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.

Figure 1.

Sarcopenia: EWGSOP2 algorithm for case-finding, making a diagnosis and quantifying severity in practice. The steps of the pathway are represented as Find-Assess-Confirm-Severity or F-A-C-S. ^*Consider other reasons for low muscle strength (e.g. depression, sroke, balance disorders, peripheral vascular disorders).

Figure 2.

Normative data for grip strength across the life course in men and women in the UK (Dodds RM, et al. PLoS One. 2014;9:e113637). Centiles shown are 10th, 25th, 50th, 75th and 90th. Cut-off points based on T-score of ≤ -2.5 are shown for males and females (≤27 kg and 16 kg, respectively). Color-coding represents different birth cohorts used for the study (Figure adapted with permission from R Dodds and PLOS One).

Figure 3.

Muscle strength and the life course. To prevent or delay sarcopenia development, maximise muscle in youth and young adulthood, maintain muscle in middle age and minimise loss in older age

Figure 4.

Factors that cause and worsen muscle quantity and quality, sarcopenia, are categorised as primary (ageing) and secondary (disease, inactivity, and poor nutrition). Because a wide range of factors contribute to sarcopenia development, numerous muscle changes seem possible when these multiple factors interact.