REVIEW URRENT C OPINION
Sarcopenia: the new definitions Tommy Cederholm a,b and John E. Morley c
Purpose of review To highlight the new international definitions of sarcopenia. Recent findings New international definitions of sarcopenia have been evaluated and shown to be predictive of poor outcomes in older persons. Summary There is now international agreement that the definition for sarcopenia should include not only muscle mass, but also some measure of muscle function, such as walking speed or distance or grip strength. Keywords FRAIL, frailty syndrome, muscle power, SARC-F, sarcopenia, skeletal mass, the European Working Group on Sarcopenia in Older Persons
INTRODUCTION Skeletal mass comprises 45% of body mass and a decline in skeletal mass function plays a key role in the development of the frailty syndrome [1,2]. Muscle mass declines at the rate of about 1% per year after 30 years of age. The loss of skeletal mass associated with aging was originally termed sarcopenia (loss of flesh) [3]. More recently, it has become recognized that there is no clear relationship between muscle mass and strength and power [4]. This has led to a number of consensus groups redefining the criteria for sarcopenia to include measures of physical performance (walking speed or distance) and grip strength in addition to low muscle mass [5–8,9 ] (Table 1). &
NEW SARCOPENIA DEFINITIONS Three of the definitions; viz the European Working Group on Sarcopenia in Older Persons [5,8,10–16,17 ], the Society for Sarcopenia, Cachexia and Wasting Disorders [7,18 ] and the Foundation of National International Health-Sarcopenia [9 ] have been validated cross-sectionally and longitudinally. The Society for Sarcopenia, Cachexia and Wasting Disorders group pointed out that although aging was a common cause of sarcopenia, it was not a prerequisite for its diagnosis [7]. For example, there is evidence suggesting that middleaged persons with diabetes mellitus have accelerated loss of muscle mass and strength and develop sarcopenia at a younger age [19,20 ]. Overall, it appears
that muscle function is a better predictor of poor outcomes, than is muscle mass [21,22]. This is, in part, related to the fact that persons with ‘obese sarcopenia’ tend to have worse outcomes, possibly related to insulin resistance [23].
FUNCTION AND MASS: WHAT IS IMPORTANT? A function is more important than muscle mass. It would appear that simple questionnaires aimed at examining muscle function could be useful as a screening tool for sarcopenia. This is similar to the development of the simple ‘FRAIL’ screen for frailty [24–26]. Two groups have developed such screening questionnaire s [27,28]. The screening tool by Evans et al. [27] has a good development basis but lacks epidemiological validation. The Strength Assistance in Walking, Rise from a chair, Climb stairs, Falls (Table 1) has now been validated
&
&
&
a Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, bDepartment of Geriatric Medicine, Uppsala University Hospital, Uppsala, Sweden and cDivisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, Missouri, USA
Correspondence to John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104, USA. Tel: +1 314 977 8462; e-mail: [email protected] Curr Opin Clin Nutr Metab Care 2015, 18:1–4
&
DOI:10.1097/MCO.0000000000000119
1363-1950 ß 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
www.co-clinicalnutrition.com
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Ageing: biology and nutrition
KEY POINTS Sarcopenia is now defined as decreased gait speed or grip strength in a person with low muscle mass. A simple screen (SARC-F) is available for screening for sarcopenia.
hormone) also plays a role in loss of muscle mass [34]. An increase in inflammatory cytokines (i.e., interleukin-6 and tumor necrosis factor alpha) represents a further reason for muscle loss [35]. The loss of motor end-plate function appears to be a cause of declining muscle strength in about half of older persons with sarcopenia [36 ]. Finally, a decline in blood flow to muscle capillaries with aging further decreases muscle function. This appears to be particularly true in persons with insulin resistance [37]. &
Resistance exercise protein and vitamin D are the basic treatments for sarcopenia.
&
in Chinese and American populations [29 ,30,31]. In the Hong Kong population it appeared to be similar to the European Working Group on Sarcopenia in Older Persons and the Asian Sarcopenia Working Group in prediction of outcomes [8,29 ]. As it can be rapidly administered in under 30 s, it may be an ideal screening tool for general practitioners. &
SARCOPENIA MECHANISMS The causes of sarcopenia are multifactorial. Both genetic causes (e.g., myostatin activin II receptor and notch genes), mitochondrial abnormalities and small birth size have been related to sarcopenia in older persons [32]. The major cause of sarcopenia appears to be related to a lack of physical activity with advancing age [33]. This can further be aggravated by poor calorie and protein intake. The decline in anabolic hormones (i.e., testosterone, dehydroepiandrosterone, insulin-like growth factor-1 and growth
IS SARCOPENIA REVERSIBLE? A number of recent studies have highlighted the major role that resistance exercise plays in reversing sarcopenia [38,39,40 ]. Aerobic exercise as highlighted by the ‘LIFE’ study also improves muscle function [41]. High quality leucine-enriched protein also improves muscle function [42–44]. The role of anabolic steroids remains controversial, although a small study combining calories and low-dose testosterone showed a marked decrease in hospitalizations [45]. In persons with low vitamin D, vitamin D replacement also appears to improve muscle strength [46]. &
SCREENING FOR SARCOPENIA There is increasing evidence that physicians should be screening for sarcopenia in their practice [6]. When it is present there is evidence that physical exercise, vitamin D and increased protein intake will
Table 1. SARC-F screen for sarcopenia Component
Question
Scoring
Strength
How much difficulty do you have in lifting and carrying 10 pounds?
None ¼ 0 Some ¼ 1 A lot or unable ¼ 2
Assistance in walking
How much difficulty do you have walking across a room?
None ¼ 0 Some ¼ 1 A lot, use aids, or unable ¼ 2
Rise from a chair
How much difficulty do you have transferring from a chair or bed?
None ¼ 0 Some ¼ 1 A lot or unable without help ¼ 2
Climb stairs
How much difficulty do you have climbing a flight of 10 stairs?
None ¼ 0 Some ¼ 1 A lot or unable ¼ 2
Falls
How many times have you fallen in the last year?
None ¼ 0 1–3 falls ¼ 1 4 or more falls ¼ 2
2
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Volume 18 Number 1 January 2015
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Sarcopenia: the new definitions Cederholm and Morley
improve muscle function and decrease long-term complications related to sarcopenia.
CONCLUSION The concept of sarcopenia, recently defined as the combined loss of function and mass, emerges as an effective tool to combat frailty and dependence in old adults. The current challenge is to reach professional awareness, implement regular screening procedures, provide resistance training to older adults and promote good protein intake and control of vitamin D status. Whether pharmacological substances will prove helpful is still a question for the future. Acknowledgements Dr Morley serves as a consultant for Danone and SanofiAventis and has a research grant from Purina (Nestle). Dr Cederholm receives unconditional research funding from Nutricia/Danone and Nestle Medical Nutrition. Conflicts of interest There are no conflicts of interest.
REFERENCES AND RECOMMENDED READING Papers of particular interest, published within the annual period of review, have been highlighted as: & of special interest && of outstanding interest 1. Morley JE. Editorial: frailty screening comes of age. J Nutr Health Aging 2014; 18:453–454. 2. Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14:392–397. 3. Michel JP. Sarcopenia: there is a need for some steps forward. J Am Med Dir Assoc 2014; 15:379–380. 4. Clark BC, Manini TM. What is dynapenia? Nutrition 2012; 28:495–503. 5. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39:412–423. 6. Fielding RA, Vellas B, Evans WJ, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 2011; 12:249–256. 7. Morley JE, Abbatecola AM, Argiles JM, et al. Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc 2011; 12:403–409. 8. Chen L-K, Liu L-K, Woo J, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 2014; 15:95– 101. 9. Dam T-T, Peters KW, Fragala M, et al. An evidence-based comparison of & operational criteria for the presence of sarcopenia. J Geront A Biol Sci Med Sci 2014; 69:584–590. This is the foundation of the National Institute of Medicine definition for sarcopenia. It is basically equivalent to the earlier definitions. 10. Kim YP, Kim S, John JY, Hwang HS. Effect of interaction between dynapenic component of the European working group on sarcopenia in older people sarcopenia criteria and obesity on activities of daily living in the elderly. J Am Med Dir Assoc 2014; 15:371.e1–e5. 11. Yamada M, Nishiguchi S, Fukutani N, et al. Prevalence of sarcopenia in community-dwelling Japanese older adults. J Am Med Dir Assoc 2013; 14:911–915. 12. Valpato S, Bianchi L, Cherubini A, et al. Prevalence and clinical correlates of sarcopenia in community-dwelling older people: application of the EWGSOP definition and diagnostic algorithm. J Gerontol A Biol Sci Med Sci 2014; 69:438–446. 13. Vetrano DL, Landi F, Volpato S, et al. Association of sarcopenia with shortand long-term mortality in older adults admitted to acute care wards: results from the CRIME study. J Gerontol A Biol Sci Med Sci 2014; 69:1154–1161.
14. Patel HP, Syddall HE, Jameson K, et al. Prevalence of sarcopenia in community-dwelling older people in the UK using the European Working Group on Sarcopenia in Older People (EWGSOP) definition: findings from the Hertfordshire Cohort Study (HCS). Age Ageing 2013; 42:378–384. 15. Lee WJ, Liu LK, Peng LN, et al., ILAS Research Group. Comparisons of sarcopenia defined by IWGS and EWGSOP criteria among older people: results from the I-Lan longitudinal aging study. J Am Med Dir Assoc 2013; 14:528.e1–e7. 16. DaSilva Alexandre T, de Oliveira Duarte YA, Ferreira Santos JL, et al. Sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) versus dynapenia as a risk factor for disability in the elderly. J Nutr Health Aging 2014; 18:547–553. 17. Landi F, Liperoti R, Fusco D, et al. Sarcopenia and mortality among older & nursing home residents. J Am Med Dir Assoc 2012; 13:121–126. A key article highlighting that sarcopenia is important in frail nursing home residents. 18. Malmstrom TK, Miller DK, Herning MM, Morley JE. Low appendicular skeletal & muscle mass (ASM) with limited mobility and poor health outcomes in middleaged African Americans. J Cachexia Sarcopenia Muscle 2013; 4:179–186. Validation of the sarcopenia definition of the Society for Sarcopenia Cachexia and Wasting Disorders. 19. Landi F, Onder G, Bernabei R. Sarcopenia and diabetes: two sides of the same coin. J Am Med Dir Assoc 2013; 14:540–541. 20. Leenders M, Verdijk LB, van der Hoeven L, et al. Patients with type 2 diabetes & show a greater decline in muscle mass, muscle strength, and functional capacity with aging. J Am Med Dir Assoc 2013; 14:585–592. Diabetics are at greater risk of developing sarcopenia. 21. Barbat-Artigas S, Rolland Y, Vellas B, Aubertin-Leheudre M. Muscle quantity is not synonymous with muscle quality. J Am Med Dir Assoc 2013; 14:852.e1–e7. 22. Barbat-Artigas S, Pion CH, Leduc-Gaudet JP, et al. Exploring the role of muscle mass, obesity, and age in the relationship between muscle quality and physical function. J Am Med Dir Assoc 2014; 15:303.e13–e20. 23. Rolland Y, Lauwers-Cances V, Cristini C, et al. Difficulties with physical function associated with obesity, sarcopenia, and sarcopenic-obesity in community-dwelling elderly women: the PIDOS (EPIDemiologie de l’OSteoporose) Study. Am J Clin Nutr 2009; 89:1895–1900. 24. Ravindrarajah R, Lee DM, Pye SR, et al., European Male Aging Study Group. The ability of three different models of frailty to predict all-cause mortality: results from the European Male Aging study (EMAS). Arch Gerontol Geriatr 2013; 57:360–368. 25. Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging 2012; 16:601–608. 26. Woo J, Leung J, Morley JE. Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation. J Am Geriatr Soc 2012; 60:1478–1486. 27. Evans CJ, Chiou CF, Fitzgerald KA, et al. Development of a new patient-reported outcome measure in sarcopenia. J Am Med Dir Assoc 2011; 12:226–233. 28. Malmstrom TK, Morley JE. SARC-F: a simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc 2013; 14:531–532. 29. Woo J, Leung J, Morley JE. Validating the SARC-F: a suitable community & screening tool for sarcopenia? J Am Med Dir Assoc 2014; 15:630–634. This is the key validation of the simple sarcopenia screening tool. 30. Cao L, Chen S, Zou C, et al. A pilot study of the SARC-F scale on screening sarcopenia and physical disability in the Chinese older people. J Nutr Health Aging 2014; 18:277–283. 31. Malmstrom TK, Miller DK, Morley JE, et al. A comparison of four frailty models. J Am Geriatr Soc 2014; 62:721–726. 32. Sakuma K, Aoi W, Yamaguchi A. Current understanding of sarcopenia: possible candidates modulating muscle mass. Pflugers Arch 2014. [Epub ahead of print] 33. Morley JE. Sarcopenia in the elderly. Fam Pract 2012; 29 (Suppl 1):i44–i48. 34. Rolland Y, Onder G, Morley JE, et al. Current and future pharmacologic treatment of sarcopenia. Clin Geriatr Med 2011; 27:423–447. 35. Michaud M, Balardy L, Moulis G, et al. Proinflammatory cytokines, aging, and age-related diseases. J Am Med Dir Assoc 2013; 14:877–882. 36. Drey M, Krieger B, Sieber CC, et al. Motoneuron loss is associated with & sarcopenia. J Am Med Dir Assoc 2014; 15:435–439. Motorneuron loss is a major reason for the development of sarcopenia. 37. Matthieu-Costello O, Kong A, Ciaraldi TP, et al. Regulation of skeletal muscle morphology in type 2 diabetic subjects by troglitazone and metformin: relationship to glucose disposal. Metabolism 2003; 52:540–546. 38. Carlsson M, Littbrand H, Gustafson Y, et al. Effects of high-intensity exercise and protein supplement on muscle mass in ADL dependent older people with and without malnutrition: a randomized controlled trial. J Nutr Health Aging 2011; 15:554–560. 39. Singh NA, Quine S, Clemson LM, et al. Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: a randomized controlled trial. J Am Med Dir Assoc 2012; 13:24–30. 40. Valenzuela T. Efficacy of progressive resistance training interventions in older & adults in nursing homes: a systematic review. J Am Med Dir Assoc 2012; 13:418–428. Provides the evidence for resistance training as a treatment for sarcopenia.
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3
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Ageing: biology and nutrition 41. Pahor M, Guralnik JM, Ambrosius WT, et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE Study randomized clinical trial. JAMA 2014; 311:2387–2396. 42. Bauer J, Biolo G, Cederholm T, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc 2013; 14:542– 559. 43. Pedersen AN, Cederholm T. Health effects of protein intake in healthy elderly populations: a systematic literature review. Food Nutr Res 2014; 58.:. doi: 10.3402/fnr.v58.23364; e-Collection 2014.
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www.co-clinicalnutrition.com
44. Deutz NE, Bauer JM, Barazzoni R, et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr 2014. [Epub ahead of print] 45. Chapman IM, Visvanathan R, Hammond AJ, et al. Effect of testosterone and a nutritional supplement, alone and in combination, on hospital admissions in undernourished older men and women. Am J Clin Nutr 2009; 89:880–889. 46. Rolland Y, de Souto Barreto P, Abellan Van Kan G, et al., French Group of Geriatrics and Nutrition. Vitamin D supplementation in older adults: searching for specific guidelines in nursing homes. J Nutr Health Aging 2013; 17:402– 412.
Volume 18 Number 1 January 2015
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Sarcopenia: the new definitions Tommy Cederholm a,b and John E. Morley c
Purpose of review To highlight the new international definitions of sarcopenia. Recent findings New international definitions of sarcopenia have been evaluated and shown to be predictive of poor outcomes in older persons. Summary There is now international agreement that the definition for sarcopenia should include not only muscle mass, but also some measure of muscle function, such as walking speed or distance or grip strength. Keywords FRAIL, frailty syndrome, muscle power, SARC-F, sarcopenia, skeletal mass, the European Working Group on Sarcopenia in Older Persons
INTRODUCTION Skeletal mass comprises 45% of body mass and a decline in skeletal mass function plays a key role in the development of the frailty syndrome [1,2]. Muscle mass declines at the rate of about 1% per year after 30 years of age. The loss of skeletal mass associated with aging was originally termed sarcopenia (loss of flesh) [3]. More recently, it has become recognized that there is no clear relationship between muscle mass and strength and power [4]. This has led to a number of consensus groups redefining the criteria for sarcopenia to include measures of physical performance (walking speed or distance) and grip strength in addition to low muscle mass [5–8,9 ] (Table 1). &
NEW SARCOPENIA DEFINITIONS Three of the definitions; viz the European Working Group on Sarcopenia in Older Persons [5,8,10–16,17 ], the Society for Sarcopenia, Cachexia and Wasting Disorders [7,18 ] and the Foundation of National International Health-Sarcopenia [9 ] have been validated cross-sectionally and longitudinally. The Society for Sarcopenia, Cachexia and Wasting Disorders group pointed out that although aging was a common cause of sarcopenia, it was not a prerequisite for its diagnosis [7]. For example, there is evidence suggesting that middleaged persons with diabetes mellitus have accelerated loss of muscle mass and strength and develop sarcopenia at a younger age [19,20 ]. Overall, it appears
that muscle function is a better predictor of poor outcomes, than is muscle mass [21,22]. This is, in part, related to the fact that persons with ‘obese sarcopenia’ tend to have worse outcomes, possibly related to insulin resistance [23].
FUNCTION AND MASS: WHAT IS IMPORTANT? A function is more important than muscle mass. It would appear that simple questionnaires aimed at examining muscle function could be useful as a screening tool for sarcopenia. This is similar to the development of the simple ‘FRAIL’ screen for frailty [24–26]. Two groups have developed such screening questionnaire s [27,28]. The screening tool by Evans et al. [27] has a good development basis but lacks epidemiological validation. The Strength Assistance in Walking, Rise from a chair, Climb stairs, Falls (Table 1) has now been validated
&
&
&
a Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, bDepartment of Geriatric Medicine, Uppsala University Hospital, Uppsala, Sweden and cDivisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, St. Louis, Missouri, USA
Correspondence to John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104, USA. Tel: +1 314 977 8462; e-mail: [email protected] Curr Opin Clin Nutr Metab Care 2015, 18:1–4
&
DOI:10.1097/MCO.0000000000000119
1363-1950 ß 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
www.co-clinicalnutrition.com
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Ageing: biology and nutrition
KEY POINTS Sarcopenia is now defined as decreased gait speed or grip strength in a person with low muscle mass. A simple screen (SARC-F) is available for screening for sarcopenia.
hormone) also plays a role in loss of muscle mass [34]. An increase in inflammatory cytokines (i.e., interleukin-6 and tumor necrosis factor alpha) represents a further reason for muscle loss [35]. The loss of motor end-plate function appears to be a cause of declining muscle strength in about half of older persons with sarcopenia [36 ]. Finally, a decline in blood flow to muscle capillaries with aging further decreases muscle function. This appears to be particularly true in persons with insulin resistance [37]. &
Resistance exercise protein and vitamin D are the basic treatments for sarcopenia.
&
in Chinese and American populations [29 ,30,31]. In the Hong Kong population it appeared to be similar to the European Working Group on Sarcopenia in Older Persons and the Asian Sarcopenia Working Group in prediction of outcomes [8,29 ]. As it can be rapidly administered in under 30 s, it may be an ideal screening tool for general practitioners. &
SARCOPENIA MECHANISMS The causes of sarcopenia are multifactorial. Both genetic causes (e.g., myostatin activin II receptor and notch genes), mitochondrial abnormalities and small birth size have been related to sarcopenia in older persons [32]. The major cause of sarcopenia appears to be related to a lack of physical activity with advancing age [33]. This can further be aggravated by poor calorie and protein intake. The decline in anabolic hormones (i.e., testosterone, dehydroepiandrosterone, insulin-like growth factor-1 and growth
IS SARCOPENIA REVERSIBLE? A number of recent studies have highlighted the major role that resistance exercise plays in reversing sarcopenia [38,39,40 ]. Aerobic exercise as highlighted by the ‘LIFE’ study also improves muscle function [41]. High quality leucine-enriched protein also improves muscle function [42–44]. The role of anabolic steroids remains controversial, although a small study combining calories and low-dose testosterone showed a marked decrease in hospitalizations [45]. In persons with low vitamin D, vitamin D replacement also appears to improve muscle strength [46]. &
SCREENING FOR SARCOPENIA There is increasing evidence that physicians should be screening for sarcopenia in their practice [6]. When it is present there is evidence that physical exercise, vitamin D and increased protein intake will
Table 1. SARC-F screen for sarcopenia Component
Question
Scoring
Strength
How much difficulty do you have in lifting and carrying 10 pounds?
None ¼ 0 Some ¼ 1 A lot or unable ¼ 2
Assistance in walking
How much difficulty do you have walking across a room?
None ¼ 0 Some ¼ 1 A lot, use aids, or unable ¼ 2
Rise from a chair
How much difficulty do you have transferring from a chair or bed?
None ¼ 0 Some ¼ 1 A lot or unable without help ¼ 2
Climb stairs
How much difficulty do you have climbing a flight of 10 stairs?
None ¼ 0 Some ¼ 1 A lot or unable ¼ 2
Falls
How many times have you fallen in the last year?
None ¼ 0 1–3 falls ¼ 1 4 or more falls ¼ 2
2
www.co-clinicalnutrition.com
Volume 18 Number 1 January 2015
Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Sarcopenia: the new definitions Cederholm and Morley
improve muscle function and decrease long-term complications related to sarcopenia.
CONCLUSION The concept of sarcopenia, recently defined as the combined loss of function and mass, emerges as an effective tool to combat frailty and dependence in old adults. The current challenge is to reach professional awareness, implement regular screening procedures, provide resistance training to older adults and promote good protein intake and control of vitamin D status. Whether pharmacological substances will prove helpful is still a question for the future. Acknowledgements Dr Morley serves as a consultant for Danone and SanofiAventis and has a research grant from Purina (Nestle). Dr Cederholm receives unconditional research funding from Nutricia/Danone and Nestle Medical Nutrition. Conflicts of interest There are no conflicts of interest.
REFERENCES AND RECOMMENDED READING Papers of particular interest, published within the annual period of review, have been highlighted as: & of special interest && of outstanding interest 1. Morley JE. Editorial: frailty screening comes of age. J Nutr Health Aging 2014; 18:453–454. 2. Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14:392–397. 3. Michel JP. Sarcopenia: there is a need for some steps forward. J Am Med Dir Assoc 2014; 15:379–380. 4. Clark BC, Manini TM. What is dynapenia? Nutrition 2012; 28:495–503. 5. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39:412–423. 6. Fielding RA, Vellas B, Evans WJ, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 2011; 12:249–256. 7. Morley JE, Abbatecola AM, Argiles JM, et al. Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc 2011; 12:403–409. 8. Chen L-K, Liu L-K, Woo J, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 2014; 15:95– 101. 9. Dam T-T, Peters KW, Fragala M, et al. An evidence-based comparison of & operational criteria for the presence of sarcopenia. J Geront A Biol Sci Med Sci 2014; 69:584–590. This is the foundation of the National Institute of Medicine definition for sarcopenia. It is basically equivalent to the earlier definitions. 10. Kim YP, Kim S, John JY, Hwang HS. Effect of interaction between dynapenic component of the European working group on sarcopenia in older people sarcopenia criteria and obesity on activities of daily living in the elderly. J Am Med Dir Assoc 2014; 15:371.e1–e5. 11. Yamada M, Nishiguchi S, Fukutani N, et al. Prevalence of sarcopenia in community-dwelling Japanese older adults. J Am Med Dir Assoc 2013; 14:911–915. 12. Valpato S, Bianchi L, Cherubini A, et al. Prevalence and clinical correlates of sarcopenia in community-dwelling older people: application of the EWGSOP definition and diagnostic algorithm. J Gerontol A Biol Sci Med Sci 2014; 69:438–446. 13. Vetrano DL, Landi F, Volpato S, et al. Association of sarcopenia with shortand long-term mortality in older adults admitted to acute care wards: results from the CRIME study. J Gerontol A Biol Sci Med Sci 2014; 69:1154–1161.
14. Patel HP, Syddall HE, Jameson K, et al. Prevalence of sarcopenia in community-dwelling older people in the UK using the European Working Group on Sarcopenia in Older People (EWGSOP) definition: findings from the Hertfordshire Cohort Study (HCS). Age Ageing 2013; 42:378–384. 15. Lee WJ, Liu LK, Peng LN, et al., ILAS Research Group. Comparisons of sarcopenia defined by IWGS and EWGSOP criteria among older people: results from the I-Lan longitudinal aging study. J Am Med Dir Assoc 2013; 14:528.e1–e7. 16. DaSilva Alexandre T, de Oliveira Duarte YA, Ferreira Santos JL, et al. Sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) versus dynapenia as a risk factor for disability in the elderly. J Nutr Health Aging 2014; 18:547–553. 17. Landi F, Liperoti R, Fusco D, et al. Sarcopenia and mortality among older & nursing home residents. J Am Med Dir Assoc 2012; 13:121–126. A key article highlighting that sarcopenia is important in frail nursing home residents. 18. Malmstrom TK, Miller DK, Herning MM, Morley JE. Low appendicular skeletal & muscle mass (ASM) with limited mobility and poor health outcomes in middleaged African Americans. J Cachexia Sarcopenia Muscle 2013; 4:179–186. Validation of the sarcopenia definition of the Society for Sarcopenia Cachexia and Wasting Disorders. 19. Landi F, Onder G, Bernabei R. Sarcopenia and diabetes: two sides of the same coin. J Am Med Dir Assoc 2013; 14:540–541. 20. Leenders M, Verdijk LB, van der Hoeven L, et al. Patients with type 2 diabetes & show a greater decline in muscle mass, muscle strength, and functional capacity with aging. J Am Med Dir Assoc 2013; 14:585–592. Diabetics are at greater risk of developing sarcopenia. 21. Barbat-Artigas S, Rolland Y, Vellas B, Aubertin-Leheudre M. Muscle quantity is not synonymous with muscle quality. J Am Med Dir Assoc 2013; 14:852.e1–e7. 22. Barbat-Artigas S, Pion CH, Leduc-Gaudet JP, et al. Exploring the role of muscle mass, obesity, and age in the relationship between muscle quality and physical function. J Am Med Dir Assoc 2014; 15:303.e13–e20. 23. Rolland Y, Lauwers-Cances V, Cristini C, et al. Difficulties with physical function associated with obesity, sarcopenia, and sarcopenic-obesity in community-dwelling elderly women: the PIDOS (EPIDemiologie de l’OSteoporose) Study. Am J Clin Nutr 2009; 89:1895–1900. 24. Ravindrarajah R, Lee DM, Pye SR, et al., European Male Aging Study Group. The ability of three different models of frailty to predict all-cause mortality: results from the European Male Aging study (EMAS). Arch Gerontol Geriatr 2013; 57:360–368. 25. Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging 2012; 16:601–608. 26. Woo J, Leung J, Morley JE. Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation. J Am Geriatr Soc 2012; 60:1478–1486. 27. Evans CJ, Chiou CF, Fitzgerald KA, et al. Development of a new patient-reported outcome measure in sarcopenia. J Am Med Dir Assoc 2011; 12:226–233. 28. Malmstrom TK, Morley JE. SARC-F: a simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc 2013; 14:531–532. 29. Woo J, Leung J, Morley JE. Validating the SARC-F: a suitable community & screening tool for sarcopenia? J Am Med Dir Assoc 2014; 15:630–634. This is the key validation of the simple sarcopenia screening tool. 30. Cao L, Chen S, Zou C, et al. A pilot study of the SARC-F scale on screening sarcopenia and physical disability in the Chinese older people. J Nutr Health Aging 2014; 18:277–283. 31. Malmstrom TK, Miller DK, Morley JE, et al. A comparison of four frailty models. J Am Geriatr Soc 2014; 62:721–726. 32. 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