Getting to grips with sarcopenia: recent advances and practical management for the gastroenterologist

Abstract

Sarcopenia is a progressive and generalised disorder of skeletal muscle strength, function and mass, that is most commonly associated with the normal ageing process. It is increasingly recognised that sarcopenia can also develop as a consequence of malabsorptive and inflammatory conditions, such as those seen by gastroenterologists and hepatologists. It affects 1%-30% of the general population, but is seen in approximately 40% of patients with gastrointestinal conditions including inflammatory bowel disease and cirrhosis. Within this group of patients, it is associated with increased complications and mortality. The pathogenesis of sarcopenia is multifactorial with several risk factors implicated in its development including undernutrition, physical inactivity and coexistent multimorbidity. The SARC-F questionnaire has been developed to screen for patients at risk of sarcopenia, however, this focuses on the functional consequences and will therefore not identify those patients who are early in the progression of sarcopenia. There are several different non-invasive techniques available to assess muscle quantity and quality including; grip strength, dual energy X-ray absorptiometry, CT which can be used together to diagnose sarcopenia. Assessment and correction of malnutrition, particularly protein intake, in those at risk of sarcopenia is important in preventing the development and progression of sarcopenia. There are no specific drugs that are available for the treatment of sarcopenia, however, resistance exercise programmes combined with nutritional interventions show promise. It is important that this common condition is screened for and recognised, with any contributing factors addressed to reduce the risk of its progression.

Keywords: nutrition; nutritional status; nutritional support.

Figure 1

Results from the International Weightlifting Federation World Masters Championship 2018.

Figure 2

Contributors to sarcopenia relevant to clinical gastroenterology. GH, growth hormone; IGF-1, insulin-like growth factor-1; IL, interleukin; TNF-α, tumour necrosis factor-α.

Figure 3

European Working Group of Sarcopenia in Older People updated algorithm for screening, diagnosis and assessing the severity of sarcopenia. BIA, bio-impedance; DXA, dual energy X-ray absorptiometry; SPPB, short physical performance battery; TUG, timed up & go.

Figure 4

The different pathways implicated in the pathogenesis of sarcopenia. Akt, serine/threonine kinase; CRP, C-reactive protein; Fox-O, forkhead box-O; IGF-1, insulin-like growth factor-1; IL, interleukin; mTOR, mammalian target of rapamycin; NF-κB, nuclear factor-kappa B.