What is Sarcopenia?

Sarcopenia is a condition where reduced muscle mass can lead to decline in physical ability. The most widely accepted definition is from the European Working Group on Sarcopenia in older people (EWGSOP) that was created in 2010 [1,2].

Sarcopenia is usually age-related (geriatric patients), but can occur prematurely due to severe, chronic illnesses (such as cancer, stroke etc) .  Other causes of sarcopenia includes inactivity and malabsorption (fig. 1)

. Sarcopenia not only diminishes the quality of life itself but also increases the risk of other comorbidities such as trauma. EWGSOP2 also has recently classified sarcopenia into acute and chronic (less than 6 months and more than 6 months respectively)[2]. 

F-A-C-S approach[3]:

This is to screen and diagnose cases of sarcopenia.

Find-Cases: EWGSOP advises use of questionnaire or clinical supicion to find sarcopenia - asscoated symptoms.

Assess: by grip strength or a chair stand measure. 

Confirm:  DEXA for clinical practice. DEXA, CT, MRI and BIA for research. 

Severity Assessment: by ait speed, (Short Physical Performance Battery Protocol)SPPB, TUG test, 400-m walk

 

Fraility is often confused with sarcopenia. It is a different entity.

Frailty is defined as a condition as meeting three of five of these criteria: low grip strength, low energy, slowed walking speed, low physical activity, and unintentional weight loss. Another terminology which appears similar is ‘cachexia’. This can be considered as secondary sarcopenia.

Pathophysiology:

Possible theories/factors include.

• Reduction of growth hormone and sex-steroid hormones with age.
• Reduced mobility leading to reduced muscle mass.
• Reduced nutrition.
• Myokines and cytokines.
• Metabolic function leading to fat accumulation.

Clinical Impact (Fig. 2)

:

• Reduced survival in patients with malignancies.
• Increased post-operative morbidity and mortality (in cases of liver transplantation, abdominal aneurysm repair, curative surgeries for malignancies etc).
• Predictive risk factor for mortality in ICU and Emergency care.