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

  • Published:
The journal of nutrition, health & aging

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.

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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

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  1. Elsa Dent
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  2. J. E. Morley
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  3. A. J. Cruz-Jentoft
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  4. H. Arai
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Correspondence to Elsa Dent.

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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

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

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