Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People

Alfonso J Cruz-Jentoft, Jean Pierre Baeyens, Jürgen M Bauer, Yves Boirie, Tommy Cederholm, Francesco Landi, Finbarr C Martin, Jean-Pierre Michel, Yves Rolland, Stéphane M Schneider, Eva Topinková, Maurits Vandewoude, Mauro Zamboni, European Working Group on Sarcopenia in Older People, Alfonso J Cruz-Jentoft, Jean Pierre Baeyens, Jürgen M Bauer, Yves Boirie, Tommy Cederholm, Francesco Landi, Finbarr C Martin, Jean-Pierre Michel, Yves Rolland, Stéphane M Schneider, Eva Topinková, Maurits Vandewoude, Mauro Zamboni, European Working Group on Sarcopenia in Older People

Abstract

The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics-European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as 'presarcopenia', 'sarcopenia' and 'severe sarcopenia'. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.

Figures

Figure 1
Figure 1
Mechanisms of sarcopenia.
Figure 2
Figure 2
EWGSOP-suggested algorithm for sarcopenia case finding in older individuals.

References

    1. Rosenberg I. Summary comments: epidemiological and methodological problems in determining nutritional status of older persons. Am J Clin Nutr. 1989;50:1231–3.
    1. Rosenberg IH. Sarcopenia: origins and clinical relevance. J Nutr. 1997;127:990S–91S.
    1. Morley JE, Baumgartner RN, Roubenoff R, et al. Sarcopenia. J Lab Clin Med. 2001;137:231–43.
    1. Inouye SK, Studenski S, Tinetti ME, et al. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55:780–91.
    1. Olde Rikkert MG, Rigaud AS, van Hoeyweghen RJ, et al. Geriatric syndromes: medical misnomer or progress in geriatrics? Neth J Med. 2003;61:83–7.
    1. Cruz-Jentoft A, Landi F, Topinková E, et al. Understanding sarcopenia as a geriatric syndrome. Curr Opin Clin Nutr Metab Care. 2010;13:1–7.
    1. Iannuzzi-Sucich M, Prestwood KM, Kenny AM. Prevalence of sarcopenia and predictors of skeletal muscle mass in healthy, older men and women. J Gerontol A Biol Sci Med Sci. 2002;57:M772–7.
    1. Chien MY, Huang TY, Wu YT. Prevalence of sarcopenia estimated using a bioelectrical impedance analysis prediction equation in community-dwelling elderly people in Taiwan. J Am Geriatr Soc. 2008;56:1710–5.
    1. Paddon-Jones D, Short KR, Campbell WW, et al. Role of dietary protein in the sarcopenia of aging. Am J Clin Nutr. 2008;87:1562S–6S.
    1. Sayer AA, Syddall H, Martin H, et al. The developmental origins of sarcopenia. J Nutr Health Aging. 2008;12:427–32.
    1. Thompson DD. Aging and sarcopenia. J Musculoskelet Neuronal Interact. 2007;7:344–5.
    1. Cawthon PM, Marshall LM, Michael Y, et al. Frailty in older men: prevalence, progression, and relationship with mortality. J Am Geriatr Soc. 2007;55:1216–23.
    1. Laurentani F, Russo C, Bandinelli S, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol. 2003;95:1851–60.
    1. Rolland Y, Czerwinski S, Abellan Van Kan G, et al. Sarcopenia: its assessment, etiology, pathogenesis, consequences and future perspectives. J Nutr Health Aging. 2008;12:433–50.
    1. Topinkova E. Aging, disability and frailty. Ann Nutr Metab. 2008;52(Suppl 1):6–11.
    1. Hartman MJ, Fields DA, Byrne NM, et al. Resistance training improves metabolic economy during functional tasks in older adults. J Strength Cond Res. 2007;21:91–5.
    1. Delmonico MJ, Harris TB, Lee JS, et al. Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women. J Am Geriatr Soc. 2007;55:769–74.
    1. Goodpaster BH, Park SW, Harris TB, et al. The loss of skeletal muscle strength, mass, and quality in older adults: The health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2006;61:1059–64.
    1. Janssen I, Baumgartner R, Ross R, et al. Skeletal muscle cutpoints associated with elevated physical disability risk in older men and women. Am J Epidemiol. 2004;159:413–21.
    1. Clark BC, Manini TM. Sarcopenia ≠ dynapenia. J Gerontol A Biol Sci Med Sci. 2008;63:829–34.
    1. Thomas DR. Loss of skeletal muscle mass in aging: examining the relationship of starvation, sarcopenia and cachexia. Clin Nutr. 2007;26:389–99.
    1. Evans WJ, Morley JE, Argiles J, et al. Cachexia: a new definition. Clin Nutr. 2008;27:793–9.
    1. Morley JE, Anker SD, Evans WJ. Cachexia and aging: an update based on the Fourth International Cachexia Meeting. J Nutr Health Aging. 2009;13:47–55.
    1. Durham WJ, Dillon EL, Sheffield-Moore M. Inflammatory burden and amino acid metabolism in cancer cachexia. Curr Opin Clin Nutr Metab Care. 2009;12:72–7.
    1. Muscaritoli M, Anker SD, Argiles J, et al. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) “cachexia–anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr. 2010;29:154–9.
    1. Bauer JM, Sieber CC. Sarcopenia and frailty: a clinician's controversial point of view. Exp Gerontol. 2008;43:674–8.
    1. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56.
    1. Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9:629–35.
    1. Stenholm S, Harris TB, Rantanen T, et al. Sarcopenic obesity: definition, cause and consequences. Curr Opin Clin Nutr Metab Care. 2008;11:693–700.
    1. Visser M, Kritchevsky SB, Goodpaster BH, et al. Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: the health, aging and body composition study. J Am Geriatr Soc. 2002;50:897–904.
    1. Ding J, Kritchevsky SB, Newman AB, et al. Effects of birth cohort and age on body composition in a sample of community-based elderly. Am J Clin Nutr. 2007;85:405–10.
    1. Hughes VA, Roubenoff R, Wood M, et al. Anthropometric assessment of 10-y changes in body composition in the elderly. Am J Clin Nutr. 2004;80:475–82.
    1. Song MY, Ruts E, Kim J, et al. Sarcopenia and increased adipose tissue infiltration of muscle in elderly African American women. Am J Clin Nutr. 2004;79:874–80.
    1. Assessing muscle mass. In: Lukasi H, editor; Heymsfield M, et al., editors. Human body composition. Champaign, IL, USA: Human Kinetics; 2005.
    1. NIH Bioelectrical impedance analysis in body composition measurement: National Institutes of Health Technology Assessment Conference Statement. Am J Clin Nutr. 1996;64:524S–32S.
    1. Janssen I, Heymsfield SB, Baumgartner RN, et al. Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol. 2000;89:465–71.
    1. Kyle UG, Genton L, Slosman DO, et al. Fat-free and fat mass percentiles in 5225 healthy subjects aged 15 to 98 years. Nutrition. 2001;17:534–41.
    1. Roubenoff R, Baumgartner RN, Harris TB, et al. Application of bioelectrical impedance analysis to elderly populations. J Gerontol A Biol Sci Med Sci. 1997;52:M129–36.
    1. Kyle UG, Genton L, Karsegard L, et al. Single prediction equation for bioelectrical impedance analysis in adults aged 20–94 years. Nutrition. 2001;17:248–53.
    1. Wielopolski L, Ramirez LM, Gallagher D, et al. Measuring partial body potassium in the arm versus total body potassium. J Appl Physiol. 2006;101:945–9.
    1. Rolland Y, Lauwers-Cances V, Cournot M, et al. Sarcopenia, calf circumference, and physical function of elderly women: a cross-sectional study. J Am Geriatr Soc. 2003;51:1120–4.
    1. Al Snih S, Markides K, Ottenbacher K, et al. Hand grip strength and incident ADL disability in elderly Mexican Americans over a seven-year period. Aging Clin Exp Res. 2004;16:481–6.
    1. Bean JF, Kiely DK, Herman S, et al. The relationship between leg power and physical performance in mobility-limited older people. J Am Geriatr Soc. 2002;50:461–7.
    1. Suzuki T, Bean JF, Fielding RA. Muscle power of the ankle flexors predicts functional performance in community-dwelling older women. J Am Geriatr Soc. 2001;49:1161–7.
    1. Foldvari M, Clark M, Laviolette LC, et al. Association of muscle power with functional status in community-dwelling elderly women. J Gerontol A Biol Sci Med Sci. 2000;55:M192–9.
    1. Bassey EJ, Short AH. A new method for measuring power output in a single leg extension: feasibility, reliability and validity. Eur J Appl Physiol Occup Physiol. 1990;60:385–90.
    1. Edwards RH, Young A, Hosking GP, et al. Human skeletal muscle function: description of tests and normal values. Clin Sci Mol Med. 1977;52:283–90.
    1. Feiring DC, Ellenbecker TS, Derscheid GL. Test–retest reliability of the biodex isokinetic dynamometer. J Orthop Sports Phys Ther. 1990;11:298–300.
    1. Hartmann A, Knols R, Murer K, et al. Reproducibility of an isokinetic strength-testing protocol of the knee and ankle in older adults. Gerontology. 2009;55:259–68.
    1. Brown M, Sinacore DR, Binder EF, et al. Physical and performance measures for the identification of mild to moderate frailty. J Gerontol A Biol Sci Med Sci. 2000;55:M350–5.
    1. Callahan D, Phillips E, Carabello R, et al. Assessment of lower extremity muscle power in functionally-limited elders. Aging Clin Exp Res. 2007;19:194–9.
    1. Neder JA, Nery LE, Shinzato GT, et al. Reference values for concentric knee isokinetic strength and power in nonathletic men and women from 20 to 80 years old. J Orthop Sports Phys Ther. 1999;29:116–26.
    1. Goodpaster BH, Carlson CL, Visser M, et al. Attenuation of skeletal muscle and strength in the elderly: The Health ABC Study. J Appl Physiol. 2001;90:2157–65.
    1. Newman AB, Haggerty CL, Goodpaster B, et al. Strength and muscle quality in a well-functioning cohort of older adults: The health, aging and body composition study. J Am Geriatr Soc. 2003;51:323–30.
    1. Chen HI, Kuo CS. Relationship between respiratory muscle function and age, sex, and other factors. J Appl Physiol. 1989;66:943–8.
    1. Kim J, Davenport P, Sapienza C. Effect of expiratory muscle strength training on elderly cough function. Arch Gerontol Geriatr. 2009;48:361–6.
    1. Working Group on Functional Outcome Measures for Clinical Trials. Functional outcomes for clinical trials in frail older persons: time to be moving. J Gerontol A Biol Sci Med Sci. 2008;63:160–4.
    1. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49:M85–94.
    1. Perera S, Mody SH, Woodman RC, et al. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006;54:743–9.
    1. Kwon S, Perera S, Pahor M, et al. What is a meaningful change in physical performance? Findings from a clinical trial in older adults (the LIFE-P study) J Nutr Health Aging. 2009;13:538–44.
    1. Buchner DM, Larson EB, Wagner EH, et al. Evidence for a non-linear relationship between leg strength and gait speed. Age Ageing. 1996;25:386–91.
    1. Guralnik JM, Ferrucci L, Pieper CF, et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000;55:M221–31.
    1. Cesari M, Kritchevsky SB, Newman AB, et al. Added value of physical performance measures in predicting adverse health-related events: results from the health, aging and body composition study. J Am Geriatr Soc. 2009;57:251–9.
    1. Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the “get-up and go” test. Arch Phys Med Rehabil. 1986;67:387–9.
    1. Bean JF, Kiely DK, LaRose S, et al. Is stair climb power a clinically relevant measure of leg power impairments in at-risk older adults? Arch Phys Med Rehabil. 2007;88:604–9.
    1. Baumgartner R, Koehler K, Gallagher D, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998;147:755–63.
    1. Janssen I, Heymsfield SB, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc. 2002;50:889–96.
    1. Newman A, Kupelian V, Visser M, et al. Sarcopenia: alternative definitions and association with lower extremity function. J Am Geriatr Soc. 2003;51:1602–9.
    1. Norman K, Pirlich M, Sorensen J, et al. Bioimpedance vector analysis as a measure of muscle function. Clin Nutr. 2009;28:78–82.
    1. Abellan van Kan G, Rolland Y, Onder G, et al. Gait speed as a marker of adverse outcomes. J Nutr Health Aging. 2009;13:881–9.
    1. Morley JE. Sarcopenia: diagnosis and treatment. J Nutr Health Aging. 2008;12:452–6.
    1. World Health Organization. Ageing and life course. 2009 [cited 2009 April 30]; Available from:
    1. Sayer AA, Dennison EM, Syddall HE, et al. Type 2 diabetes, muscle strength, and impaired physical function: the tip of the iceberg? Diabetes Care. 2005;28:2541–2.
    1. Janssen I, Shepard DS, Katzmarzyk PT, et al. The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc. 2004;52:80–5.
    1. Gale CR, Martyn CN, Cooper C, et al. Grip strength, body composition, and mortality. Int J Epidemiol. 2007;36:228–35.

Source: PubMed

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