Sarcopenia: A condition in need for identification in different health care settings

Patel, H.P.

doi:10.1016/j.rce.2014.05.013

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Bone marrow aspirate smear showing three macrophages displaying hemophagocytic activity (May–Grünwald–Giemsa stain; magnification 400×)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Machaczka" "autores" => array:1 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Machaczka" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256514002203?idApp=WRCEE" "url" => "/00142565/0000021400000006/v1_201407221202/S0014256514002203/v1_201407221202/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0014256514002227" "issn" => "00142565" "doi" => "10.1016/j.rce.2014.05.008" "estado" => "S300" "fechaPublicacion" => "2014-08-01" "aid" => "971" "copyright" => "Elsevier España, S.L." 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"apellidos" => "Silveira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256514002227?idApp=WRCEE" "url" => "/00142565/0000021400000006/v1_201407221202/S0014256514002227/v1_201407221202/en/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Editorial" "titulo" => "Sarcopenia: A condition in need for identification in different health care settings" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "313" "paginaFinal" => "314" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "H.P. Patel" "autores" => array:1 [ 0 => array:3 [ "nombre" => "H.P." "apellidos" => "Patel" "email" => array:1 [ 0 => "hp@mrc.soton.ac.uk" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "University Hospital Southampton, Tremona Road, Southampton, United Kingdom" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcopenia: una condición que debe identificarse en los diferentes ámbitos asistenciales" ] ] "textoCompleto" => "Sarcopenia, the loss of muscle mass and function with age, is common in both men and women over the age of 65 with the estimated worldwide prevalence of 3–30% according to the operational definition implemented.<a class="elsevierStyleCrossRefs" href="#bib0005">1–7</a> Sarcopenia is associated with a number of adverse physical and metabolic outcomes which are especially relevant in the context of global population ageing. Examples include frailty, disability, obesity, diabetes and osteoporosis.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> As a consequence there is a substantial healthcare cost attributable to sarcopenia which runs into billions of dollars.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> Research into sarcopenia has expanded exponentially since the term was coined by Irwin Rosenberg in 1988 recognizing that “there may be no single feature of age related decline more striking than the decline in lean body mass in affecting ambulation, ability, energy intake and status, independence and breathing”.<a class="elsevierStyleCrossRef" href="#bib0055">11</a>The pathophysiology of sarcopenia is multifactorial and ranges from intrinsic changes within muscle itself including atrophy and loss of both type I and type II myofibres and decreased muscle quality secondary to neural and neurohormonal adaptations. For example, denervation and the age associated decline in anabolic hormones.<a class="elsevierStyleCrossRefs" href="#bib0060">12,13</a> There are several aetiological factors associated with sarcopenia; however, it is useful to think of sarcopenia as primary age related or secondary, related to decreased activity, disease or undernutrition.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>A major clinical problem for older people, there is increased need for the recognition of sarcopenia in research and across a range of health care settings. Historically defining sarcopenia was based on lean mass. Whereas implementation of these lean mass associated definitions identified people with disability, they perhaps did not encompass the larger spectrum of functional limitation within the population studied.There has recently been progress in the approaches used to define sarcopenia. The European Working Group on Sarcopenia in Older People (EWGSOP),<a class="elsevierStyleCrossRef" href="#bib0070">14</a> defined sarcopenia as a syndrome based on the ascertainment of lean mass, grip strength and gait speed that provides a clear, structured and understandable method for sarcopenia case finding. Determining the prevalence of sarcopenia in health care settings has also been possible using the EWGSOP definition. To this end, sarcopenia prevalence has mainly been determined in community dwelling older adults but recently, there have been efforts to estimate prevalence in hospital as well as within care homes.<a class="elsevierStyleCrossRefs" href="#bib0075">15–17</a>However, more evidence for the usefulness of the EWGSOP definition in clinical practice is needed especially where there is need to disentangle the interactive effects of malnutrition and cachexia. In this issue of Rev Clin Esp, Rubio-Maicas et al.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> determined the prevalence of sarcopenia in patients hospitalized in a medium to long stay unit. Their study was a descriptive, cross sectional observational study of patients undergoing non-end stage palliative treatment, convalescence and rehabilitation over the course of one year. This was novel as prevalence of sarcopenia has not, to date, been described in this setting. Their use of the EWGSOP definition relied on the ascertainment of grip strength, muscle mass, measured by bioelectrical impedance and expressed as an index (muscle mass/height2) and physical performance measures. This setting also allowed measurements of various other anthropometric indices, functional status through the Barthel index, cognition and length of stay.Their study of 166 patients, of whom 86 (51.8%) were women showed that 146 patients had severe reductions in grip strength as well as moderate to severe reductions in muscle mass. Perhaps striking is that only four patients could perform all the tests of physical performance. It is therefore not surprising that the prevalence of sarcopenia was 73.7% in women and 79.2% in men. In their paper, 151 patients had severe sarcopenia – that is, reduction in grip strength, muscle mass as well as decreased walking speed. What is not clear is how patients were classified according to sarcopenia status using the EWGSOP algorithm and how these prevalence data were calculated. Given these were patients admitted from both medical and surgical specialties, it would also be important to know whether the degree of comorbidity correlated with sarcopenia prevalence, and to see demographic, anthropometric and phenotypic characteristics according to EWGSOP sarcopenia status.International efforts in defining sarcopenia were a significant milestone in sarcopenia research and figures describing the prevalence of sarcopenia in different populations are now available.<a class="elsevierStyleCrossRefs" href="#bib0070">14,19,20</a> Whereas describing prevalence of sarcopenia in the community has been relatively less complicated, accurately describing prevalence in hospitalized older people is harder. This paper highlights this significant stumbling block. For this reason it is difficult to compare and contrast prevalence data obtained from studies in the community. More evidence for the usefulness of sarcopenia diagnostic algorithms within clinical settings is needed<a class="elsevierStyleCrossRef" href="#bib0105">21</a> and the authors have gone some way to show this. Furthermore, as this paper highlights, disentangling the effects of co-morbidity, cachexia and inflammation, which impart significant catabolic insult on the muscle of older people who have been hospitalized is challenging.Pragmatic approaches to the identification of sarcopenia, which do not rely on resource intensive scanning or scarce reference data are required to characterise the burden of sarcopenia in a wide range of populations. It is clear that sarcopenia case finding is important. Standardisation of methodology is important if we are to provide accurate data on sarcopenia prevalence.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> Incorporation of walking speed and grip strength into routine clinical assessment may well be the direction forward in identifying patients who would need further diagnostic testing. What of those patients who are not ambulant? Does the research and clinical community need a modified diagnostic algorithm to identify outcomes as well as cut-offs relevant to the population being studied in order to identify parameters for preventative and therapeutic intervention? There are still many unanswered questions; however, they do lend themselves to a promising future in sarcopenia research." 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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Sarcopenia&#44; the loss of muscle mass and function with age&#44; is common in both men and women over the age of 65 with the estimated worldwide prevalence of 3&#8211;30&#37; according to the operational definition implemented&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;7</span></a> Sarcopenia is associated with a number of adverse physical and metabolic outcomes which are especially relevant in the context of global population ageing&#46; Examples include frailty&#44; disability&#44; obesity&#44; diabetes and osteoporosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> As a consequence there is a substantial healthcare cost attributable to sarcopenia which runs into billions of dollars&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Research into sarcopenia has expanded exponentially since the term was coined by Irwin Rosenberg in 1988 recognizing that &#8220;<span class="elsevierStyleItalic">there may be no single feature of age related decline more striking than the decline in lean body mass in affecting ambulation&#44; ability&#44; energy intake and status&#44; independence and breathing</span>&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The pathophysiology of sarcopenia is multifactorial and ranges from intrinsic changes within muscle itself including atrophy and loss of both type I and type II myofibres and decreased muscle quality secondary to neural and neurohormonal adaptations&#46; For example&#44; denervation and the age associated decline in anabolic hormones&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> There are several aetiological factors associated with sarcopenia&#59; however&#44; it is useful to think of sarcopenia as primary age related or secondary&#44; related to decreased activity&#44; disease or undernutrition&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A major clinical problem for older people&#44; there is increased need for the recognition of sarcopenia in research and across a range of health care settings&#46; Historically defining sarcopenia was based on lean mass&#46; Whereas implementation of these lean mass associated definitions identified people with disability&#44; they perhaps did not encompass the larger spectrum of functional limitation within the population studied&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">There has recently been progress in the approaches used to define sarcopenia&#46; The European Working Group on Sarcopenia in Older People &#40;EWGSOP&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> defined sarcopenia as a syndrome based on the ascertainment of lean mass&#44; grip strength and gait speed that provides a clear&#44; structured and understandable method for sarcopenia case finding&#46; Determining the prevalence of sarcopenia in health care settings has also been possible using the EWGSOP definition&#46; To this end&#44; sarcopenia prevalence has mainly been determined in community dwelling older adults but recently&#44; there have been efforts to estimate prevalence in hospital as well as within care homes&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;17</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">However&#44; more evidence for the usefulness of the EWGSOP definition in clinical practice is needed especially where there is need to disentangle the interactive effects of malnutrition and cachexia&#46; In this issue of Rev Clin Esp&#44; Rubio-Maicas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> determined the prevalence of sarcopenia in patients hospitalized in a medium to long stay unit&#46; Their study was a descriptive&#44; cross sectional observational study of patients undergoing non-end stage palliative treatment&#44; convalescence and rehabilitation over the course of one year&#46; This was novel as prevalence of sarcopenia has not&#44; to date&#44; been described in this setting&#46; Their use of the EWGSOP definition relied on the ascertainment of grip strength&#44; muscle mass&#44; measured by bioelectrical impedance and expressed as an index &#40;muscle mass&#47;height<span class="elsevierStyleSup">2</span>&#41; and physical performance measures&#46; This setting also allowed measurements of various other anthropometric indices&#44; functional status through the Barthel index&#44; cognition and length of stay&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Their study of 166 patients&#44; of whom 86 &#40;51&#46;8&#37;&#41; were women showed that 146 patients had severe reductions in grip strength as well as moderate to severe reductions in muscle mass&#46; Perhaps striking is that only four patients could perform all the tests of physical performance&#46; It is therefore not surprising that the prevalence of sarcopenia was 73&#46;7&#37; in women and 79&#46;2&#37; in men&#46; In their paper&#44; 151 patients had severe sarcopenia &#8211; that is&#44; reduction in grip strength&#44; muscle mass as well as decreased walking speed&#46; What is not clear is how patients were classified according to sarcopenia status using the EWGSOP algorithm and how these prevalence data were calculated&#46; Given these were patients admitted from both medical and surgical specialties&#44; it would also be important to know whether the degree of comorbidity correlated with sarcopenia prevalence&#44; and to see demographic&#44; anthropometric and phenotypic characteristics according to EWGSOP sarcopenia status&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">International efforts in defining sarcopenia were a significant milestone in sarcopenia research and figures describing the prevalence of sarcopenia in different populations are now available&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;19&#44;20</span></a> Whereas describing prevalence of sarcopenia in the community has been relatively less complicated&#44; accurately describing prevalence in hospitalized older people is harder&#46; This paper highlights this significant stumbling block&#46; For this reason it is difficult to compare and contrast prevalence data obtained from studies in the community&#46; More evidence for the usefulness of sarcopenia diagnostic algorithms within clinical settings is needed<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and the authors have gone some way to show this&#46; Furthermore&#44; as this paper highlights&#44; disentangling the effects of co-morbidity&#44; cachexia and inflammation&#44; which impart significant catabolic insult on the muscle of older people who have been hospitalized is challenging&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Pragmatic approaches to the identification of sarcopenia&#44; which do not rely on resource intensive scanning or scarce reference data are required to characterise the burden of sarcopenia in a wide range of populations&#46; It is clear that sarcopenia case finding is important&#46; Standardisation of methodology is important if we are to provide accurate data on sarcopenia prevalence&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Incorporation of walking speed and grip strength into routine clinical assessment may well be the direction forward in identifying patients who would need further diagnostic testing&#46; What of those patients who are not ambulant&#63; Does the research and clinical community need a modified diagnostic algorithm to identify outcomes as well as cut-offs relevant to the population being studied in order to identify parameters for preventative and therapeutic intervention&#63; There are still many unanswered questions&#59; however&#44; they do lend themselves to a promising future in sarcopenia research&#46;</p></span>"
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                        "paginaInicial" => "423"
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