New parameters for diagnosing sarcopenia have been proposed

Skeletal myasopenia is a clinical syndrome characterized by a progressive and widespread decline in skeletal muscle mass, strength, and function, widely recognized as part of
aging.
Early diagnosis is extremely important, starting with measuring the grip
with a dynamometer.

Researchers at the Federal University of Söo Carlos (UFSCar) in Paulo, Brazil, recently conducted a study in collaboration with colleagues at University College London (UCL) in the United Kingdom, and concluded that the diagnostic protocol should be changed to improve the cut-off point
of grip strength used to detect muscle weakness.
They say the new criteria proposed in their paper will better predict the risk of death in older adults, allowing healthcare professionals to detect the onset
of skeletal sarcopenia earlier and more accurately.

The researchers compared cut-off points
proposed in previous studies on the topic.
Their analysis is based on the UK Longitudinal Study on Ageing (ELSA), which followed 6182 men and women aged 60 and over for up to 14 years
.

The UFSCar/UCL study was supported by FAPESP and published in
the journal Age and Ageing.

The researchers used a diagnostic definition published in 2010 and revised in 2019 by the European Working Group on Skeletal Skeletia in the Elderly (EWGSOP), according to which the cut-off value for grip strength is 27 kg for men and 16 kg
for women.
The article recommends raising it to 36 kg and 23 kg
, respectively.

"We found that lower cut-off values are not predictors of death risk
.
The purpose of the new reference value is to detect the risk of
death as early as possible.
Interventions such as dietary changes and resistance exercise are difficult to implement
if detected late.
Therefore, it is important that our proposal is accepted by the scientific community and becomes a new consensus for diagnosing sarcopenia," said Tiago da Silva Alexandre, the
last author of the article.
Alexander is a professor in the Department of Gerontology at UFSCar and a visiting fellow
at University College London.

The lower threshold proposed in 2019 has been questioned
by the academic community.
"Other studies have shown that there are problems with the way to diagnose skeletal myopenia, but we are the first to come up with cut-off values that predict the risk of death and compare them to
the cut-off values that are being used," he said.

With this comparison, the researchers were able to understand why the 2019 standards didn't work
well.
"In addition to failing to predict the risk of death, diagnostic approaches to sarcopenia underestimate the prevalence of the condition
.
Our study shows that gait speed is a better indicator
of mortality risk when the threshold is low.
However, this criterion only applies to cases of advanced skeletal muscle reduction, and prevention of these cases may no longer be possible," said
Maria Claudia Bernardes Spexoto, lead author of the article and professor at the Faculty of Health Sciences (FCS-UFGD) at the Federal University of Gran Durados do Sul, Mato Grosso do Sul, Brazil.

Loss of muscle mass, strength, and function is more widely
affected than movement disorders, lack of autonomy, and fall risk in older adults.
"Muscles have more functions
besides contracting and generating strength.
They are involved in immune and endocrine processes
.
For example, they help control certain infections
through the immune system.
They also help control blood sugar," Alexander said
.

Therefore, muscle mass and mass should be monitored
.
"The skeletal muscle system is involved in several other systems
of the body.
If older people have good muscle mass and mass, they will have a wonderful old age
.
There's no doubt about that," he said
.

Risk of death

According to the results of the new study, according to the definition of EWGSOP, the risk of death is 30%
higher in patients with "probable sarcopenia" or prosarcopenia than in patients without sarcopenia.
Patients with skeletal myasopenia had a 48% higher risk of death than controls, and those with severe skeletal myasopenia had a 78%
higher risk of death than controls.

Notably, the study took into account all-cause mortality and adjusted for relevant variables (independent variables) such as sex, age, household income, marital status, schooling, smoking, alcohol intake, physical activity, arterial hypertension, diabetes, cancer, lung disease, heart disease, stroke, falls, depressive symptoms, memory status, number of medications, and abdominal obesity
.

Alexandre said the difficulty in predicting the risk of death at lower thresholds lies in the monitoring period
of the study.
The previous survey followed older adults for a maximum of 6 years, while the UFSCar/UCL team used a follow-up period of 14 years
.

"Studies that propose lower cut-off values either did not estimate the risk of death or used data from very short monitoring times, so the results are
incorrect," Alexander said.
"Obviously, people with weaker muscle strength die faster, which prevents those at risk in the medium to long term from being accurately identified
.
"

The loss of muscle mass, strength, and function does not happen overnight, but gradually over
a period of time.
"The natural history of skeletal sarcopenia is that it happens slowly, day after day
," he said.

Generally underestimated

The impact of the new boundaries proposed by the UFSCar/UCL panel is significant
.
In addition to this, it will also affect the statistics
of skeletal muscle to reduce the prevalence.
"A higher cut-off means a higher prevalence and more patients must be screened to be detected
before the disease becomes a risk of death," Alexandre said.

Differences in EWGSOP guidelines developed in 2010 and 2019 led to differences in prevalence, ranging from 11% to 27.
7% with the former and 4.
6% to 13.
6%
with the latter.

The researchers calculated higher prevalence values based on cut-off values of 36 kg and 23 kg: anterior muscle reduction of 33.
9%, confirmed muscle reduction of 6.
2%, and severe myasopenia of 8.
6%.

"If properly diagnosed and treated, the prevalence of this disease is high and can be controlled, improving the quality of life of older people and avoiding premature death
," Alexander said.
"We are planning a new study based on these boundaries to estimate the prevalence of skeletal muscle reduction in Brazilians over 60 years of age
.
"