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      Sarcopenia in daily practice: assessment and management

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          Abstract

          Background

          Sarcopenia is increasingly recognized as a correlate of ageing and is associated with increased likelihood of adverse outcomes including falls, fractures, frailty and mortality. Several tools have been recommended to assess muscle mass, muscle strength and physical performance in clinical trials. Whilst these tools have proven to be accurate and reliable in investigational settings, many are not easily applied to daily practice.

          Methods

          This paper is based on literature reviews performed by members of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) working group on frailty and sarcopenia. Face-to-face meetings were afterwards organized for the whole group to make amendments and discuss further recommendations.

          Results

          This paper proposes some user-friendly and inexpensive methods that can be used to assess sarcopenia in real-life settings. Healthcare providers, particularly in primary care, should consider an assessment of sarcopenia in individuals at increased risk; suggested tools for assessing risk include the Red Flag Method, the SARC-F questionnaire, the SMI method or different prediction equations. Management of sarcopenia should primarily be patient centered and involve the combination of both resistance and endurance based activity programmes with or without dietary interventions. Development of a number of pharmacological interventions is also in progress.

          Conclusions

          Assessment of sarcopenia in individuals with risk factors, symptoms and/or conditions exposing them to the risk of disability will become particularly important in the near future.

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          Most cited references89

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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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              A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach.

              the European Working Group on Sarcopenia in Older People has developed a clinical definition of sarcopenia based on low muscle mass and reduced muscle function (strength or performance). Grip strength is recommended as a good simple measure of muscle strength when 'measured in standard conditions'. However, standard conditions remain to be defined. a literature search was conducted to review articles describing the measurement of grip strength listed in Medline, Web of Science and Cochrane Library databases up to 31 December 2009. there is wide variability in the choice of equipment and protocol for measuring grip strength. The Jamar hand dynamometer is the most widely used instrument with established test-retest, inter-rater and intra-rater reliability. However, there is considerable variation in how it is used and studies often provide insufficient information on the protocol followed making comparisons difficult. There is evidence that variation in approach can affect the values recorded. Furthermore, reported summary measures of grip strength vary widely including maximum or mean value, from one, two or three attempts, with either hand or the dominant hand alone. there is considerable variation in current methods of assessing grip strength which makes comparison between studies difficult. A standardised method would enable more consistent measurement of grip strength and better assessment of sarcopenia. Our approach is described.
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                Author and article information

                Contributors
                0032 43664933 , c.beaudart@ulg.ac.be
                e.v.mccloskey@sheffield.ac.uk
                olivier.bruyere@ulg.ac.be
                macesari@gmail.com
                rolland.y@chu-toulouse.fr
                rene.rizzoli@unige.ch
                araujodecarvalho@who.int
                amuthavallithiya@who.int
                ivan.bautmans@vub.ac.be
                mcbertiere@cerin.org
                marialuisa.brandi@unifi.it
                aldaghri2011@gmail.com
                nansaburlet@gmail.com
                etienne.cavalier@chu.ulg.ac.be
                francesca.cerreta@ema.europa.eu
                a.cherubini@inrca.it
                roger.fielding@tufts.edu
                evelien.gielen@uzleuven.be
                francesco.landi@rm.unicatt.it
                jean.petermans@chu.ulg.ac.be
                jyr.ch@bluewin.ch
                m.visser@vu.nl
                jakanis@outlook.com
                cc@mrc.soton.ac.uk
                Journal
                BMC Geriatr
                BMC Geriatr
                BMC Geriatrics
                BioMed Central (London )
                1471-2318
                5 October 2016
                5 October 2016
                2016
                : 16
                : 170
                Affiliations
                [1 ]Department of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU B23, 4000 Liège, Belgium
                [2 ]Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
                [3 ]MRC and Arthritis Research UK Centre for Integrated research in Musculoskeletal Ageing (CIMA), London, UK
                [4 ]Gérontopôle, University Hospital of Toulouse, Toulouse, France
                [5 ]INSERM UMR1027, University of Toulouse III Paul Sabatier, Toulouse, France
                [6 ]Gérontopôle of Toulouse, University of Toulouse III, CHU Purpan, Toulouse, France
                [7 ]Service of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
                [8 ]World Health Organization, Geneva, Switzerland
                [9 ]Gerontology and Frailty in Ageing Research Department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
                [10 ]Centre de Recherche et d’information Nutritionnelles, Paris, France
                [11 ]Department of Surgery and Translational Medicine, University of Florence, viale Pieraccini 6, 59139 Florence, Italy
                [12 ]Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451 Saudi Arabia
                [13 ]Department of Clinical Chemistry, University of Liège, CHU Sart-Tilman, Bât B35, 4000 Liège, Belgium
                [14 ]Human Medicines Research and Development Support Division, Scientific Advice, London, UK
                [15 ]Geriatrics and Geriatric Emergency Care, IRCCS-INRCA, Ancona, Italy
                [16 ]Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, USA
                [17 ]Department of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
                [18 ]Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart Rome, Milano, Italy
                [19 ]Geriatric Department, CHU Sart-Tilman, Bât B35, 4000 Liège, Belgium
                [20 ]Department of Health Sciences, VU University Amsterdam, Amsterdam, Netherlands
                [21 ]Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, Netherlands
                [22 ]Institute for Health and Aging, Catholic University of Australia, Melbourne, Australia
                [23 ]MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, England UK
                [24 ]NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
                Author information
                http://orcid.org/0000-0002-0827-5303
                Article
                349
                10.1186/s12877-016-0349-4
                5052976
                27716195
                11ea8973-785a-4aa7-8c67-ed5873ca32a6
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 24 March 2016
                : 29 September 2016
                Funding
                Funded by: European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis
                Categories
                Debate
                Custom metadata
                © The Author(s) 2016

                Geriatric medicine
                sarcopenia,daily practice,assessment,management,tools
                Geriatric medicine
                sarcopenia, daily practice, assessment, management, tools

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