The Conceptual Definition of Sarcopenia: Delphi Consensus from the Global Leadership Initiative in Sarcopenia (GLIS)

doi:10.1093/ageing/afae052

. 2024 Mar 1;53(3):afae052.

doi: 10.1093/ageing/afae052.

The Conceptual Definition of Sarcopenia: Delphi Consensus from the Global Leadership Initiative in Sarcopenia (GLIS)

Ben Kirk^{1

2}, Peggy M Cawthon^{3

4}, Hidenori Arai⁵, José A Ávila-Funes^{6

7}, Rocco Barazzoni⁸, Shalender Bhasin⁹, Ellen F Binder¹⁰, Olivier Bruyere^{11

12}, Tommy Cederholm^{13

14}, Liang-Kung Chen^{15

16}, Cyrus Cooper^{17

18}, Gustavo Duque^{19

20}, Roger A Fielding²¹, Jack Guralnik²², Douglas P Kiel²³, Francesco Landi²⁴, Jean-Yves Reginster^{25

26}, Avan A Sayer²⁷, Marjolein Visser^{28

29}, Stephan von Haehling^{30

31}, Jean Woo³², Alfonso J Cruz-Jentoft³³; Global Leadership Initiative in Sarcopenia (GLIS) group

Collaborators, Affiliations

Collaborators

Global Leadership Initiative in Sarcopenia (GLIS) group:
Alberto Frisoli Júnior, Andrea Britta Maier, Anne B Newman, Anton De Spiegeleer, Antoneta Granic, Antonio Cherubini, Assim AlAbdulKader, Charlotte Beaudart, Brian Clark, Todd Brown, Carla Prado, Carolyn Greig, Chang Won Won, Charlotte Suetta, Chih-Kuang Liang, Christopher Hurst, Daniel Rooks, David Le Couteur, David Scott, Debra Waters, Dolores Sanchez-Rodriguez, Esmee Reijnierse, Eva Topinková, Fanny Petermann, Finbarr Callaghan Martin, Gülistan Bahat, Haya Alhmly, Ivan Aprahamian, Jae-Young Lim, Jean-Pierre Michel, Jesse Zanker, John Batsis, John Kanis, Joshua Lewis, Juergen Bauer, Julie Pasco, Justin Keogh, Kaisu Pitkala, Ken Madden, Kenji Toba, Kristina Norman, Laura Schaap, Lin Kang, Li-Ning Peng, Lisa Micklesfield, Lisette CPGM de Groot, Lorenzo M Donini, Marc Sim, Maria Cristina Gonzalez, Marie-Josiane Ntsama Essomba, Masafumi Kuzuya, Mathis Grossmann, Matteo Cesari, Michael Tieland, Miles Witham, Ming-Yueh Chou, Minoru Yamada, Miranda Grounds, Pedro Abizanda Soler, Qianli Xue, Rachel Cooper, Rainer Wirth, Renuka Visvanathan, Reshma Aziz Merchant, Rene Rizzoli, Robin Daly, Sebastiana Kalula, Sian Robinson, Stany perkisas, Stéphane Schneider, Steven B Heymsfield, Steven Phu, Stuart Phillips, Sunyoung Kim, Suzette Pereira, Thomas Gill, Tomasz Grodzicki, Tomasz Kostka, Tungwai Auyeung, Wee-Shiong Lim, Wei-Ju Lee, Yasmin Algindan, Yosuke Yamada, Yunhwan Lee, Yves Boirie, Yvette Luiking

Affiliations

¹ Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.
² Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, Melbourne, VIC, Australia.
³ California Pacific Medical Center, Research Institute, 550 16th Street, Second Floor, San Francisco, CA 94143USA.
⁴ Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CAUSA.
⁵ National Center for Geriatrics and Gerontology, Obu, AichiJapan.
⁶ Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
⁷ Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Inserm, Bordeaux F-33000, France.
⁸ Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
⁹ Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MAUSA.
¹⁰ Division of General Medicine and Geriatrics, School of Medicine, Washington University in St. Louis, St. Louis MO, USA.
¹¹ WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
¹² Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium.
¹³ Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
¹⁴ Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden.
¹⁵ Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
¹⁶ Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁷ MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
¹⁸ Department of Epidemiology, University of Oxford, Oxford, OXUK.
¹⁹ Bone, Muscle & Geroscience Group, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
²⁰ Dr Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada.
²¹ Nutrition Exercise, Physiology, and Sarcopenia Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MAUSA.
²² Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MDUSA.
²³ Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MAUSA.
²⁴ Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome 00168, Italy.
²⁵ WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Liège, Belgium.
²⁶ Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
²⁷ AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle Hospitals and Faculty of Medical Sciences Newcastle University, Newcastle, UK.
²⁸ Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
²⁹ The Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
³⁰ Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany.
³¹ German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
³² Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
³³ Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.

PMID: 38520141
PMCID: PMC10960072
DOI: 10.1093/ageing/afae052

The Conceptual Definition of Sarcopenia: Delphi Consensus from the Global Leadership Initiative in Sarcopenia (GLIS)

Ben Kirk et al. Age Ageing. 2024.

. 2024 Mar 1;53(3):afae052.

doi: 10.1093/ageing/afae052.

Authors

Collaborators

Global Leadership Initiative in Sarcopenia (GLIS) group:
Alberto Frisoli Júnior, Andrea Britta Maier, Anne B Newman, Anton De Spiegeleer, Antoneta Granic, Antonio Cherubini, Assim AlAbdulKader, Charlotte Beaudart, Brian Clark, Todd Brown, Carla Prado, Carolyn Greig, Chang Won Won, Charlotte Suetta, Chih-Kuang Liang, Christopher Hurst, Daniel Rooks, David Le Couteur, David Scott, Debra Waters, Dolores Sanchez-Rodriguez, Esmee Reijnierse, Eva Topinková, Fanny Petermann, Finbarr Callaghan Martin, Gülistan Bahat, Haya Alhmly, Ivan Aprahamian, Jae-Young Lim, Jean-Pierre Michel, Jesse Zanker, John Batsis, John Kanis, Joshua Lewis, Juergen Bauer, Julie Pasco, Justin Keogh, Kaisu Pitkala, Ken Madden, Kenji Toba, Kristina Norman, Laura Schaap, Lin Kang, Li-Ning Peng, Lisa Micklesfield, Lisette CPGM de Groot, Lorenzo M Donini, Marc Sim, Maria Cristina Gonzalez, Marie-Josiane Ntsama Essomba, Masafumi Kuzuya, Mathis Grossmann, Matteo Cesari, Michael Tieland, Miles Witham, Ming-Yueh Chou, Minoru Yamada, Miranda Grounds, Pedro Abizanda Soler, Qianli Xue, Rachel Cooper, Rainer Wirth, Renuka Visvanathan, Reshma Aziz Merchant, Rene Rizzoli, Robin Daly, Sebastiana Kalula, Sian Robinson, Stany perkisas, Stéphane Schneider, Steven B Heymsfield, Steven Phu, Stuart Phillips, Sunyoung Kim, Suzette Pereira, Thomas Gill, Tomasz Grodzicki, Tomasz Kostka, Tungwai Auyeung, Wee-Shiong Lim, Wei-Ju Lee, Yasmin Algindan, Yosuke Yamada, Yunhwan Lee, Yves Boirie, Yvette Luiking

Affiliations

¹ Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.
² Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, Melbourne, VIC, Australia.
³ California Pacific Medical Center, Research Institute, 550 16th Street, Second Floor, San Francisco, CA 94143USA.
⁴ Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CAUSA.
⁵ National Center for Geriatrics and Gerontology, Obu, AichiJapan.
⁶ Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
⁷ Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Inserm, Bordeaux F-33000, France.
⁸ Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
⁹ Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MAUSA.
¹⁰ Division of General Medicine and Geriatrics, School of Medicine, Washington University in St. Louis, St. Louis MO, USA.
¹¹ WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
¹² Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium.
¹³ Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
¹⁴ Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden.
¹⁵ Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
¹⁶ Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.
¹⁷ MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
¹⁸ Department of Epidemiology, University of Oxford, Oxford, OXUK.
¹⁹ Bone, Muscle & Geroscience Group, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
²⁰ Dr Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada.
²¹ Nutrition Exercise, Physiology, and Sarcopenia Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MAUSA.
²² Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MDUSA.
²³ Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MAUSA.
²⁴ Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome 00168, Italy.
²⁵ WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Liège, Belgium.
²⁶ Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
²⁷ AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle Hospitals and Faculty of Medical Sciences Newcastle University, Newcastle, UK.
²⁸ Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
²⁹ The Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
³⁰ Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany.
³¹ German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
³² Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
³³ Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.

PMID: 38520141
PMCID: PMC10960072
DOI: 10.1093/ageing/afae052

Abstract

Importance: Sarcopenia, the age-related loss of muscle mass and strength/function, is an important clinical condition. However, no international consensus on the definition exists.

Objective: The Global Leadership Initiative in Sarcopenia (GLIS) aimed to address this by establishing the global conceptual definition of sarcopenia.

Design: The GLIS steering committee was formed in 2019-21 with representatives from all relevant scientific societies worldwide. During this time, the steering committee developed a set of statements on the topic and invited members from these societies to participate in a two-phase International Delphi Study. Between 2022 and 2023, participants ranked their agreement with a set of statements using an online survey tool (SurveyMonkey). Statements were categorised based on predefined thresholds: strong agreement (>80%), moderate agreement (70-80%) and low agreement (<70%). Statements with strong agreement were accepted, statements with low agreement were rejected and those with moderate agreement were reintroduced until consensus was reached.

Results: 107 participants (mean age: 54 ± 12 years [1 missing age], 64% men) from 29 countries across 7 continents/regions completed the Delphi survey. Twenty statements were found to have a strong agreement. These included; 6 statements on 'general aspects of sarcopenia' (strongest agreement: the prevalence of sarcopenia increases with age (98.3%)), 3 statements on 'components of sarcopenia' (muscle mass (89.4%), muscle strength (93.1%) and muscle-specific strength (80.8%) should all be a part of the conceptual definition of sarcopenia)) and 11 statements on 'outcomes of sarcopenia' (strongest agreement: sarcopenia increases the risk of impaired physical performance (97.9%)). A key finding of the Delphi survey was that muscle mass, muscle strength and muscle-specific strength were all accepted as 'components of sarcopenia', whereas impaired physical performance was accepted as an 'outcome' rather than a 'component' of sarcopenia.

Conclusion and relevance: The GLIS has created the first global conceptual definition of sarcopenia, which will now serve to develop an operational definition for clinical and research settings.

Keywords: GLIS; conceptual; definitions; older people; sarcopenia.

PubMed Disclaimer

Conflict of interest statement

Before starting the GLIS initiative, all authors submitted a Declaration of Interest form. This declaration, which is more detailed than the standard COI form, was open for public scrutiny and can be viewed here: https://www.eugms.org/fileadmin/images/news/2022/GLIS_Steering_Committee_Rev3.pdf.

Figures

**Figure 1**
List of accepted and rejected statements from round 1 and 2 of the Delphi Process (n = 107 respondents).

**Figure 2**
A graphical representation of the conceptual definition of sarcopenia.

See this image and copyright information in PMC

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References

1. Cawthon PM, Manini T, Patel SM et al. Putative cut-points in sarcopenia components and incident adverse health outcomes: an SDOC analysis. J Am Geriatr Soc 2020; 68: 1429–37. - PMC - PubMed
1. Cawthon PM, Blackwell T, Cummings SR et al. Muscle mass assessed by the D3-creatine dilution method and incident self-reported disability and mortality in a prospective observational study of community-dwelling older men. J Gerontol A Biol Sci Med Sci 2021; 76: 123–30. - PMC - PubMed
1. Guralnik JM, Cawthon PM, Bhasin S et al. Limited physician knowledge of sarcopenia: a survey. J Am Geriatr Soc 2023; 71: 1595–602. - PubMed
1. Cruz-Jentoft AJ, Sayer AA. Sarcopenia. Lancet 2019; 393: 2636–46. - PubMed
1. Anker SD, Morley JE, von HaehlingS. Welcome to the ICD-10 code for sarcopenia. J Cachexia Sarcopenia Muscle 2016; 7: 512–4. - PMC - PubMed

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[1] Cawthon PM, Manini T, Patel SM et al. Putative cut-points in sarcopenia components and incident adverse health outcomes: an SDOC analysis. J Am Geriatr Soc 2020; 68: 1429–37. - PMC - PubMed

[2] Cawthon PM, Manini T, Patel SM et al. Putative cut-points in sarcopenia components and incident adverse health outcomes: an SDOC analysis. J Am Geriatr Soc 2020; 68: 1429–37. - PMC - PubMed

[3] Cawthon PM, Blackwell T, Cummings SR et al. Muscle mass assessed by the D3-creatine dilution method and incident self-reported disability and mortality in a prospective observational study of community-dwelling older men. J Gerontol A Biol Sci Med Sci 2021; 76: 123–30. - PMC - PubMed

[4] Cawthon PM, Blackwell T, Cummings SR et al. Muscle mass assessed by the D3-creatine dilution method and incident self-reported disability and mortality in a prospective observational study of community-dwelling older men. J Gerontol A Biol Sci Med Sci 2021; 76: 123–30. - PMC - PubMed

[5] Guralnik JM, Cawthon PM, Bhasin S et al. Limited physician knowledge of sarcopenia: a survey. J Am Geriatr Soc 2023; 71: 1595–602. - PubMed

[6] Guralnik JM, Cawthon PM, Bhasin S et al. Limited physician knowledge of sarcopenia: a survey. J Am Geriatr Soc 2023; 71: 1595–602. - PubMed

[7] Cruz-Jentoft AJ, Sayer AA. Sarcopenia. Lancet 2019; 393: 2636–46. - PubMed

[8] Cruz-Jentoft AJ, Sayer AA. Sarcopenia. Lancet 2019; 393: 2636–46. - PubMed

[9] Anker SD, Morley JE, von HaehlingS. Welcome to the ICD-10 code for sarcopenia. J Cachexia Sarcopenia Muscle 2016; 7: 512–4. - PMC - PubMed

[10] Anker SD, Morley JE, von HaehlingS. Welcome to the ICD-10 code for sarcopenia. J Cachexia Sarcopenia Muscle 2016; 7: 512–4. - PMC - PubMed

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The Conceptual Definition of Sarcopenia: Delphi Consensus from the Global Leadership Initiative in Sarcopenia (GLIS)

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Affiliations

The Conceptual Definition of Sarcopenia: Delphi Consensus from the Global Leadership Initiative in Sarcopenia (GLIS)

Authors

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Abstract

Conflict of interest statement

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Abstract

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