Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People

Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People Alfonso J. Cruz‐Jentoft Jean‐Pierre Baeyens Jürgen M. Bauer Yves Boirie‌ Tommy Cederholm Francesco Landi Finbarr C. Martin Jean‐Pierre Michel Yves Rolland S. Schneider Eva Topinková M. Vandewoude Mauro Zamboni

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Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People 2010 Age and Ageing 10.1093/ageing/afq034 cruz-jentoft2010-sarcopenia-european-consensus-on-d cruz-jentoft2010-sarcopenia-european-consensus-on-d.txt, the project's staged copy db2d33ab77a713305efb991e0265b37796eb07e7 cc-by-nc medicine

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0 spans located by searching the stored text for the quote's exact words, allowing any whitespace between them A WORKING GROUP DEFINING A CONDITION THAT HAD BEEN NAMED FOR TWENTY-ONE YEARS - four European societies convened to give sarcopenia a clinical definition, diagnostic criteria and cut-off points, because it had none Quotation withheld because this record is not cleared for redistribution. what sarcopenia is, what parameters define it, which variables measure those parameters, at what cut-off points, and how it relates to cachexia, frailty and sarcopenic obesity Quotation withheld because this record is not cleared for redistribution. the EWGSOP definition - low muscle mass PLUS low muscle function - with three conceptual stages (presarcopenia, sarcopenia, severe sarcopenia), a primary/secondary category split, a table of cut-off points from the literature, and a gait-speed case-finding algorithm Quotation withheld because this record is not cleared for redistribution. method Quotation withheld because this record is not cleared for redistribution. a term in wide use whose prevalence estimate depends on which definition of it the estimator chose Quotation withheld because this record is not cleared for redistribution. expert-consensus expert-consensus Quotation withheld because this record is not cleared for redistribution. A TERM COINED IN 1989 THAT STILL HAD NO AGREED DEFINITION IN 2010: `In 1989, Irwin Rosenberg proposed the term `SARCOPENIA` (GREEK `SARX` or flesh + `PENIA` or loss) to describe this age-related decrease of muscle mass. Sarcopenia has since been defined as the loss of skeletal muscle mass and strength that occurs with advancing age. However, a widely accepted definition of sarcopenia suitable for use in research and clinical practice is still lacking.` The coinage is dated, attributed and given its etymology, and the gap it left is stated in the next sentence Quotation withheld because this record is not cleared for redistribution. AND THE ABSENCE IS ENUMERATED, INCLUDING THE ADMINISTRATIVE ONE: `sarcopenia still has no broadly accepted clinical definition, consensus diagnostic criteria, International Classification of Diseases 9th Revision (ICD-9) codes or treatment guidelines.` A missing ICD code is a missing SLOT IN A CONTROLLED VOCABULARY, listed beside the missing definition as the same kind of lack - the clearest statement in this corpus that a definition and its administrative code are one problem Quotation withheld because this record is not cleared for redistribution. AND A BETTER TERM WAS REJECTED BECAUSE THE WORSE ONE IS ALREADY KNOWN: `Some have argued that the term dynapenia is better suited to describe age-associated loss of muscle strength and function. However, sarcopenia is already a widely recognised term, so replacing it might lead to further confusion.` THE EXACT MIRROR OF haas2018: Banff DELETED the word `acute` because it confused clinicians; EWGSOP KEPT `sarcopenia`, against a term it concedes is better suited, because replacing it would confuse. Two consensus bodies, opposite decisions, the same reason - and neither decision is about the biology Quotation withheld because this record is not cleared for redistribution. AND THE PREVALENCE RANGE IS ATTRIBUTED TO THE DEFINITION IN ONE SENTENCE: `Depending on the literature definition used for sarcopenia, the prevalence in 60-70-year-olds is reported as 5-13%, while the prevalence ranges from 11 to 50% in people >80 years.` bellomo2004 and hoste2006 each gave a range and left the reader to infer the cause; this paper names it Quotation withheld because this record is not cleared for redistribution. AND A THRESHOLD SET BY WHAT DATA EXISTED, CALLED ARBITRARY BY THE PAPER ITSELF: `Quotation withheld` The class boundary is where the reference data ran out, and the sentence says which population's absence set it Quotation withheld because this record is not cleared for redistribution. AND THE CONVENTION BEHIND EVERY OTHER CUT-OFF IS STATED AS A CHOICE: `EWGSOP recommends use of normative (healthy young adult) rather than other predictive reference populations, with cut-off points at two standard deviations below the mean reference value. More research is urgently needed in order to obtain good reference values for populations around the world.` Two decisions - which population is the reference, and how many SDs below it - and the paper concedes the first is under-supplied Quotation withheld because this record is not cleared for redistribution. AND THE INTENSION IS DECLARED TOO NARROW, WITH THE REASON: `muscle strength does not depend solely on muscle mass, and the relationship between strength and mass is not linear. Thus, defining sarcopenia only in terms of muscle mass is too narrow and may be of limited clinical value.` The two-criterion rule is derived from a non-linearity rather than asserted Quotation withheld because this record is not cleared for redistribution. and the category is adopted BECAUSE the causes are unknown, not despite it: `We suggest it may be likewise helpful to recognise sarcopenia as a geriatric syndrome because this view promotes its identification and treatment even when the exact causes remain unknown.` A class chosen for what it lets clinicians do, with the aetiological ignorance stated as part of the justification Quotation withheld because this record is not cleared for redistribution. THE NEIGHBOURING CONSTRUCTS OVERLAP ASYMMETRICALLY AND ONE IS PART OF THE OTHER'S DEFINITION: `most cachectic individuals are also sarcopenic, but most sarcopenic individuals are not considered cachectic. Sarcopenia is one of the elements of the proposed definition for cachexia.` A concept that is a COMPONENT OF ANOTHER CONCEPT'S DEFINITION while also being distinguished from it - the corpus has no edge type for `is part of the definition of`, only for parts of things Quotation withheld because this record is not cleared for redistribution. AND FRAILTY OVERLAPS IT WHILE EXTENDING BEYOND IT: `Frailty and sarcopenia overlap; most frail older people exhibit sarcopenia, and some older people with sarcopenia are also frail. The general concept of frailty, however, goes beyond physical factors to encompass psychological and social dimensions as well.` Overlap without containment in either direction, said in one sentence Quotation withheld because this record is not cleared for redistribution. and there is no standard outcome to test a treatment against: `only a handful of clinical trials are under way to test potential sarcopenia treatments. The absence of standardised primary outcomes is a major challenge for the design of such studies.` The definition is proposed so that trials become possible, and the paper says in the same paragraph that the outcomes for those trials do not exist either Quotation withheld because this record is not cleared for redistribution. and the stages are labelled CONCEPTUAL, with presarcopenia reachable only by an instrument most clinics do not have: `This stage can only be identified by techniques that measure muscle mass accurately and in reference to standard populations` - so the first stage of the classification is, in practice, unobservable wherever the reference populations are the ones the paper says are missing Quotation withheld because this record is not cleared for redistribution. requiring BOTH low muscle mass and low muscle function for the diagnosis, rather than mass alone eliminates: a definition that the paper argues is too narrow, on the grounds that 'muscle strength does not depend solely on muscle mass, and the relationship between strength and mass is not linear' · outcome: held Quotation withheld because this record is not cleared for redistribution. normative (healthy young adult) reference populations rather than predictive ones, with cut-offs two standard deviations below the mean eliminates: cut-off points that drift with whichever study population happens to be at hand · outcome: partial Quotation withheld because this record is not cleared for redistribution. the primary/secondary split by whether a cause other than ageing is evident eliminates: treating disease-, activity- and nutrition-related muscle loss as age-related sarcopenia · outcome: partial Quotation withheld because this record is not cleared for redistribution. sarcopenia sarcopenia Quotation withheld because this record is not cleared for redistribution. syndrome syndrome Quotation withheld because this record is not cleared for redistribution. cachexia cachexia Quotation withheld because this record is not cleared for redistribution. dynapenia dynapenia Quotation withheld because this record is not cleared for redistribution. primary sarcopenia primary sarcopenia Quotation withheld because this record is not cleared for redistribution. secondary sarcopenia secondary sarcopenia Quotation withheld because this record is not cleared for redistribution. frailty frailty Quotation withheld because this record is not cleared for redistribution. `sarcopenia` (Rosenberg 1989) - the COINAGE: Greek `sarx` (flesh) + `penia` (loss), for the age-related decrease of muscle MASS alone Quotation withheld because this record is not cleared for redistribution. `sarcopenia` (EWGSOP 2010) - MASS PLUS FUNCTION: `a syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength`, diagnosed as `low muscle mass PLUS low muscle strength or low physical performance`. The 1989 sense is declared `too narrow` Quotation withheld because this record is not cleared for redistribution. `dynapenia` - the term EWGSOP concedes is `better suited to describe age-associated loss of muscle strength and function`, and declines to adopt because `sarcopenia is already a widely recognised term` Quotation withheld because this record is not cleared for redistribution. `primary` vs `secondary sarcopenia` - the same condition split by whether a cause OTHER THAN AGEING is evident; the paper adds that in many older people the aetiology is multi-factorial so neither label applies Quotation withheld because this record is not cleared for redistribution. `presarcopenia` / `sarcopenia` / `severe sarcopenia` - three CONCEPTUAL stages by how many of the three criteria are met Quotation withheld because this record is not cleared for redistribution. extends → Rosenberg's 1989 coinage of 'sarcopenia' for the age-related decrease of muscle mass - this paper keeps the name and widens the intension to require function Quotation withheld because this record is not cleared for redistribution. critiques → the literature's definitions of sarcopenia by muscle mass alone, which the paper calls 'too narrow and may be of limited clinical value' Quotation withheld because this record is not cleared for redistribution. sarcopenia —distinct-from→ cachexia sarcopenia cachexia the relation itself is separately evidenced · strength of the relation: 0.95 · note: 'most cachectic…' Distinct, asymmetrically overlapping, and one is a component of the other's DEFINITION - which the schema cannot say, so it is in the note · the relation stated: the overlap runs ONE WAY: most cachectic individuals are sarcopenic, most sarcopenic individuals are not cachectic Quotation withheld because this record is not cleared for redistribution. sarcopenia —is-a→ syndrome sarcopenia syndrome the relation itself is separately evidenced · strength of the relation: 0.9 · note: Weight 0.9, not 0.95: 'syndrome' is a broad endpoint, and the paper's sharper claim is the narrower class 'GERIATRIC syndrome', argued separately and adopted BECAUSE the causes are unknown - 'this view promotes…' · the relation stated: 'Sarcopenia is a syndrome characterised by ...' - the working definition's own opening clause Quotation withheld because this record is not cleared for redistribution. primary sarcopenia —distinct-from→ secondary sarcopenia primary sarcopenia secondary sarcopenia the relation itself is separately evidenced · strength of the relation: 0.95 · note: `Sarcopenia can be considered `primary` (or age-related) when no other cause is evident but ageing itself, while sarcopenia can be considered `secondary` when one or more other causes are evident.` The split is by AETIOLOGY, not by presentation - and the paper immediately concedes that `in many older people the aetiology is multi-factorial so that it may not be possible to characterise each individual as having a primary or secondary condition` · the relation stated: one condition split by whether a cause OTHER THAN AGEING is evident Quotation withheld because this record is not cleared for redistribution. A TERM COINED IN 1989 AND STILL UNDEFINED IN 2010: `In 1989, Irwin Rosenberg proposed the term `SARCOPENIA` ... However, a widely accepted definition of sarcopenia suitable for use in research and clinical practice is still lacking` A TERM COINED IN 1989 AND STILL UNDEFINED IN 2010: `In 1989, Irwin Rosenberg proposed the term `SARCOPENIA` ... However, a widely accepted definition of sarcopenia suitable for use in research and clinical practice is still lacking` Quotation withheld because this record is not cleared for redistribution. AND NO ICD CODE EITHER, LISTED BESIDE THE MISSING DEFINITION AS THE SAME KIND OF LACK: `sarcopenia still has no broadly accepted clinical definition, consensus diagnostic criteria, International Classification of Diseases 9th Revision (ICD-9) codes or treatment guidelines` AND NO ICD CODE EITHER, LISTED BESIDE THE MISSING DEFINITION AS THE SAME KIND OF LACK: `sarcopenia still has no broadly accepted clinical definition, consensus diagnostic criteria, International Classification of Diseases 9th Revision (ICD-9) codes or treatment guidelines` Quotation withheld because this record is not cleared for redistribution. dynapenia may better describe age-associated loss of strength, but sarcopenia is kept as already widely recognised dynapenia may better describe age-associated loss of strength, but sarcopenia is kept as already widely recognised Quotation withheld because this record is not cleared for redistribution. THE PREVALENCE RANGE ATTRIBUTED TO THE DEFINITION IN ONE SENTENCE: `Depending on the literature definition used for sarcopenia, the prevalence in 60-70-year-olds is reported as 5-13%, while the prevalence ranges from 11 to 50% in people >80 years` THE PREVALENCE RANGE ATTRIBUTED TO THE DEFINITION IN ONE SENTENCE: `Depending on the literature definition used for sarcopenia, the prevalence in 60-70-year-olds is reported as 5-13%, while the prevalence ranges from 11 to 50% in people >80 years` Quotation withheld because this record is not cleared for redistribution. A THRESHOLD SET BY WHICH POPULATION HAD NO REFERENCE DATA, AND CALLED ARBITRARY: `Because population norms for young adult blacks and whites are not currently available, the gender-specific 20th percentile was arbitrarily chosen as the cut-off point for each method` A THRESHOLD SET BY WHICH POPULATION HAD NO REFERENCE DATA, AND CALLED ARBITRARY: `Because population norms for young adult blacks and whites are not currently available, the gender-specific 20th percentile was arbitrarily chosen as the cut-off point for each method` Quotation withheld because this record is not cleared for redistribution. AND THE NEIGHBOURING CONSTRUCT CONTAINS THIS ONE IN ITS DEFINITION WHILE BEING DISTINCT FROM IT: `most cachectic individuals are also sarcopenic, but most sarcopenic individuals are not considered cachectic. Sarcopenia is one of the elements of the proposed definition for cachexia` AND THE NEIGHBOURING CONSTRUCT CONTAINS THIS ONE IN ITS DEFINITION WHILE BEING DISTINCT FROM IT: `most cachectic individuals are also sarcopenic, but most sarcopenic individuals are not considered cachectic. Sarcopenia is one of the elements of the proposed definition for cachexia` Quotation withheld because this record is not cleared for redistribution. `a syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life and death`, diagnosed as LOW MUSCLE MASS PLUS low muscle strength or low physical performance sarcopenia Quotation withheld because this record is not cleared for redistribution. `Greek `SARX` or flesh + `PENIA` or loss`, coined `to describe this age-related decrease of muscle mass` - mass only, and declared too narrow in this paper sarcopenia Quotation withheld because this record is not cleared for redistribution. `low muscle mass without impact on muscle strength or physical performance. This stage can only be identified by techniques that measure muscle mass accurately and in reference to standard populations` presarcopenia Quotation withheld because this record is not cleared for redistribution. `Depending on the literature definition used` - the range is attributed to the definition, not to the populations prevalence of sarcopenia, 60-70 years Quotation withheld because this record is not cleared for redistribution. the same sentence, the same attribution - a fourfold spread on one construct prevalence of sarcopenia, over 80 years Quotation withheld because this record is not cleared for redistribution. `More research is urgently needed in order to obtain good reference values for populations around the world` - the rule is stated and the data it needs is declared missing in the same paragraph EWGSOP cut-off convention Quotation withheld because this record is not cleared for redistribution. `Because population norms for young adult blacks and whites are not currently available` cut-off used when no normative data existed Quotation withheld because this record is not cleared for redistribution. the instrument of the class boundary: two SDs below a normative mean is what makes a measurement `low`, so the reference population chooses the diagnosis standard deviation Quotation withheld because this record is not cleared for redistribution. the 1989 definition's only variable, and the one this paper says is not enough on its own muscle mass Quotation withheld because this record is not cleared for redistribution. the added variable, justified by a NON-LINEARITY: `the relationship between strength and mass is not linear` muscle strength Quotation withheld because this record is not cleared for redistribution.

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