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БШЬ.
СуГЛОБИ. JOINTS. I ХРЕБЕТ SPINE I
УДК 616.7:613.98 DOI: 10.22141/2224-1507.9.4.2019.191925
N.I. Dzerovych ¡>
State Institution "D.F. Chebotarev Institute of Gerontology of the National Academy of Medical Sciences of Ukraine",
Kyiv, Ukraine
2019 European recommendations on sarcopenia diagnosis
For citation: Bol', sustavy, pozvonocnik. 2019;9(4):257-261. doi: 10.22141/2224-1507.9.4.2019.191925_
Abstract. Today, in the field of geriatric conditions, a lot of attention is paid to the study of sarcopenia. This is explained by the significant medical and social consequences of this disease. In 2010, European Working Group on Sarcopenia in Older People (EWGSOP) published its first consensus on the diagnosis of sarcopenia, presenting the first definition and diagnostic criteria of this disease. In 2016, the diagnosis of sarcopenia was officially included in the supplemented 10th international classification of diseases under the code of M 62.84. Over the recent decade, many studies on sarcopenia have been conducted in the world, which has led the EWGSOP representatives to revise the existing definitions and criteria for sarcopenia in 2018, and thus, the second consensus on the diagnosis of sarcopenia was published in 2019. The article presents epidemiological data, updated definition of sarcopenia, modern cutoff points of its diagnosis, Find-Assess-Confirm-Severity (F-A-C-S) algorithm for the diagnosis of sarcopenia. Keywords: sarcopenia; diagnosis; recommendations
Nowadays we observe the population ageing rapidly all over the world. In Ukraine, people of 50 years and over account for 32 % of men and 42 % of women, i.e. about every one in four Ukrainians is aged 50 years and over. This age is characterized by a general worsening of health and a growing number of ailments [ 1].
At the moment, within the field of geriatric problems attention is riveted towards sarcopenia, associated with an increased falls risk, reduced life quality, mobility, life expectancy and increased mortality levels [2-6]. According to the latest international estimates, by 2045 sarcopenia will be one of the global scourges [7].
The recent data on sarcopenia prevalence are presented in Table 1.
In a sample of otherwise healthy Ukrainian women, sar-copenia frequency was growing with age from 5.1 % in the group of 50-59 year-olds to 30.8 % in the group of 80-89 year-olds (Table 2).
In the presence of sarcopenia, the risk of falls and fractures is growing, the daily activity and life quality is degrading; sarcopenia patients require assistance, their hospi-talization risk is growing, attended by the association with cardiovascular and pulmonary disorders, cognitive impairments etc. Sarcopenia patients require optimal care, con-
sidering individual, social and economic consequences of its absence [15].
In 2009, the European Union Geriatric Medicine Society (EUGMS) established the European Working Group on Sarcopenia in Older People (EWGSOP) aimed at developing sarcopenia's definitions and diagnostic criteria for the clinical practice and trials [16]. Other European agencies, the European Society of Clinical Nutrition and Metabolism (ESPEN), the International Academy of Nutrition and Aging (IANA), the International Association of Gerontology, Geriatrics — European Region (IAGG-ER), were also invited to join the European Working Group on Sarcopenia in Older People (EWGSOP). At the first EW-GSOP meetings, held in 2009, the following issues were discussed: sarcopenia's definition, diagnostic criteria, variability of diagnostic procedures, "cut-off" points and sarcopenia's association with clinical syndromes/ conditions.
As a result, the five agencies of EWGSOP, EUGMS, ESPEN, IAGG-ER, IANA developed a consensus on sarcopenia diagnostics [8, 16]. According to this consensus, sarcopenia is a syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life and death (EWGSOP, 2010).
© 2019. The Authors. This is an open access article under the terms of the Creative Commons Attribution 4.0 International License, CC BY, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
Для кореспонденцй: Дзерович Наталiя 1вашвна, доктор медичних наук, головний науковий сшвробггник вщдту шшчно!' фвюлогй i патологи' опорно-рухового апарату, ДУ «1нсппут геронтологи iMeHi Д.Ф. Чебопарьова НАМН Укра'ни», вул. Вишгородська, 67, м. Ки'в, 04114, Укра'на; e-mail: zeronat@ukr.net
For correspondence: Nataliia Dzerovych, MD, PhD, Leading Research Fellow at the Department of clinical physiology and pathology of locomotor apparatus, State Institution "D.F. Chebotarev Institute of Gerontology of the NAMS of Ukraine', Vyshgorodska st., 67, Kyiv, 04114, Ukraine; e-mail: zeronat@ukr.net Full list of author information is available at the end of the article.
Early in 2018, there was another meeting of EWGSOP aimed at adapting the sarcopenia's definition in the light of scientific and clinical findings of the recent decades. The new data on sarcopenia's epidemiology and pathophysiology were revealed. For a long time sarcopenia was associated with ageing in the older age groups; however, now it is found that its development starts much earlier.
The researchers revealed new associations between skeletal muscle changes and sarcopenia's outcomes. At the moment, sarcopenia is considered a skeletal muscle disease (muscle failure). In September 2016, the diagnosis of sarcopenia was officially included in the supplemented 10th international classification of diseases under the code M 62.84 [1, 17]. A lot of attention is drawn to the strength
Table 1. Sarcopenia prevalence according to the EWGSOP criteria, 2010.
Study Age of patients, years Women, n Sarcopenia frequency in women, n (%) Men, n Sarcopenia frequency in men, n (%)
Doods R.M. et al., 2016 [8] > 85 437 90 (20.6) 282 59 (20.9)
Brown J.C. et al., 2016 [9] > 60 2500 756 (30.2) 1925 862 (44.8)
Kim J.H. et al., 2014 [10] > 65 272 24 (8.8) 284 25 (8.8)
Patel H.P et al., 2014 [11] 68-76 N/A N/A 88 18 (20.4)
Yamada M. et al., 2013 [12] 65-89 1314 N/A (22.1) 568 N/A (21.8)
Legrand D. et al., 2013 [13] > 80 185 23 (12.4) 103 13 (12.6)
Landi F. et al., 2012 [14] > 70 91 19 (21.0) 31 21 (68.0)
Note: N/A - not available.
Table 2. Sarcopenia frequency in the otherwise healthy Ukrainian women of the older age groups, %
Age group, years Sarcopenia frequency (%)
50-59 4.1
60-69 3.7
70-79 18.4
80-89 30.8
Table 3. Sarcopenia stages (EWGSOP, 2019)
Stages Skeletal muscle strength Skeletal muscle mass/ quality Skeletal muscle performance
Probable sarcopenia i
Sarcopenia i i or i
Severe sarcopenia i i i
Table 4. Sarcopenia "cut-off"points (EWGSOP, 2019)
Diagnostic test Men Women
Skeletal muscle strength "cut-off" points
Grip strength, kg (hand dynamometrics) [18] < 27 < 16
Chair stand [19] > 15 sec / 5 times N/A
Skeletal muscle mass "cut-off" points
Appendicular Lean Mass (ALM), kg [20] < 20 < 15
Appendicular Lean Mass index , kg/m2 [21] < 7.0 < 6.0
Skeletal muscle performance "cut-off" points
Gait speed, m/sec [15, 22] < 8 N/A
SPPB test [23, 24] < 8
"3-m walk" test, sec [25] > 20
"400-m walk" test, sec [26] Failure or performance > 6 minutes
Note: N/A - not available.
of skeletal muscles, despite the earlier established determinant of the skeletal muscle mass. Sarcopenia is associated with a low quantity and quality of muscle; however, these parameters are at present largely used in the clinical trials rather than in the medical practice, as muscle mass and quality are difficult to assess. Furthermore, the impaired muscle strength has a lot more in common with sarcopenia outcomes. That is why, the strategical vectors of prophylaxis and treatment of sarcopenia and its outcomes were revised [15].
According to the revised EWGSOP consensus of 2019 [15], sarcopenia is a progressive and generalised skeletal muscle disorder that is associated with increased likelihood of adverse outcomes including falls, fractures, physical disability and mortality.
The European Working Group on Sarcopenia in Older People (EWGSOP)'s recommendations on sarcopenia diagnostics (2019)
Diagnostic criteria (EWGSOP, 2019) [15]:
1. Low muscle strength
2. Low muscle quantity or quality
3. Low physical performance
Sarcopenia is diagnosed whenever two of the three above-mentioned criteria are present (Table 3).
In 2019, the EWGSOP suggested the following "cut-off" points for sarcopenia diagnostics [15] (Table 4).
In 2019, the EWGSOP suggested an updated diagnostic («Find-Asess-Confirm-Severity» (F-A-C-S)) algorithm targeted at sarcopenia (Fig. 1). At the screening stage, it recommends to start with SARC-F diagnostic questionnaire; its original version is presented in Table 5, however, there exists a version translated into Ukrainian and adapted by the authors for clinical use. In order to assess strength, mass and performance of skeletal muscles, the researchers have a wide spectrum of tools on their disposal. Their price, accessibility and ease determine which of them are used for clinical practice/ trials.
Taking into account the above-mentioned facts, sarcope-nia is a geriatric syndrome commonly affecting the elderly and older people, impairing their physical performance, life quality, increasing the falls frequency and thus the fragility fracture risks. In this regard, more epidemiological studies are necessary to study the prevalence and risk factors of sar-copenia in the older age groups, develop methodology and tools of diagnostics, prophylaxis and treatment of muscle failures [8].
Assess
Fig. 1.2019 EWGSOP's updated diagnostic («Find-Asess-Confirm-Severity» (F-A-C-S)) algorithm targeted at sarcopenia [15]
Table 5. SARC-F: sarcopenia diagnostic questionnaire [8].
SARC-F Screen for Sarcopenia
Component
Question
Scoring
Strength
Assistance in walking
Rise from a chair
Climb stairs
Falls
How much difficulty do you have in lifting and carrying 10 pounds?
How much difficulty do you have walking across a room?
How much difficulty do you have transferring from a chair or bed?
How much difficulty do you have climbing a flight of 10 stairs?
How many times have you fallen in the past year?
None = 0 Some = 1
A lot or unable = 2 None — 0 Some = 1 A lot, use aids, or
unable — 2 None — 0 Some = 1
A lot or unable without
help = 2 None — 0 Some = 1
A lot or unable = 2 None = 0 1-3 falls = 1 4 or more falls = 2
Note: Interpretation of findings: total value of over 4 points indicates a high probability of sarcopenia and its adverse consequences in an examined patient.
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Received 10.11.2019 Revised 21.11.2019 Accepted 06.12.2019 ■
Information about author
Nataliia Dzerovych, MD, PhD, Leading Research Fellow at the Department of clinical physiology and pathology of locomotor apparatus, State Institution "D.F. Chebotarev Institute of Gerontology of the NAMS of Ukraine', Kyiv, Ukraine; e-mail: zeronat@ukr.net; ORCID iD: https://orcid.org/0000-0002-4278-972X
Дзерович Н.1.
ДУ «1нститут геронтологи теш Д.Ф. Чеботарьова НАМН Украни», м. Кив, Украша
Свропейсьм рекомендацп 2019 року щодо дiагностики саркопенй'
Резюме. На сьогодш серед repiaTpmHKX сташв науковщ придшяють велику увагу вивченню саркопенй, що зумовле-но значними медико-сощальними наслщками захворюван-ня. У 2010 рощ бвропейською робочою групою з вивчення саркопенй (European Working Group on Sarcopenia in Older People (EWGSOP)) було опублшовано перший консенсус щодо i"i дiагностики, у якому вперше було подано визначення й дiагностичш критерй саркопенй. У 2016 рощ дiагноз «сар-копенш» був офiцiйно включений у доповнену М1жнародну класифiкацiю хвороб 10-го перегляду пщ кодом М 62.84. За
останню декаду у cbiti проведено чимало дослщжень 1з саркопенй, що зумовило у 2018 рощ перегляд представниками EWGSOP дефшщш i д1агностичних критерив саркопенй, вщ-повщно до чого у 2019 рощ було опублшовано другий консенсус i3 дiагностики саркопенй. У статт наведенi епщемь ологiчнi данi, оновлене визначення саркопенй, сучасш вщ-правш точки il дiагностики й алгоритм дiагностики саркопенй «виявити — ощнити — пщтвердити тяжшсть» (Find-Assess-Confirm-Severity (F-A-C-S)).
Ключовi слова: саркопешя; дiагностика; рекомендацй
Дзерович Н.И.
ГУ «Институт геронтологии имени Д.Ф. Чеботарева НАМН Украины», г. Киев, Украина
Европейские рекомендации 2019 года по диагностике саркопении
Резюме. На сегодняшний день среди гериатрических состояний ученые уделяют большое внимание изучению саркопении, что обусловлено значительными медико-социальными последствиями заболевания. В 2010 году Европейской рабочей группой по изучению саркопении (European Working Group on Sarcopenia in Older People (EWGSOP)) был опубликован первый консенсус по диагностике саркопении, в котором были впервые представлены определение и диагностические критерии саркопении. В 2016 году диагноз «сарко-пения» был официально включен в дополненную Международную классификацию болезней 10-го пересмотра под ко-
дом М 62.84. За последнюю декаду в мире проведено немало исследований по саркопении, что обусловило в 2018 году пересмотр представителями EWGSOP дефиниций и диагностических критериев саркопении, в связи с чем в 2019 году был опубликован второй консенсус по диагностике саркопении. В статье представлены эпидемиологические данные, обновленное определение саркопении, современные отправные точки ее диагностики, алгоритм диагностики саркопении «выявить — оценить — подтвердить тяжесть» (Find-Assess-Confirm-Severity (F-A-C-S)).
Ключевые слова: саркопения; диагностика; рекомендации
