Skip to main content

International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management

The journal of nutrition, health & aging volume 22, pages 1148–1161 (2018)Cite this article

Abstract

Objectives

Sarcopenia, defined as an age-associated loss of skeletal muscle function and muscle mass, occurs in approximately 6 - 22 % of older adults. This paper presents evidence-based clinical practice guidelines for screening, diagnosis and management of sarcopenia from the task force of the International Conference on Sarcopenia and Frailty Research (ICSFR).

Methods

To develop the guidelines, we drew upon the best available evidence from two systematic reviews paired with consensus statements by international working groups on sarcopenia. Eight topics were selected for the recommendations: (i) defining sarcopenia; (ii) screening and diagnosis; (iii) physical activity prescription; (iv) protein supplementation; (v) vitamin D supplementation; (vi) anabolic hormone prescription; (vii) medications under development; and (viii) research. The ICSFR task force evaluated the evidence behind each topic including the quality of evidence, the benefitharm balance of treatment, patient preferences/values, and cost-effectiveness. Recommendations were graded as either strong or conditional (weak) as per the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Consensus was achieved via one face-to-face workshop and a modified Delphi process.

Recommendations

We make a conditional recommendation for the use of an internationally accepted measurement tool for the diagnosis of sarcopenia including the EWGSOP and FNIH definitions, and advocate for rapid screening using gait speed or the SARC-F. To treat sarcopenia, we strongly recommend the prescription of resistance-based physical activity, and conditionally recommend protein supplementation/a protein-rich diet. No recommendation is given for Vitamin D supplementation or for anabolic hormone prescription. There is a lack of robust evidence to assess the strength of other treatment options.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Anker SD, Morley JE, von Haehling S. Welcome to the ICD-10 code for sarcopenia. Journal of cachexia, sarcopenia and muscle. 2016;7(5):512–4.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Rosenberg IH. Sarcopenia: origins and clinical relevance. Clinics in geriatric medicine. 2011;27(3):337–9.

    Article  PubMed  Google Scholar 

  3. 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. Journal of the American Medical Directors Association. 2014;15(2):95–101.

    Article  PubMed  Google Scholar 

  4. Yoshimura Y, Wakabayashi H, Yamada M, Kim H, Harada A, Arai H. Interventions for Treating Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Journal of the American Medical Directors Association. 2017;18(6):553.e1-.e16.

    Article  PubMed  Google Scholar 

  5. 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. Journal of the American Medical Directors Association. 2011;12(4):249–56.

    Google Scholar 

  6. Akishita M, Kozaki K, Iijima K, Tanaka T, Shibasaki K, Ogawa S, et al. Chapter 1 Definitions and diagnosis of sarcopenia. Geriatrics & gerontology international. 2018;18 (Suppl. 1)):7-12.

    Google Scholar 

  7. Landi F, Liperoti R, Fusco D, Mastropaolo S, Quattrociocchi D, Proia A, et al. Prevalence and risk factors of sarcopenia among nursing home older residents. The journals of gerontology Series A, Biological sciences and medical sciences. 2012;67(1):48–55.

    Article  PubMed  Google Scholar 

  8. Bianchi L, Abete P, Bellelli G, Bo M, Cherubini A, Corica F, et al. Prevalence and Clinical Correlates of Sarcopenia, Identified According to the EWGSOP Definition and Diagnostic Algorithm, in Hospitalized Older People: The GLISTEN Study. The journals of gerontology Series A, Biological sciences and medical sciences. 2017;72(11):1575–81.

    Article  PubMed  Google Scholar 

  9. Cerri AP, Bellelli G, Mazzone A, Pittella F, Landi F, Zambon A, et al. Sarcopenia and malnutrition in acutely ill hospitalized elderly: Prevalence and outcomes. Clinical nutrition (Edinburgh, Scotland). 2015;34(4):745–51.

    Article  Google Scholar 

  10. Sanchez-Rodriguez D, Marco E, Ronquillo-Moreno N, Miralles R, Vazquez-Ibar O, Escalada F, et al. Prevalence of malnutrition and sarcopenia in a post-acute care geriatric unit: Applying the new ESPEN definition and EWGSOP criteria. Clinical nutrition (Edinburgh, Scotland). 2017;36(5):1339–44.

    Article  Google Scholar 

  11. Cruz-Jentoft AJ, Landi F, Schneider SM, Zuniga C, Arai H, Boirie Y, et al. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing. 2014;43(6):748–59.

    PubMed  PubMed Central  Google Scholar 

  12. Yoshida D, Suzuki T, Shimada H, Park H, Makizako H, Doi T, et al. Using two different algorithms to determine the prevalence of sarcopenia. Geriatrics & gerontology international. 2014;14 Suppl 1:46–51.

    Google Scholar 

  13. Castillo EM, Goodman-Gruen D, Kritz-Silverstein D, Morton DJ, Wingard DL, Barrett-Connor E. Sarcopenia in elderly men and women: the Rancho Bernardo study. American journal of preventive medicine. 2003;25(3):226–31.

    Article  PubMed  Google Scholar 

  14. Janssen I, Heymsfield SB, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. Journal of the American Geriatrics Society. 2002;50(5):889–96.

    Article  PubMed  Google Scholar 

  15. Shimotakta H, Shimada H, Satake S, Endo N, Shibasaki K, Ogawa S, et al. Chapter 2 Epidemiology of sarcopenia. Geriatrics & gerontology international. 2018;18 (Suppl. 1):13–22.

    Google Scholar 

  16. Davies B, Garcia F, Ara I, Artalejo FR, Rodriguez-Manas L, Walter S. Relationship Between Sarcopenia and Frailty in the Toledo Study of Healthy Aging: A Population Based Cross-Sectional Study. Journal of the American Medical Directors Association. 2018;19(4):282–6.

    Article  CAS  PubMed  Google Scholar 

  17. Morley JE, Anker SD, von Haehling S. Prevalence, incidence, and clinical impact of sarcopenia: facts, numbers, and epidemiology—update 2014. Journal of cachexia, sarcopenia and muscle. 2014;5(4):253–9.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ethgen O, Beaudart C, Buckinx F, Bruyere O, Reginster JY. The Future Prevalence of Sarcopenia in Europe: A Claim for Public Health Action. Calcified tissue international. 2017;100(3):229–34.

    Article  CAS  PubMed  Google Scholar 

  19. Arai H, Wakabayashi H, Yoshimura Y, Yamada M, Kim H, Harada A. Chapter 4 Treatment of sarcopenia. Geriatrics & gerontology international. 2018;18 (Suppl 1):1-17.

    Google Scholar 

  20. Landi F, Calvani R, Cesari M, Tosato M, Martone AM, Ortolani E, et al. Sarcopenia: An Overview on Current Definitions, Diagnosis and Treatment. Current protein & peptide science. 2018;19(7):633–8.

    Article  CAS  Google Scholar 

  21. Perez-Zepeda MU, Sgaravatti A, Dent E. Sarcopenia and post-hospital outcomes in older adults: A longitudinal study. Archives of gerontology and geriatrics. 2017;69:105–9.

    Article  PubMed  Google Scholar 

  22. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. CMAJ: Canadian Medical Association journal = journal de l’Association medicale canadienne. 2010;182(18):E839-42.

    Google Scholar 

  23. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ (Clinical research ed). 2008;336(7650):924–6.

    Article  PubMed Central  Google Scholar 

  24. Alonso-Coello P, Oxman AD, Moberg J, Brignardello-Petersen R, Akl EA, Davoli M, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines. BMJ (Clinical research ed). 2016;353:i2089.

    Google Scholar 

  25. 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(4):412–23.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Studenski SA, Peters KW, Alley DE, Cawthon PM, McLean RR, Harris TB, et al. The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. The journals of gerontology Series A, Biological sciences and medical sciences. 2014;69(5):547–58.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Cruz JE, Fahim G, Moore K. Practice Guideline Development, Grading, and Assessment. P & T: a peer-reviewed journal for formulary management. 2015;40(12):854–7.

    Google Scholar 

  28. Woolf S, Schunemann HJ, Eccles MP, Grimshaw JM, Shekelle P. Developing clinical practice guidelines: types of evidence and outcomes; values and economics, synthesis, grading, and presentation and deriving recommendations. Implementation science: IS. 2012;7:61.

    Article  Google Scholar 

  29. World Health Organisation. WHO handbook for guideline development, 2nd ed: World Health Organization; 2014. Available from: http://www.who.int/iris/ handle/10665/145714.

  30. Woo J, Leung J, Morley JE. Defining sarcopenia in terms of incident adverse outcomes. Journal of the American Medical Directors Association. 2015;16(3):247–52.

    Article  PubMed  Google Scholar 

  31. Bijlsma AY, Meskers CG, van den Eshof N, Westendorp RG, Sipila S, Stenroth L, et al. Diagnostic criteria for sarcopenia and physical performance. Age (Dordrecht, Netherlands). 2014;36(1):275–85.

    Article  CAS  Google Scholar 

  32. Woo J, Leung J, Morley JE. Validating the SARC-F: a suitable community screening tool for sarcopenia? Journal of the American Medical Directors Association. 2014;15(9):630–4.

    Article  PubMed  Google Scholar 

  33. Law TD, Clark LA, Clark BC. Resistance Exercise to Prevent and Manage Sarcopenia and Dynapenia. Annual review of gerontology & geriatrics. 2016;36(1):205–28.

    Article  Google Scholar 

  34. von Haehling S, Morley JE, Anker SD. An overview of sarcopenia: facts and numbers on prevalence and clinical impact. Journal of cachexia, sarcopenia and muscle. 2010;1(2):129–33.

    Article  Google Scholar 

  35. Morley JE, Anker SD, von Haehling S. Prevalence, incidence, and clinical impact of sarcopenia: facts, numbers, and epidemiology-update 2014. Journal of cachexia, sarcopenia and muscle. 2014;5(4):253–9.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Yamada M, Nishiguchi S, Fukutani N, Tanigawa T, Yukutake T, Kayama H, et al. Prevalence of sarcopenia in community-dwelling Japanese older adults. Journal of the American Medical Directors Association. 2013;14(12):911–5.

    Article  PubMed  Google Scholar 

  37. Volpato S, Bianchi L, Cherubini A, Landi F, Maggio M, Savino E, et al. Prevalence and clinical correlates of sarcopenia in community-dwelling older people: application of the EWGSOP definition and diagnostic algorithm. The journals of gerontology Series A, Biological sciences and medical sciences. 2014;69(4):438–46.

    Article  CAS  PubMed  Google Scholar 

  38. Smoliner C, Sieber CC, Wirth R. Prevalence of sarcopenia in geriatric hospitalized patients. Journal of the American Medical Directors Association. 2014;15(4):267–72.

    Article  PubMed  Google Scholar 

  39. Beaudart C, Reginster JY, Slomian J, Buckinx F, Locquet M, Bruyere O. Prevalence of sarcopenia: the impact of different diagnostic cut-off limits. Journal of musculoskeletal & neuronal interactions. 2014;14(4):425–31.

    CAS  Google Scholar 

  40. Morley JE, Malmstrom TK. Frailty, sarcopenia, and hormones. Endocrinology and metabolism clinics of North America. 2013;42(2):391–405.

    Article  PubMed  Google Scholar 

  41. Liguori I, Russo G, Aran L, Bulli G, Curcio F, Della-Morte D, et al. Sarcopenia: assessment of disease burden and strategies to improve outcomes. Clinical interventions in aging. 2018;13:913–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. 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(2):203–9.

    Article  PubMed  Google Scholar 

  43. Kuzuya M, Sugimoto K, Suzuki T, Watanabe Y, Kamibayashi K, Kurihara T, et al. Chapter 3 Prevention of sarcopenia. Geriatrics & gerontology international. 2018;18((Suppl. 1)):23-7.

    Google Scholar 

  44. Kim S, Kim M, Won CW. Validation of the Korean Version of the SARC-F Questionnaire to Assess Sarcopenia: Korean Frailty and Aging Cohort Study. Journal of the American Medical Directors Association. 2018;19(1):40–5.e1.

    Article  PubMed  Google Scholar 

  45. Ida S, Nakai M, Ito S, Ishihara Y, Imataka K, Uchida A, et al. Association Between Sarcopenia and Mild Cognitive Impairment Using the Japanese Version of the SARC-F in Elderly Patients With Diabetes. Journal of the American Medical Directors Association. 2017;18(9):809.e9-.e13.

    Article  PubMed  Google Scholar 

  46. Kemmler W, Sieber C, Freiberger E, von Stengel S. The SARC-F Questionnaire: Diagnostic Overlap with Established Sarcopenia Definitions in Older German Men with Sarcopenia. Gerontology. 2017;63(5):411–6.

    Article  PubMed  Google Scholar 

  47. Rolland Y, Dupuy C, Abellan Van Kan G, Cesari M, Vellas B, Faruch M, et al. Sarcopenia Screened by the SARC-F Questionnaire and Physical Performances of Elderly Women: A Cross-Sectional Study. Journal of the American Medical Directors Association. 2017;18(10):848–52.

    Article  PubMed  Google Scholar 

  48. 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. The journal of nutrition, health & aging. 2014;18(3):277–83.

    Article  CAS  Google Scholar 

  49. Parra-Rodriguez L, Szlejf C, Garcia-Gonzalez AI, Malmstrom TK, Cruz-Arenas E, Rosas-Carrasco O. Cross-Cultural Adaptation and Validation of the Spanish-Language Version of the SARC-F to Assess Sarcopenia in Mexican Community-Dwelling Older Adults. Journal of the American Medical Directors Association. 2016;17(12):1142–6.

    Article  PubMed  Google Scholar 

  50. Barbosa-Silva TG, Menezes AM, Bielemann RM, Malmstrom TK, Gonzalez MC. Enhancing SARC-F: Improving Sarcopenia Screening in the Clinical Practice. Journal of the American Medical Directors Association. 2016;17(12):1136–41.

    Article  PubMed  Google Scholar 

  51. Calvani R, Marini F, Cesari M, Tosato M, Picca A, Anker SD, et al. Biomarkers for physical frailty and sarcopenia. Aging clinical and experimental research. 2017;29(1):29–34.

    Article  PubMed  Google Scholar 

  52. Cesari M, Fielding RA, Pahor M, Goodpaster B, Hellerstein M, van Kan GA, et al. Biomarkers of sarcopenia in clinical trials-recommendations from the International Working Group on Sarcopenia. Journal of cachexia, sarcopenia and muscle. 2012;3(3):181–90.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Morley JE. Frailty and Sarcopenia: The New Geriatric Giants. Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion. 2016;68(2):59–67.

    PubMed  Google Scholar 

  54. Beaudart C, McCloskey E, Bruyere O, Cesari M, Rolland Y, Rizzoli R, et al. Sarcopenia in daily practice: assessment and management. BMC geriatrics. 2016;16(1):170.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Malmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. Journal of cachexia, sarcopenia and muscle. 2016;7(1):28–36.

    Article  PubMed  Google Scholar 

  56. Tanaka S, Kamiya K, Hamazaki N, Matsuzawa R, Nozaki K, Maekawa E, et al. Utility of SARC-F for Assessing Physical Function in Elderly Patients With Cardiovascular Disease. Journal of the American Medical Directors Association. 2017;18(2):176–81.

    Article  PubMed  Google Scholar 

  57. Ida S, Kaneko R, Murata K. SARC-F for Screening of Sarcopenia Among Older Adults: A Meta-analysis of Screening Test Accuracy. Journal of the American Medical Directors Association. 2018.

    Google Scholar 

  58. Yang M, Hu X, Xie L, Zhang L, Zhou J, Lin J, et al. Screening Sarcopenia in Community-Dwelling Older Adults: SARC-F vs SARC-F Combined With Calf Circumference (SARC-CalF). Journal of the American Medical Directors Association. 2018;19(3):277.e1-.e8.

    Article  PubMed  Google Scholar 

  59. Cruz-Jentoft A, Bahat G, Bauer JM, Boirie Y, Bruyere O T. C, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2018; EPub ahead of print, doi: 10.1093/ageing/afy169.

    Google Scholar 

  60. Locquet M, Beaudart C, Reginster JY, Petermans J, Bruyere O. Comparison of the performance of five screening methods for sarcopenia. Clinical epidemiology. 2018;10:71–82.

    Article  PubMed  Google Scholar 

  61. 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. The journals of gerontology Series A, Biological sciences and medical sciences. 2014;69(5):584–90.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clinical nutrition (Edinburgh, Scotland). 2017;36(1):49–64.

    Article  CAS  Google Scholar 

  63. McLean RR, Kiel DP, Berry SD, Broe KE, Zhang X, Cupples LA, et al. Lower Lean Mass Measured by Dual-Energy X-ray Absorptiometry (DXA) is Not Associated with Increased Risk of Hip Fracture in Women: The Framingham Osteoporosis Study. Calcified tissue international. 2018.

    Google Scholar 

  64. Cawthon PM, Orwoll ES, Peters KE, Ensrud KE, Cauley JA, Kado DM, et al. Strong Relation between Muscle Mass Determined by D3-creatine Dilution, Physical Performance and Incidence of Falls and Mobility Limitations in a Prospective Cohort of Older Men. The Journals of Gerontology: Series A. 2018:gly129-gly.

    Google Scholar 

  65. Messina C, Maffi G, Vitale JA, Ulivieri FM, Guglielmi G, Sconfienza LM. Diagnostic imaging of osteoporosis and sarcopenia: a narrative review. Quantitative imaging in medicine and surgery. 2018;8(1):86–99.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Ismail C, Zabal J, Hernandez HJ, Woletz P, Manning H, Teixeira C, et al. Diagnostic ultrasound estimates of muscle mass and muscle quality discriminate between women with and without sarcopenia. Frontiers in physiology. 2015;6:302.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Hellerstein M, Evans W. Recent advances for measurement of protein synthesis rates, use of the ‘Virtual Biopsy’ approach, and measurement of muscle mass. Curr Opin Clin Nutr Metab Care. 2017;20(3):191–200.

    Article  CAS  PubMed  Google Scholar 

  68. Reiss J, Iglseder B, Kreutzer M, Weilbuchner I, Treschnitzer W, Kassmann H, et al. Case finding for sarcopenia in geriatric inpatients: performance of bioimpedance analysis in comparison to dual X-ray absorptiometry. BMC geriatrics. 2016;16:52.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Kim M, Kim H. Accuracy of segmental multi-frequency bioelectrical impedance analysis for assessing whole-body and appendicular fat mass and lean soft tissue mass in frail women aged 75 years and older. European journal of clinical nutrition. 2013;67(4):395–400.

    Article  CAS  PubMed  Google Scholar 

  70. Lourenco RA, Perez-Zepeda M, Gutierrez-Robledo L, Garcia-Garcia FJ, Rodriguez Manas L. Performance of the European Working Group on Sarcopenia in Older People algorithm in screening older adults for muscle mass assessment. Age Ageing. 2015;44(2):334–8.

    Article  PubMed  Google Scholar 

  71. Borde R, Hortobagyi T, Granacher U. Dose-Response Relationships of Resistance Training in Healthy Old Adults: A Systematic Review and Meta-Analysis. Sports medicine (Auckland, NZ). 2015;45(12):1693–720.

    Article  Google Scholar 

  72. Manini TM, Clark BC, Tracy BL, Burke J, Ploutz-Snyder L. Resistance and functional training reduces knee extensor position fluctuations in functionally limited older adults. European journal of applied physiology. 2005;95(5–6):436–46.

    Article  PubMed  Google Scholar 

  73. Ramirez-Campillo R, Alvarez C, Garcia-Hermoso A, Celis-Morales C, Ramirez-Velez R, Gentil P, et al. High-speed resistance training in elderly women: Effects of cluster training sets on functional performance and quality of life. Experimental gerontology. 2018;110:216–22.

    Article  PubMed  Google Scholar 

  74. Lazarus NR, Izquierdo M, Higginson IJ, Harridge SDR. Exercise Deficiency Diseases of Ageing: The Primacy of Exercise and Muscle Strengthening as First-Line Therapeutic Agents to Combat Frailty. Journal of the American Medical Directors Association. 2018;19(9):741–3.

    Article  PubMed  Google Scholar 

  75. Barbalho MSM, Gentil P, Izquierdo M, Fisher J, Steele J, Raiol RA. There are no no-responders to low or high resistance training volumes among older women. Experimental gerontology. 2017;99:18–26.

    Article  PubMed  Google Scholar 

  76. Kim HK, Suzuki T, Saito K, Yoshida H, Kobayashi H, Kato H, et al. Effects of exercise and amino acid supplementation on body composition and physical function in community-dwelling elderly Japanese sarcopenic women: a randomized controlled trial. Journal of the American Geriatrics Society. 2012;60(1):16–23.

    Article  PubMed  Google Scholar 

  77. Kim H, Suzuki T, Saito K, Yoshida H, Kojima N, Kim M, et al. Effects of exercise and tea catechins on muscle mass, strength and walking ability in community-dwelling elderly Japanese sarcopenic women: a randomized controlled trial. Geriatrics & gerontology international. 2013;13(2):458–65.

    Article  Google Scholar 

  78. Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, et al. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. Journal of the American Medical Directors Association. 2017;18(7):564–75.

    Article  PubMed  Google Scholar 

  79. Mijnarends DM, Schols JM, Meijers JM, Tan FE, Verlaan S, Luiking YC, et al. Instruments to assess sarcopenia and physical frailty in older people living in a community (care) setting: similarities and discrepancies. Journal of the American Medical Directors Association. 2015;16(4):301–8.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  81. Binder EF, Yarasheski KE, Steger-May K, Sinacore DR, Brown M, Schechtman KB, et al. Effects of progressive resistance training on body composition in frail older adults: results of a randomized, controlled trial. The journals of gerontology Series A, Biological sciences and medical sciences. 2005;60(11):1425–31.

    Article  PubMed  Google Scholar 

  82. Beaudart C, Locquet M, Reginster JY, Delandsheere L, Petermans J, Bruyere O. Quality of life in sarcopenia measured with the SarQoL(R): impact of the use of different diagnosis definitions. Aging clinical and experimental research. 2018;30(4):307–13.

    Article  PubMed  Google Scholar 

  83. Picorelli AM, Pereira LS, Pereira DS, Felicio D, Sherrington C. Adherence to exercise programs for older people is influenced by program characteristics and personal factors: a systematic review. Journal of physiotherapy. 2014;60(3):151–6.

    Article  PubMed  Google Scholar 

  84. Deutz NE, Bauer JM, Barazzoni R, Biolo G, Boirie Y, Bosy-Westphal A, et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clinical nutrition (Edinburgh, Scotland). 2014;33(6):929–36.

    Article  CAS  PubMed Central  Google Scholar 

  85. Valenzuela PL, Morales JS, Pareja-Galeano H, Izquierdo M, Emanuele E, de la Villa P, et al. Physical strategies to prevent disuse-induced functional decline in the elderly. Ageing research reviews. 2018;47:80–8.

    Article  PubMed  Google Scholar 

  86. de Souto Barreto P, Morley JE, Chodzko-Zajko W, K HP, Weening-Djiksterhuis E, Rodriguez-Manas L, et al. Recommendations on Physical Activity and Exercise for Older Adults Living in Long-Term Care Facilities: A Taskforce Report. Journal of the American Medical Directors Association. 2016;17(5):381–92.

    Article  PubMed  Google Scholar 

  87. Bauer JM, Verlaan S, Bautmans I, Brandt K, Donini LM, Maggio M, et al. Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial. Journal of the American Medical Directors Association. 2015;16(9):740–7.

    Article  PubMed  Google Scholar 

  88. Cramer JT, Cruz-Jentoft AJ, Landi F, Hickson M, Zamboni M, Pereira SL, et al. Impacts of High-Protein Oral Nutritional Supplements Among Malnourished Men and Women with Sarcopenia: A Multicenter, Randomized, Double-Blinded, Controlled Trial. Journal of the American Medical Directors Association. 2016;17(11):1044–55.

    Article  PubMed  Google Scholar 

  89. Cruz-Jentoft AJ. Beta-Hydroxy-Beta-Methyl Butyrate (HMB): From Experimental Data to Clinical Evidence in Sarcopenia. Current protein & peptide science. 2018;19(7):668–72.

    Article  CAS  Google Scholar 

  90. Chen LK, Lee WJ, Peng LN, Liu LK, Arai H, Akishita M. Recent Advances in Sarcopenia Research in Asia: 2016 Update From the Asian Working Group for Sarcopenia. Journal of the American Medical Directors Association. 2016;17(8):767. e1-7.

    Article  PubMed  Google Scholar 

  91. Zdzieblik D, Oesser S, Baumstark MW, Gollhofer A, Konig D. Collagen peptide supplementation in combination with resistance training improves body composition and increases muscle strength in elderly sarcopenic men: a randomised controlled trial. The British journal of nutrition. 2015;114(8):1237–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Kim H, Kim M, Kojima N, Fujino K, Hosoi E, Kobayashi H, et al. Exercise and Nutritional Supplementation on Community-Dwelling Elderly Japanese Women With Sarcopenic Obesity: A Randomized Controlled Trial. Journal of the American Medical Directors Association. 2016;17(11):1011–9.

    Article  PubMed  Google Scholar 

  93. Gumieiro DN, Murino Rafacho BP, Buzati Pereira BL, Cavallari KA, Tanni SE, Azevedo PS, et al. Vitamin D serum levels are associated with handgrip strength but not with muscle mass or length of hospital stay after hip fracture. Nutrition (Burbank, Los Angeles County, Calif). 2015;31(7–8):931–4.

    Article  CAS  Google Scholar 

  94. Girgis CM, Baldock PA, Downes M. Vitamin D, muscle and bone: Integrating effects in development, aging and injury. Molecular and cellular endocrinology. 2015;410:3–10.

    Article  CAS  PubMed  Google Scholar 

  95. Holick MF. Bioavailability of vitamin D and its metabolites in black and white adults. The New England journal of medicine. 2013;369(21):2047–8.

    Article  CAS  PubMed  Google Scholar 

  96. McKee A, Morley JE, Matsumoto AM, Vinik A. SARCOPENIA: AN ENDOCRINE DISORDER? Endocrine practice: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2017;23(9):1140–9.

    Article  Google Scholar 

  97. Huff H, Merchant AT, Lonn E, Pullenayegum E, Smaill F, Smieja M. Vitamin D and progression of carotid intima-media thickness in HIV-positive Canadians. HIV medicine. 2018;19(2):143–51.

    Article  CAS  PubMed  Google Scholar 

  98. Baumgartner RN, Waters DL, Gallagher D, Morley JE, Garry PJ. Predictors of skeletal muscle mass in elderly men and women. Mechanisms of ageing and development. 1999;107(2):123–36.

    Article  CAS  PubMed  Google Scholar 

  99. Papanicolaou DA, Ather SN, Zhu H, Zhou Y, Lutkiewicz J, Scott BB, et al. A phase IIA randomized, placebo-controlled clinical trial to study the efficacy and safety of the selective androgen receptor modulator (SARM), MK-0773 in female participants with sarcopenia. The journal of nutrition, health & aging. 2013;17(6):533–43.

    Article  CAS  Google Scholar 

  100. Isidori AM, Giannetta E, Greco EA, Gianfrilli D, Bonifacio V, Isidori A, et al. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clinical endocrinology. 2005;63(3):280–93.

    Article  CAS  PubMed  Google Scholar 

  101. Snyder P, Bhasin S, Cunningham G, Matsumoto A, Stephens-Shields A, Cauley J, et al. Effects of Testosterone Treatment in Older Men. The New England journal of medicine. 2016;374(7):611–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  102. Dalton JT, Barnette KG, Bohl CE, Hancock ML, Rodriguez D, Dodson ST, et al. The selective androgen receptor modulator GTx-024 (enobosarm) improves lean body mass and physical function in healthy elderly men and postmenopausal women: results of a double-blind, placebo-controlled phase II trial. Journal of cachexia, sarcopenia and muscle. 2011;2(3):153–61.

    Article  PubMed  PubMed Central  Google Scholar 

  103. Coss CC, Jones A, Hancock ML, Steiner MS, Dalton JT. Selective androgen receptor modulators for the treatment of late onset male hypogonadism. Asian Journal of Andrology. 2014;16(2):256–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  104. Dobs AS, Boccia RV, Croot CC, Gabrail NY, Dalton JT, Hancock ML, et al. Effects of enobosarm on muscle wasting and physical function in patients with cancer: a double-blind, randomised controlled phase 2 trial. Lancet Oncol. 2013;14(4):335–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  105. Kim MJ, Morley JE. The hormonal fountains of youth: myth or reality? Journal of endocrinological investigation. 2005;28(11 Suppl Proceedings):5-14.

    Google Scholar 

  106. Blackman MR, Sorkin JD, Munzer T, Bellantoni MF, Busby-Whitehead J, Stevens TE, et al. Growth hormone and sex steroid administration in healthy aged women and men: a randomized controlled trial. Jama. 2002;288(18):2282–92.

    Article  CAS  PubMed  Google Scholar 

  107. Kaiser FE, Silver AJ, Morley JE. The effect of recombinant human growth hormone on malnourished older individuals. Journal of the American Geriatrics Society. 1991;39(3):235–40.

    Article  CAS  PubMed  Google Scholar 

  108. Garcia JM, Boccia RV, Graham CD, Yan Y, Duus EM, Allen S, et al. Anamorelin for patients with cancer cachexia: an integrated analysis of two phase 2, randomised, placebo-controlled, double-blind trials. Lancet Oncol. 2015;16(1):108–16.

    Article  CAS  PubMed  Google Scholar 

  109. Wagner KR, Fleckenstein JL, Amato AA, Barohn RJ, Bushby K, Escolar DM, et al. A phase I/IItrial of MYO-029 in adult subjects with muscular dystrophy. Annals of neurology. 2008;63(5):561–71.

    Article  CAS  PubMed  Google Scholar 

  110. Padhi D, Higano CS, Shore ND, Sieber P, Rasmussen E, Smith MR. Pharmacological inhibition of myostatin and changes in lean body mass and lower extremity muscle size in patients receiving androgen deprivation therapy for prostate cancer. The Journal of clinical endocrinology and metabolism. 2014;99(10):E1967-75.

    Google Scholar 

  111. Amato AA, Sivakumar K, Goyal N, David WS, Salajegheh M, Praestgaard J, et al. Treatment of sporadic inclusion body myositis with bimagrumab. Neurology. 2014;83(24):2239–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  112. Attie KM, Borgstein NG, Yang Y, Condon CH, Wilson DM, Pearsall AE, et al. A single ascending-dose study of muscle regulator ACE-031 in healthy volunteers. Muscle & nerve. 2013;47(3):416–23.

    Article  CAS  Google Scholar 

  113. Morley JE. Pharmacologic Options for the Treatment of Sarcopenia. Calcified tissue international. 2016;98(4):319–33.

    Article  CAS  PubMed  Google Scholar 

  114. Pahor M, Guralnik JM, Ambrosius WT, Blair S, Bonds DE, Church TS, et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. Jama. 2014;311(23):2387–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  115. Bann D, Hire D, Manini T, Cooper R, Botoseneanu A, McDermott MM, et al. Light Intensity physical activity and sedentary behavior in relation to body mass index and grip strength in older adults: cross-sectional findings from the Lifestyle Interventions and Independence for Elders (LIFE) study. PloS one. 2015;10(2):e0116058.

    Google Scholar 

  116. Marzetti E, Calvani R, Landi F, Hoogendijk EO, Fougere B, Vellas B, et al. Innovative Medicines Initiative: The SPRINTT Project. The Journal of frailty & aging. 2015;4(4):207–8.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Torrens University Australia, Wakefield Street, Adelaide, SA, Australia

    Elsa Dent

  2. Baker Heart and Diabetes Institute, Melbourne, Australia

    Elsa Dent

  3. Division of Geriatric Medicine, School of Medicine, Saint Louis University, St. Louis, MO, USA

    J. E. Morley

  4. Servicio de Geriatría Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain

    A. J. Cruz-Jentoft

  5. National Center for Geriatrics and Gerontology, Obu, Japan

    H. Arai

  6. Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA

    S. B. Kritchevsky

  7. Dept of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA

    J. Guralnik

  8. Center for Geriatric Medicine, Heidelberg University Agaplesion Bethanien Krankenhaus, Heidelberg, Germany

    J. M. Bauer

  9. Dept of Aging & Geriatric Research, University of Florida, Gainesville, FL, USA

    M. Pahor

  10. Ohio Musculoskeletal and Neurological Institute (OMNI), Athens, Ohio, USA

    B. C. Clark

  11. Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    M. Cesari

  12. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    M. Cesari

  13. Division of Geriatrics & Palliative Medicine, University of Miami Miller School of Medicine, Miami, FL, USA

    J. Ruiz

  14. Institute for Biomedicine on Ageing, Friedrich-Alexander-University Erlangen-Nürnberg, Nürnberg, Germany

    C. C. Sieber

  15. Département des sciences de l’activité physique, Faculté des sciences, Université du Quebec à Montreal, Montréal, Quebec, Canada

    M. Aubertin-Leheudre

  16. Dept of Medicine/School of Physiotherapy, University of Otago, Dunedin, New Zealand

    D. L. Waters

  17. Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia

    R. Visvanathan & O. Theou

  18. Fondazione Policlinico A. Gemelli, Roma, Italy

    F. Landi

  19. Center for Translational Research on Inflammatory Diseases, Michael E DeBakey VA Medical Center and Baylor College of Medicine, Houston, Tx, USA

    D. T. Villareal

  20. Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA

    R. Fielding

  21. Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea

    C. W. Won

  22. Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

    O. Theou

  23. Population Health Sciences, King’s College, London, UK

    F. C. Martin

  24. National Clinical Research Center of Geriatrics, West China Hospital, Sichuan Universtiy, Chengdu, China

    B. Dong

  25. Department of Medicine, The Chinese University of Hong Kong, Hong Kong, China

    J. Woo

  26. Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia

    L. Flicker

  27. Intramural Research Program of the National Institute on Aging, Bethesda, Maryland, USA

    L. Ferrucci

  28. Division of Geriatric Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore

    R. A. Merchant

  29. Center of Gerontology and Geriatrics, West China hospital, Sichuan University, Chengdu, Sichuan, China

    L. Cao

  30. Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University and Theme Aging, Karolinska University Hospital, Stockholm, Sweden

    T. Cederholm

  31. School of Public Health, University of São Paulo, São Paulo, SP, Brazil

    S. M. L. Ribeiro

  32. Servicio de Geriatria, Servicio de Geriatri, Hospital Universitario de Getafe, Madrid, Spain

    L. Rodríguez-Mañas

  33. Department of Cardiology (CVK), Berlin, Germany

    S. D. Anker

  34. Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Berlin, Germany

    S. D. Anker

  35. German Centre for Cardiovascular Research (DZHK) partner site Berlin, Berlin, Germany

    S. D. Anker

  36. Charité Universitätsmedizin, Berlin, Germany

    S. D. Anker

  37. Department of Cardiology and Pneumology, University of Göttingen Medical School, Göttingen, Germany

    S. D. Anker

  38. Perry County Memorial Hospital, Perryville, Mo, USA

    J. Lundy

  39. National Institute of Geriatrics, Mexico City, Mexico

    L. M. Gutiérrez Robledo

  40. Gerontology Department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090, Brussels, Belgium

    I. Bautmans

  41. Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090, Brussels, Belgium

    I. Bautmans

  42. Geriatrics Department, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium

    I. Bautmans

  43. Department of Internal Medicine, Division of Geriatrics, Faculty of Medicine of Jundiaí, Jundiaí, Brazil

    I. Aprahamian

  44. FHML, Caphri, Dept. Health Services Research and Dept. Family Medicine (section Old Age Medicine), Maastricht University, Maastricht, The Netherlands

    J. M. G. A. Schols

  45. Department of Health Sciences, Public University of Navarre, CIBER de Fragilidad y Envejecimiento Saludable, Navarrabiomed, IdiSNA, Navarra Institute for Health Research, Pamplona, Navarra, Spain

    M. Izquierdo

  46. Gérontopôle Clinique, CHU Toulouse, Toulouse, France

    B. Vellas

Authors
  1. Elsa Dent
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. E. Morley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. J. Cruz-Jentoft
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Arai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. B. Kritchevsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Guralnik
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. M. Bauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. Pahor
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. B. C. Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. Cesari
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. J. Ruiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. C. C. Sieber
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. M. Aubertin-Leheudre
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. D. L. Waters
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. R. Visvanathan
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. F. Landi
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. D. T. Villareal
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. R. Fielding
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. C. W. Won
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. O. Theou
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. F. C. Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. B. Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. J. Woo
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. L. Flicker
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. L. Ferrucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. R. A. Merchant
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. L. Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. T. Cederholm
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. S. M. L. Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  30. L. Rodríguez-Mañas
    View author publications

    You can also search for this author in PubMed Google Scholar

  31. S. D. Anker
    View author publications

    You can also search for this author in PubMed Google Scholar

  32. J. Lundy
    View author publications

    You can also search for this author in PubMed Google Scholar

  33. L. M. Gutiérrez Robledo
    View author publications

    You can also search for this author in PubMed Google Scholar

  34. I. Bautmans
    View author publications

    You can also search for this author in PubMed Google Scholar

  35. I. Aprahamian
    View author publications

    You can also search for this author in PubMed Google Scholar

  36. J. M. G. A. Schols
    View author publications

    You can also search for this author in PubMed Google Scholar

  37. M. Izquierdo
    View author publications

    You can also search for this author in PubMed Google Scholar

  38. B. Vellas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elsa Dent.

Electronic supplementary material

12603_2018_1139_MOESM1_ESM.docx

Appendix 1. Patient Information for Treatment of Sarcopenia (poor muscle function with low muscle mass)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Dent, E., Morley, J.E., Cruz-Jentoft, A.J. et al. International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management. J Nutr Health Aging 22, 1148–1161 (2018). https://doi.org/10.1007/s12603-018-1139-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-018-1139-9

Key words

  • Sarcopenia/diagnosis
  • sarcopenia/therapy
  • muscle strength
  • aged
  • 80 and over
  • practice guideline