and RMSE (1.54 kg (CI: 1.14–1.93)). The Sergi equation is applicable in adult Australians (Caucasian) whereas the Kyle equation can be considered in males. The need remains to validate PEs in other ethnicities and to develop equations suitable for multi-frequency BIA.
28 citations