BACKGROUND: in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. OBJECTIVES: to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. RECOMMENDATIONS: sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. CONCLUSIONS: EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

Center for Geriatric Medicine University Heidelberg Agaplesion Bethanien Krankenhaus Heidelberg Germany

Department Geriatrics University of Antwerp Ziekenhuisnetwerk Antwerpen Antwerp Belgium

Department of Gastroenterology and Clinical Nutrition Centre Hospitalier Universitaire de Nice Université Côte d'Azur Nice France

Department of Geriatrics 1st Faculty of Medicine Charles University and General Faculty Hospital Prague Czech Republic

Department of Geriatrics Hospital and University of Toulouse Toulouse France

Department of Health Sciences Faculty of Science Vrije Universiteit Amsterdam; and the Amsterdam Public Health Research Institute; Amsterdam The Netherlands

Department of Internal Medicine Division of Geriatrics Istanbul Medical School Istanbul University Istanbul Turkey

Department of Internal Medicine Geriatrics Institute for Biomedicine and Ageing Friedrich Alexander University Erlangen Nürnberg Germany

Department of Medicine Geriatric section University of Verona Verona Italy

Department of Public Health and Caring Sciences Clinical Nutrition and Metabolism Uppsala University Uppsala and Theme Ageing Karolinska University Hospital Stockholm Sweden

Department of Public Health Epidemiology and Health Economics University of Liège Liège Belgium

Instituto di Medicina Interna e Geriatria Università Cattolica del Sacro Cuore Roma Italy

MRC Lifecourse Epidemiology Unit University of Southampton; Southampton UK; and Department of Epidemiology University of Oxford OX UK

NIHR Newcastle Biomedical Research Centre Newcastle upon Tyne Hospitals NHS Foundation Trust and Faculty of Medical Sciences Newcastle University Newcastle UK

Research Department Centre Hospitalier Universitaire de Clermont Ferrand Clermont Ferrand France

Servicio de Geriatría Hospital Universitario Ramón y Cajal Madrid Spain

Komentář v

Breast Cancer Res Treat. 2019 Jul;176(2):479. doi: 10.1007/s10549-019-05247-3. PubMed

Erratum v

Age Ageing. 2019 Jul 1;48(4):601. doi: 10.1093/ageing/afz046. PubMed

Komentář v

Eur Rev Med Pharmacol Sci. 2023 Apr;27(7):2858-2864. doi: 10.26355/eurrev_202304_31916. PubMed

Zobrazit více v PubMed

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: 412–23. PubMed PMC

Morley JE, Abbatecola AM, Argiles JM et al. . Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc 2011; 12: 403–9. PubMed PMC

Studenski SA, Peters KW, Alley DE et al. . The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci 2014; 69: 547–58. PubMed PMC

Chen LK, Liu LK, 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. PubMed

Argiles JM, Campos N, Lopez-Pedrosa JM et al. . Skeletal muscle regulates metabolism via interorgan crosstalk: roles in health and disease. J Am Med Dir Assoc 2016; 17: 789–96. PubMed

Frontera WR, Ochala J. Skeletal muscle: a brief review of structure and function. Calcif Tissue Int 2015; 96: 183–95. PubMed

http://www.icd10data.com/ICD10CM/Codes/M00-M99/M60-M63/M62-/M62.84 2018 ICD-10-CM Diagnosis Code M62.84. 2018. [cited 2018 March 12].

Vellas B, Fielding RA, Bens C et al. . Implications of ICD-10 for sarcopenia clinical practice and clinical trials: report by the International Conference on Frailty and Sarcopenia Research Task Force. J Frailty Aging 2018; 7: 2–9. PubMed

Mijnarends DM, Luiking YC, Halfens RJG et al. . Muscle, health and costs: a glance at their relationship. J Nutr Health Aging 2018; 22: 766–73. PubMed PMC

Bischoff-Ferrari HA, Orav JE, Kanis JA et al. . Comparative performance of current definitions of sarcopenia against the prospective incidence of falls among community-dwelling seniors age 65 and older. Osteoporos Int 2015; 26: 2793–802. PubMed

Schaap LA, van Schoor NM, Lips P et al. . Associations of sarcopenia definitions, and their components, with the incidence of recurrent falling and fractures: the longitudinal aging study Amsterdam. J Gerontol A Biol Sci Med Sci 2018; 73: 1199–204. PubMed

Malmstrom TK, Miller DK, Simonsick EM et al. . SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle 2016; 7: 28–36. PubMed PMC

Bahat G, Ilhan B. Sarcopenia and the cardiometabolic syndrome: a narrative review. Eur Geriatr Med 2016; 6: 220–23.

Bone AE, Hepgul N, Kon S et al. . Sarcopenia and frailty in chronic respiratory disease. Chron Respir Dis 2017; 14: 85–99. PubMed PMC

Chang KV, Hsu TH, Wu WT et al. . Association between sarcopenia and cognitive impairment: a systematic review and meta-analysis. J Am Med Dir Assoc 2016; 17: 1164.e7–64.e15. PubMed

Beaudart C, Biver E, Reginster JY et al. . Validation of the SarQoL(R), a specific health-related quality of life questionnaire for Sarcopenia. J Cachexia Sarcopenia Muscle 2017; 8: 238–44. PubMed PMC

Dos Santos L, Cyrino ES, Antunes M et al. . Sarcopenia and physical independence in older adults: the independent and synergic role of muscle mass and muscle function. J Cachexia Sarcopenia Muscle 2017; 8: 245–50. PubMed PMC

Akune T, Muraki S, Oka H et al. . Incidence of certified need of care in the long-term care insurance system and its risk factors in the elderly of Japanese population-based cohorts: the ROAD study. Geriatr Gerontol Int 2014; 14: 695–701. PubMed

Steffl M, Bohannon RW, Sontakova L et al. . Relationship between sarcopenia and physical activity in older people: a systematic review and meta-analysis. Clin Interv Aging 2017; 12: 835–45. PubMed PMC

De Buyser SL, Petrovic M, Taes YE et al. . Validation of the FNIH sarcopenia criteria and SOF frailty index as predictors of long-term mortality in ambulatory older men. Age Ageing 2016; 45: 602–8. PubMed

Cawthon PM, Lui LY, Taylor BC et al. . Clinical definitions of sarcopenia and risk of hospitalization in community-dwelling older men: the osteoporotic fractures in men study. J Gerontol A Biol Sci Med Sci 2017; 72: 1383–89. PubMed PMC

Antunes AC, Araujo DA, Verissimo MT et al. . Sarcopenia and hospitalisation costs in older adults: a cross-sectional study. Nutr Diet 2017; 74: 46–50. PubMed

Steffl M, Sima J, Shiells K et al. . The increase in health care costs associated with muscle weakness in older people without long-term illnesses in the Czech Republic: results from the Survey of Health, Ageing and Retirement in Europe (SHARE). Clin Interv Aging 2017; 12: 2003–07. PubMed PMC

Sousa AS, Guerra RS, Fonseca I et al. . Financial impact of sarcopenia on hospitalization costs. Eur J Clin Nutr 2016; 70: 1046–51. PubMed

Sayer AA, Syddall H, Martin H et al. . The developmental origins of sarcopenia. J Nutr Health Aging 2008; 12: 427–32. PubMed PMC

Dodds RM, Syddall HE, Cooper R et al. . Grip strength across the life course: normative data from twelve British studies. PLoS One 2014; 9: e113637. PubMed PMC

Sayer AA, Syddall HE, Gilbody HJ et al. . Does sarcopenia originate in early life? Findings from the Hertfordshire cohort study. J Gerontol A Biol Sci Med Sci 2004; 59: M930–4. PubMed

Ibrahim K, May C, Patel HP et al. . A feasibility study of implementing grip strength measurement into routine hospital practice (GRImP): study protocol. Pilot Feasibility Stud 2016; 2: 27. PubMed PMC

Leong DP, Teo KK, Rangarajan S et al. . Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet 2015; 386: 266–73. PubMed

Alley DE, Shardell MD, Peters KW et al. . Grip strength cutpoints for the identification of clinically relevant weakness. J Gerontol A Biol Sci Med Sci 2014; 69: 559–66. PubMed PMC

Buckinx F, Landi F, Cesari M et al. . Pitfalls in the measurement of muscle mass: a need for a reference standard. J Cachexia Sarcopenia Muscle 2018; 9: 269–78. PubMed PMC

Masanes F, Rojano ILX, Salva A et al. . Cut-off points for muscle mass—not grip strength or gait speed—determine variations in sarcopenia prevalence. J Nutr Health Aging 2017; 21: 825–29. PubMed

McGregor RA, Cameron-Smith D, Poppitt SD. It is not just muscle mass: a review of muscle quality, composition and metabolism during ageing as determinants of muscle function and mobility in later life. Longev Healthspan 2014; 3: 9. PubMed PMC

Trevino-Aguirre E, Lopez-Teros T, Gutierrez-Robledo L et al. . Availability and use of dual energy X-ray absorptiometry (DXA) and bio-impedance analysis (BIA) for the evaluation of sarcopenia by Belgian and Latin American geriatricians. J Cachexia Sarcopenia Muscle 2014; 5: 79–81. PubMed PMC

Keller K. Sarcopenia. Wien Med Wochenschr 2018. 10.1007/s10354-018-0618-2 [Epub ahead of print]. PubMed DOI

Han A, Bokshan SL, Marcaccio SE et al. . Diagnostic criteria and clinical outcomes in sarcopenia research: a literature review. J Clin Med 2018; 7 10.3390/jcm7040070. PubMed DOI PMC

Schaap LA, Koster A, Visser M. Adiposity, muscle mass, and muscle strength in relation to functional decline in older persons. Epidemiol Rev 2013; 35: 51–65. PubMed

Reginster JY, Cooper C, Rizzoli R et al. . Recommendations for the conduct of clinical trials for drugs to treat or prevent sarcopenia. Aging Clin Exp Res 2016; 28: 47–58. PubMed PMC

Mijnarends DM, Meijers JM, Halfens RJ et al. . Validity and reliability of tools to measure muscle mass, strength, and physical performance in community-dwelling older people: a systematic review. J Am Med Dir Assoc 2013; 14: 170–8. PubMed

Ishii S, Tanaka T, Shibasaki K et al. . Development of a simple screening test for sarcopenia in older adults. Geriatr Gerontol Int 2014; 14(Suppl 1): 93–101. PubMed

Roberts HC, Denison HJ, Martin HJ et al. . A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing 2011; 40: 423–9. PubMed

Schweitzer L, Geisler C, Pourhassan M et al. . What is the best reference site for a single MRI slice to assess whole-body skeletal muscle and adipose tissue volumes in healthy adults? Am J Clin Nutr 2015; 102: 58–65. PubMed

Mitsiopoulos N, Baumgartner RN, Heymsfield SB et al. . Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J Appl Physiol (1985) 1998; 85: 115–22. PubMed

Shen W, Punyanitya M, Wang Z et al. . Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol (1985) 2004; 97: 2333–8. PubMed

Sergi G, De Rui M, Stubbs B et al. . Measurement of lean body mass using bioelectrical impedance analysis: a consideration of the pros and cons. Aging Clin Exp Res 2017; 29: 591–97. PubMed

Maden-Wilkinson TM, Degens H, Jones DA et al. . Comparison of MRI and DXA to measure muscle size and age-related atrophy in thigh muscles. J Musculoskelet Neuronal Interact 2013; 13: 320–8. PubMed

Heymsfield SB, Smith R, Aulet M et al. . Appendicular skeletal muscle mass: measurement by dual-photon absorptiometry. Am J Clin Nutr 1990; 52: 214–8. PubMed

Kim J, Wang Z, Heymsfield SB et al. . Total-body skeletal muscle mass: estimation by a new dual-energy X-ray absorptiometry method. Am J Clin Nutr 2002; 76: 378–83. PubMed

Yamada Y, Nishizawa M, Uchiyama T et al. . Developing and validating an age-independent equation using multi-frequency bioelectrical impedance analysis for estimation of appendicular skeletal muscle mass and establishing a cutoff for sarcopenia. Int J Environ Res Public Health 2017; 14 10.3390/ijerph14070809. PubMed DOI PMC

Lee SJ, Janssen I, Heymsfield SB et al. . Relation between whole-body and regional measures of human skeletal muscle. Am J Clin Nutr 2004; 80: 1215–21. PubMed

van der Werf A, Langius JAE, de van der Schueren MAE et al. . Percentiles for skeletal muscle index, area and radiation attenuation based on computed tomography imaging in a healthy Caucasian population. Eur J Clin Nutr 2018; 72: 288–96. PubMed PMC

Derstine BA, Holcombe SA, Ross BE et al. . Skeletal muscle cutoff values for sarcopenia diagnosis using T10 to L5 measurements in a healthy US population. Sci Rep 2018; 8: 11369. PubMed PMC

Goodpaster BH, Kelley DE, Thaete FL et al. . Skeletal muscle attenuation determined by computed tomography is associated with skeletal muscle lipid content. J Appl Physiol (1985) 2000; 89: 104–10. PubMed

Reinders I, Murphy RA, Brouwer IA et al. . Muscle quality and myosteatosis: novel associations with mortality risk: the Age, Gene/Environment Susceptibility (AGES)-Reykjavik study. Am J Epidemiol 2016; 183: 53–60. PubMed PMC

Grimm A, Meyer H, Nickel MD et al. . Evaluation of 2-point, 3-point, and 6-point Dixon magnetic resonance imaging with flexible echo timing for muscle fat quantification. Eur J Radiol 2018; 103: 57–64. PubMed

Distefano G, Standley RA, Zhang X et al. . Physical activity unveils the relationship between mitochondrial energetics, muscle quality, and physical function in older adults. J Cachexia Sarcopenia Muscle 2018; 9: 279–94. PubMed PMC

Ruan XY, Gallagher D, Harris T et al. . Estimating whole body intermuscular adipose tissue from single cross-sectional magnetic resonance images. J Appl Physiol (1985) 2007; 102: 748–54. PubMed PMC

Woo J, Leung J, Morley JE. Defining sarcopenia in terms of incident adverse outcomes. J Am Med Dir Assoc 2015; 16: 247–52. PubMed

Bahat G, Yilmazi O, Kilic C et al. . Performance of SARC-F in regard to sarcopenia definitions, muscle mass and functional measures. J Nutr Health Aging 2018. 10.1007/s12603-018-1067-8; Epub ahead of print. PubMed DOI

Bahat G, Yilmaz O, Oren M et al. . Cross-cultural adaptation and validation of the SARC-F to assess sarcopenia: methodological report from European Union Geriatric Medicine Society Sarcopenia Special Interest Group. Eur Geriatr Med 2018; 9: 23–8. PubMed

Locquet M, Beaudart C, Reginster JY et al. . Comparison of the performance of five screening methods for sarcopenia. Clin Epidemiol 2018; 10: 71–82. PubMed PMC

Rossi AP, Fantin F, Micciolo R et al. . Identifying sarcopenia in acute care setting patients. J Am Med Dir Assoc 2014; 15: 303.e7–12. PubMed

Steiber N. Strong or weak handgrip? Normative reference values for the German population across the life course stratified by sex, age, and body height. PLoS One 2016; 11: e0163917. PubMed PMC

Beaudart C, McCloskey E, Bruyere O et al. . Sarcopenia in daily practice: assessment and management. BMC Geriatr 2016; 16: 170. PubMed PMC

Sipers WM, Verdijk LB, Sipers SJ et al. . The Martin vigorimeter represents a reliable and more practical tool than the Jamar dynamometer to assess handgrip strength in the geriatric patient. J Am Med Dir Assoc 2016; 17: 466.e1–7. PubMed

Francis P, Toomey C, Mc Cormack W et al. . Measurement of maximal isometric torque and muscle quality of the knee extensors and flexors in healthy 50- to 70-year-old women. Clin Physiol Funct Imaging 2017; 37: 448–55. PubMed

Cesari M, Kritchevsky SB, Newman AB et al. . Added value of physical performance measures in predicting adverse health-related events: results from the Health, Aging And Body Composition Study. J Am Geriatr Soc 2009; 57: 251–9. PubMed PMC

Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport 1999; 70: 113–9. PubMed

Cooper C, Fielding R, Visser M et al. . Tools in the assessment of sarcopenia. Calcif Tissue Int 2013; 93: 201–10. PubMed PMC

Cawthon PM, Peters KW, Shardell MD et al. . Cutpoints for low appendicular lean mass that identify older adults with clinically significant weakness. J Gerontol A Biol Sci Med Sci 2014; 69: 567–75. PubMed PMC

Hull H, He Q, Thornton J et al. . iDXA, Prodigy, and DPXL dual-energy X-ray absorptiometry whole-body scans: a cross-calibration study. J Clin Densitom 2009; 12: 95–102. PubMed PMC

Kim KM, Jang HC, Lim S. Differences among skeletal muscle mass indices derived from height-, weight-, and body mass index-adjusted models in assessing sarcopenia. Korean J Intern Med 2016; 31: 643–50. PubMed PMC

Kyle UG, Genton L, Hans D et al. . Validation of a bioelectrical impedance analysis equation to predict appendicular skeletal muscle mass (ASMM). Clin Nutr 2003; 22: 537–43. PubMed

Sergi G, De Rui M, Veronese N et al. . Assessing appendicular skeletal muscle mass with bioelectrical impedance analysis in free-living Caucasian older adults. Clin Nutr 2015; 34: 667–73. PubMed

Gonzalez MC, Heymsfield SB. Bioelectrical impedance analysis for diagnosing sarcopenia and cachexia: what are we really estimating? J Cachexia Sarcopenia Muscle 2017; 8: 187–89. PubMed PMC

Yu SC, Powell A, Khow KS et al. . The performance of five bioelectrical impedance analysis prediction equations against dual X-ray absorptiometry in estimating appendicular skeletal muscle mass in an Adult Australian Population. Nutrients 2016; 8: 189. PubMed PMC

Reiss J, Iglseder B, Kreutzer M et al. . Case finding for sarcopenia in geriatric inpatients: performance of bioimpedance analysis in comparison to dual X-ray absorptiometry. BMC Geriatr 2016; 16: 52. PubMed PMC

Tosato M, Marzetti E, Cesari M et al. . Measurement of muscle mass in sarcopenia: from imaging to biochemical markers. Aging Clin Exp Res 2017; 29: 19–27. PubMed

Landi F, Onder G, Russo A et al. . Calf circumference, frailty and physical performance among older adults living in the community. Clin Nutr 2014; 33: 539–44. PubMed

Beaudart C, Rolland Y, Cruz-Jentoft A et al. . Assessment of muscle function and physical performance in daily clinical practice. Submitted 2018. PubMed

Bruyere O, Beaudart C, Reginster J-V et al. . Assessment of muscle mass, muscle strength and physical performance in clinical practice: an international survey. Eur Geriatr Med 2016; 7: 243–46.

Abellan van Kan G, Rolland Y, Andrieu S et al. . Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging 2009; 13: 881–9. PubMed

Peel NM, Kuys SS, Klein K. Gait speed as a measure in geriatric assessment in clinical settings: a systematic review. J Gerontol A Biol Sci Med Sci 2013; 68: 39–46. PubMed

Studenski S, Perera S, Patel K et al. . Gait speed and survival in older adults. JAMA 2011; 305: 50–8. PubMed PMC

Guralnik JM, Ferrucci L, Pieper CF et al. . Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 2000; 55: M221–31. PubMed

Maggio M, Ceda GP, Ticinesi A et al. . Instrumental and non-instrumental evaluation of 4-meter walking speed in older individuals. PLoS One 2016; 11: e0153583. PubMed PMC

Rydwik E, Bergland A, Forsen L et al. . Investigation into the reliability and validity of the measurement of elderly people’s clinical walking speed: a systematic review. Physiother Theory Pract 2012; 28: 238–56. PubMed

https://www.nia.nih.gov/research/labs/leps/short-physical-performance-battery-sppb Short Physical Performance Battery. [cited 2018 March 19].

Podsiadlo D, Richardson S. The timed ‘Up & Go’: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39: 142–8. PubMed

Pavasini R, Guralnik J, Brown JC et al. . Short physical performance battery and all-cause mortality: systematic review and meta-analysis. BMC Med 2016; 14: 215. PubMed PMC

Vestergaard S, Patel KV, Bandinelli S et al. . Characteristics of 400-meter walk test performance and subsequent mortality in older adults. Rejuvenation Res 2009; 12: 177–84. PubMed PMC

Bergland A, Jorgensen L, Emaus N et al. . Mobility as a predictor of all-cause mortality in older men and women: 11.8 year follow-up in the Tromso study. BMC Health Serv Res 2017; 17: 22. PubMed PMC

Heymsfield SB, Gonzalez MC, Lu J et al. . Skeletal muscle mass and quality: evolution of modern measurement concepts in the context of sarcopenia. Proc Nutr Soc 2015; 74: 355–66. PubMed

Mourtzakis M, Prado CM, Lieffers JR et al. . A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab 2008; 33: 997–1006. PubMed

Fearon K, Strasser F, Anker SD et al. . Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 2011; 12: 489–95. PubMed

Kim EY, Kim YS, Park I et al. . Prognostic significance of CT-determined sarcopenia in patients with small-cell lung cancer. J Thorac Oncol 2015; 10: 1795–9. PubMed

Baracos V, Kazemi-Bajestani SM. Clinical outcomes related to muscle mass in humans with cancer and catabolic illnesses. Int J Biochem Cell Biol 2013; 45: 2302–8. PubMed

Moisey LL, Mourtzakis M, Cotton BA et al. . Skeletal muscle predicts ventilator-free days, ICU-free days, and mortality in elderly ICU patients. Crit Care 2013; 17: R206. PubMed PMC

Montano-Loza AJ, Meza-Junco J, Baracos VE et al. . Severe muscle depletion predicts postoperative length of stay but is not associated with survival after liver transplantation. Liver Transpl 2014; 20: 640–8. PubMed

Baracos VE, Reiman T, Mourtzakis M et al. . Body composition in patients with non-small cell lung cancer: a contemporary view of cancer cachexia with the use of computed tomography image analysis. Am J Clin Nutr 2010; 91: 1133S–37S. PubMed

Gu DH, Kim MY, Seo YS et al. . Clinical usefulness of psoas muscle thickness for the diagnosis of sarcopenia in patients with liver cirrhosis. Clin Mol Hepatol 2018; 24: 319–30. PubMed PMC

Hanaoka M, Yasuno M, Ishiguro M et al. . Morphologic change of the psoas muscle as a surrogate marker of sarcopenia and predictor of complications after colorectal cancer surgery. Int J Colorectal Dis 2017; 32: 847–56. PubMed

Baracos VE. Psoas as a sentinel muscle for sarcopenia: a flawed premise. J Cachexia Sarcopenia Muscle 2017; 8: 527–28. PubMed PMC

Rutten IJG, Ubachs J, Kruitwagen R et al. . Psoas muscle area is not representative of total skeletal muscle area in the assessment of sarcopenia in ovarian cancer. J Cachexia Sarcopenia Muscle 2017; 8: 630–38. PubMed PMC

Hamaguchi Y, Kaido T, Okumura S et al. . Impact of skeletal muscle mass index, intramuscular adipose tissue content, and visceral to subcutaneous adipose tissue area ratio on early mortality of living donor liver transplantation. Transplantation 2017; 101: 565–74. PubMed

Lynch NA, Metter EJ, Lindle RS et al. . Muscle quality. I. Age-associated differences between arm and leg muscle groups. J Appl Physiol (1985) 1999; 86: 188–94. PubMed

Rolland Y, Lauwers-Cances V, Pahor M et al. . Muscle strength in obese elderly women: effect of recreational physical activity in a cross-sectional study. Am J Clin Nutr 2004; 79: 552–7. PubMed

Tracy BL, Ivey FM, Hurlbut D et al. . Muscle quality. II. Effects Of strength training in 65- to 75-yr-old men and women. J Appl Physiol (1985) 1999; 86: 195–201. PubMed

Shankaran M, Czerwieniec G, Fessler C et al. . Dilution of oral D3-creatine to measure creatine pool size and estimate skeletal muscle mass: development of a correction algorithm. J Cachexia Sarcopenia Muscle 2018; 9: 540–46. PubMed PMC

Clark RV, Walker AC, Miller RR et al. . Creatine ( methyl-d3) dilution in urine for estimation of total body skeletal muscle mass: accuracy and variability vs. MRI and DXA. J Appl Physiol 2018; 124: 1–9. PubMed PMC

Buehring B, Siglinsky E, Krueger D et al. . Comparison of muscle/lean mass measurement methods: correlation with functional and biochemical testing. Osteoporos Int 2018; 29: 675–83. PubMed

Galindo Martin CA, Monares Zepeda E, Lescas Mendez OA. Bedside ultrasound measurement of rectus femoris: a tutorial for the nutrition support clinician. J Nutr Metab 2017; 2017: 2767232. PubMed PMC

Ticinesi A, Narici MV, Lauretani F et al. . Assessing sarcopenia with vastus lateralis muscle ultrasound: an operative protocol. Aging Clin Exp Res 2018. 10.1007/s40520-018-0958-1 [Epub ahead of print]. PubMed DOI

SARCUS working group on behalf of the Sarcopenia Special Interest Group of the European Geriatric Medicine Society Perkisas S, Baudry S et al. . Application of ultrasound for muscle assessment in sarcopenia: towards standardized measurements. Eur J Med 2018. In press. 10.1007/s41999-018-0104-9. PubMed DOI

Sipila S, Suominen H. Muscle ultrasonography and computed tomography in elderly trained and untrained women. Muscle Nerve 1993; 16: 294–300. PubMed

Ismail C, Zabal J, Hernandez HJ et al. . Diagnostic ultrasound estimates of muscle mass and muscle quality discriminate between women with and without sarcopenia. Front Physiol 2015; 6: 302. PubMed PMC

Nijholt W, Scafoglieri A, Jager-Wittenaar H et al. . The reliability and validity of ultrasound to quantify muscles in older adults: a systematic review. J Cachexia Sarcopenia Muscle 2017; 8: 702–12. PubMed PMC

Ticinesi A, Meschi T, Narici MV et al. . Muscle ultrasound and sarcopenia in older individuals: a clinical perspective. J Am Med Dir Assoc 2017; 18: 290–300. PubMed

Abe T, Loenneke JP, Young KC et al. . Validity of ultrasound prediction equations for total and regional muscularity in middle-aged and older men and women. Ultrasound Med Biol 2015; 41: 557–64. PubMed

Curcio F, Ferro G, Basile C et al. . Biomarkers in sarcopenia: a multifactorial approach. Exp Gerontol 2016; 85: 1–8. PubMed

Calvani R, Marini F, Cesari M et al. . Biomarkers for physical frailty and sarcopenia. Aging Clin Exp Res 2017; 29: 29–34. PubMed

Beaudart C, Biver E, Reginster JY et al. . Development of a self-administrated quality of life questionnaire for sarcopenia in elderly subjects: the SarQoL. Age Ageing 2015; 44: 960–6. PubMed PMC

Beaudart C, Reginster JY, Geerinck A et al. . Current review of the SarQoL(R): a health-related quality of life questionnaire specific to sarcopenia. Expert Rev Pharmacoecon Outcomes Res 2017; 17: 335–41. PubMed

Beaudart C, Locquet M, Reginster JY et al. . Quality of life in sarcopenia measured with the SarQoL(R): impact of the use of different diagnosis definitions. Aging Clin Exp Res 2018; 30: 307–13. PubMed PMC

Gould H, Brennan SL, Kotowicz MA et al. . Total and appendicular lean mass reference ranges for Australian men and women: the Geelong osteoporosis study. Calcif Tissue Int 2014; 94: 363–72. PubMed

Guralnik JM, Ferrucci L, Simonsick EM et al. . Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995; 332: 556–61. PubMed PMC

Bischoff HA, Stahelin HB, Monsch AU et al. . Identifying a cut-off point for normal mobility: a comparison of the timed ‘up and go’ test in community-dwelling and institutionalised elderly women. Age Ageing 2003; 32: 315–20. PubMed

Newman AB, Simonsick EM, Naydeck BL et al. . Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA 2006; 295: 2018–26. PubMed

Keller K, Engelhardt M. Strength and muscle mass loss with aging process. Age and strength loss. Muscles Ligaments Tendons J 2013; 3: 346–50. PubMed PMC

Dodds R, Denison HJ, Ntani G et al. . Birth weight and muscle strength: a systematic review and meta-analysis. J Nutr Health Aging 2012; 16: 609–15. PubMed PMC

Bloom I, Shand C, Cooper C et al. . Diet quality and sarcopenia in older adults: a systematic review. Nutrients 2018; 10. PubMed PMC

Mijnarends DM, Koster A, Schols JM et al. . Physical activity and incidence of sarcopenia: the population-based AGES-Reykjavik Study. Age Ageing 2016; 45: 614–20. PubMed PMC

Prado CM, Wells JC, Smith SR et al. . Sarcopenic obesity: a critical appraisal of the current evidence. Clin Nutr 2012; 31: 583–601. PubMed

Johnson Stoklossa CA, Sharma AM, Forhan M et al. . Prevalence of sarcopenic obesity in adults with class II/III obesity using different diagnostic criteria. J Nutr Metab 2017; 2017: 7307618. PubMed PMC

Kalinkovich A, Livshits G. Sarcopenic obesity or obese sarcopenia: A cross talk between age-associated adipose tissue and skeletal muscle inflammation as a main mechanism of the pathogenesis. Ageing Res Rev 2017; 35: 200–21. PubMed

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.e13–20. PubMed

Tian S, Xu Y. Association of sarcopenic obesity with the risk of all-cause mortality: A meta-analysis of prospective cohort studies. Geriatr Gerontol Int 2016; 16: 155–66. PubMed

Newman AB, Haggerty CL, Goodpaster B et al. . Strength and muscle quality in a well-functioning cohort of older adults: the Health, Aging and Body Composition Study. J Am Geriatr Soc 2003; 51: 323–30. PubMed

Morley JE, Vellas B, van Kan GA et al. . Frailty consensus: a call to action. J Am Med Dir Assoc 2013; 14: 392–7. PubMed PMC

Clegg A, Young J, Iliffe S et al. . Frailty in elderly people. Lancet 2013; 381: 752–62. PubMed PMC

Langlois F, Vu TT, Kergoat MJ et al. . The multiple dimensions of frailty: physical capacity, cognition, and quality of life. Int Psychogeriatr 2012; 24: 1429–36. PubMed

Sieber CC. Frailty - From concept to clinical practice. Exp Gerontol 2017; 87: 160–67. PubMed

Fried LP, Tangen CM, Walston J et al. . Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–56. PubMed

Dodds R, Sayer AA. Sarcopenia and frailty: new challenges for clinical practice. Clin Med (Lond) 2015; 15(Suppl 6): s88–91. PubMed

Cederholm T. Overlaps between frailty and sarcopenia definitions. Nestle Nutr Inst Workshop Ser 2015; 83: 65–9. PubMed

Steverink N, Slaets J, Schuurmans H et al. . Measuring frailty: developing and testing the Groningen Frailty Indicator (GFI). Gerontologist 2001; 41: 236–37.

Rockwood K, Song X, MacKnight C et al. . A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489–95. PubMed PMC

Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical practice: A review. Eur J Intern Med 2016; 31: 3–10. PubMed

Roppolo M, Mulasso A, Gobbens RJ et al. . A comparison between uni- and multidimensional frailty measures: prevalence, functional status, and relationships with disability. Clin Interv Aging 2015; 10: 1669–78. PubMed PMC

Muscaritoli M, Anker SD, Argiles J et al. . Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) ‘cachexia-anorexia in chronic wasting diseases’ and ‘nutrition in geriatrics’. Clin Nutr 2010; 29: 154–9. PubMed

Cederholm T, Barazzoni R, Austin P et al. . ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2017; 36: 49–64. PubMed

Cederholm T, Jensen GL, Correia M et al. . GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. Clin Nutr 2018. 10.1002/jpen.1440 [Epub ahead of print]. PubMed DOI

Residual Effects of Physical Exercise After Periods of Training Cessation in Older Adults: A Systematic Review With Meta-Analysis and Meta-Regression

International norms for adult handgrip strength: A systematic review of data on 2.4 million adults aged 20 to 100+ years from 69 countries and regions

Pharmacological Treatment of Obesity in Older Adults

Does computed tomography-derived volumometry and densitometry of psoas muscle really correlate with complications in rectal cancer patients after elective surgery?

Endurance Training Inhibits the JAK2/STAT3 Pathway to Alleviate Sarcopenia

Sarcopenia and Sarcopenic Obesity and Mortality Among Older People

Muscle Dysfunction and Functional Status in COVID-19 Patients during Illness and after Hospital Discharge

The effect of regular running on body weight and fat tissue of individuals aged 18 to 65

The use of tensiomyography in older adults: a systematic review

Osteosarcopenia in Patients with Chronic Obstructive Pulmonary Diseases: Which Pathophysiologic Implications for Rehabilitation?

Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study

Biomarkers of the Physical Function Mobility Domains Among Patients Hospitalized in Internal Medicine

Benefits of Resistance Training in Early and Late Stages of Frailty and Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

The sarcopenia and physical frailty in older people: multi-component treatment strategies (SPRINTT) project: description and feasibility of a nutrition intervention in community-dwelling older Europeans

Psoas density - an optimal sarcopaenic indicator associated with postoperative complications after colorectal resection for cancer?

Standard error of measurement and smallest detectable change of the Sarcopenia Quality of Life (SarQoL) questionnaire: An analysis of subjects from 9 validation studies