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      Diagnosis, prevalence, and clinical impact of sarcopenia in COPD: a systematic review and meta‐analysis

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          Abstract

          Sarcopenia prevalence and its clinical impact are reportedly variable in chronic obstructive pulmonary disease (COPD) due partly to definition criteria. This review aimed to identify the criteria used to diagnose sarcopenia and the prevalence and impact of sarcopenia on health outcomes in people with COPD. This review was registered in PROSPERO (CRD42018092576). Five electronic databases were searched to August 2018 to identify studies related to sarcopenia and COPD. Study quality was assessed using validated instruments matched to study designs. Sarcopenia prevalence was determined using authors' definitions. Comparisons were made between people who did and did not have sarcopenia for pulmonary function, exercise capacity, quality of life, muscle strength, gait speed, physical activity levels, inflammation/oxidative stress, and mortality. Twenty‐three studies (70% cross‐sectional) from Europe (10), Asia (9), and North and South America (4) involving 9637 participants aged ≥40 years were included (69.5% men). Sarcopenia criteria were typically concordant with recommendations of hEuropean and Asian consensus bodies. Overall sarcopenia prevalence varied from 15.5% [95% confidence interval (CI) 11.8–19.1; combined muscle mass, strength, and/or physical performance criteria] to 34% (95%CI 20.6–47.3; muscle mass criteria alone) ( P = 0.009 between subgroups) and was greater in people with more severe [37.6% (95%CI 24.8–50.4)] versus less severe [19.1% (95%CI 10.2–28.0)] lung disease ( P = 0.020), but similar between men [41.0% (95%CI 26.2–55.9%)] and women [31.9% (95%CI 7.0–56.8%)] ( P = 0.538). People with sarcopenia had lower predicted forced expiratory volume in the first second (mean difference −7.1%; 95%CI −9.0 to −5.1%) and poorer exercise tolerance (standardized mean difference −0.8; 95%CI −1.4 to −0.2) and quality of life (standardized mean difference 0.26; 95%CI 0.2–0.4) compared with those who did not ( P < 0.001 for all). No clear relationship was observed between sarcopenia and inflammatory or oxidative stress biomarkers. Incident mortality was unreported in the literature. Sarcopenia is prevalent in a significant proportion of people with COPD and negatively impacts upon important clinical outcomes. Opportunities exist to optimize its early detection and management and to evaluate its impact on mortality in this patient group.

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

          David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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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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              ATS statement: guidelines for the six-minute walk test.

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                Author and article information

                Contributors
                vanessaprobst@gmail.com
                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
                30 August 2020
                October 2020
                : 11
                : 5 ( doiID: 10.1002/jcsm.v11.5 )
                : 1164-1176
                Affiliations
                [ 1 ] Department of Physiotherapy Londrina State University Londrina Paraná Brazil
                [ 2 ] Centre of Research and Post‐Graduation in Health Sciences (CEPPOS) Londrina State University Londrina Paraná Brazil
                [ 3 ] Department of Physiotherapy Monash University Melbourne VIC Australia
                [ 4 ] Monash Lung and Sleep, Monash Health Monash Medical Centre Melbourne VIC Australia
                [ 5 ] Department of Medicine—Western Health, Melbourne Medical School The University of Melbourne St Albans VIC Australia
                [ 6 ] Australian Institute for Musculoskeletal Science (AIMSS) University of Melbourne and Western Health St Albans VIC Australia
                Author notes
                [*] [* ] Correspondence to: Vanessa Suziane Probst, Av. Robert Koch. 60‐Vila Operária, CEP: 86038‐350, Londrina, Paraná, Brazil . Email: vanessaprobst@ 123456gmail.com
                Author information
                https://orcid.org/0000-0001-6173-1104
                https://orcid.org/0000-0001-9040-8007
                https://orcid.org/0000-0003-0305-9940
                https://orcid.org/0000-0003-3798-3445
                https://orcid.org/0000-0001-8126-0637
                https://orcid.org/0000-0003-1483-5319
                Article
                JCSM12600 JCSM-D-19-00582
                10.1002/jcsm.12600
                7567149
                32862514
                62bf852d-c048-46f6-b441-f81f5744ce20
                © 2020 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 December 2019
                : 06 June 2020
                : 10 June 2020
                Page count
                Figures: 3, Tables: 3, Pages: 13, Words: 4407
                Categories
                Review
                Reviews
                Custom metadata
                2.0
                October 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.2 mode:remove_FC converted:16.10.2020

                Orthopedics
                sarcopenia,copd,prevalence,diagnosis,aging
                Orthopedics
                sarcopenia, copd, prevalence, diagnosis, aging

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