Skip to main content
SpringerLink
Log in

Sarcopenia: Clinical evaluation, biological markers and other evaluation tools

  • Published:
JNHA - The Journal of Nutrition, Health and Aging

Abstract

Sarcopenia is characterized by a lower skeletal muscle quantity, higher fat accumulation in the muscle, lower muscle strength, and lower physical performance. The most commonly used, low cost and accessible methods to assess skeletal muscle mass include dual energy X-ray absorptiometry (DEXA), anthropometry and bioelectrical impedance analysis (BIA). Magnetic resonance imaging (MRI), computerized tomography (CT) and creatinine excretion are the most specific golden standards for assessing muscle mass or cross sectional muscle area. Other available measures include peripheral quantitative computerized tomography (pQCT), ultrasound and neutron activation. Skeletal muscle strength is another important component for the assessment of sarcopenia and muscle quality. Several methods are available for the measurement of muscle strength which include simple dynamometers to measure isometric strength and the most complex isokinetic strength measures of power and torque. Standardized physical performance measures complement the measures of muscle mass for the assessment of sarcopenia. A clinical definition of sarcopenia ought to use methods of assessment that are valid, reliable, specific to skeletal muscle, predictive of future health events, non-invasive, practical, low cost and widely accessible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wang ZM, Visser M, Ma R, Baumgartner RN, Kotler D, Gallagher D, Heymsfield SB. Skeletal muscle mass: evaluation of neutron activation and dual-energy X-ray absorptiometry methods. J Appl Physiol 1996 March;80(3):824–831.

    CAS  PubMed  Google Scholar 

  2. Proctor DN, O’Brien PC, Atkinson EJ, Nair KS. Comparison of techniques to estimate total body skeletal muscle mass in people of different age groups. Am J Physiol 1999 September;277(3 Pt 1):E489–E495.

    CAS  PubMed  Google Scholar 

  3. Levine JA, Abboud L, Barry M, Reed JE, Sheedy PF, Jensen MD. Measuring leg muscle and fat mass in humans: comparison of CT and dual-energy X-ray absorptiometry. J Appl Physiol 2000 February;88(2):452–456.

    CAS  PubMed  Google Scholar 

  4. Visser M, Fuerst T, Lang T, Salamone L, Harris TB. Validity of fan-beam dual-energy X-ray absorptiometry for measuring fat-free mass and leg muscle mass. Health, Aging, and Body Composition Study—Dual-Energy X-ray Absorptiometry and Body Composition Working Group. J Appl Physiol 1999 October;87(4):1513–1520.

    CAS  PubMed  Google Scholar 

  5. Janssen I, Baumgartner RN, Ross R, Rosenberg IH, Roubenoff R. Skeletal muscle cutpoints associated with elevated physical disability risk in older men and women. Am J Epidemiol 2004 February 15;159(4):413–421.

    Article  PubMed  Google Scholar 

  6. Baumgartner RN, Wayne SJ, Waters DL, Janssen I, Gallagher D, Morley JE. Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obes Res 2004 December;12(12):1995–2004.

    Article  PubMed  Google Scholar 

  7. Fuller NJ, Hardingham CR, Graves M, Screaton N, Dixon AK, Ward LC, Elia M. Predicting composition of leg sections with anthropometry and bioelectrical impedance analysis, using magnetic resonance imaging as reference. Clin Sci (Lond) 1999 June;96(6):647–657.

    Article  CAS  Google Scholar 

  8. Rolland Y, Lauwers-Cances V, Cournot M, Nourhashemi F, Reynish W, Riviere D, Vellas B, Grandjean H. Sarcopenia, calf circumference, and physical function of elderly women: a cross-sectional study. J Am Geriatr Soc 2003 August;51(8):1120–1124.

    Article  PubMed  Google Scholar 

  9. Heymsfield SB, McManus C, Smith J, Stevens V, Nixon DW. Anthropometric measurement of muscle mass: revised equations for calculating bone-free arm muscle area. Am J Clin Nutr 1982 October;36(4):680–690.

    CAS  PubMed  Google Scholar 

  10. Cesari M, Leeuwenburgh C, Lauretani F, Onder G, Bandinelli S, Maraldi C, Guralnik JM, Pahor M, Ferrucci L. Frailty syndrome and skeletal muscle: results from the Invecchiare in Chianti study. Am J Clin Nutr 2006 May;83(5):1142–1148.

    CAS  PubMed  Google Scholar 

  11. Goodpaster BH, Kelley DE, Thaete FL, He J, Ross R. Skeletal muscle attenuation determined by computed tomography is associated with skeletal muscle lipid content. J Appl Physiol 2000 July;89(1):104–110.

    CAS  PubMed  Google Scholar 

  12. Reeves ND, Maganaris CN, Narici MV. Ultrasonographic assessment of human skeletal muscle size. Eur J Appl Physiol 2004 January;91(1):116–118.

    Article  PubMed  Google Scholar 

  13. Cohn SH, Vartsky D, Yasumura S, Sawitsky A, Zanzi I, Vaswani A, Ellis KJ. Compartmental body composition based on total-body nitrogen, potassium, and calcium. Am J Physiol 1980 December;239(6):E524–E530.

    CAS  PubMed  Google Scholar 

  14. Goodpaster BH, rd PJ, Ward BK, Rossi A, Glynn NW, Delmonico MJ, Kritchevsky SB, Pahor M, Newman AB. Effects of Physical Activity on Strength and Skeletal Muscle Fat Infiltration in Older Adults: A Randomized Controlled Trial. J Appl Physiol 2008 September 25.

  15. Clark BC, Manini TM. Sarcopenia =/= dynapenia. J Gerontol A Biol Sci Med Sci 2008 August;63(8):829–834.

    PubMed  Google Scholar 

  16. Visser M, Goodpaster BH, Kritchevsky SB, Newman AB, Nevitt M, Rubin SM, Simonsick EM, Harris TB. Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol A Biol Sci Med Sci 2005 March;60(3):324–333.

    PubMed  Google Scholar 

  17. Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH, Kritchevsky SB, Tylavsky FA, Rubin SM, Harris TB. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci 2006 January;61(1):72–77.

    PubMed  Google Scholar 

  18. Willcox BJ, He Q, Chen R, Yano K, Masaki KH, Grove JS, Donlon TA, Willcox DC, Curb JD. Midlife risk factors and healthy survival in men. JAMA 2006 November 15;296(19):2343–2350.

    Article  CAS  PubMed  Google Scholar 

  19. Rantanen T, Guralnik JM, Foley D, Masaki K, Leveille S, Curb JD, White L. Midlife hand grip strength as a predictor of old age disability. JAMA 1999 February 10;281(6):558–560.

    Article  CAS  PubMed  Google Scholar 

  20. Lauretani F, Russo CR, Bandinelli S, Bartali B, Cavazzini C, Di IA, Corsi AM, Rantanen T, Guralnik JM, Ferrucci L. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol 2003 November;95(5):1851–1860.

    PubMed  Google Scholar 

  21. Newman AB, Kupelian V, Visser M, Simonsick E, Goodpaster B, Nevitt M, Kritchevsky SB, Tylavsky FA, Rubin SM, Harris TB. Sarcopenia: alternative definitions and associations with lower extremity function. J Am Geriatr Soc 2003 November;51(11):1602–1609.

    Article  PubMed  Google Scholar 

  22. Visser M, Kritchevsky SB, Goodpaster BH, Newman AB, Nevitt M, Stamm E, Harris TB. Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: the health, aging and body composition study. J Am Geriatr Soc 2002 May;50(5):897–904.

    Article  PubMed  Google Scholar 

  23. Delmonico MJ, Harris TB, Lee JS, Visser M, Nevitt M, Kritchevsky SB, Tylavsky FA, Newman AB. Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women. J Am Geriatr Soc 2007 May;55(5):769–774.

    Article  PubMed  Google Scholar 

  24. Newman AB, Simonsick EM, Naydeck EM, Kritchevsky SB, Nevitt M, Pahor M, Satterfield S, Brach JS, Studenski SA, Harris TB. Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA 2006;295(17):2018–2026.

    Article  CAS  PubMed  Google Scholar 

  25. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995;332(9):556–561.

    Article  CAS  PubMed  Google Scholar 

  26. Cesari M, Kritchevsky SB, Penninx BWJH, Nicklas BJ, Simonsick EM, Newman AB, Tylavsky F, Brach JS, Satterfield S, Bauer DC, Visser M, Rubin S, Harris TB, Pahor M. Prognostic value of usual gait speed in well-functioning older people-results from the health, aging and body composition study. J Am Geriatr Soc 2005;53:1675–1680.

    Article  PubMed  Google Scholar 

  27. Rolland Y, Lauwers-Cances V, Cesari M, Vellas B, Pahor M, Grandjean H. Physical Performance Measures as Predictors of Mortality in a Cohort of Community-dwelling Older French Women. Eur J Epidemiol 2006;21(2):113–122.

    Article  PubMed  Google Scholar 

  28. Ettinger WH, Burns R, Messier SP, Applegate WB, Rejeski WJ, Morgan T, Shumaker S, Berry MJ, O’Toole M, Monu J, Craven T. The Fitness Arthritis and Seniors Trial (FAST): a randomized trial comparing aerobic exercise and resistance exercise to a health education program on physical disability in older people with knee osteoarthritis. JAMA 1997;277:25–31.

    Article  PubMed  Google Scholar 

  29. Kuriansky JB, Gurland BJ, Fleiss JL. The assessment of self-care capacity in geriatric psychiatric patients by objective and subjective methods. J Clin Psychol 1976 January;32(1):95–102.

    Article  CAS  PubMed  Google Scholar 

  30. Manini TM, Cook SB, VanArnam T, Marko M, Ploutz-Snyder L. Evaluating task modification as an objective measure of functional limitation: repeatability and comparability. J Gerontol A Biol Sci Med Sci 2006 July;61(7):718–725.

    PubMed  Google Scholar 

  31. Jette AM, Branch LG. Impairment and disability in the aged. J Chronic Dis 1985;38(1):59–65.

    Article  CAS  PubMed  Google Scholar 

  32. Reuben DB, Siu AL. An objective measure of physical function of elderly outpatients. The Physical Performance Test. J Am Geriatr Soc 1990 October;38(10):1105–1112.

    CAS  PubMed  Google Scholar 

  33. Roubenoff R, Harris TB, Abad LW, Wilson PW, Dallal GE, Dinarello CA. Monocyte cytokine production in an elderly population: effect of age and inflammation. J Gerontol A Biol Sci Med Sci 1998 January;53(1):M20–M26.

    CAS  PubMed  Google Scholar 

  34. Cesari M, Kritchevsky SB, Baumgartner RN, Atkinson H, Penninx BWJH, Lenchik L, Palla S, Ambrosius WT, Tracy RP, Pahor M. Sarcopenia, obesity and inflammation — Results from theTrial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors study. Am J Clin Nutr 2005;82:428–434.

    CAS  PubMed  Google Scholar 

  35. Visser M, Pahor M, Taaffe D, Goodpaster BH, Simonsick E, Newman AB, Nevitt MC, Harris TB. Relationship of interleukin-6 and tumor necrosis factor-á with muscle mass and muscle strength in elderly men and women: the Health ABC Study. J Gerontol A Biol Sci Med Sci 2002;57:M326–M332.

    PubMed  Google Scholar 

  36. Bales CW, Ritchie CS. Sarcopenia, weight loss, and nutritional frailty in the elderly. Annu Rev Nutr 2002;22:309–323. Epub;%2002 Jan 4.: 309–23.

    Article  CAS  PubMed  Google Scholar 

  37. Anker SD, Ponikowski PP, Clark AL, Leyva F, Rauchhaus M, Kemp M, Teixeira MM, Hellewell PG, Hooper J, Poole-Wilson PA, Coats AJ. Cytokines and neurohormones relating to body composition alterations in the wasting syndrome of chronic heart failure. Eur Heart J 1999 May;20(9):683–693.

    Article  CAS  PubMed  Google Scholar 

  38. Penninx BW, Kritchevsky SB, Newman AB, Nicklas BJ, Simonsick EM, Rubin S, Nevitt M, Visser M, Harris T, Pahor M. Inflammatory markers and incident mobility limitation in the elderly. J Am Geriatr Soc 2004 July;52(7):1105–1113.

    Article  PubMed  Google Scholar 

  39. Penninx BW, Abbas H, Ambrosius W, Nicklas BJ, Davis C, Messier SP, Pahor M. Inflammatory Markers and Physical Function Among Older Adults with Knee Osteoarthritis. J Rheumatol 2004 October;31(10):2027–2031.

    PubMed  Google Scholar 

  40. Cesari M, Penninx BW, Pahor M, Lauretani F, Corsi AM, Guralnik JM, Ferrucci L. Inflammatory markers and physical performance in older persons: the InChianti study. J Gerontol A Biol Sci Med Sci 2004;59:242–248.

    PubMed  Google Scholar 

  41. Ferrucci L, Harris TB, Guralnik JM, Wacholder S, Tracy RP, Corti MC, Penninx BWJH, Pahor M, Wallace RB, Havlik RJ. Inflammation, a novel risk factor for disability in older persons. J Am Geriatr Soc 1999;47:639–646.

    CAS  PubMed  Google Scholar 

  42. Cesari M, Kritchevsky SB, Nicklas BJ, Penninx BW, Holvoet P, Koh-Banerjee P, Cummings SR, Harris TB, Newman AB, Pahor M. Lipoprotein peroxidation and mobility limitation: results from the health, aging, and body composition study. Arch Intern Med 2005 October 10;165(18):2148–2154.

    Article  CAS  PubMed  Google Scholar 

  43. Howard C, Ferrucci L, Sun K, Fried LP, Walston J, Varadhan R, Guralnik JM, Semba RD. Oxidative protein damage is associated with poor grip strength among older women living in the community. J Appl Physiol 2007 July;103(1):17–20.

    Article  CAS  PubMed  Google Scholar 

  44. Semba RD, Ferrucci L, Sun K, Walston J, Varadhan R, Guralnik JM, Fried LP. Oxidative stress and severe walking disability among older women. Am J Med 2007 December;120(12):1084–1089.

    Article  CAS  PubMed  Google Scholar 

  45. Cesari M, Pahor M, Bartali B, Cherubini A, Penninx BW, Williams GR, Atkinson H, Martin A, Guralnik JM, Ferrucci L. Antioxidants and physical performance in elderly persons: the Invecchiare in Chianti (InCHIANTI) study. Am J Clin Nutr 2004 February;79(2):289–294.

    CAS  PubMed  Google Scholar 

  46. Semba RD, Blaum C, Guralnik JM, Moncrief DT, Ricks MO, Fried LP. Carotenoid and vitamin E status are associated with indicators of sarcopenia among older women living in the community. Aging Clin Exp Res 2003 December;15(6):482–487.

    CAS  PubMed  Google Scholar 

  47. Semba RD, Lauretani F, Ferrucci L. Carotenoids as protection against sarcopenia in older adults. Arch Biochem Biophys 2007 February 15;458(2):141–145.

    Article  CAS  PubMed  Google Scholar 

  48. Penninx BWJH, Pahor M, Cesari M, Corsi AM, Woodman RC, Guralnik JM, Ferrucci L. Anemia is associated with decreased physical performance and muscle strength in the elderly. J Am Geriatr Soc 2004;52:719–724.

    Article  PubMed  Google Scholar 

  49. Schalk BW, Deeg DJ, Penninx BW, Bouter LM, Visser M. Serum albumin and muscle strength: a longitudinal study in older men and women. J Am Geriatr Soc 2005 August;53(8):1331–1338.

    Article  PubMed  Google Scholar 

  50. Lauretani F, Semba RD, Bandinelli S, Ray AL, Guralnik JM, Ferrucci L. Association of low plasma selenium concentrations with poor muscle strength in older community-dwelling adults: the InCHIANTI Study. Am J Clin Nutr 2007 August;86(2):347–352.

    CAS  PubMed  Google Scholar 

  51. Macchi C, Molino-Lova R, Polcaro P, Guarducci L, Lauretani F, Cecchi F, Bandinelli S, Guralnik JM, Ferrucci L. Higher circulating levels of uric acid are prospectively associated with better muscle function in older persons. Mech Ageing Dev 2008 September;129(9):522–527.

    Article  CAS  PubMed  Google Scholar 

  52. Dominguez LJ, Barbagallo M, Lauretani F, Bandinelli S, Bos A, Corsi AM, Simonsick EM, Ferrucci L. Magnesium and muscle performance in older persons: the InCHIANTI study. Am J Clin Nutr 2006 August;84(2):419–426.

    CAS  PubMed  Google Scholar 

  53. Visser M, Deeg DJ, Lips P. Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. J Clin Endocrinol Metab 2003 December;88(12):5766–5772.

    Article  CAS  PubMed  Google Scholar 

  54. Roth SM, Metter EJ, Ling S, Ferrucci L. Inflammatory factors in age-related muscle wasting. Curr Opin Rheumatol 2006 November;18(6):625–630.

    Article  CAS  PubMed  Google Scholar 

  55. Ishibashi Y, Hanyu N, Suzuki Y, Yanai S, Tashiro K, Usuba T, Iwabuchi S, Takahashi T, Takada K, Ohkawa K, Urashima M, Yanaga K. Quantitative analysis of free ubiquitin and multi-ubiquitin chain in colorectal cancer. Cancer Lett 2004 July 28;211(1):111–117.

    Article  CAS  PubMed  Google Scholar 

  56. Takada K, Nasu H, Hibi N, Tsukada Y, Shibasaki T, Fujise K, Fujimuro M, Sawada H, Yokosawa H, Ohkawa K. Serum concentrations of free ubiquitin and multiubiquitin chains. Clin Chem 1997 July;43(7):1188–1195.

    CAS  PubMed  Google Scholar 

  57. Matulevicius S, Rohatgi A, Khera A, Das SR, Owens A, Ayers CR, Timaran CH, Rosero EB, Drazner MH, Peshock RM, de Lemos JA. The association between plasma caspase-3, atherosclerosis, and vascular function in the Dallas Heart Study. Apoptosis 2008 October;13(10):1281–1289.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Aging and Geriatric Research, University of Florida — Institute on Aging, Gainesville, FL, USA

    Marco Pahor & T. Manini

  2. Department of Gerontological, Geriatric and Physiatric Sciences, Catholic University of Sacred Heart, Rome, Italy

    M. Cesari

  3. Department of Aging and Geriatric Research, University of Florida — Institute on Aging, Gainesville, FL, 32608, PO Box 100107, zip 32610-0107, USA

    Marco Pahor

Authors
  1. Marco Pahor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Manini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Cesari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Pahor.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pahor, M., Manini, T. & Cesari, M. Sarcopenia: Clinical evaluation, biological markers and other evaluation tools. J Nutr Health Aging 13, 724–728 (2009). https://doi.org/10.1007/s12603-009-0204-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-009-0204-9

Keywords

Search

Navigation