New developments in sarcopenia: findings from the second

European Working Group on Sarcopenia in Older People

Alfonso J. Cruz-JentoftHospital Universitario Ramón y Cajal (IRYCIS)

Madrid. Spain

BGS Autumn 2

018

There is no universally agreed definition of sarcopenia

Source: Google Scholar, accessed November 6th, 2018

• EWGSOP (2010): 5287 citations

• IWGS (2011): 1488 citations

• AWGS (2014): 935 citations

• FNIH (2014): 535 citations

BGS Autumn 2

018

2010April 2010

April 2010

May 2011

July 2011

Musclemass

AND

Musclefunction

BGS Autumn 2

018

Do we need an update of the 2010 definition of sarcopenia?

BGS Autumn 2

018

Conceptual advances in sarcopenia

Musclemass +

functionSyndromic approach

Adverse outcomes

Degreesof severity

BGS Autumn 2

018

Problems to be addressed• Sarcopenia begins earlier in life (important for interventions and

prevention).

• Conceptualization of sarcopenia as a muscle disease.

• Problems in accurately measuring and categorizing muscle massand muscle quality.

• Outcome measures for interventions not agreed.

• SARCOPENIA HAS NOT REACHED MAINSTREAM CLINICAL PRACTICE (is it still too complicated)? BGS Autu

mn 201

8

Parameters Variables Measurementinstrument Cutoff-points

Muscle massMuscle strengthPhysical performance?Mass: total? regional? appendicular? single muscle?

Muscle strength: where? single or groups?… Muscle mass: anthropometry? BIA? DXA? CT? MRI?

Biochemistry? Protocols, equations, assumptions… Cutoff points for each variable and instrument:

reference populations? local or global?…

OUTCOME VARIABLESPerformance, mobility, ADL, falls, NH admission, PRO…BGS Autu

mn 201

8

2018 EWGSOP}Alfonso J. CRUZ-JENTOFT, Spain}Gülistan BAHAT, Turkey}Jürgen BAUER, Germany}Yves BOIRIE, France}Olivier BRUYÉRE, Belgium}Tommy CEDERHOLM, Sweden}Cyrus COOPER, UK}Francesco LANDI, Italy}Yves ROLAND, France}Avan SAYER, UK

}Stephane SCHNEIDER, France}Cornel SIEBER, Germany}Eva TOPINKOVÁ, Czech Republic}Maurits VANDEWOUDE, Belgium}Marjolein VISSER, Netherlands}Mauro ZAMBONI, Italy

}Cecilia HOFFMAN, Medical Writer

}Ricardo RUEDA + Carole GLENCORSE, Abbott Nutrition International (Observers)

WRITING GROUP

BGS Autumn 2

018

}Ivan BAUTMANS, Belgium}Jean Pierre BAEYENS, Belgium}Matteo CESARI, Italy}Antonio CHERUBINI, Italy}John KANIS, UK}Marcello MAGGIO, Italy}Finbarr MARTIN, UK

}Jean-Pierre MICHEL, Switzerland}Kaisu PITKALA, Finland}Jean-Yves REGINSTER, Belgium}René RIZZOLI, Switzerland}Mª Dolores SÁNCHEZ, Spain}Jos SCHOLS, Netherlands

EXTENDED GROUP2018 EWGSOP

BGS Autumn 2

018

Age and Ageing 2018; 0: 1–16doi: 10.1093/ageing/afy169

© The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society.This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-

use, distribution, and reproduction in any medium, provided the original work is properly cited. Forcommercial re-use, please contact journals.permissions@oup.com

GUIDELINES

Sarcopenia: revised European consensuson definition and diagnosisALFONSO J. CRUZ-JENTOFT

1, GÜLISTAN BAHAT2, JÜRGEN BAUER3, YVES BOIRIE4, OLIVIER BRUYÈRE5,

TOMMY CEDERHOLM6, CYRUS COOPER

7, FRANCESCO LANDI8, YVES ROLLAND

9, AVAN AIHIE SAYER10,STÉPHANE M. SCHNEIDER

11, CORNEL C. SIEBER12, EVA TOPINKOVA13, MAURITS VANDEWOUDE

14,MARJOLEIN VISSER

15, MAURO ZAMBONI16, WRITING GROUP FOR THE EUROPEAN WORKING GROUP ON

SARCOPENIA IN OLDER PEOPLE 2 (EWGSOP2), AND THE EXTENDED GROUP FOR EWGSOP21Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain2Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Istanbul, Turkey3Center for Geriatric Medicine, University Heidelberg, Agaplesion Bethanien Krankenhaus, Heidelberg, Germany4Research Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France5Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium6Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, and ThemeAgeing, Karolinska University Hospital, Stockholm, Sweden7MRC Lifecourse Epidemiology Unit, University of Southampton; Southampton, UK; and Department of Epidemiology,University of Oxford, OX, UK8Instituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Roma, Italy9Department of Geriatrics, Hospital and University of Toulouse, Toulouse, France10NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Faculty of MedicalSciences, Newcastle University, Newcastle, UK11Department of Gastroenterology and Clinical Nutrition, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur,Nice, France12Department of Internal Medicine-Geriatrics, Institute for Biomedicine and Ageing, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany13Department of Geriatrics, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic14Department Geriatrics, University of Antwerp, Ziekenhuisnetwerk Antwerpen (ZNA), Antwerp, Belgium15Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam; and the Amsterdam Public Health ResearchInstitute; Amsterdam, The Netherlands16Department of Medicine, Geriatric section, University of Verona, Verona, Italy

Address correspondence to: Alfonso J. Cruz-Jentoft, MD, Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Ctra.Colmenar, km 9.1, 28034 Madrid, Spain. Tel: +34 913368172; Fax: +34 913368172. Email: alfonsojose.cruz@salud.madrid.org

Abstract

Background: in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopeniadefinition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the WorkingGroup met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that hasbuilt 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 alifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paperon sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of lowmuscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative ofsevere sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and

1

Dow

nloaded from https://academ

ic.oup.com/ageing/advance-article-abstract/doi/10.1093/ageing/afy169/5126243 by guest on 14 O

ctober 2018

BGS Autumn 2

018

Definition of sarcopenia

Sarcopenia is a progressive and generalized skeletal muscle disorderthat is associated with increased likelihood of adverse outcomesincluding falls, fractures, physical disability, and mortality.

Muscle failure

BGS Autumn 2

018

Operational definition of sarcopenia:EWGSOP

LOW MUSCLE

MASS

LOW PHYSICAL PERFORMANCE

LOW MUSCLE STRENGH

AND/OR SARCOPENIA

BGS Autumn 2

018

New operational definition of sarcopenia:EWGSOP2

LOW MUSCLE QUANTITY/

QUALITY

LOW PHYSICAL PERFORMANCE

LOW MUSCLE STRENGH

PROBABLE SARCOPENIA

SEVERE SARCOPENIA

DEFINITE SARCOPENIA

weak, slow walking speed, difficulty rising from a chair orweight loss/muscle wasting). In such cases, further testingfor sarcopenia is recommended [2].

EWGSOP2 recommends use of the SARC-F question-naire as a way to elicit self-reports from patients on signsthat are characteristic of sarcopenia. SARC-F can be readilyused in community healthcare and other clinical settings.The SARC-F is a 5-item questionnaire that is self-reportedby patients as a screen for sarcopenia risk [12]. Responsesare based on the patient’s perception of his or her limita-tions in strength, walking ability, rising from a chair, stairclimbing and experiences with falls. This screening tool wasevaluated in three large populations—the African AmericanHealth Study, Baltimore Longitudinal Study of Aging andthe National Health and Nutrition Examination study [12],

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 2. Choosing tools for sarcopenia case finding and for measurement of muscle strength, muscle mass and physical per-formance in clinical practice and in research

Variable Clinical practice Research studies Video for practical instruction, reference

Case finding SARC-F questionnaireIshii screening tool

SARC-F Malmstrom et al. (2016) [12]Ishii et al. (2014) [40]

Skeletal musclestrength

Grip strength Grip strength Roberts et al. (2011) [41]Chair stand test (chair rise test) Chair stand test (5-times sit-to-stand) American Academy of Orthotists &

Prosthetistshttps://www.youtube.com/watch?v=_jPl-IuRJ5A

Skeletal musclemass orSkeletalmuscle quality

Appendicular skeletal muscle mass(ASMM) by Dual-energy X-rayabsorptiometry (DXA)*

ASMM by DXA Schweitzer (2015) [42]Mitsiopoulos (1998) [43]

Whole-body skeletal muscle mass (SMM)or ASMM predicted by Bioelectricalimpedance analysis (BIA)*

Whole-body SMM or ASMM by MagneticResonance Imaging (MRI, total body protocoI)

Shen (2004) [44]Sergi (2017) [45]Maden-Wilkinson (2013) [46]Heymsfield (1990) [47]Kim (2002) [48]Yamada (2017) [49]

Mid-thigh muscle cross-sectional area by ComputedTomography (CT) or MRI

Lee (2004) [50]

Lumbar muscle cross-sectional area by CTor MRI

Lumbar muscle cross-sectional area by CT or MRI Van der Werf (2018) [51]Derstine (2018) [52]

Muscle quality by mid-thigh or total body musclequality by muscle biopsy, CT, MRI or Magneticresonance Spectroscopy (MRS)

Goodpaster (2000) [53]Reinders (2016) [54]Grimm (2018) [55]Distefano (2018) [56]Ruan (2007) [57]

Physicalperformance

Gait speed Gait speed NIH Toolbox 4 Meter Walk Gait SpeedTest

https://www.nia.nih.gov/research/labs/leps/short-physical-performance-battery-sppb

https://www.youtube.com/watch?v=xLScK_NXUN0

Short physical performance battery (SPPB) SPPB Short Physical Performance BatteryProtocol

https://research.ndorms.ox.ac.uk/prove/documents/assessors/outcomeMeasures/SPPB_Protocol.pdf

NIH Toolboxhttps://www.nia.nih.gov/research/labs/leps/short-physical-performance-battery-sppb

Timed-up-and-go test (TUG) TUG Mathias (1986) [40]400-meter walk or long-distance corridorwalk (400-m walk)

400-m walk Newman (2006) [41]

*Sometimes divided by height2 or BMI to adjust for body size.

Table 1. 2018 operational definition of sarcopenia

Probable sarcopenia is identified by Criterion 1.Diagnosis is confirmed by additional documentation of Criterion 2.If Criteria 1, 2 and 3 are all met, sarcopenia is considered severe.

• Low muscle strength• Low muscle quantity or quality• Low physical performance

A. J. Cruz-Jentoft et al.

4

5

10

15

20

25

30

35

40

45

50

55

60

65

70

75

80

85

90

95

100

105

110

BGS Autumn 2

018

Case finding

• In clinical practice, case-finding may start when a patient reportssymptoms or signs of sarcopenia (i.e., falling, feeling weak, slowwalking speed, difficulty rising from a chair, or weight loss/musclewasting). In such cases, further testing for sarcopenia isrecommended.

• EWGSOP2 recommends use of the SARC-F questionnaire as a wayto elicit self-reports.

BGS Autumn 2

018

Measuring sarcopenia parameters

MUS

CLE

STRE

NGTH • Handgrip

strength• Chair

stand test

MUS

CLE

QUAN

TITY • DXA

• (BIA)• CT / MRI

PHYS

ICAL

PER

FORM

ANCE • Gait

speed• SPPB• TUG• 400 m

walk

BGS Autumn 2

018

Alternative and new tools

• Lumbar 3rd vertebra imaging by computed tomography• Mid-thigh muscle measurement• Psoas muscle measurement with computed tomography• Muscle quality measurements?• Creatine dilution test• Ultrasound assessment of muscle• Specific biomarkers or panels of biomarkers• SarQoL questionnaireBGS Autu

mn 201

8

Cut-off points!Test Cut-off points for

menCut-off points for women

References

EWGSOP2 sarcopenia cutoff points for low strength by chair stand and grip strengthGrip strength <27 kg <16 kg Dodds, 2014[26]

Chair stand >15 sec for 5 rises Cesari, 2009[67]

EWGSOP sarcopenia cut-off points for low muscle quantityASM < 20 kg < 15 kg Studenski,

2014[3]ASM/height2 < 7.0 kg/m2 < 6.0 kg/m2 Gould,

2014[125]

BGS Autumn 2

018

Cut-off points!Test Cut-off points

for menCut-off points for women

References

EWGSOP sarcopenia cut-off points for low performanceGait speed ≤ 0.8 m/sec Cruz-Jentoft,

2010[1]

Studenski, 2011[84]

SPPB ≤ 8 point score Pavasini, 2016[90]

Guralnik, 1995[126]

TUG ≥ 20 sec Bischoff, 2003[127]

400m walk test Non-completion or ≥ 6 min for completion

Newman, 2006[128]BGS Autu

mn 201

8

New algorithm

Sarcopenic obesity is a distinct condition, and there areongoing initiatives to improve its definition. Sarcopenic obes-ity is therefore outside of the scope of this article.

Frailty

Frailty is a multidimensional geriatric syndrome that is char-acterized by cumulative decline in multiple body systems or

functions [139, 140], with pathogenesis involving physical aswell as social dimensions [141]. Frailty increases vulnerabilityto poor health outcomes such as disability, hospital admis-sion, reduced quality of life and even death [141, 142].

The physical phenotype of frailty, described by Fried andco-workers [143], shows significant overlap with sarcopenia;low grip strength and slow gait speed are characteristic ofboth. Weight loss, another diagnostic criterion for frailty, isalso a major etiologic factor for sarcopenia. Treatmentoptions for physical frailty and for sarcopenia likewise over-lap—provision of optimal protein intake, supplementation ofvitamin D, and physical exercise [19, 144, 145].

Taken together, frailty and sarcopenia are still distinct—one a geriatric syndrome and the other a disease. While sar-copenia is a contributor to the development of physicalfrailty, the syndrome of frailty represents a much broaderconcept. Frailty is seen as the decline over a lifetime in mul-tiple physiological systems, resulting in negative conse-quences to physical, cognitive, and social dimensions.Frailty’s diagnostic tools reflect these multiple dimensions,e.g. the Groningen Frailty Indicator, the Frailty Index ofRockwood et al. and others [146–149].

Malnutrition-associated sarcopenia

The sarcopenia phenotype is also associated with malnutri-tion, regardless of whether the malnourished condition isrooted in low dietary intake (starvation, inability to eat),reduced nutrient bioavailability (e.g. with diarrhea, vomiting)or high nutrient requirements (e.g. with inflammatory dis-eases such as cancer or organ failure with cachexia) [150,151]. Low muscle mass has recently been proposed as partof the definition of malnutrition [152]. Also in malnutrition,low fat mass is usually present, which is not necessarily thecase in sarcopenia [151, 152].

Looking ahead: gaps in sarcopenia research

There are still many gaps in our knowledge about sarcope-nia—its initiation and progression, diagnostic tools and cut-off points, and outcomes.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 3. EWGSOP sarcopenia cut-off points

Test Cut-off points for men Cut-off points for women References

EWGSOP2 sarcopenia cut-off points for low strength by chair stand and grip strengthGrip strength <27 kg <16 kg Dodds (2014) [26]Chair stand >15 s for five rises Cesari (2009) [67]

EWGSOP sarcopenia cut-off points for low muscle quantityASM <20 kg <15 kg Studenski (2014) [3]ASM/height2 <7.0 kg/m2 <6.0 kg/m2 Gould (2014) [125]

EWGSOP sarcopenia cut-off points for low performanceGait speed ≤0.8 m/s Cruz-Jentoft (2010) [1]

Studenski (2011) [84]SPPB ≤8 point score Pavasini (2016) [90]

Guralnik (1995) [126]TUG ≥20 s Bischoff (2003) [127]400 m walk test Non-completion or ≥6min for completion Newman (2006) [128]

LOW

LOW

POSITIVEOR PRESENT

Sarcopenia suspected

MuscleassessmentMass, Quality

PHYSICAL PERFORMANCE

SPPB, TUG, 400m

Sarcopenia confirmed

LOW Sarcopenia severe

DETERMINE SEVERITY

CONFIRM

FIND CASES

ASSESSMusclestrength

Grip strength, chairstands

NORMAL

rescreenlater

SARC-Forclinical

suspicion

No sarcopenia;rescreen later

Sarcopenia probable*

NEGATIVE

Muscle quantityor quality

DXA; BIA, CT, MRI

PhysicalPerformance

Gait speed, SPPB, TUG, 400m walk

Sarcopenia confirmed

Sarcopenia severeSEVERITY

Muscle strengthGrip strength,

Chair stand test

No sarcopenia; rescreen later

In clinical practice, this is enough to

trigger assessment of causes and start

intervention

NORMAL

Figure 1. Sarcopenia: EWGSOP2 algorithm for case-finding,making a diagnosis and quantifying severity in practice. Thesteps of the pathway are represented as Find-Assess-Confirm-Severity or F-A-C-S. *Consider other reasons for low musclestrength (e.g. depression, sroke, balance disorders, peripheralvascular disorders).

Sarcopenia: revised European consensus on definition and diagnosis Q1

9

5

10

15

20

25

30

35

40

45

50

55

60

65

70

75

80

85

90

95

100

105

110

Sarcopenic obesity is a distinct condition, and there areongoing initiatives to improve its definition. Sarcopenic obes-ity is therefore outside of the scope of this article.

Frailty

Frailty is a multidimensional geriatric syndrome that is char-acterized by cumulative decline in multiple body systems or

functions [139, 140], with pathogenesis involving physical aswell as social dimensions [141]. Frailty increases vulnerabilityto poor health outcomes such as disability, hospital admis-sion, reduced quality of life and even death [141, 142].

The physical phenotype of frailty, described by Fried andco-workers [143], shows significant overlap with sarcopenia;low grip strength and slow gait speed are characteristic ofboth. Weight loss, another diagnostic criterion for frailty, isalso a major etiologic factor for sarcopenia. Treatmentoptions for physical frailty and for sarcopenia likewise over-lap—provision of optimal protein intake, supplementation ofvitamin D, and physical exercise [19, 144, 145].

Taken together, frailty and sarcopenia are still distinct—one a geriatric syndrome and the other a disease. While sar-copenia is a contributor to the development of physicalfrailty, the syndrome of frailty represents a much broaderconcept. Frailty is seen as the decline over a lifetime in mul-tiple physiological systems, resulting in negative conse-quences to physical, cognitive, and social dimensions.Frailty’s diagnostic tools reflect these multiple dimensions,e.g. the Groningen Frailty Indicator, the Frailty Index ofRockwood et al. and others [146–149].

Malnutrition-associated sarcopenia

The sarcopenia phenotype is also associated with malnutri-tion, regardless of whether the malnourished condition isrooted in low dietary intake (starvation, inability to eat),reduced nutrient bioavailability (e.g. with diarrhea, vomiting)or high nutrient requirements (e.g. with inflammatory dis-eases such as cancer or organ failure with cachexia) [150,151]. Low muscle mass has recently been proposed as partof the definition of malnutrition [152]. Also in malnutrition,low fat mass is usually present, which is not necessarily thecase in sarcopenia [151, 152].

Looking ahead: gaps in sarcopenia research

There are still many gaps in our knowledge about sarcope-nia—its initiation and progression, diagnostic tools and cut-off points, and outcomes.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Table 3. EWGSOP sarcopenia cut-off points

Test Cut-off points for men Cut-off points for women References

EWGSOP2 sarcopenia cut-off points for low strength by chair stand and grip strengthGrip strength <27 kg <16 kg Dodds (2014) [26]Chair stand >15 s for five rises Cesari (2009) [67]

EWGSOP sarcopenia cut-off points for low muscle quantityASM <20 kg <15 kg Studenski (2014) [3]ASM/height2 <7.0 kg/m2 <6.0 kg/m2 Gould (2014) [125]

EWGSOP sarcopenia cut-off points for low performanceGait speed ≤0.8 m/s Cruz-Jentoft (2010) [1]

Studenski (2011) [84]SPPB ≤8 point score Pavasini (2016) [90]

Guralnik (1995) [126]TUG ≥20 s Bischoff (2003) [127]400 m walk test Non-completion or ≥6min for completion Newman (2006) [128]

LOW

LOW

POSITIVEOR PRESENT

Sarcopenia suspected

MuscleassessmentMass, Quality

PHYSICAL PERFORMANCE

SPPB, TUG, 400m

Sarcopenia confirmed

LOW Sarcopenia severe

DETERMINE SEVERITY

CONFIRM

FIND CASES

ASSESSMusclestrength

Grip strength, chairstands

NORMAL

rescreenlater

SARC-Forclinical

suspicion

No sarcopenia;rescreen later

Sarcopenia probable*

NEGATIVE

Muscle quantityor quality

DXA; BIA, CT, MRI

PhysicalPerformance

Gait speed, SPPB, TUG, 400m walk

Sarcopenia confirmed

Sarcopenia severeSEVERITY

Muscle strengthGrip strength,

Chair stand test

No sarcopenia; rescreen later

In clinical practice, this is enough to

trigger assessment of causes and start

intervention

NORMAL

Figure 1. Sarcopenia: EWGSOP2 algorithm for case-finding,making a diagnosis and quantifying severity in practice. Thesteps of the pathway are represented as Find-Assess-Confirm-Severity or F-A-C-S. *Consider other reasons for low musclestrength (e.g. depression, sroke, balance disorders, peripheralvascular disorders).

Sarcopenia: revised European consensus on definition and diagnosis Q1

9

5

10

15

20

25

30

35

40

45

50

55

60

65

70

75

80

85

90

95

100

105

110

BGS Autumn 2

018

Early lifeMaximize peak

Age

Mus

cle st

reng

th

Adult lifeMaintain peak

Older lifeMinimize loss

Threshold of disability

Threshold of low physical performance Range of strength in individuals

Time course

Aging

Disease

Inactivity

Malnutrition

• Age-associated muscle loss

• Inflammatory conditions (e.g., organ failure, malignancy)

• Osteoarthritis• Neurological disorders• Sedentary behavior (e.g., limited mobility

or bedrest)• Physical inactivity

• Under-nutrition or malabsorption• Medication-related anorexia• Over-nutrition/obesity

Sarcopenia categories

Acute and chronic sarcopenia

• Acute sarcopenia: less than 6 months.• Usually related to an acute illness or injury.

• Chronic sarcopenia: sarcopenia lasting ≥ 6 months.• Comes with chronic and progressive conditions.

• Underscored the need to conduct periodic sarcopenia assessmentsin individuals at risk.

• May facilitate early intervention.

Some gaps in researchq How can we identify older persons at high risk of sarcopenia?

q Need of normative data to define validated cut-off points

q Management of stature-, gender- and region-dependent measures.

q What muscle quality indicators best predict outcomes?

q What are the kinetics of muscle loss?

q What outcomes are best used as sensitive measures of response to sarcopenia treatments?