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• W2875266306 abstract "ViewpointRejuvenation of the term sarcopeniaJacob Bülow, Stanley J. Ulijaszek, and Lars HolmJacob BülowInstitute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark, Stanley J. UlijaszekInstitute of Social and Cultural Anthropology, University of Oxford, United Kingdom, and Lars HolmDepartment of Biomedical Sciences, University of Copenhagen, DenmarkSchool of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, United KingdomPublished Online:29 Jan 2019https://doi.org/10.1152/japplphysiol.00400.2018This is the final version - click for previous versionMoreSectionsPDF (40 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat It is our viewpoint that the recent consensus definitions of sarcopenia are dysfunctional for clinical and experimental practice as well as in theory. In 1989, the term sarcopenia was introduced to describe the phenomenon of age-related loss of lean body mass (10). Since 2010, six consensus definitions have been presented, and in 2016, it was assigned its own ICD-10 code (1, 3, 5, 6, 8, 9, 11). A comparison of the original definition with the new consensus definitions clarifies how the term sarcopenia no longer describes the phenomenon it originally addressed. Rather, the term is now caught in tautological association, which causes confusion and hinders rather than helps understanding of this condition.The Original DefinitionIn 1989, Rosenberg (10) observed that the phenomenon of decreasing lean body mass with older age had not been given the scientific attention it deserved and drew attention to it by suggesting a name combining the two words sarco (meaning flesh) and penia (meaning loss) in accordance with the characteristic that it described. The focus of this original definition was the loss of muscle mass as a discrete phenomenon, with a leading interest in legitimizing clinical and scientific attention to it (10). This definition of sarcopenia was used descriptively with the purpose of defining and articulating the loss of skeletal muscle mass, as a concrete object.The New Consensus DefinitionsBetween 2011 and 2014, six consensus definitions of sarcopenia were agreed upon (3, 5, 6, 8, 9, 11). These shifted the focus from the original phenomenon of loss of skeletal muscle mass to that of physical function. All of these definitions employ an algorithm with the same logic. Physical function capability is initially assessed (gait speed or grip strength) and, only if function is impaired below a cut-point, is muscle mass (as the appendicular lean mass) secondarily evaluated. Hence, low muscle mass is not a single stand-alone determinant by which sarcopenia is defined, and having only a low muscle mass is not an adequate criterion by which to be defined as being sarcopenic. Physical function is not synonymous with muscle function, although the concepts are sometimes used interchangeably in the six consensus articles. Physical function is an interplay between multiple organ systems that can be estimated through tests like gait speed, whereas skeletal muscle, other than having the capability of contracting and allowing movement, has many functions in metabolism and as an endocrine organ.The consensus definitions were made by working groups, with representatives from different societies within the geriatric field in Europe, the United States, and Asia, two of them receiving partial funding from the pharmaceutical industry. Discussion surrounding these definitions focuses most strongly on determination of the exact cut-off values for both physical function tests and muscle mass measurements. Surprisingly, the theoretical framework underpinning the definitions is not discussed thoroughly in any of the articles and arguments for the inclusion of physical function is found in only three (5, 8, 11) of the six papers. They share one main argument only, that the original definition is not clinically relevant.Questioning the Reasoning for Changing the DefinitionThe main argument for including physical function in the definition is at least twofold. First, if a well-defined phenomenon is not clinically relevant, changing the definition does not make it become clinically relevant. Instead, it changes the phenomenon under consideration. Second, every definition can become clinically relevant by adding a criterion that is clinically relevant, as in this case with physical function. The linking of loss of skeletal muscle mass to physical function reflects the logic behind the change of focus in the research field of sarcopenia, which is notably absent from the consensus articles. During the 1990s there was a research drive to develop operational criteria for cutoff values for categorizing adults as suffering from sarcopenia. The initial suggestion for an operational criterion and cutoff value was established by Baumgartner in 1998 (2), who legitimized the criterion by showing its association with a decrease in physical function and mortality. This initiated the shift in focus from muscle mass to physical function. From around 2000, the research focus shifted to considerations of how muscle strength and physical function such as gait speed have stronger association than low muscle mass to a decrease in physical function and mortality. Instead of concentrating on the loss of muscle mass, research interest centered on the robustness of the phenomenon’s association with decreased physical function and mortality, thereby making physical function the primary object of interest.From a clinical perspective it appears reasonable to focus on the phenomenon with the strongest association to a negative health outcome. However, in this case, the outcome and the phenomenon is almost, if not exactly, identical, and the argument for the change of focus from muscle mass to physical function is a tautology—arguing that there should be a change in focus from decreased muscle mass to decreased physical function, since a decrease in physical function has a stronger association with a decrease in physical function.There are several consequences of the change in definition. According to the algorithms used in the consensus definitions, skeletal muscle is only of value to the definitions if it is associated with bodily movement. If gait speed is not reduced, presence of a low muscle mass is irrelevant according to the consensus definitions. This is despite the fact that skeletal muscle is the largest metabolic organ of the body and is crucial in the endocrine regulation of metabolism as well as being the body’s largest reservoir of amino acids (7). Such functions are likely to be overlooked clinically when the primary inclusion criterion for sarcopenia is physical function and not muscle mass. Likewise, physical function is at risk of being reduced to the question of muscle mass when both are directly coupled in the definition (4). Furthermore, it reduces the relevance of the term in other clinical specialties such as nephrology and endocrinology, where muscle mass per se could be of clinical importance for both categorizing patients as well as in selecting treatment. Beside the reductionist understanding of the two different phenomena, the new definitions also lead to general confusion of what is meant by the term sarcopenia, since it no longer covers one but two phenomena.ConclusionSince the reasoning behind the change in definition of sarcopenia rests upon a tautological association and that the meaning of the term has become misleading as it no longer corresponds with the phenomenon that it addresses, we suggest a return to the use of the original definition for future research. ‘Sarcopenia’ should exclusively be used as a descriptive term addressing age-related loss of muscle mass. This would return focus onto uncovering the causes and consequences of the phenomenon, and clinicians will hereby have an unambiguous and useful term. Perhaps returning to the original definition could cause confusion in relation to acceptance of age-related loss of muscle mass as a clinical relevant phenomenon. However, the theoretical foundations of the consensus definitions are tautological, and we anticipate that the consequences of these definitions would continue to create confusion. There may be other and better definitions than the original but since nobody will benefit from the current consensus definitions, breaking out of the tautology is necessary to allow science and clinical practice to move on.GRANTSGrant provided by P. Carl Petersen Fond, Stipend from RegionH.DISCLOSURESNo conflicts of interest, financial or otherwise, are declared by the authors.AUTHOR CONTRIBUTIONSJ.B. conceived and designed research; J.B., S.J.U., and L.H. drafted manuscript; J.B., S.J.U., and L.H. edited and revised manuscript; J.B., S.J.U., and L.H. approved final version of manuscript.REFERENCES1. Anker SD, Morley JE, von Haehling S. Welcome to the ICD-10 code for sarcopenia. J Cachexia Sarcopenia Muscle 7: 512–514, 2016. doi:10.1002/jcsm.12147. Crossref | PubMed | ISI | Google Scholar2. 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Crossref | PubMed | ISI | Google ScholarAUTHOR NOTESAddress for reprint requests and other correspondence: J. Bülow, Institute of Sports Medicine, Copenhagen M81, Bispebjerg Hospital (Building 8, level 1), Nielsine Nielsens Vej 11, 2400 Copenhagen NV, Denmark (e-mail: jacob.[email protected]dk). Download PDF Previous Back to Top Next FiguresReferencesRelatedInformation Related ArticlesCommentaries on Viewpoint: Rejuvenation of the term sarcopenia 29 Jan 2019Journal of Applied PhysiologyCited BySarcopenia in chronic kidney disease: prevalence by different definitions and relationship with adiposityApplied Physiology, Nutrition, and Metabolism, Vol. 47, No. 9Association of Low Muscle Mass With Cognitive Function During a 3-Year Follow-up Among Adults Aged 65 to 86 Years in the Canadian Longitudinal Study on Aging1 July 2022 | JAMA Network Open, Vol. 5, No. 7Influence of Walking as Physiological Training to Improve Respiratory Parameters in the Elderly Population29 June 2022 | International Journal of Environmental Research and Public Health, Vol. 19, No. 13Association between sarcopenia and clinical outcomes in chronic kidney disease patients: A systematic review and meta-analysisClinical Nutrition, Vol. 41, No. 5Dietary protein requirements and recommendations for healthy older adults: a critical narrative review of the scientific evidence20 October 2021 | Nutrition Research Reviews, Vol. 37Aging biomarkers and the measurement of health and risk23 February 2021 | History and Philosophy of the Life Sciences, Vol. 43, No. 1The Dunkin Hartley Guinea Pig Is a Model of Primary Osteoarthritis That Also Exhibits Early Onset Myofiber Remodeling That Resembles Human Musculoskeletal Aging29 October 2020 | Frontiers in Physiology, Vol. 11Impact of using the updated EWGSOP2 definition in diagnosing sarcopenia: A clinical perspectiveArchives of Gerontology and Geriatrics, Vol. 90 Preserving Mobility in Older Adults with Physical Frailty and Sarcopenia: Opportunities, Challenges, and Recommendations for Physical Activity Interventions 1 September 2020 | Clinical Interventions in Aging, Vol. Volume 15Functional and/or structural brain changes in response to resistance exercises and resistance training lead to cognitive improvements – a systematic review10 July 2019 | European Review of Aging and Physical Activity, Vol. 16, No. 1Physical function‐derived cut‐points for the diagnosis of sarcopenia and dynapenia from the Canadian longitudinal study on aging15 July 2019 | Journal of Cachexia, Sarcopenia and Muscle, Vol. 10, No. 5Exercise-Induced Mitohormesis for the Maintenance of Skeletal Muscle and Healthspan Extension11 July 2019 | Sports, Vol. 7, No. 7Last Word on Viewpoint: Rejuvenation of the term sarcopeniaJacob Bülow, Stanley J. Ulijaszek, and Lars Holm29 January 2019 | Journal of Applied Physiology, Vol. 126, No. 1Commentaries on Viewpoint: Rejuvenation of the term sarcopenia29 January 2019 | Journal of Applied Physiology, Vol. 126, No. 1 More from this issue > Volume 126Issue 1January 2019Pages 255-256 Copyright & PermissionsCopyright © 2019 the American Physiological Societyhttps://doi.org/10.1152/japplphysiol.00400.2018PubMed30001155History Received 8 May 2018 Accepted 9 July 2018 Published online 29 January 2019 Published in print 1 January 2019 Metrics" @default.
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