Sarcopenia: revised European consensus on definition and diagnosis

Sarcopenia: revised European consensus on definition and diagnosis Alfonso J. Cruz‐Jentoft Gülistan Bahat Jürgen M. Bauer Yves Boirie‌ Olivier Bruyère Tommy Cederholm Cyrus Cooper Francesco Landi Yves Rolland Avan Aihie Sayer S. Schneider Cornel Sieber Eva Topinková M. Vandewoude Marjolein Visser Mauro Zamboni Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2 Ivan Bautmans Jean‐Pierre Baeyens Matteo Cesari Antonio Cherubini John А. Kanis Marcello Maggio Finbarr C. Martin Jean‐Pierre Michel Kaisu Pitkälä Jean‐Yves Reginster René Rizzoli Dolores Sánchez‐Rodríguez Jos M. G. A. Schols

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Sarcopenia: revised European consensus on definition and diagnosis 2018 Age and Ageing 10.1093/ageing/afy169 cruz-jentoft2018-sarcopenia-revised-european-consen cruz-jentoft2018-sarcopenia-revised-european-consen.txt, the project's staged copy d0c3b7c0800e129c3bb2718d13d5e99fa3e36866 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 the definition of sarcopenia itself - what the term should pick out, which variables identify it, and at what thresholds Quotation withheld because this record is not cleared for redistribution. whether a decade of evidence justified changing the 2010 definition, and if so which parameter should be primary Quotation withheld because this record is not cleared for redistribution. a revised operational definition in which muscle strength replaces muscle mass as the primary parameter, plus the cut-off points the 2010 consensus declined to give Quotation withheld because this record is not cleared for redistribution. method Quotation withheld because this record is not cleared for redistribution. sarcopenia - a progressive generalised skeletal muscle disorder, now classed as a muscle disease, carrying raised risk of falls, fractures, disability and death Quotation withheld because this record is not cleared for redistribution. expert-consensus expert-consensus Quotation withheld because this record is not cleared for redistribution. why the primary parameter changed: strength predicts adverse outcomes better than mass does, so putting it first is expected to speed up identification in practice - a change justified by predictive validity, not by new biology strength before mass Quotation withheld because this record is not cleared for redistribution. why quantity and quality are NOT primary despite being part of the definition - they are technically difficult to measure accurately, so the constraint on the definition is instrumentation rather than concept technological limit Quotation withheld because this record is not cleared for redistribution. BIA does not measure muscle mass; it estimates it from whole-body conductivity using an equation calibrated against DXA in a specific population - so a BIA reading inherits both DXA's error and the reference population's demography measurement chained on measurement Quotation withheld because this record is not cleared for redistribution. the mechanism by which an incomplete definition damages a field: with no cut-off points advised, studies chose their own, and the resulting disputes are said to have hampered research and development threshold silence Quotation withheld because this record is not cleared for redistribution. A REGIONAL FORK FIXED THE PARENT STANDARD AND THE PARENT ADOPTED THE FIX BACK: `Quotation withheld More recently, the Asian Working Group on Sarcopenia developed an EWGSOP-based consensus that specified cut-off points ... The cut-off points in the Asian consensus proved to be very useful ... Thus, EWGSOP2 has opted to provide recommendations for cut-off points.` A derived standard added what its parent left out, the addition worked, and the parent then took it back in - a fork and a merge in the history of one definition, both steps stated in one paragraph. Quotation withheld because this record is not cleared for redistribution. AND THE THRESHOLDS ARE SCOPED TO A POPULATION IN THE SAME BREATH AS THEY ARE PUBLISHED: `The current EWGSOP recommendations focus on European populations and use of normative references (healthy young ... ) ... we recommend use of regional normative populations when available.` The numbers in Table 3 are offered as universal diagnostic criteria and qualified as regional in the surrounding prose - which is exactly the condition that produced the Asian fork. Quotation withheld because this record is not cleared for redistribution. the authors say their own cut-off points are ARBITRARY at this time, and that validated ones await normative data and predictive value against hard end-points Quotation withheld because this record is not cleared for redistribution. the cut-offs are set for European populations against healthy-young-adult references at −2 SD, with −2.5 SD offered for a more conservative diagnosis - so the boundary is a choice on a continuum, not a natural break Quotation withheld because this record is not cleared for redistribution. round figures were preferred to accurate ones, deliberately, for ease of use Quotation withheld because this record is not cleared for redistribution. gait speed and strength depend on stature, so regional normative populations are needed and are not always available Quotation withheld because this record is not cleared for redistribution. different DXA instrument brands do not give consistent results, and DXA is the instrument advised for confirming the diagnosis in clinical practice Quotation withheld because this record is not cleared for redistribution. MRI and CT are the gold standards for muscle quantity and cut-off points for low muscle mass are not yet well defined for them - the best instrument has no threshold Quotation withheld because this record is not cleared for redistribution. BIA prediction models belong to the populations they were derived in, and the recommended equation is based on older Europeans Quotation withheld because this record is not cleared for redistribution. no recommendation is made on whether to adjust muscle mass for body size, and the authors record that the choice between height-squared, weight and BMI is under debate Quotation withheld because this record is not cleared for redistribution. the recommended screening questionnaire has low-to-moderate sensitivity - it will mostly detect severe cases, so screening with it misses the mild ones the paper wants found early Quotation withheld because this record is not cleared for redistribution. sarcopenic obesity is declared outside the scope of the article while being acknowledged as a distinct condition with its own definitional work ongoing Quotation withheld because this record is not cleared for redistribution. the research-gap list is the authors' own: causes and life-course intervention points, risk identification, validated cut-offs, gender- and region-specific thresholds, muscle-quality indicators, the kinetics of loss, and which outcomes measure treatment response Quotation withheld because this record is not cleared for redistribution. two structured face-to-face meetings with literature searches between them, a circulated draft, email review by both groups, and a final poll of all members for agreement eliminates: the recommendations being the view of whoever wrote the draft - every member was polled on the final content, and the disagreement had somewhere to go before publication · outcome: held Quotation withheld because this record is not cleared for redistribution. including the original EWGSOP members alongside newly recruited European researchers in a 16-member writing group and a 13-member extended group eliminates: a revision made by a different set of people from the original, which would leave it open whether the definition changed because the evidence changed or because the committee did · outcome: held Quotation withheld because this record is not cleared for redistribution. review and endorsement by five independent scientific societies after completion eliminates: a single society's consensus being taken for the field's - the definition carries geriatrics, nutrition, osteoporosis and gerontology bodies behind it · outcome: held Quotation withheld because this record is not cleared for redistribution. setting cut-off points against normative references of healthy young adults at −2 standard deviations, with −2.5 SD available where a conservative diagnosis is wanted eliminates: each study picking its own threshold, which is the specific failure the authors attribute to the 2010 consensus having advised none · outcome: partial Quotation withheld because this record is not cleared for redistribution. taking the Asian Working Group's EWGSOP-based consensus, which did specify cut-off points, as evidence that specifying them helps eliminates: the decision to give thresholds being untested - another group had already done it and the result was reported as very useful for implementation · outcome: held Quotation withheld because this record is not cleared for redistribution. separating sarcopenia from frailty, sarcopenic obesity and malnutrition explicitly, each in its own subsection eliminates: the new definition absorbing its neighbours - frailty overlaps on grip strength and gait speed and is still held to be a different KIND of thing, a geriatric syndrome rather than a disease · outcome: held Quotation withheld because this record is not cleared for redistribution. recording that other experts argue CT psoas measurement is not representative of overall sarcopenia, and that further studies are needed to verify or reject it eliminates: a method being adopted into the consensus on the strength of its convenience - the objection is printed rather than resolved · outcome: held Quotation withheld because this record is not cleared for redistribution. sarcopenia sarcopenia Quotation withheld because this record is not cleared for redistribution. muscle strength muscle strength Quotation withheld because this record is not cleared for redistribution. muscle mass muscle mass Quotation withheld because this record is not cleared for redistribution. muscle quality muscle quality Quotation withheld because this record is not cleared for redistribution. physical performance physical performance Quotation withheld because this record is not cleared for redistribution. grip strength grip strength Quotation withheld because this record is not cleared for redistribution. chair stand test chair stand test Quotation withheld because this record is not cleared for redistribution. gait speed gait speed Quotation withheld because this record is not cleared for redistribution. DXA DXA Quotation withheld because this record is not cleared for redistribution. BIA BIA Quotation withheld because this record is not cleared for redistribution. SARC-F SARC-F Quotation withheld because this record is not cleared for redistribution. anthropometry anthropometry Quotation withheld because this record is not cleared for redistribution. cut-off points cut-off points Quotation withheld because this record is not cleared for redistribution. frailty frailty Quotation withheld because this record is not cleared for redistribution. malnutrition malnutrition Quotation withheld because this record is not cleared for redistribution. ageing ageing Quotation withheld because this record is not cleared for redistribution. muscle disease muscle disease Quotation withheld because this record is not cleared for redistribution. geriatric syndrome geriatric syndrome Quotation withheld because this record is not cleared for redistribution. Asian Working Group on Sarcopenia Asian Working Group on Sarcopenia Quotation withheld because this record is not cleared for redistribution. cut-off points → sarcopenia A DEFINITION DAMAGED THE FIELD BY WHAT IT LEFT OUT. The 2010 consensus advised no cut-off points, and the paper says the resulting disputes HAMPERED RESEARCH AND DEVELOPMENT through lack of study consistency. The relation is between an ABSENCE in a definition and harm to a research literature, and there is no edge type for it - 'causes' would need the 'from' endpoint to be the missing thresholds, which are not a thing that existed Quotation withheld because this record is not cleared for redistribution. SARC-F → sarcopenia A SCREEN THAT MISSES WHAT THE PAPER WANTS FOUND. SARC-F has low-to-moderate sensitivity and very high specificity, so it 'will mostly detect severe cases' - and the stated purpose of the whole revision is EARLY detection. 'operationalised-as' asserts the instrument measures the construct; the true relation is that it measures one end of it, and the schema has no way to say which end Quotation withheld because this record is not cleared for redistribution. sarcopenia - THREE DATED SENSES, ALL THREE NAMED IN THIS ONE SENTENCE. Before 2010 the term meant low muscle MASS alone. EWGSOP 2010 added muscle FUNCTION, which the authors call `a major change at that time`. EWGSOP2 2018 puts muscle STRENGTH at the forefront because strength predicts adverse outcomes better than mass does. A study citing `sarcopenia` without a date is citing one of three different populations Quotation withheld because this record is not cleared for redistribution. physical performance - ONE VARIABLE, THREE ROLES, IN ONE SENTENCE. It was part of the core definition; other groups used it as an OUTCOME MEASURE, which makes it a dependent variable rather than a criterion; EWGSOP2 now uses it to grade SEVERITY. The same measurement is a definiens, an outcome and a severity scale depending on whose paper you are reading Quotation withheld because this record is not cleared for redistribution. probable sarcopenia versus confirmed sarcopenia - A TWO-STAGE DIAGNOSIS AND THE STAGES REQUIRE DIFFERENT EQUIPMENT. Low strength alone makes it PROBABLE, which a dynamometer can establish anywhere; CONFIRMED needs muscle quantity or quality, which needs DXA, BIA, CT or MRI. So a prevalence figure depends on what machines the study had, and the design makes that explicit rather than hiding it Quotation withheld because this record is not cleared for redistribution. muscle quality - A RELATIVELY NEW TERM WITH FOUR INCOMPATIBLE OPERATIONALISATIONS LISTED IN ONE PARAGRAPH: fat infiltration and attenuation on MRI or CT, the ratio of strength to appendicular skeletal muscle mass, the ratio to muscle volume, and BIA-derived phase angle. The paper says outright there is no universal consensus on assessment. Two papers reporting `muscle quality` may share no measurement at all Quotation withheld because this record is not cleared for redistribution. cut-off point, in EWGSOP2 - A ROUND NUMBER CHOSEN FOR USABILITY, and the paper says so: `we opted to use round figures, with the confidence that the minor reduction in accuracy will be overcome by ease of use`. Grip strength <27 kg and <16 kg are not measured boundaries, they are −2 SD against a young reference, rounded Quotation withheld because this record is not cleared for redistribution. acute versus chronic sarcopenia - A NEW DISTINCTION MADE ON DURATION ALONE, at six months, and made in order to change BEHAVIOUR rather than to describe biology: the point is to force periodic reassessment so the rate of change is visible. A category defined by a clock Quotation withheld because this record is not cleared for redistribution. extends → EWGSOP's own 2010 definition, which added muscle function to definitions based only on low muscle mass note: the relation is to the AUTHORS' OWN earlier consensus, and the paper is explicit that the 2010 version was itself a major change to what came before it - so this is the third position in a documented sequence, not a first revision Quotation withheld because this record is not cleared for redistribution. qualifies → the pre-2010 definitions of sarcopenia based only on detection of low muscle mass note: AUDIT CHANGED THIS FROM 'contradicts'. Mass is not rejected here and the paper never says the old criterion was wrong - mass is DEMOTED, from the primary parameter to the confirming one, on evidence that strength predicts adverse outcomes better. It still appears in the 2018 definition as criterion 2. A demotion is a qualification Quotation withheld because this record is not cleared for redistribution. builds-on → the Asian Working Group on Sarcopenia's EWGSOP-based consensus, which specified cut-off points and was found useful for implementation Quotation withheld because this record is not cleared for redistribution. distinguishes-from → Fried and co-workers' physical phenotype of frailty, which overlaps sarcopenia on grip strength, gait speed and weight loss Quotation withheld because this record is not cleared for redistribution. distinguishes-from → the proposal that low muscle mass become part of the definition of malnutrition note: the same measurement entering a SECOND definition, and the paper marks the difference by what is absent - low fat mass is usually present in malnutrition and not necessarily in sarcopenia Quotation withheld because this record is not cleared for redistribution. builds-on → expert groups worldwide who have published complementary definitions of sarcopenia in the intervening decade note: re-cut in the audit onto the sentence that actually says it. And the word is the paper's own: COMPLEMENTARY definitions, not competing ones - so the term had at least three more senses in circulation while this revision was being written Quotation withheld because this record is not cleared for redistribution. builds-on → the Asian Working Group on Sarcopenia's EWGSOP-based consensus, which specified cut-off points the original EWGSOP paper omitted note: The direction is worth recording: the ASIAN group derived from EWGSOP, and EWGSOP2 then cites the derived work's success as its reason to change. Influence running from the fork back to the parent. Quotation withheld because this record is not cleared for redistribution. sarcopenia —is-a→ muscle disease sarcopenia muscle disease strength of the relation: 0.95 · note: the reclassification is itself one of the paper's changes - and it is what the ICD-10 code follows from, so the ontological move has a billing consequence Quotation withheld because this record is not cleared for redistribution. frailty —is-a→ geriatric syndrome frailty geriatric syndrome strength of the relation: 0.95 Quotation withheld because this record is not cleared for redistribution. sarcopenia —distinct-from→ frailty sarcopenia frailty strength of the relation: 0.95 · note: and the distinction is made at the level of KIND, not of degree: a disease against a syndrome, even though both are diagnosed partly by grip strength and gait speed Quotation withheld because this record is not cleared for redistribution. sarcopenia —distinct-from→ malnutrition sarcopenia malnutrition strength of the relation: 0.85 · note: the discriminator the paper offers is an ABSENCE - low fat mass is usually present in malnutrition and not necessarily in sarcopenia. The shared feature, low muscle mass, is being proposed as part of the malnutrition definition too Quotation withheld because this record is not cleared for redistribution. muscle strength —operationalised-as→ grip strength muscle strength grip strength strength of the relation: 0.95 · note: and the paper is careful about the warrant: grip correlates only MODERATELY with strength elsewhere in the body and is called a surrogate Audit 2026-09-28: DOUBTFUL - read against its full span and kept, but endpoint by anaphora: the section is headed 'Muscle strength' (immediately before the span). Quotation withheld because this record is not cleared for redistribution. muscle strength —operationalised-as→ chair stand test muscle strength chair stand test strength of the relation: 0.8 · note: the paper's own hedge is in the tag: the test needs endurance as well as strength, so it is 'a qualified but convenient measure' Audit 2026-09-28: DOUBTFUL - read against its full span and kept, but the span writes 'a ... measure of strength', not 'muscle strength'. Quotation withheld because this record is not cleared for redistribution. muscle mass —operationalised-as→ DXA muscle mass DXA strength of the relation: 0.85 · note: weight below 1.0 because the same quote that establishes the operationalisation says different DXA brands disagree Quotation withheld because this record is not cleared for redistribution. muscle mass —operationalised-as→ BIA muscle mass BIA strength of the relation: 0.7 · note: the weakest of the four and deliberately so: BIA does not measure mass, it estimates it from conductivity through an equation calibrated against DXA. The chain is conductivity -> equation -> DXA -> mass Quotation withheld because this record is not cleared for redistribution. ageing —causes→ sarcopenia ageing sarcopenia direction on the measure: increases · strength of the relation: 0.85 · note: and the edge is exactly as strong as the residual category allows - 'primary' means no OTHER cause was found, which is a diagnosis of exclusion rather than a demonstrated mechanism Audit 2026-09-28: DOUBTFUL - read against its full span and kept, but sarcopenia is DEFINED as primary when ageing is the only evident cause; causes[increases] is loose. Quotation withheld because this record is not cleared for redistribution. sarcopenia —causes→ frailty sarcopenia frailty direction on the measure: increases · strength of the relation: 0.8 Quotation withheld because this record is not cleared for redistribution. muscle strength replaces muscle mass as the primary parameter, because strength predicts adverse outcomes better Quotation withheld because this record is not cleared for redistribution. the diagnosis becomes two-stage: low strength = PROBABLE sarcopenia; low muscle quantity or quality CONFIRMS it; adding low physical performance makes it SEVERE Quotation withheld because this record is not cleared for redistribution. physical performance is demoted from definitional criterion to severity grader Quotation withheld because this record is not cleared for redistribution. sarcopenia is reclassified as a muscle disease and now carries an ICD-10-MC diagnosis code billable in some countries Quotation withheld because this record is not cleared for redistribution. two new subcategories on duration alone: acute under six months, chronic at six months or more Quotation withheld because this record is not cleared for redistribution. sarcopenia is no longer treated as beginning in old age - development is now recognised to begin earlier in life with causes beyond ageing Quotation withheld because this record is not cleared for redistribution. the 2010 consensus advised no cut-off points and the resulting disputes are said to have hampered research and development in the field Quotation withheld because this record is not cleared for redistribution. sarcopenia = a progressive and generalised skeletal muscle disorder associated with increased likelihood of falls, fractures, physical disability and mortality sarcopenia Quotation withheld because this record is not cleared for redistribution. the 2018 operational definition in three criteria: low muscle strength, low muscle quantity or quality, low physical performance sarcopenia Quotation withheld because this record is not cleared for redistribution. primary sarcopenia = no cause other than ageing is evident; secondary = other causal factors are present primary sarcopenia Quotation withheld because this record is not cleared for redistribution. muscle quality = micro- and macroscopic changes in muscle architecture and composition, AND muscle function delivered per unit of muscle mass - two senses in one sentence muscle quality Quotation withheld because this record is not cleared for redistribution. physical performance = objectively measured whole-body function related to locomotion, involving nervous function and balance as well as muscle physical performance Quotation withheld because this record is not cleared for redistribution. the recommended pathway, Find cases - Assess - Confirm - Severity Find-Assess-Confirm-Severity Quotation withheld because this record is not cleared for redistribution. cut-off points are set at −2 standard deviations below a healthy-young-adult reference mean, with −2.5 SD offered for a more conservative diagnosis Quotation withheld because this record is not cleared for redistribution. and then rounded, deliberately, trading accuracy for ease of use Quotation withheld because this record is not cleared for redistribution. the authors state that some of their own cut-off points are arbitrary at this time Quotation withheld because this record is not cleared for redistribution. SARC-F: low-to-moderate sensitivity, very high specificity - it will mostly detect severe cases Quotation withheld because this record is not cleared for redistribution. hospitalised older adults with sarcopenia on admission were more than 5-fold more likely to incur higher hospital costs; Czech community data put direct healthcare costs more than 2-fold higher Quotation withheld because this record is not cleared for redistribution. muscle strength - the primary parameter, measured by grip strength or chair stand muscle strength Quotation withheld because this record is not cleared for redistribution. muscle quantity and quality - the confirming parameter, measured by DXA, BIA, CT or MRI, and held back from primacy by technological limits rather than by concept muscle quantity/quality Quotation withheld because this record is not cleared for redistribution. physical performance - the severity grader, measured by gait speed, SPPB, TUG or the 400-m walk physical performance Quotation withheld because this record is not cleared for redistribution.

The full text of this article is not redistributable, so it is not included here. The evidence sentences are withheld with it; the tag layer and its grounding status remain. The article itself is at https://doi.org/10.1093/ageing/afy169.