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      Validating muscle mass cutoffs of four international sarcopenia‐working groups in Japanese people using DXA and BIA

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          Abstract

          Background

          The Asian Working Group for Sarcopenia (AWGS) 2019 recommended the use of dual‐energy X‐ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA) to assess appendicular lean mass (ALM). AWGS, European Working Group on Sarcopenia in Older People 2 (EWGSOP2), Foundation for the National Institutes of Health Sarcopenia Project (FNIH), and International Working Group on Sarcopenia (IWGS) reported different cutoff values for sarcopenia. We aimed to validate these cutoff values in a Japanese population using DXA and two different devices of segmental multi‐frequency BIA (MF‐BIA).

          Methods

          We examined the data of Japanese individuals aged 18–86 years using the DXA ( n = 756) and two 8‐electrode MF‐BIA devices (InBody and TANITA MC) ( n = 1884). To validate these cutoff values, we used a population aged 18–40 years, and calculated the 95% confidence intervals (CIs) of [mean−2SD].

          Results

          In DXA, the 95%CIs of [mean−2SD] for ALM/Ht 2 were 5.2–5.8 and 6.6–7.3 kg/m 2 in women and men, respectively. The AWGS (<5.4 in women and <7.0 in men), and IWGS (≤5.67 in women and ≤7.23 in men) cutoffs were acceptable. Regarding TANITA MC, the 95%CIs of [mean−2SD] for ALM/Ht 2 were 5.6–6.0 and 6.9–7.4 kg/m 2 in women and men, respectively. The AWGS (<5.7 in women and <7.0 in men), EWGSOP2 (<6.0 in women and <7.0 in men), and IWGS cutoffs were acceptable. Regarding InBody, the 95%CIs of [mean−2SD] for ALM/Ht 2 were 4.8–5.2 and 6.4–6.8 kg/m 2 in young women and men, respectively. All cutoff values were too high compared to those measured by InBody. InBody and TANITA MC were highly correlated ( P < 0.001), but the values by InBody were significantly lower than those by TANITA MC or DXA. Using Yamada's equation for InBody raw data, the AWGS, EWGSOP2, or IWGS cutoffs were acceptable. The BMI‐adjusted muscle mass cutoff values were <0.60 and <0.82 m 2 in women and men, respectively. We also obtained the 20th percentile in older adult population (ALM/Ht 2, <6.2 in women and <7.5 in men for TANITA MC; <5.4 in women and <7.0 in men for InBody).

          Conclusions

          The AWGS and IWGS cutoffs were valid for DXA, and the AWGS, IWGS, and EWGSOP2 cutoffs were valid for TANITA MC in Japanese population. Because the prevalence of sarcopenia is too low particularly in women when using those criteria, the 20th percentile might be a good alternative criteria. If the ALM original InBody values are used, the cutoffs should be <5.0 kg/m 2 in women and <6.6 kg/m 2 in men.

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          Most cited references35

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          Sarcopenia: revised European consensus on definition and diagnosis

          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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            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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              Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

              Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as "age-related loss of muscle mass, plus low muscle strength, and/or low physical performance" and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength <28 kg for men and <18 kg for women; criteria for low physical performance are 6-m walk <1.0 m/s, Short Physical Performance Battery score ≤9, or 5-time chair stand test ≥12 seconds. AWGS 2019 retains the original cutoffs for height-adjusted muscle mass: dual-energy X-ray absorptiometry, <7.0 kg/m2 in men and <5.4 kg/m2 in women; and bioimpedance, <7.0 kg/m2 in men and <5.7 kg/m2 in women. In addition, the AWGS 2019 update proposes separate algorithms for community vs hospital settings, which both begin by screening either calf circumference (<34 cm in men, <33 cm in women), SARC-F (≥4), or SARC-CalF (≥11), to facilitate earlier identification of people at risk for sarcopenia. Although skeletal muscle strength and mass are both still considered fundamental to a definitive clinical diagnosis, AWGS 2019 also introduces "possible sarcopenia," defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions. Although defining sarcopenia by body mass index-adjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, more evidence is needed before changing current recommendations. Lifestyle interventions, especially exercise and nutritional supplementation, prevail as mainstays of treatment. Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia in Asians.
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                Author and article information

                Contributors
                yamaday@nibiohn.go.jp
                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
                07 June 2021
                August 2021
                : 12
                : 4 ( doiID: 10.1002/jcsm.v12.4 )
                : 1000-1010
                Affiliations
                [ 1 ] Department of Physical Activity Research National Institutes of Biomedical Innovation, Health and Nutrition Tokyo Japan
                [ 2 ] Faculty of Human Sciences University of Tsukuba Tsukuba Japan
                [ 3 ] National Center for Geriatrics and Gerontology Aichi Japan
                Author notes
                [*] [* ]Correspondence to: Yosuke Yamada, Department of Physical Activity, National Institutes of Biomedical Innovation, Health and Nutrition 1‐23‐1 Toyama, Shinjuku‐ku, Tokyo, 162‐8636. Japan. Email: yamaday@ 123456nibiohn.go.jp
                Author information
                https://orcid.org/0000-0002-4284-6317
                https://orcid.org/0000-0003-3291-0175
                https://orcid.org/0000-0003-2304-6872
                https://orcid.org/0000-0002-1146-0905
                https://orcid.org/0000-0002-9000-6849
                Article
                JCSM12732 JCSM-D-21-00136
                10.1002/jcsm.12732
                8350199
                34101377
                c8eef639-e843-48d5-9951-eb57ea6f1799
                © 2021 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
                : 05 May 2021
                : 02 March 2021
                : 21 May 2021
                Page count
                Figures: 2, Tables: 4, Pages: 11, Words: 5212
                Funding
                Funded by: JSPS KAKENHI , doi 10.13039/501100001691;
                Award ID: 18H03164
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                August 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.4 mode:remove_FC converted:09.08.2021

                Orthopedics
                biomarkers,sarcopenia,dual‐energy x‐ray absorptiometry,bioelectrical impedance analysis,diagnosis,muscle diseases

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