- Email: [email protected]
Can sarcopenia be diagnosed without measurements?
European Geriatric Medicine 5 (2014) 291–293
Available online at
ScienceDirect www.sciencedirect.com
Editorial
Can sarcopenia be diagnosed without measurements? MacDonald Critchley noted that with aging there was a visual loss of muscle in the hands and feet [1]. This loss of muscle was named sarcopenia by Irwing Rosenberg. Baumgartner provided an objective definition using appendicular muscle mass corrected for height [2]. Subsequently, numerous studies have shown that muscle wasting associated with old age leads to a decrease in function, fractures and an increase in mortality [3–6]. Sarcopenia is a major cause of frailty [7–11]. It has been suggested that sarcopenia should be screened for even in the absence of complaints [12], as sarcopenia is potentially reversible [13]. More recently it was recognized that muscle function was not necessarily related to muscle mass [14,15]. This is in part due to lipid infiltration with aging. It has been clearly demonstrated that obese persons with muscle wasting–‘‘Sarcopenic obesity’’–have poorer function than those who have sarcopenia alone [16,17]. With aging, there is not a direct correlation between muscle quality and muscle mass [18,19]. Further, an increase in muscle mass, produced by growth hormone does not lead to an increase in muscle strength [20]. This led to a number of organizations to redefine sarcopenia as being limited muscle function (walking speed or distance or grip strength) associated with a low muscle mass (Table 1) [21–25]. A number of studies have validated this definition, which appears to be more predictive of poor outcomes [26–30]. By coupling function with muscle mass, this excludes other causes of poor function such as arthritis, chronic obstructive pulmonary disease, congestive heart failure and anaemia [31]. There are many causes of sarcopenia. Approximately half of the persons with sarcopenia have degeneration of the motor end plates [32]. This leads to an increase in c-terminal agrin, which is an excellent biomarker for sarcopenia due to nerve damage [33]. Table 1 Comparison of sarcopenia definitions: while definitions include similar criteria, there is marked variation in cut-off values. Definition
Function
Muscle Mass
EWGSOP [21]
Gait speed Grip strength Gait speed
Low muscle mass
IANA Sarcopenia Task Force [22] Sarcopenia with Limited Mobility (SCWD) [23] Asian Working Group for Sarcopenia [25] FNIH Sarcopenia Project [24]
6 min walk or gait speed Grip strength Gait speed Grip strength Gait speed
Low appendicular lean mass/height2 Low appendicular lean mass/height2 Low appendicular lean mass/height2 Appendicular lean mass/BMI
EWGSOP: European Working Group on Sarcopenia in Older People; SCWD: Society on Sarcopenia, Cachexia and Wasting Diseases; IANA: International Academy on Nutrition and Aging; FNIH: Foundation for the National Institutes of Health. http://dx.doi.org/10.1016/j.eurger.2014.07.014 1878-7649/ß 2014 Published by Elsevier Masson SAS.
Persons with diabetes mellitus have accelerated muscle loss associated with their peripheral neuropathy and decreased blood flow to the muscles [34,35]. In addition, insulin resistance leads to mitochondrial dysfunction resulting in oxidative damage. Another major cause of sarcopenia is the age related decline of anabolic hormones, i.e., testosterone, insulin growth factor and DHEA [36]. Testosterone stimulates beta-catenin leading to an increase in satellite cells as well as an increase in protein synthesis [37]. In parabiosis experiments, testosterone has been shown to have a necessary permissive effect to allow GDF-13 to reverse the atrophy of aging muscles [38]. An excess of inflammatory cytokines has been demonstrated to cause age-associated muscle loss [39]. The anorexia of aging results in a decrease in protein to maintain muscle mass [40]. Older persons tend to have a decrease in physical activity, which adds to muscle loss. Finally, a variety of genetic factors such as alterations in myostatin and angiotensin converting enzymes, as well as mitochondrial deficits, further decrease muscle mass and function. The factors causing sarcopenia are summarized in Fig. 1. It has been recognized that bone strength does not directly correlate with bone mineral density. This lead researchers to query whether the questions associated with the FRAX (www.shef.ac.uk.FRAX/) would be sufficient to identify the persons at highest risk for fractures. Recently, studies have shown that the FRAX questions alone are capable of identifying those at highest risk for fractures [41]. As muscle function is more observable than bone function, it was suggested that it should be feasible to develop a simple questionnaire to identify persons with sarcopenia. Our group developed such a questionnaire–the SARC-F (Table 2) [42]. A number of studies have provided a robust validation for the SARCF. Woo et al. [43] showed that the SARC-F performed at a similar level to the European Working Group on Sarcopenia in Older People [21] and the Asian Working Group for Sarcopenia [25] at identifying persons with sarcopenia. Similarly, a group in China demonstrated that the SARC-F was highly predictive of muscle function [44]. Further validations of the SARC-F exist in the St. Louis African American Health Study, the National Health and Nutrition Examination Survey (NHANES), and the Baltimore Longitudinal Study of Aging. Evans et al. [45] have developed a more complex sarcopenia questionnaire, but at present it lacks an in-depth validation. These studies certainly suggest that sarcopenia can be screened for without a necessity to measure muscle mass or to directly measure muscle function. Sarcopenia is a treatable malady of aging. It is clear that both aerobic and resistance exercise can improve muscle function [46–50]. Further, there is increasing evidence that high quality protein supplementation can enhance muscle mass and function
292
Editorial / European Geriatric Medicine 5 (2014) 291–293
Fig. 1. Factors causing sarcopenia and outcomes in persons with sarcopenia. DHEAS: dehydroepiandrosterone sulfate; TNFa: tumor necrosis factor alpha; IL6: interleukin 6; CNTF: ciliary neurotrophic factor.
Table 2 The SARC-F Scale: A rapid, validated scale for the detection of sarcopenia. Scores of 4 or more–sarcopenia. Item
Scoring
Strength
Difficulty lifting and carrying 10 pounds
None = 0 Some = 1 A lot or unable = 2
Assistance in walking
Difficulty walking across a room
None = 0 Some = 1 A lot, use aids, or unable = 2
Rise from a chair
Difficulty transferring from a chair or bed
None = 0 Some = 1 A lot or unable without help = 2
Climb stairs
Difficulty climbing a flight of ten stairs
None = 0 Some = 1 A lot or unable = 2
Falls
Number of falls in the past year
None = 0 1–3 falls = 1 4 or more falls = 2
[51–56]. Vitamin D replacement in persons with low vitamin D also can improve muscle function [57]. At present, the role of testosterone is controversial [58]. Other drugs such as selective androgen receptor molecules and myostatin and activin receptor molecules are under development [59]. The availability of a simple questionnaire to identify persons at risk for sarcopenia becomes a powerful tool for general practitioners. Once identified simple interventions, viz. exercise, protein supplementation and vitamin D, can be utilized to improve health outcomes in older persons. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. Acknowledgements No outside funding was received by either of the authors (JEM, TKM) for the writing of this article.
References [1] Morley JE. Sarcopenia in the elderly. Fam Pract 2012;29(Suppl 1):i44–8. [2] Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 1998;147:755–63. [3] Morley JE. Weight loss in older persons: new therapeutic approaches. Curr Pharm Des 2007;13:3637–47. [4] Amigues I, Schott Am, Amine M, Gelas-Dore B, Veerabudun K, Paillaud E, et al. Low skeletal muscle mass and risk of functional decline in elderly communitydwelling women: the prospective EPIDOS study. J Am Med Dir Assoc 2013;14:352–7. [5] Yu R, Leung J, Woo J. Incremental predictive value of sarcopenia for incident fracture in an elderly Chinese cohort: results from the osteoporotic fractures in men (MrOs) study. J Am Med Dir Assoc 2014;15:551–8. [6] Vetrano DL, Landi F, Volpato S, Corsonello A, Meloni E, Bernabei R, et al. Association of sarcopenia with short- and long-term mortality in older adults admitted to acute care wards: results from the CRIME study. J Gerontol A Biol Sci Med Sci 2014 [Epub ahead of print]. [7] Romero-Ortuno R. An alternative method for frailty index cut-off points to define frailty categories. Eur Geriatr Med 2013;4:299–303. [8] Morley JE. Frailty: a time for action. Eur Geriatr Med 2013;4:215–6. [9] Romero-Ortuno R. The frailty instrument of the survey of health, ageing and retirement in Europe (SHARE-F1) predicts mortality beyond age, comorbidities, disability, self-rated health, education and depression. Eur Geriatr Med 2011;2:323–6.
Editorial / European Geriatric Medicine 5 (2014) 291–293 [10] Morley JE, Malmstrom Tk, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging 2012;16:601–8. [11] Cruz-Jentoft A, Michel J-P. Sarcopenia: a useful paradigm for physical frailty. Eur Geriatr Med 2013;4:102–5. [12] Esperto H, Ferreira E, Canha C, et al. Sarcopenia: test it, even in the absence of complaints. Eur Geriatric Med 2013;4:183–4. [13] Michel JP, Sarcopenia:. There is a need for some steps forward. J Am Med Dir Assoc 2014;15:379–80. [14] Clark BC, Manini TM. What is dynapenia? Nutrition 2012;28:495–503. [15] Manini Tm, Clark BC. Dynapenia and aging: an update. J Gerontol A Biol Sci Med Sci 2012;67:28–40. [16] Baumgartner RN, Wayne SJ, Waters DL, Janssen I, Gallagher D, Morley JE. Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obes Res 2004;12:1995–2004. [17] Rolland Y, Lauwers-Cances V, Cristini C, Abellan van Kan G, Janssen I, Morley JE, et al. Difficulties with physical function associated with obesity, sarcopenia, and sarcopenic-obesity in community-dwelling elderly women: the EPIDOS (EPIDemiologie de l’OSteoporose) Study. Am J Clin Nutr 2009;89:1895–900. [18] 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.e1–7. [19] Barbat-Artigas S, Pion CH, Leduc-Gaudet JP, Rolland Y, Aubertin-Leheudre M. 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.e13–2. [20] Kaiser FE, Silver AJ, Morley JE. The effect of recombinant human growth hormone on malnourished older individuals. J Am Geriatr Soc 1991;39: 235–40. [21] Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in older people. Age Ageing 2010; 39:412–23. [22] Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, 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;12:249–56. [23] Morley JE, Abbatecola AM, Argiles JM, Baracos V, Bauer J, Bhasin S, et al. Society on sarcopenia, cachexia and wasting disorders trialist workshop. Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc 2011;12:403–9. [24] Dam TT, Peters KW, Fragala M, Cawthon PM, Harris TB, McLean R, et al. An evidence-based comparison of operational criteria for the presence of Sarcopenia. J Gerontol A Biol Sci Med Sci 2014;69:584–90. [25] Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia: consensus report of the Asian working group for Sarcopenia. J Am Med Dir Assoc 2014;15:95–101. [26] Lee WJ, Liu LK, Peng LN, Lin MH, Chen LK, 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– 7. [27] Landi F, Cruz-Jentoft AJ, Liperoti R, Russo A, Giovannini S, Tosato M, et al. Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing 2013;42:203–9. [28] Landi F, Liperoti R, Fusco D, Mastropaolo S, Quattrociocchi D, Proia A, et al. Sarcopenia and mortality among older nursing home residents. J Am Med Dir Assoc 2012;13:121–6. [29] Kim YP, Kim S, Joh 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.e1–5. [30] Malmstrom TK, Miller DK, Herning MM, Morley JE. Low appendicular skeletal muscle mass (ASM) with limited mobility and poor health outcomes in middle-aged African Americans. J Cachexia Sarcopenia Muscle 2013;4: 179–86. [31] Rolland Y, Czerwinski S, Abellan Van Kan G, Morley JE, Cesari M, Onder G, et al. Sarcopenia: its assessment, etiology, pathogenesis, consequences and future perspectives. J Nutr Health Aging 2008;12:433–50. [32] Drey M, Krieger B, Sieber CC, Bauer JM, Hettwer S, Bertsch T, DISARCO Study Group. Motoneuron loss is associated with sarcopenia. J Am Med Dir Assoc 2014;15:435–9. [33] Hettwer S, Dahinden P, Kucsera S, Farina C, Ahmed S, Fariello R, et al. Elevated levels of a C-terminal agrin fragment identifies a new subset of sarcopenia patients. Exp Gerotol 2013;48:69–75. [34] Landi F, Onder G, Bernabei R. Sarcopenia and diabetes: two sides of the same coin. J Am Med Dir Assoc 2013;14:540–1. [35] Leenders M, Verdijk LB, van der Hoeven L, Adam JJ, van Kranenburg J, Nilwik R, 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;14:585–92. [36] Morley JE, Malmstrom TK. Frailty, sarcopenia, and hormones. Endocrinol Metab Clin North Am 2013;42:391–405. [37] Samaras N, Frangos E, Forster A, Lang PO, Samaras D. Andropause: a review of the definition and treatment. Eur Geriatr Med 2012;3:368–73. [38] Sinha I, Sinha-Hikim AP, Wagers AJ, Sinha-Hikim I. Testosterone is essential for skeletal muscle growth in aged mice in a heterochronic parabiosis model. Cell Tissue Res 2014 [Epub ahead of print].
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[39] Michaud M, Balardy L, Moulis G, Gaudin C, Peyrot C, Vellas B, et al. Proinflammatory cytokines, aging, and age-related diseases. J Am Med Dir Assoc 2013;14:877–82. [40] MacIntosh C, Morley JE, Chapman IM. The anorexia of aging. Nutrition 2000;16:983–95. [41] Leslie WD, Morris J, Lu LM, et al. Fracture risk assessment without bone density measurement in routine clinical practice. Osteoporosis Int 2012;23:75–85. [42] Malmstrom TK, Morley JE. SARC-F: a simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc 2013;14:531–2. [43] Woo J, Leung J, Morley JE. Validating the SARC-F: a suitable community screening tool for sarcopenia? J Am Med Dir Assoc 2014;15(7). http:// dx.doi.org/10.1016/j.jamda.2014.04.021 [Epub ahead of print]. [44] Cao L, Chen S, Zou C, Ding X, Gao L, Liao Z, 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;18:277–83. [45] Evans CJ, Chiou CF, Fitzgerald KA, Evans WJ, Ferrall BR, Dale W, et al. Development of a new patient-reported outcome measure in sarcopenia. J Am Med Dir Assoc 2011;12:226–33. [46] Silva RB, Eslick GD, Duque G. Exercise for falls and fracture prevention in long term care facilities: a systematic review and meta-analysis. J Am Med Dir Assoc 2013;14:685–689.e2. [47] Valenzuela T. Efficacy of progressive resistance training interventions in older adults in nursing homes: a systematic review. J Am Med Dir Assoc 2012;13: 418–28. [48] Yamada M, Arai H, Sonoda T, Aoyama T. Community-based exercise program is cost-effective by preventing care and disability in Japanese frail older adults. J Am Med Dir Assoc 2012;13:507–11. [49] Lam LC, Chau RC, Wong BM, Fung AW, Tam CW, Leung GT, et al. A 1-year randomized controlled trial comparing mind body exercise (Tai Chi) with stretching and toning exercise on cognitive function in older Chinese adults at risk of cognitive decline. J Am Med Dir Assoc 2012;13:568.e15–2. [50] Singh NA, Quine S, Clemson LM, Williams EJ, Williamson DA, Stavrinos TM, 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. [51] Morley JE, Argiles JM, Evans WJ, Bhasin S, Cella D, Deutz NE, et al. Nutritional recommendations for the management of sarcopenia. J Am Med Dir Assoc 2010;11:391–6. [52] Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, 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;14:542–59. [53] Tieland M, Dirks ML, van der Zwaluw N, Verdijk LB, van de Rest O, de Groot LC, et al. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, doubleblind, placebo-controlled trial. J Am Med Dir Assoc 2012;13:713–9. [54] Cermak NM, de Groot LC, van Loon LJ. Perspective: protein supplementation during prolonged resistance type exercise training augments skeletal muscle mass and strength gains. J Am Med Dir Assoc 2013;14:71–2. [55] Paddon-Jones D. Perspective: exercise and protein supplementation in frail elders. J Am Med Dir Assoc 2013;14:73–4. [56] Morley JE. Do frail older persons need more protein? J Am Med Dir Assoc 2012;13:667–8. [57] Janssen HC, Emmelot-Vonk MH, Verhaar HJ, van der Schouw YT. Vitamin D and muscle function: is there a threshold in the relation? J Am Med Dir Assoc 2013;14:627.e13–1. [58] Wang C, Nieschlag E, Swerdloff R, Behre HM, Hellstrom WJ, Gooren LJ, et al. Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA, and ASA recommendations. Eur Urol 2009;55: 121–30. [59] Morley JE, von Haehling S, Anker SD. Are we closer to having drugs to treat muscle wasting disease? J Cachexia Sarcopenia Muscle 2014;5:83–7.
J.E. Morley MB, BCh* Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, 1402, S. Grand Blvd., M238, Saint Louis, MO 63104, USA T.K. Malmstrom PhD Department of Neurology and Psychiatry and Division of Geriatric Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA *Corresponding author E-mail address: [email protected] (J.E. Morley)
Received 28 July 2014 Accepted 31 July 2014 Available online 17 September 2014
Available online at
ScienceDirect www.sciencedirect.com
Editorial
Can sarcopenia be diagnosed without measurements? MacDonald Critchley noted that with aging there was a visual loss of muscle in the hands and feet [1]. This loss of muscle was named sarcopenia by Irwing Rosenberg. Baumgartner provided an objective definition using appendicular muscle mass corrected for height [2]. Subsequently, numerous studies have shown that muscle wasting associated with old age leads to a decrease in function, fractures and an increase in mortality [3–6]. Sarcopenia is a major cause of frailty [7–11]. It has been suggested that sarcopenia should be screened for even in the absence of complaints [12], as sarcopenia is potentially reversible [13]. More recently it was recognized that muscle function was not necessarily related to muscle mass [14,15]. This is in part due to lipid infiltration with aging. It has been clearly demonstrated that obese persons with muscle wasting–‘‘Sarcopenic obesity’’–have poorer function than those who have sarcopenia alone [16,17]. With aging, there is not a direct correlation between muscle quality and muscle mass [18,19]. Further, an increase in muscle mass, produced by growth hormone does not lead to an increase in muscle strength [20]. This led to a number of organizations to redefine sarcopenia as being limited muscle function (walking speed or distance or grip strength) associated with a low muscle mass (Table 1) [21–25]. A number of studies have validated this definition, which appears to be more predictive of poor outcomes [26–30]. By coupling function with muscle mass, this excludes other causes of poor function such as arthritis, chronic obstructive pulmonary disease, congestive heart failure and anaemia [31]. There are many causes of sarcopenia. Approximately half of the persons with sarcopenia have degeneration of the motor end plates [32]. This leads to an increase in c-terminal agrin, which is an excellent biomarker for sarcopenia due to nerve damage [33]. Table 1 Comparison of sarcopenia definitions: while definitions include similar criteria, there is marked variation in cut-off values. Definition
Function
Muscle Mass
EWGSOP [21]
Gait speed Grip strength Gait speed
Low muscle mass
IANA Sarcopenia Task Force [22] Sarcopenia with Limited Mobility (SCWD) [23] Asian Working Group for Sarcopenia [25] FNIH Sarcopenia Project [24]
6 min walk or gait speed Grip strength Gait speed Grip strength Gait speed
Low appendicular lean mass/height2 Low appendicular lean mass/height2 Low appendicular lean mass/height2 Appendicular lean mass/BMI
EWGSOP: European Working Group on Sarcopenia in Older People; SCWD: Society on Sarcopenia, Cachexia and Wasting Diseases; IANA: International Academy on Nutrition and Aging; FNIH: Foundation for the National Institutes of Health. http://dx.doi.org/10.1016/j.eurger.2014.07.014 1878-7649/ß 2014 Published by Elsevier Masson SAS.
Persons with diabetes mellitus have accelerated muscle loss associated with their peripheral neuropathy and decreased blood flow to the muscles [34,35]. In addition, insulin resistance leads to mitochondrial dysfunction resulting in oxidative damage. Another major cause of sarcopenia is the age related decline of anabolic hormones, i.e., testosterone, insulin growth factor and DHEA [36]. Testosterone stimulates beta-catenin leading to an increase in satellite cells as well as an increase in protein synthesis [37]. In parabiosis experiments, testosterone has been shown to have a necessary permissive effect to allow GDF-13 to reverse the atrophy of aging muscles [38]. An excess of inflammatory cytokines has been demonstrated to cause age-associated muscle loss [39]. The anorexia of aging results in a decrease in protein to maintain muscle mass [40]. Older persons tend to have a decrease in physical activity, which adds to muscle loss. Finally, a variety of genetic factors such as alterations in myostatin and angiotensin converting enzymes, as well as mitochondrial deficits, further decrease muscle mass and function. The factors causing sarcopenia are summarized in Fig. 1. It has been recognized that bone strength does not directly correlate with bone mineral density. This lead researchers to query whether the questions associated with the FRAX (www.shef.ac.uk.FRAX/) would be sufficient to identify the persons at highest risk for fractures. Recently, studies have shown that the FRAX questions alone are capable of identifying those at highest risk for fractures [41]. As muscle function is more observable than bone function, it was suggested that it should be feasible to develop a simple questionnaire to identify persons with sarcopenia. Our group developed such a questionnaire–the SARC-F (Table 2) [42]. A number of studies have provided a robust validation for the SARCF. Woo et al. [43] showed that the SARC-F performed at a similar level to the European Working Group on Sarcopenia in Older People [21] and the Asian Working Group for Sarcopenia [25] at identifying persons with sarcopenia. Similarly, a group in China demonstrated that the SARC-F was highly predictive of muscle function [44]. Further validations of the SARC-F exist in the St. Louis African American Health Study, the National Health and Nutrition Examination Survey (NHANES), and the Baltimore Longitudinal Study of Aging. Evans et al. [45] have developed a more complex sarcopenia questionnaire, but at present it lacks an in-depth validation. These studies certainly suggest that sarcopenia can be screened for without a necessity to measure muscle mass or to directly measure muscle function. Sarcopenia is a treatable malady of aging. It is clear that both aerobic and resistance exercise can improve muscle function [46–50]. Further, there is increasing evidence that high quality protein supplementation can enhance muscle mass and function
292
Editorial / European Geriatric Medicine 5 (2014) 291–293
Fig. 1. Factors causing sarcopenia and outcomes in persons with sarcopenia. DHEAS: dehydroepiandrosterone sulfate; TNFa: tumor necrosis factor alpha; IL6: interleukin 6; CNTF: ciliary neurotrophic factor.
Table 2 The SARC-F Scale: A rapid, validated scale for the detection of sarcopenia. Scores of 4 or more–sarcopenia. Item
Scoring
Strength
Difficulty lifting and carrying 10 pounds
None = 0 Some = 1 A lot or unable = 2
Assistance in walking
Difficulty walking across a room
None = 0 Some = 1 A lot, use aids, or unable = 2
Rise from a chair
Difficulty transferring from a chair or bed
None = 0 Some = 1 A lot or unable without help = 2
Climb stairs
Difficulty climbing a flight of ten stairs
None = 0 Some = 1 A lot or unable = 2
Falls
Number of falls in the past year
None = 0 1–3 falls = 1 4 or more falls = 2
[51–56]. Vitamin D replacement in persons with low vitamin D also can improve muscle function [57]. At present, the role of testosterone is controversial [58]. Other drugs such as selective androgen receptor molecules and myostatin and activin receptor molecules are under development [59]. The availability of a simple questionnaire to identify persons at risk for sarcopenia becomes a powerful tool for general practitioners. Once identified simple interventions, viz. exercise, protein supplementation and vitamin D, can be utilized to improve health outcomes in older persons. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. Acknowledgements No outside funding was received by either of the authors (JEM, TKM) for the writing of this article.
References [1] Morley JE. Sarcopenia in the elderly. Fam Pract 2012;29(Suppl 1):i44–8. [2] Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 1998;147:755–63. [3] Morley JE. Weight loss in older persons: new therapeutic approaches. Curr Pharm Des 2007;13:3637–47. [4] Amigues I, Schott Am, Amine M, Gelas-Dore B, Veerabudun K, Paillaud E, et al. Low skeletal muscle mass and risk of functional decline in elderly communitydwelling women: the prospective EPIDOS study. J Am Med Dir Assoc 2013;14:352–7. [5] Yu R, Leung J, Woo J. Incremental predictive value of sarcopenia for incident fracture in an elderly Chinese cohort: results from the osteoporotic fractures in men (MrOs) study. J Am Med Dir Assoc 2014;15:551–8. [6] Vetrano DL, Landi F, Volpato S, Corsonello A, Meloni E, Bernabei R, et al. Association of sarcopenia with short- and long-term mortality in older adults admitted to acute care wards: results from the CRIME study. J Gerontol A Biol Sci Med Sci 2014 [Epub ahead of print]. [7] Romero-Ortuno R. An alternative method for frailty index cut-off points to define frailty categories. Eur Geriatr Med 2013;4:299–303. [8] Morley JE. Frailty: a time for action. Eur Geriatr Med 2013;4:215–6. [9] Romero-Ortuno R. The frailty instrument of the survey of health, ageing and retirement in Europe (SHARE-F1) predicts mortality beyond age, comorbidities, disability, self-rated health, education and depression. Eur Geriatr Med 2011;2:323–6.
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J.E. Morley MB, BCh* Divisions of Geriatric Medicine and Endocrinology, Saint Louis University School of Medicine, 1402, S. Grand Blvd., M238, Saint Louis, MO 63104, USA T.K. Malmstrom PhD Department of Neurology and Psychiatry and Division of Geriatric Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA *Corresponding author E-mail address: [email protected] (J.E. Morley)
Received 28 July 2014 Accepted 31 July 2014 Available online 17 September 2014