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

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          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.

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          Most cited references 51

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          Epidemiology of sarcopenia among the elderly in New Mexico.

          Muscle mass decreases with age, leading to "sarcopenia," or low relative muscle mass, in elderly people. Sarcopenia is believed to be associated with metabolic, physiologic, and functional impairments and disability. Methods of estimating the prevalence of sarcopenia and its associated risks in elderly populations are lacking. Data from a population-based survey of 883 elderly Hispanic and non-Hispanic white men and women living in New Mexico (the New Mexico Elder Health Survey, 1993-1995) were analyzed to develop a method for estimating the prevalence of sarcopenia. An anthropometric equation for predicting appendicular skeletal muscle mass was developed from a random subsample (n = 199) of participants and was extended to the total sample. Sarcopenia was defined as appendicular skeletal muscle mass (kg)/height2 (m2) being less than two standard deviations below the mean of a young reference group. Prevalences increased from 13-24% in persons under 70 years of age to >50% in persons over 80 years of age, and were slightly greater in Hispanics than in non-Hispanic whites. Sarcopenia was significantly associated with self-reported physical disability in both men and women, independent of ethnicity, age, morbidity, obesity, income, and health behaviors. This study provides some of the first estimates of the extent of the public health problem posed by sarcopenia.
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            Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability.

            To establish the prevalence of sarcopenia in older Americans and to test the hypothesis that sarcopenia is related to functional impairment and physical disability in older persons. Cross-sectional survey. Nationally representative cross-sectional survey using data from the Third National Health and Nutrition Examination Survey (NHANES III). Fourteen thousand eight hundred eighteen adult NHANES III participants aged 18 and older. The presence of sarcopenia and the relationship between sarcopenia and functional impairment and disability were examined in 4,504 adults aged 60 and older. Skeletal muscle mass was estimated from bioimpedance analysis measurements and expressed as skeletal muscle mass index (SMI = skeletal muscle mass/body mass x 100). Subjects were considered to have a normal SMI if their SMI was greater than -one standard deviation above the sex-specific mean for young adults (aged 18-39). Class I sarcopenia was considered present in subjects whose SMI was within -one to -two standard deviations of young adult values, and class II sarcopenia was present in subjects whose SMI was below -two standard deviations of young adult values. The prevalence of class I and class II sarcopenia increased from the third to sixth decades but remained relatively constant thereafter. The prevalence of class I (59% vs 45%) and class II (10% vs 7%) sarcopenia was greater in the older (> or = 60 years) women than in the older men (P <.001). The likelihood of functional impairment and disability was approximately two times greater in the older men and three times greater in the older women with class II sarcopenia than in the older men and women with a normal SMI, respectively. Some of the associations between class II sarcopenia and functional impairment remained significant after adjustment for age, race, body mass index, health behaviors, and comorbidity. Reduced relative skeletal muscle mass in older Americans is a common occurrence that is significantly and independently associated with functional impairment and disability, particularly in older women. These observations provide strong support for the prevailing view that sarcopenia may be an important and potentially reversible cause of morbidity and mortality in older persons.
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              Estimation of skeletal muscle mass by bioelectrical impedance analysis.

              The purpose of this study was to develop and cross-validate predictive equations for estimating skeletal muscle (SM) mass using bioelectrical impedance analysis (BIA). Whole body SM mass, determined by magnetic resonance imaging, was compared with BIA measurements in a multiethnic sample of 388 men and women, aged 18-86 yr, at two different laboratories. Within each laboratory, equations for predicting SM mass from BIA measurements were derived using the data of the Caucasian subjects. These equations were then applied to the Caucasian subjects from the other laboratory to cross-validate the BIA method. Because the equations cross-validated (i.e., were not different), the data from both laboratories were pooled to generate the final regression equation SM mass (kg) = [(Ht 2 / R x 0.401) + (gender x 3.825) + (age x -0. 071)] + 5.102 where Ht is height in centimeters; R is BIA resistance in ohms; for gender, men = 1 and women = 0; and age is in years. The r(2) and SE of estimate of the regression equation were 0.86 and 2.7 kg (9%), respectively. The Caucasian-derived equation was applicable to Hispanics and African-Americans, but it underestimated SM mass in Asians. These results suggest that the BIA equation provides valid estimates of SM mass in healthy adults varying in age and adiposity.
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                Author and article information

                Journal
                Age Ageing
                ageing
                ageing
                Age and Ageing
                Oxford University Press
                0002-0729
                1468-2834
                July 2010
                13 April 2010
                13 April 2010
                : 39
                : 4
                : 412-423
                Affiliations
                [1 ]Servicio de Geriatría, Hospital Universitario Ramón y Cajal , Madrid, Spain
                [2 ]AZ Damiaan Hospital , Oostende, Belgium
                [3 ]Department of Geriatric Medicine, University of Erlangen-Nürnberg , Nürnberg, Germany
                [4 ]Clermont Université , UFR Médecine, UMR 1019, F-63001 Clermont-Ferrand, France
                [5 ]Institutionen för Folkhälso- och Vårdvetenskap/Klinisk Nutrition och Metabolism, Uppsala Universitet , Uppsala, Sweden
                [6 ]Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore , Roma, Italy
                [7 ]Department of Ageing and Health, Guys and St Thomas' NHS Foundation Trust , London, UK
                [8 ]Département de Réhabilitation et Gériatrie, Hôpitaux Universitaires de Genève , Geneva, Switzerland
                [9 ]Gérontopôle de Toulouse, Hospital La Grave-Casselardit , Toulouse, France
                [10 ]Gastroentérologie et Nutrition Clinique, CHU de Nice, Université de Nice Sophia-Antipolis , Nice, France
                [11 ]Geriatrická Klinika 1 Lékařská Fakulta, Univerzita Karlova v Praze , Prague, Czech Republic
                [12 ]Department of Geriatrics, University of Antwerp , Ziekenhuisnetwerk Antwerpen (ZNA), Antwerp, Belgium
                [13 ]Department of Biomedical and Surgical Sciences, Division of Geriatrics, University of Verona , Verona, Italy
                Author notes
                Address correspondence to: Alfonso J. Cruz-Jentoft, Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Ctra. Colmenar, km 9,1, 28034 Madrid, Spain. Tel: +34 913368172. Email: acruz.hrc@ 123456salud.madrid.org

                Endorsed by the European Geriatric Medicine Society (EUGMS), the European Society for Clinical Nutrition and Metabolism (ESPEN), the International Association of Gerontology and Geriatrics—European Region (IAGG-ER) and the International Association of Nutrition and Aging (IANA).

                Article
                afq034
                10.1093/ageing/afq034
                2886201
                20392703
                © The Author 2010. 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/2.5/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Report

                Geriatric medicine

                sarcopenia, elderly, muscle strength, physical performance, muscle mass

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