2019肌少症定义和诊断的亚洲肌少症工作组共识(2019

Abstract

Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as “age-related loss of muscle mass, plus low muscle strength, and/or low physical performance” and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength <28 kg for men and <18 kg for women; criteria for low physical performance are 6-m walk <1.0 m/s, Short Physical Performance Battery score 9, or 5-time chair stand test 12 seconds. AWGS 2019 retains the original cutoffs for height-adjusted muscle mass: dual-energy X-ray absorptiometry, <7.0 kg/m2 in men and <5.4 kg/m2 in women; and bioimpedance, <7.0 kg/m2 in men and <5.7 kg/m2 in women. In addition, the AWGS 2019 update proposes separate algorithms for community vs hospital settings, which both begin by screening either calf circumference (<34 cm in men, <33 cm in women), SARC-F (4), or SARC-CalF (11), to facilitate earlier identification of people at risk for sarcopenia. Although skeletal muscle strength and mass are both still considered fundamental to a definitive clinical diagnosis, AWGS 2019 also introduces “possible sarcopenia,” defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions. Although defining sarcopenia by body mass indexeadjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, more evidence is needed before changing current recommendations. Lifestyle interventions, especially exercise and nutritional supplementation, prevail as mainstays of treatment. Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia in Asians.

Age-related loss of skeletal muscle, termed “sarcopenia,” has grave physiological and clinical consequences.1e4 The original operational definition compared loss of appendicular skeletal muscle mass (ASM) in older adults relative to sex-specific ASM measurements of 20- to 40-year-olds; however, there was no universal definition of muscle strength.1,2 In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) proposed a diagnostic algorithm for sarcopenia, in which both muscle quantity and quality were cardinal requirements.4 Subsequently, sarcopenia research burgeoned worldwide,2 Asia being no exception. However, diagnosing sarcopenia in Asian people requires some special considerations because of anthropometric and cultural or lifestyle-related differences compared with Western contemporaries; for example, relatively smaller body size, higher adiposity, and less mechanized, more physically active lifetimes.5

In 2014, the Asian Working Group for Sarcopenia (AWGS) proposed a diagnostic algorithm based on Asian data; this resembled EWGSOP 2010 but, besides measurement protocols, clearly defined cutoffs for individual diagnostic components.5 AWGS 2014 invigorated sarcopenia research in Asia, which augmented the evidence base, and ongoing AWGS discussions consolidated the challenges and questions in sarcopenia. The AWGS6 reported important advances in 2016 and planned to update its consensus accordingly.

Sarcopenia was assigned an individual International Statistical Classification of Diseases and Related Health Problems code (M62.84) in 2016, which stimulated diagnostic and therapeutic trials internationally. Japan published clinical practice guidelines for sarcopenia in 2018,7 which systematically reviewed the latest evidence and promoted awareness. The EWGSOP issued an updated consensus in 2019 (EWGSOP2).8

笔记

成员很少有内地的,毕竟研究经费都是日本港台机构出

This research was supported by funding from the National Center for Geriatrics and Gerontology (NCGG), Research Funding for Longevity Sciences (28-30) Japan, the Hong Kong Geriatrics Society (HKGS) and the Taiwan Association of Integrated Care (TAIC). The NCGG, HKGS, and TAIC were not involved in designing the study, nor subject recruitment, acquiring or analyzing data, or preparing the article.

a Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan b Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan c Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R., China d Division of Geriatric Medicine, Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand e The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong S.A.R, China f Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan g Institute of Gerontology, The University of Tokyo, Tokyo, Japan h Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea i Department of Geriatrics, Peking Union Medical College Hospital, Beijing, China j Department of Biomedical Science and Technology, College of Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Korea k Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea l Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan m Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan n Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea o Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea p Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yilan, Taiwan q Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea r Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore s Department of Geriatric Medicine, Osaka University Graduate School of Medicine, Osaka, Japan t Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan u Beijing Institute of Geriatrics, Beijing Hospital, Ministry of Health, Beijing, China v National Center for Geriatrics and Gerontology, Obu, Aichi, Japan

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