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"apellidos" => "García-Alegría" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Internal Medicine, Hospital Virgen del Rocío Seville, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Research Network of Health Services in Chronic Diseases (REDISSEC), Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Area of Medicine, Healthcare Agency Costa del Sol Marbella (Malaga), Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcopenia en medicina interna: ¿tiempo para la acción?" ] ] "textoCompleto" => "The demographic evolution of Western countries due to the aging of the population is creating healthcare, social and financial problems of considerable impact. The progressive growth in life expectancy in Spain, among the longest in the world, has changed the patient profile, with a higher prevalence of chronic diseases and age-related conditions. Sarcopenia is currently one of the most relevant geriatric syndromes and the substrate of numerous health problems in the elderly because it dramatically reduces quality of life and increases morbidity and mortality.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>Sarcopenia is defined by a progressive and generalized loss of strength, skeletal muscle mass and physical performance. Sarcopenia can be considered the end result of various pathogenic mechanisms such as inflammation, malnutrition, hormonal imbalance, frailty and physical inactivity.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The prevalence of sarcopenia increases with age. After 50 years of age, muscle mass decreases 1–2% per year; muscle strength decreases 1.5% annually between 50 and 60 years of age and by 3% every year thereafter. Between 5% and 13% of individuals between 60 and 70 years of age have sarcopenia, as do 11–50% of those 80 years or older.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Two sets of guidelines have recently been published for the diagnosis, prevention and treatment of sarcopenia that update the available scientific evidence and that substantially change the previous guidelines.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a> The guidelines of the European Working Group on Sarcopenia in Older People 2 (EWGSOP2)<a class="elsevierStyleCrossRef" href="#bib0025">5</a> emphasizes that the key characteristic of sarcopenia is low muscle strength. The guidelines employ reduced muscle quantity and quality to confirm the diagnosis, while considering physical performance a deficient indicator of the severity of sarcopenia. The guidelines also provide an update of the clinical algorithm for detecting, diagnosing and treating sarcopenia for use by clinicians. A recent multicenter study with polypathological patients found a rate of sarcopenia (using the EWGSOP criteria) and frailty of 22% and 62%, respectively.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> This issue of Revista Clínica Española presents a study on nonagenarians with atrial fibrillation of the NONAVASC registry<a class="elsevierStyleCrossRef" href="#bib0035">7</a> that shows that almost half of this cohort had scores suggestive of sarcopenia and frailty in the applied clinimetric test (SARC-F and FRAIL) and that both conditions are independently associated with mortality at 1year.Currently, the validated techniques for measuring skeletal muscle mass are computed tomography, magnetic resonance imaging, dual-energy X-ray absorptiometry and bioelectrical impedance analysis, although ultrasonography could be a promising technique due to its accessibility and ease of use.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> The Clinical Ultrasonography and Polypathological and Elderly Patient Workgroups of the Spanish Society of Internal Medicine (SEMI) are assessing the usefulness of ultrasonography for measuring skeletal muscle mass in the ECOSARCO project.Physical exercise and a diet with an appropriate intake of proteins, micronutrients and vitamin D have demonstrated their usefulness for treating sarcopenia.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> There are effective hormones such as testosterone, dehydroepiandrosterone and growth hormone, although their adverse effects significantly limit their usefulness in clinical practice. New therapeutic targets, such as myostatin inhibition, proteasome inhibition and electrical stimulation, are currently being investigated.<a class="elsevierStyleCrossRefs" href="#bib0050">10–12</a>Both sarcopenia and frailty are easy-to-diagnose conditions that are potentially preventable and treatable, and the usefulness and positive health outcomes of implementing specific interventions have been more than demonstrated.<a class="elsevierStyleCrossRefs" href="#bib0045">9–11,13–15</a> However, despite the high prevalence of sarcopenia and frailty, their high impact on our patients, their easy detection and the possibility of preventing and treating them to prevent or slow their progression, strategies and programs for detecting and addressing these conditions are underdeveloped. If we prevent, diagnose early and treat osteoporosis (often aggressively), why do we not do likewise for sarcopenia, given that “sarcopenia is to muscles what osteoporosis is to bones”? In fact, skeletal muscle is the heaviest “organ” in the human body, and its metabolism and operation exert a significant influence on areas as relevant as cardiovascular conditioning, carbohydrate metabolism, bone mineral density and the release of various compounds with positive action on the neuropsychiatric area.Data from the study by Requena Calleja et al.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> reveal the emerging epidemiological reality of this syndrome that increasingly affects patients treated in internal medicine. Answering the question we posed in the title of this editorial, yes. It is time to act and raise awareness at all practitioner, institutional and, of course, societal levels to improve our training and establish specific and coordinated intervention strategies, both societal and healthcare." 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Revista Clínica Española (English Edition)

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Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI).
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