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

      research-article
      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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          Abstract

          Background

          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.

          Methods

          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.

          Results

          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.

          Conclusions

          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 references60

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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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              Anamorelin in patients with non-small-cell lung cancer and cachexia (ROMANA 1 and ROMANA 2): results from two randomised, double-blind, phase 3 trials.

              Patients with advanced cancer frequently experience anorexia and cachexia, which are associated with reduced food intake, altered body composition, and decreased functionality. We assessed anamorelin, a novel ghrelin-receptor agonist, on cachexia in patients with advanced non-small-cell lung cancer and cachexia.
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                Author and article information

                Contributors
                fanny.buckinx@ulg.ac.be
                Journal
                J Cachexia Sarcopenia Muscle
                J Cachexia Sarcopenia Muscle
                10.1007/13539.2190-6009
                JCSM
                Journal of Cachexia, Sarcopenia and Muscle
                John Wiley and Sons Inc. (Hoboken )
                2190-5991
                2190-6009
                19 January 2018
                April 2018
                : 9
                : 2 ( doiID: 10.1002/jcsm.v9.2 )
                : 269-278
                Affiliations
                [ 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@ 123456ulg.ac.be
                Article
                JCSM12268 JCSM-D-17-00099
                10.1002/jcsm.12268
                5879987
                29349935
                3ffe8c57-682c-4606-8cbb-013cb29aef8b
                © 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 http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 04 May 2017
                : 05 September 2017
                : 12 October 2017
                Page count
                Figures: 2, Tables: 2, Pages: 10, Words: 4893
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                jcsm12268
                April 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.3.4 mode:remove_FC converted:02.04.2018

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

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