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      Pitfalls in the measurement of muscle mass: a need for a reference standard

      , 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 1 , 16 , 16 , 17 , 10 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 12 , 1 , 25 , 10 , 26 , 27 , 28 , 27 , 29

      Journal of Cachexia, Sarcopenia and Muscle

      John Wiley and Sons Inc.

      Lean mass, Muscle mass, Lean body mass, Reference standard

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          All proposed definitions of sarcopenia include the measurement of muscle mass, but the techniques and threshold values used vary. Indeed, the literature does not establish consensus on the best technique for measuring lean body mass. Thus, the objective measurement of sarcopenia is hampered by limitations intrinsic to assessment tools. The aim of this study was to review the methods to assess muscle mass and to reach consensus on the development of a reference standard.


          Literature reviews were performed by members of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis working group on frailty and sarcopenia. Face‐to‐face meetings were organized for the whole group to make amendments and discuss further recommendations.


          A wide range of techniques can be used to assess muscle mass. Cost, availability, and ease of use can determine whether the techniques are better suited to clinical practice or are more useful for research. No one technique subserves all requirements but dual energy X‐ray absorptiometry could be considered as a reference standard (but not a gold standard) for measuring muscle lean body mass.


          Based on the feasibility, accuracy, safety, and low cost, dual energy X‐ray absorptiometry can be considered as the reference standard for measuring muscle mass.

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          Most cited references 96

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          Sarcopenia: European consensus on definition and diagnosis

          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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            Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia.

            Sarcopenia, a newly recognized geriatric syndrome, is characterized by age-related decline of skeletal muscle plus low muscle strength and/or physical performance. Previous studies have confirmed the association of sarcopenia and adverse health outcomes, such as falls, disability, hospital admission, long term care placement, poorer quality of life, and mortality, which denotes the importance of sarcopenia in the health care for older people. Despite the clinical significance of sarcopenia, the operational definition of sarcopenia and standardized intervention programs are still lacking. It is generally agreed by the different working groups for sarcopenia in the world that sarcopenia should be defined through a combined approach of muscle mass and muscle quality, however, selecting appropriate diagnostic cutoff values for all the measurements in Asian populations is challenging. Asia is a rapidly aging region with a huge population, so the impact of sarcopenia to this region is estimated to be huge as well. Asian Working Group for Sarcopenia (AWGS) aimed to promote sarcopenia research in Asia, and we collected the best available evidences of sarcopenia researches from Asian countries to establish the consensus for sarcopenia diagnosis. AWGS has agreed with the previous reports that sarcopenia should be described as low muscle mass plus low muscle strength and/or low physical performance, and we also recommend outcome indicators for further researches, as well as the conditions that sarcopenia should be assessed. In addition to sarcopenia screening for community-dwelling older people, AWGS recommends sarcopenia assessment in certain clinical conditions and healthcare settings to facilitate implementing sarcopenia in clinical practice. Moreover, we also recommend cutoff values for muscle mass measurements (7.0 kg/m(2) for men and 5.4 kg/m(2) for women by using dual X-ray absorptiometry, and 7.0 kg/m(2) for men and 5.7 kg/m(2) for women by using bioimpedance analysis), handgrip strength (<26 kg for men and <18 kg for women), and usual gait speed (<0.8 m/s). However, a number of challenges remained to be solved in the future. Asia is made up of a great number of ethnicities. The majority of currently available studies have been published from eastern Asia, therefore, more studies of sarcopenia in south, southeastern, and western Asia should be promoted. On the other hand, most Asian studies have been conducted in a cross-sectional design and few longitudinal studies have not necessarily collected the commonly used outcome indicators as other reports from Western countries. Nevertheless, the AWGS consensus report is believed to promote more Asian sarcopenia research, and most important of all, to focus on sarcopenia intervention studies and the implementation of sarcopenia in clinical practice to improve health care outcomes of older people in the communities and the healthcare settings in Asia. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
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              Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia.

              Sarcopenia, the age-associated loss of skeletal muscle mass and function, has considerable societal consequences for the development of frailty, disability, and health care planning. A group of geriatricians and scientists from academia and industry met in Rome, Italy, on November 18, 2009, to arrive at a consensus definition of sarcopenia. The current consensus definition was approved unanimously by the meeting participants and is as follows: Sarcopenia is defined as the age-associated loss of skeletal muscle mass and function. The causes of sarcopenia are multifactorial and can include disuse, altered endocrine function, chronic diseases, inflammation, insulin resistance, and nutritional deficiencies. Although cachexia may be a component of sarcopenia, the 2 conditions are not the same. The diagnosis of sarcopenia should be considered in all older patients who present with observed declines in physical function, strength, or overall health. Sarcopenia should specifically be considered in patients who are bedridden, cannot independently rise from a chair, or who have a measured gait speed less that 1 m/s(-1). Patients who meet these criteria should further undergo body composition assessment using dual energy x-ray absorptiometry with sarcopenia being defined using currently validated definitions. A diagnosis of sarcopenia is consistent with a gait speed of less than 1 m·s(-1) and an objectively measured low muscle mass (eg, appendicular mass relative to ht(2) that is ≤ 7.23 kg/m(2) in men and ≤ 5.67 kg/m(2) in women). Sarcopenia is a highly prevalent condition in older persons that leads to disability, hospitalization, and death. Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

                Author and article information

                J Cachexia Sarcopenia Muscle
                J Cachexia Sarcopenia Muscle
                Journal of Cachexia, Sarcopenia and Muscle
                John Wiley and Sons Inc. (Hoboken )
                19 January 2018
                April 2018
                : 9
                : 2 ( doiID: 10.1002/jcsm.v9.2 )
                : 269-278
                [ 1 ] Department of Public Health, Epidemiology and Health Economics University of Liège Liège Belgium
                [ 2 ] Department of Geriatrics, Neurosciences and Orthopedics Catholic University of the Sacred Heart Rome Milan Italy
                [ 3 ] Gérontopôle University Hospital of Toulouse Toulouse France
                [ 4 ] INSERM UMR1027, University of Toulouse III Paul Sabatier Toulouse France
                [ 5 ] Nutrition, Exercise Physiology and Sarcopenia Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University Boston MA 02111 USA
                [ 6 ] Department of Health Sciences VU University Amsterdam Amsterdam Netherlands
                [ 7 ] Department of Nutrition and Dietetics, Internal Medicine VU University Medical Center Amsterdam Netherlands
                [ 8 ] Institute of Medical Physics, University of Erlangen Erlangen Germany
                [ 9 ] National Research Council Neuroscience Institute, Aging Branch Padova Italy
                [ 10 ] MRC Lifecourse Epidemiology Unit University of Southampton Southampton England UK
                [ 11 ] Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science King Saud University Riyadh 11451 Saudi Arabia
                [ 12 ] Department of Geriatrics CHU‐Liège Liège Belgium
                [ 13 ] Department of Geriatric Medicine, Klinikum Carl von Ossietzky University Oldenburg Germany
                [ 14 ] Gerontology and Frailty in Ageing Research Department Vrije Universiteit Brussel (VUB) Brussels Belgium
                [ 15 ] Department of Surgery and Translational Medicine University of Florence viale Pieraccini 6 59139 Florence Italy
                [ 16 ] Human Medicines Research and Development Support Division, Scientific Advice London UK
                [ 17 ] Geriatrics and Geriatric Emergency Care, IRCCS‐INRCA Ancona Italy
                [ 18 ] NIHR Musculoskeletal Biomedical Research Unit University of Oxford Oxford UK
                [ 19 ] Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (Irycis) Madrid Spain
                [ 20 ] Centre for Metabolic Bone Diseases University of Sheffield Sheffield UK
                [ 21 ] MRC and Arthritis Research UK Centre for Integrated research in Musculoskeletal Ageing (CIMA) London UK
                [ 22 ] Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University Boston MA USA
                [ 23 ] Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases Ghent University Hospital Ghent Belgium
                [ 24 ] Scientific Office, Austrian Agency for Health and Food Safety Vienna Austria
                [ 25 ] Service of Bone Diseases, Department of Internal Medicine Specialties Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
                [ 26 ] National Institute for Health Research Southampton Biomedical Research Centre University of Southampton and University Hospital, Southampton NHS Foundation Trust Southampton UK
                [ 27 ] Gérontopôle de Toulouse Institut du Vieillissement, Centre Hospitalo‐Universitaire de Toulouse (CHU Toulouse); UMR INSERM 1027, University of Toulouse III Toulouse France
                [ 28 ] Abbott Nutrition R&D Granada Spain
                [ 29 ] Centre for Metabolic Bone Diseases University of Sheffield, UK and Institute of Health and Ageing, Australian Catholic University Melbourne Australia
                Author notes
                [* ]Correspondence to: Fanny Buckinx, M.Sc., PhD candidate, University of Liège, Department of Public Health, Epidemiology and Health Economics, CHU‐Sart‐Tilman, B23, Quartier Hôpital, Avenue Hippocrate, 13, 4000 Liège, Belgium. Tel.: +32 4366 49 33, Email: fanny.buckinx@
                JCSM12268 JCSM-D-17-00099
                © 2018 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders

                This is an open access article under the terms of the License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                Page count
                Figures: 2, Tables: 2, Pages: 10, Words: 4893
                Original Article
                Original Articles
                Custom metadata
                April 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.3.4 mode:remove_FC converted:02.04.2018


                lean body mass, muscle mass, reference standard, lean mass


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