Journal of the American Medical Directors Association
ReviewSarcopenia in Asia: Consensus Report of the Asian Working Group for Sarcopenia
Section snippets
Diagnosis of Sarcopenia and Its Impact to Asia
Asia is a huge and densely populated continent with a wide range of ethnicities, cultural, social, religious backgrounds, and lifestyles. Because of the rapid population aging and the population size, the impact of sarcopenia in Asia may be stronger than in other continents. However, the status of population aging and economic development varies extensively in different Asian countries. Therefore, developing a consensus for sarcopenia diagnosis and clinical approaches based on available
Strategy for Sarcopenia Screening and Assessment
In principle, AWGS followed the diagnostic approach of EWGSOP, and we added some Asian perspectives in sarcopenia diagnosis and research. In the previous studies from Western countries, the prevalence of sarcopenia in older people was around 20% among people aged 65 years and older and may reach 50%–60% in octogenarians.34 EWGSOP recommends routine screening for sarcopenia among community-dwelling people aged 65 years and older. On the other hand, the International Working Group on Sarcopenia
Suggested Outcome Indicators in Sarcopenia Research
The EWGSOP definition suggests using physical performance, muscle strength, and muscle mass as the primary treatment outcome indicators for sarcopenia intervention trials, whereas activities of daily living, quality of life, metabolic and biochemical markers, inflammatory markers, global impression of change by subject or physician, falls, admission to nursing home or hospital, social support, and mortality as secondary outcome indicators.33 While most epidemiologic studies in sarcopenia
Assessment Techniques and Suggested Cutoff Values
Assessment of sarcopenia in Asian populations presents a great challenge because of the lack of outcome-based studies. However, determining appropriate cutoff values for sarcopenia diagnosis in Asia is critical to promote further sarcopenia research and treatment in Asia. Consequently, AWGS focused on the best available evidence to determine cutoff values for the diagnosis of sarcopenia in Asia. If, however, no outcome-based data are available, AWGS would recommend standardized approaches for
Muscle Mass
EWGSOP recommends DXA, computed tomography (CT), magnetic resonance imaging (MRI), and bioimpedance analysis (BIA) for sarcopenia research. Currently, the precision of DXA, CT, and MRI has been well recognized, but the precision of BIA in measuring muscle mass is controversial. BIA was developed to estimate the volume of body fat and lean body mass, but not appendicular muscle mass. Although the accuracy of BIA in sarcopenia diagnosis has been validated,39, 40, 41 it is heavily dependent on the
Muscle Strength
Measuring handgrip strength is considered a feasible and convenient measure of muscle strength because of cost, availability, ease of use, and its association with leg strength. Wu et al49 presented the norm of handgrip strength in Taiwan, which disclosed that the mean grip strength of the study sample in Taiwan was significantly lower (male 25%, female 27%) than consolidated norms derived from largely Caucasian populations. Although some papers published in Taiwan using this adjusted cutoff
Physical Performance
A wide range of tests for physical performance are recommended in EWGSOP criteria, including the Short Physical Performance Battery (SPPB), usual gait speed, the 6-minute walk test, the stair climb power test, and the timed-up-and-go test (TUG).51 Timed usual gait is highly predictive for the onset of disability,52 and other adverse health events like severe mobility limitation and mortality.53 TUG is an assessment of ambulation and dynamic balance. Poorer TUG has been demonstrated to be
Therapeutic Implications
Physical activities, including aerobics, endurance exercise,57 and resistance exercise training58, 59 have been demonstrated to significantly increase muscle mass and strength in sarcopenic older people. Although the recommended frequency of exercise training to improve muscle strength and functional performance has been shown,60 a consensus has not yet been reached concerning the content of the prescribed exercise and the most optimal frequency and intensity. Inappropriate exercise training in
Future Challenge and Conclusion
Sarcopenia significantly impacts daily activities, functional status, disability, and quality of life in older populations. Although Asian populations are rapidly ageing, from the clinical practice or public health points of view, the understanding of and preparation for sarcopenia remain inadequate. Hence, this consensus collected as many Asian studies as possible and offers a working diagnosis of sarcopenia for Asian people. The main aims of AWGS were to promote sarcopenia research in Asian
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The authors declare no conflicts of interest.