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      Sarcopenia: revised European consensus on definition and diagnosis

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          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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          Most cited references78

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          Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.

          Functional assessment is an important part of the evaluation of elderly persons. We conducted this study to determine whether objective measures of physical function can predict subsequent disability in older persons. This prospective cohort study included men and women 71 years of age or older who were living in the community, who reported no disability in the activities of daily living, and who reported that they were able to walk one-half mile (0.8 km) and climb stairs without assistance. The subjects completed a short battery of physical-performance tests and participated in a follow-up interview four years later. The tests included an assessment of standing balance, a timed 8-ft (2.4-m) walk at a normal pace, and a timed test of five repetitions of rising from a chair and sitting down. Among the 1122 subjects who were not disabled at base line and who participated in the four-year follow-up, lower scores on the base-line performance tests were associated with a statistically significant, graduated increase in the frequency of disability in the activities of daily living and mobility-related disability at follow-up. After adjustment for age, sex, and the presence of chronic disease, those with the lowest scores on the performance tests were 4.2 to 4.9 times as likely to have disability at four years as those with the highest performance scores, and those with intermediate performance scores were 1.6 to 1.8 times as likely to have disability. Among nondisabled older persons living in the community, objective measures of lower-extremity function were highly predictive of subsequent disability. Measures of physical performance may identify older persons with a preclinical stage of disability who may benefit from interventions to prevent the development of frank disability.
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            Skeletal muscle: a brief review of structure and function.

            Skeletal muscle is one of the most dynamic and plastic tissues of the human body. In humans, skeletal muscle comprises approximately 40% of total body weight and contains 50-75% of all body proteins. In general, muscle mass depends on the balance between protein synthesis and degradation and both processes are sensitive to factors such as nutritional status, hormonal balance, physical activity/exercise, and injury or disease, among others. In this review, we discuss the various domains of muscle structure and function including its cytoskeletal architecture, excitation-contraction coupling, energy metabolism, and force and power generation. We will limit the discussion to human skeletal muscle and emphasize recent scientific literature on single muscle fibers.
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              Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery.

              Although it has been demonstrated that physical performance measures predict incident disability in previously nondisabled older persons, the available data have not been fully developed to create usable methods for determining risk profiles in community-dwelling populations. Using several populations and different follow-up periods, this study replicates previous findings by using the Established Populations for the Epidemiologic Study of the Elderly (EPESE) performance battery and provides equations for the prediction of disability risk according to age, sex, and level of performance. Tests of balance, time to walk 8 ft, and time to rise from a chair 5 times were administered to 4,588 initially nondisabled persons in the four sites of the EPESE and to 1,946 initially nondisabled persons in the Hispanic EPESE. Follow-up assessment for activity of daily living (ADL) and mobility-related disability occurred from 1 to 6 years later. In the EPESE, compared with those with the best performance (EPESE summary performance score of 10-12), the relative risks of mobility-related disability for those with scores of 4-6 ranged from 2.9 to 4.9 and the relative risk of disability for those with scores of 7-9 ranged from 1.5 to 2.1, with similar consistent results for ADL disability. The observed rates of incident disability according to performance level in the Hispanic EPESE agreed closely with rates predicted from models developed from the EPESE sites. Receiver operating characteristic curves showed that gait speed alone performed almost as well as the full battery in predicting incident disability. Performance tests of lower extremity function accurately predict disability across diverse populations. Equations derived from models using both the summary score and the gait speed alone allow for the estimation of risk of disability in community-dwelling populations and provide valuable information for estimating sample size for clinical trials of disability prevention.
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                Author and article information

                Journal
                Age Ageing
                Age Ageing
                ageing
                Age and Ageing
                Oxford University Press
                0002-0729
                1468-2834
                January 2019
                24 September 2018
                24 September 2018
                : 48
                : 1
                : 16-31
                Affiliations
                [1 ]Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
                [2 ]Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Istanbul, Turkey
                [3 ]Center for Geriatric Medicine, University Heidelberg, Agaplesion Bethanien Krankenhaus, Heidelberg, Germany
                [4 ]Research Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
                [5 ]Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
                [6 ]Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, and Theme Ageing, Karolinska University Hospital, Stockholm, Sweden
                [7 ]MRC Lifecourse Epidemiology Unit, University of Southampton; Southampton, UK; and Department of Epidemiology, University of Oxford, OX, UK
                [8 ]Instituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Roma, Italy
                [9 ]Department of Geriatrics, Hospital and University of Toulouse, Toulouse, France
                [10 ]NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Faculty of Medical Sciences, Newcastle University, Newcastle, UK
                [11 ]Department of Gastroenterology and Clinical Nutrition, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France
                [12 ]Department of Internal Medicine-Geriatrics, Institute for Biomedicine and Ageing, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany
                [13 ]Department of Geriatrics, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
                [14 ]Department Geriatrics, University of Antwerp, Ziekenhuisnetwerk Antwerpen (ZNA), Antwerp, Belgium
                [15 ]Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam; and the Amsterdam Public Health Research Institute; Amsterdam, The Netherlands
                [16 ]Department of Medicine, Geriatric section, University of Verona, Verona, Italy
                [17 ]Department of Gerontology and Department of Frailty in Ageing, Vrije University Brussel; Brussels, Belgium
                [18 ]Geriatrician at the Teaching Hospital AZ Alma; Eeklo, Belgium; and University of Luxembourg; Luxembourg City, Luxenbourg
                [19 ]Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università di Milano; Milan, Italy
                [20 ]Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS INRCA, Ancona, Italy
                [21 ]Center for Metabolic Bone Diseases, University of Sheffield Medical School; Sheffield, UK and Institute for Health and Ageing, Australian Catholic University; Melbourne, Australia
                [22 ]Geriatric Clinic Unit, Geriatric Rehabilitation Department, University-Hospital of Parma, Department of Medicine and Surgery
                [23 ]Department of Ageing and Health, Guys and St Thomas’ NHS Foundation Trust; London, UK
                [24 ]Department of Rehabilitation and Geriatrics, University of Geneva; Geneva, Switzerland
                [25 ]Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Central Hospital, Unit of Primary Health Care; Helsinki, Finland
                [26 ]Bone and Cartilage Metabolism Unit, University of Liège; Liège, Belgium
                [27 ]Department of Bone Disease, University of Geneva; Geneva, Switzerland
                [28 ]Geriatrics Department, Parc Salut Mar. Rehabilitation Research Group, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM). Universitat Autònoma de Barcelona, Universitat Pompeu Fabra; Barcelona, Spain
                [29 ]Department of Health Services Research, Maastricht University; Maastricht, the Netherlands
                Author notes
                Address correspondence to: Alfonso J. Cruz-Jentoft, MD, Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Ctra. Colmenar, km 9.1, 28034 Madrid, Spain. Tel: +34 913368172; Fax: +34 913368172. Email: alfonsojose.cruz@ 123456salud.madrid.org
                Article
                afy169
                10.1093/ageing/afy169
                6322506
                30312372
                0ffada42-f07e-4ae9-8025-ba853a62aac9
                © The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@ 123456oup.com

                Page count
                Pages: 16
                Product
                Funding
                Funded by: European Working Group on Sarcopenia in Older People 2
                Categories
                Guidelines

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