AIM Member Spotlight: European Working Group on Sarcopenia in Older People (EWGSOP)

In 2010, AIM Member European Working Group on Sarcopenia in Older People (EWGSOP) developed the Sarcopenia European consensus on definition and diagnosis guidelines, a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics—European Region and the International Association of Nutrition and Aging, all of which endorsed the final document.

The resulting document used medical literature to build an evidence-based definition of sarcopenia, identify parameters to be used in clinical research to identify the presence of sarcopenia, as well as propose appropriate measurement tools and cut-off points for studies in the development of treatments and interventions.

Dr. Alfonso J. Cruz-Jentoft, a specialist in Geriatrics and Gerontology. head of the Geriatric Department, University Hospital Ramon y Cajal in Madrid and head of the Geriatric Unit of the Ruber Clinic in Madrid., is a leader of EWGSOP and spoke more about the impact that the European Consensus has had on research and development efforts for treatments and interventions around sarcopenia and where we go from here to find ways to manage, treat and prevent this geriatric syndrome.

How do you think the Sarcopenia European consensus on definition and diagnosis has helped researchers and clinicians to move forward in research, treatment development and clinical practice, both in Europe and in the US? What obstacles remain to achieve consensus?

The European Consensus is now widely used both for research and clinical practice. In less than 3 years it has been cited 205 times in other scientific papers, and the number of ongoing studies using it is high all around the world. It is relevant to mention that it is widely used in Asia, where it has been translated into Japanese by the Japan Geriatric Society.

Research on the European Consensus is now exploring the links of sarcopenia with outcomes, ways in which to measure each of the three parameters of the definition (muscle mass, strength and physical performance) in different settings and epidemiologic studies, and exploring the use of the algorithm for case finding and other aspects.

How has the idea of sarcopenia as a geriatric syndrome been received in the research/clinical communities? How will it help the process of treatment development and prevention?

The idea of sarcopenia as a geriatric syndrome seems to be well accepted, and is usually been explored in parallel to the concept of frailty as a geriatric syndrome. The syndromic approach allows for a better understanding of the complexity of the pathophysiology of sarcopenia, so many basic researchers are using it, as well as the need to use multifaceted approaches for successful management.

How is the European consensus being used now?

As mentioned, it is mostly used now in clinical research. As results are showing that sarcopenia is a risk factor for impaired outcomes, there is a big movement in Europe trying to find ways to incorporate measures of sarcopenia in clinical practice, especially in high risk settings (nursing homes, geriatric practices). There is also some focus on “acute” sarcopenia, i.e., muscle wasting in the acute care setting.

What are the future plans and steps that EWGSOP will take in this area? Are there other research projects that EWGSOP members are working on?

At this time, the EWGSOP has expanded with people from US, Mexico, Turkey and several Asian countries to conform the International Sarcopenia Initiative. A new paper with a systematic review on screening/case finding, nutritional intervention and exercise is in preparation, and will be presented at the EUGMS Congress in October 2013.

Can you comment on your latest paper Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study and how it can help the research community to move forward in the area of sarcopenia treatment and prevention?

The value of the ilSIRENTE paper is the link with outcomes. It is quite well accepted now that measures of muscle mass by themselves do not correlate directly with adverse outcomes. Measures of muscle strength do correlate with disability, but not so clearly with other outcomes, and loss of muscle strength may be a marker for many diseases.

This paper shows that the new definition of sarcopenia identifies a specific condition that is linked with one of the most solid adverse outcomes: death, even after adjusting for many variables, including some measures of disability. Thus, although sarcopenia may increase mortality through disability, it may be detrimental by other pathways and is by itself a relevant health problem.

This finding also underlines the idea that looking for treatments or preventing sarcopenia may have an important impact, not only on function but on lifespan, and will help health authorities to consider sarcopenia as a disease or syndrome where treatments will have to be explored in clinical trials.