Sarcopenia

Andrew Ardeljan; Razvan Hurezeanu

Sarcopenia

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Continuing Education Activity

Sarcopenia is a musculoskeletal disease in which muscle mass, strength, and performance are significantly compromised with age. Sarcopenia most commonly affects elderly and sedentary populations and patients who have comorbidities that affect the musculoskeletal system or impair physical activity. This activity reviews the evaluation and treatment of sarcopenia and highlights the role of the interprofessional team in the care of patients with this condition.

Objectives:

Summarize the etiology of sarcopenia.
Describe the pathophysiology of sarcopenia.
Outline the screening indications for sarcopenia.
Explain the importance of collaboration and communication amongst the interprofessional team to improve outcomes for patients affected by sarcopenia.

Introduction

Sarcopenia is a musculoskeletal disease generally defined by the progressive loss of muscle mass and strength, particularly in elderly populations.[1] The diagnosis of sarcopenia encompasses decreased levels of the following 3 traits: muscle strength, muscle quantity or quality, and physical performance.[1] Such musculoskeletal degeneration may impede daily activities and demonstrates predictive value regarding unfavorable postoperative outcomes, and increased complication rates, mortality, and morbidity in major surgical procedures.[2][3][4][5][6][7]

Additionally, sarcopenia is strongly associated with a greater incidence of falls and increased fracture risk.[8] Furthermore, decreased muscle mass or muscle function, both criteria for sarcopenia, are risk factors for loss of independence in patients over the age of 90 years old.[9] Sarcopenia has become an increasingly studied condition and recently received a specific International Classification of Disease (ICD) 10 code to better distinguish it from similar or co-existing diseases that manifest with muscular wasting.

Etiology

Causes of sarcopenia are generally attributable to the natural processes of aging, which are not entirely understood and are multifaceted.[10] Factors contributing to its development include decreased type II muscle fiber size and number, inactivity, obesity, insulin resistance, reduced androgen and growth factor serum concentrations, inadequate protein intake, and a blunted muscle protein synthesis (MPS) response to protein meals or resistance exercise.[11][12][13][14][15][16][17]

Additionally, sarcopenia is associated with and may, in part, be caused by several chronic diseases that negatively affect the musculoskeletal system and physical activity.[10] These include chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), chronic kidney disease (CKD), diabetes mellitus (DM), human immunodeficiency virus (HIV), and cancer.[18][19][20][21][22][23]

Theoretically, the role of these disease processes on sarcopenia may exert themselves primarily through direct effects on muscle function, or secondarily through retardation of physical activity or caloric restriction.[24] It should be noted that in the context of cancer, cachexia is more commonly assessed as an indicator of tissue loss than is sarcopenia, though the clinical presentations of both diseases demonstrate significant overlap.[25]

Epidemiology

The prevalence of sarcopenia is estimated within the ranges of 5 – 13% and 11 – 50% in patients aged 60 and above, and 80 and above, respectively.[26] The worldwide prevalence of sarcopenia in patients over the age of 60 is estimated to be 10%.[27] Variations observed among studies are likely due to inconsistent diagnostic criteria, and heterogeneous populations studied. Sarcopenia almost exclusively affects elderly populations and affects both sexes equally.[27] Data regarding sarcopenia and ethnicity is inconsistent among studies. Furthermore, the prevalence of sarcopenia is greater in patients with chronic diseases such as COPD, CHF, CKD, DM, HIV, and cancer.[18][19][20][21][22][23]

Pathophysiology

Generally, a significant decline of type II, but not type I muscle fibers are observed in sarcopenic patients.[28] Several mechanisms of the underlying pathophysiology of sarcopenia have been described:

Age-related declines in anabolic hormone serum concentrations: Normal physiological serum levels of anabolic hormones such as testosterone, human growth hormone (HGH), and insulin-like growth factor-1 (IGF-1) have been demonstrated to function in the development, maintenance, or rejuvenation of muscle tissue.[29][30][31][32] Age-related declines of such hormones are observed in patients with sarcopenia and thus, support this underlying pathophysiology of the disease.[33]
Insulin resistance with “sarcopenic obesity”: Aging patients often experience changes in body composition represented by increased adipose tissue alongside decreased muscle mass, coined as “sarcopenic obesity.”[34] These changes are associated with metabolic dysfunction, including insulin resistance (IR), leading to the accumulation of visceral fat mass.[35] Additionally, IR is inversely associated with skeletal muscle mass.[36] Such pathophysiology is likely mediated via dysfunction of insulin’s exerted effects on skeletal muscle – insulin resistance impairs the anti-proteolytic and MPS enhancing properties of the hormone on skeletal muscle tissue.[37] Similarly, diminished lean body mass reduces uptake of glucose into skeletal muscle, further propagating IR.[38][39]
Age-related neurodegeneration: Progressive neurodegeneration is a commonly observed phenomenon in aging populations.[40] Aging is accompanied by a decline of alpha motor neurons in the spinal cord, loss of peripheral nerve fibers, and reduced number of neuromuscular junctions.[33][41] Considering the role of the neurological system in muscle fiber recruitment, current evidence supports neurodegeneration as underlying pathophysiology for reduced muscle strength and size in sarcopenia.[41]
Age-related increase in inflammatory markers: Elevated levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF), interleukin (IL)-6, and IL-1 are observed in elderly populations.[42] The catabolic effects that may be exerted by these cytokines on skeletal muscle are well documented and may present a mechanism in which sarcopenia develops with age.[43][44][45]

History and Physical

Sarcopenia is characterized by decreased muscle strength, quantity, and physical performance. Patients with sarcopenia are often elderly, sedentary, and may present with various comorbidities or disabilities, with a subsequent decrease in function and quality of life. A patient history consistent with sarcopenia includes progressive loss of muscle mass, strength, and function to the extent that daily activities become increasingly difficult to accomplish.

Evaluation

Patient evaluation for sarcopenia includes several modalities and screening tools, some of which are more readily available and practical than others. Evaluation ranges from screening questionnaires to radiographic imaging to the assessment of muscle mass cross-sectional area (CSA).[1][26] Additionally, the European working group on sarcopenia in older people 2 (EWGSOP2) describes an algorithm that presents as follows: "find-assess-confirm-severity" or F-A-C-S.[1]

Screening Tools to Identify Probable Sarcopenia

Strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire: The SARC-F questionnaire is a screening tool that can be rapidly implemented by clinicians to identify probable sarcopenic patients. The questionnaire screens patients for self-reported signs suggestive of sarcopenia, which include deficiencies in strength, walking, rising from a chair, climbing stairs, and experiencing falls.[46] Each of the self-reported parameters receives a minimum and maximum score of 0 and 2, respectively, with the greatest maximum SARC-F score being 10.[47] Data suggests that a SARC-F score of ≥4 best predicts the need for further, more comprehensive evaluation.[1][46]

Assessing sarcopenia: muscle strength

Handgrip test: Generally, handgrip strength is one of the two methods utilized to quantify muscle strength in patients with suspected sarcopenia. Handgrip strength correlates with strength in other muscles and is therefore used as a surrogate to detect deficits in overall strength.[48] Additionally, decreased handgrip strength predicts poor patient outcomes, including increased lengths of stay (LOS), functional deficits, and death.[48][49] Accurate grip strength measurement and interpretation of results rely on a calibrated dynamometer and relevant reference populations.[50] The Jamar dynamometer is a validated tool in measuring grip strength and may be used for this assessment.[51] The suggested cutoff point for handgrip is <27 kg and <16 kg, for males and females, respectively.[52]
Chair stand test: The chair stand test may be used as a proxy to gauge lower extremity strength, particularly the quadriceps muscles. The chair stand test measures the number of times a patient can stand and sit from a chair, without the use of their arms, over 30 seconds.[53] This test has been established as a valid indicator of lower extremity strength in community-dwelling populations.[54] The suggested cutoff point for the chair stand test is >15 seconds for five rises.[53]

Confirming sarcopenia: Muscle quantity or quality

To date, there is no consensus on the most effective modality for confirming sarcopenia. Each comes with their strengths and weaknesses, and often, greater accuracy presents with the cost of inconvenience. Ultimately the goal of these modalities is to determine whether patients meet the requirement of sarcopenia through quantifying total body skeletal muscle mass (SMM), appendicular skeletal muscle mass (ASM), or the cross-sectional area of a specific muscle. Because overall body mass is correlated with SMM, SMM, or ASM, it may be adjusted for height or BMI, yielding ratios in the format of (ASM/height^2), (ASM/weight), or (ASM/BMI). The recommended cutoff for ASM is <20 kg and <15 kg, for males and females, respectively.[55] Similarly, the recommended cutoff for ASM/height^2 is <7.0 kg/m^2 and <5.5 kg/m^2 for males and females, respectively.[56]

Magnetic resonance imaging (MRI): Considered a "gold standard" modality for confirming sarcopenia, MRI can provide highly accurate measurements of total body muscle mass.[57][58][59] However, this modality requires highly trained providers, lacks portability, presents little cost-effectiveness, and is therefore rarely used in the primary care setting.[60][58]
Computed tomography (CT): Also considered a "gold standard" for accurate lean muscle mass measurement, CT is rarely used in the primary care setting for similar reasons than MRI.[58] However, settings in which CT is routinely performed, such as trauma or surgery, this modality presents greater value and practicability, as demonstrated in previous literature.[61] More specifically, CT measured psoas cross-sectional area (PCSA) at the level of the 3rd lumbar vertebrae has consistently predicted outcomes among patient populations in the contexts of gastrointestinal cancer, heart valve surgery, orthopedic trauma, thoracolumbar surgery[62][63][64][65]
Dual-energy X-ray absorptiometry (DEXA): While not as accurate as either CT or MRI, DEXA presents with greater convenience, and is, therefore, a more widely available and practical modality for confirmation of sarcopenia.[1][66]
Bioelectrical impedance analysis (BIA): Perhaps the most widely available and portable modality of muscle mass quantification, BIA may also be used to confirm sarcopenia.[1]

Measuring physical performance to identify sarcopenia severity:

Once sarcopenia is confirmed through body composition assessment, the severity of the condition is determined by measuring physical performance. Suggested tests and their respective cutoff points for sarcopenia severity as recommended by the EWGSOP2 are listed below.

Gait speed test: Gait speed tests are simple to use in practice and predict adverse effects associated with sarcopenia.[67] The "4-meter usual walking speed test" is practical and can be used to assess sarcopenia severity.[68][69] The test measures time taken for a patient to travel 4 meters at their usual walking pace. A speed of ≤0.8 m/s may be indicative of severe sarcopenia.[70]
Short physical performance battery (SPPB): The SPPB test is composed of 3 timed tasks: chair stand tests, standing balance, and walking speed. The minimal and maximal achievable scores are 0 (low performance) and 12 (high performance), respectively. A score of ≤8 is an indicator of poor physical performance and may be indicative of greater sarcopenia severity.[1][71]
Timed-up and go test (TUG): The TUG test observes the time taken for a patient to rise from a chair, walk 3 meters away from, and 3 meters back to the chair, terminating the test in a sitting position. Time ≥20 seconds is indicative of physical deficits, though the study used to support this recommendation failed to assess male populations and therefore, may only apply to elderly female populations.[72]
The 400-meter walk test: In the 400-meter walk test, a patient attempts to walk in a series of 20, 20-meter laps as quickly as possible, with a maximum of 2 minutes rest between each lap. The inability to complete or requiring ≥6 min to complete the entire 400-meters is concerning and may suggest greater sarcopenia severity.[1][73]

Treatment / Management

Physical activity, particularly resistance training, effectively attenuates muscle loss and improves strength in sarcopenia, providing a means of both preventing and managing the condition.[74][75] Additionally, increasing total protein intake through supplementation or food sources can help prevent and manage sarcopenia. Specifically, consuming 20-35 grams of protein per meal is advised, as such amounts provide sufficient amino acid content to maximize MPS, thus minimizing age-related muscle loss.[76] Additionally, patients with sarcopenia are recommended to consume 1.0 - 1.2 g/kg (body weight)/day.[77] Furthermore, the greatest effects are observed when resistance training and high protein diets are combined and appear to act synergistically.[78]

Differential Diagnosis

Considering the high probability that sarcopenia may co-exist with the below conditions and considering the overlap between conditions, an accurate differential diagnosis may be difficult.

Frailty: While sarcopenia and frailty present with significant overlap of symptoms, they remain distinguishable. Frailty is defined as multi-system impairment and encompasses a broader range of dysfunction than sarcopenia, whereas sarcopenia mainly includes the musculoskeletal system. One condition may contribute directly to the other, as they often co-exist in elderly patients.[79][80]
Malnutrition: Both malnutrition and sarcopenia present with low muscle mass, though sarcopenia more often presents with the additional loss of function. Additionally, as a function of caloric restriction, reduced fat mass is observed in patients with malnutrition – this is often not the case with sarcopenia. Functional tests for strength and performance may be administered to rule out malnutrition.[1]
Cachexia: Cachexia is thought to have a more complex etiology than sarcopenia. Cachexia is described as severe weight loss and muscle-wasting associated with conditions such as HIV, cancer, and end-stage organ failure. While cachexia and sarcopenia may co-exist, a patient with severe muscle wasting diseases such as HIV or cancer is more likely to have cachexia. [81] Additionally, the Glasgow prognostic score can be utilized to distinguish the two conditions.[82]
Osteoarthritis of the hand: Patients with osteoarthritis of the hand may elicit a false positive test when performing the handgrip strength test. In cases where severe osteoarthritis is suspected, patients may perform methods to measure isometric torque of the lower limb to more accurately assess or rule out sarcopenia.[1][83]

Prognosis

The prognosis of sarcopenia largely depends on age, comorbidities, falls, and fractures. Additionally, patients who have sarcopenia undergoing surgical procedures have less favorable outcomes than those without sarcopenia. These include an increased risk of postoperative complications, falls, LOS, fractures, and greater morbidity and mortality. Ultimately, the prognosis of sarcopenia alone is uncertain and not well studied, though consistent evidence demonstrates sarcopenia as an indicator of poor prognosis in several medical conditions and surgical procedures.[84]

Complications

Fall, fracture, and nosocomial infection risk in the elderly: In a meta-analysis of 33 studies encompassing 45,926 patients, Yeung et al. found that sarcopenia significantly increases both fall and fracture risk in the elderly.[8] Additionally, sarcopenia increases the risk of nosocomial infection in elderly populations.[85]

Sarcopenia complications in medicine: Sarcopenia is associated with increased mortality in patients with end-stage renal disease, pancreatic cancer, and chronic heart failure.[86][87] Additionally, sarcopenia is associated with increased dose-limiting toxicities (DLT) in patients undergoing chemotherapy for renal cell carcinoma, hepatocellular carcinoma, and breast cancer.[88][89][90]

Sarcopenia complications in surgery: Sarcopenia is associated with increased postoperative complication risk in patients undergoing general surgical procedures and liver transplant surgery.[91][92] Additionally, sarcopenia is associated with greater mortality in patients undergoing general surgical procedures and colorectal surgery.[91][93]

Deterrence and Patient Education

Patients should maintain proper health etiquette and receive routine physicals, making clinicians aware of any perceived changes in health, weight, body composition, or function. Additionally, patients should be made aware of the potential dangers of sarcopenia and how it may affect them and their loved ones, especially in those with multiple comorbidities.

Prevention appears to be the most effective way to deal with the potential issues that sarcopenia presents in the elderly. Nonetheless, prevention, management, and treatment of sarcopenia are most effectively achieved by maintaining physical activity and increased protein intake. Specifically, patients should be educated on the daily and per meal basis protein recommendations. Furthermore, patients should be educated on the benefits of resistance training, in combination with the aforementioned recommendations, to avoid developing or treat or manage sarcopenia.

Enhancing Healthcare Team Outcomes

Sarcopenia presents a great financial burden on the field of healthcare, as well as decreased quality of life in those who suffer from it. Clinicians who care for elderly patients must detect and treat sarcopenia early to reduce these burdens and improve the outcomes of the condition.[1] [Level 4]

To achieve optimal outcomes in clinical practice, advancing interprofessional communication, pharmacological research, patient education, and patient adherence to recommendations is imperative. Currently, the most effective modalities available to fight sarcopenia are physical activity and nutrition optimization. To make the greatest use of this knowledge, clinicians, nutritionists, and physical therapists alike must work together as a team to improve outcomes. Additionally, further research is warranted to investigate pharmacological approaches to treat sarcopenia, as they are currently unavailable.[94] [Level 4]

Details

References

[1]

Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M, Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age and ageing. 2019 Jan 1:48(1):16-31. doi: 10.1093/ageing/afy169. Epub [PubMed PMID: 30312372]

Level 3 (low-level) evidence

[2]

Santilli V, Bernetti A, Mangone M, Paoloni M. Clinical definition of sarcopenia. Clinical cases in mineral and bone metabolism : the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases. 2014 Sep:11(3):177-80 [PubMed PMID: 25568649]

Level 3 (low-level) evidence

[3]

Kim EY, Lee HY, Kim KW, Lee JI, Kim YS, Choi WJ, Kim JH. Preoperative Computed Tomography-Determined Sarcopenia and Postoperative Outcome After Surgery for Non-Small Cell Lung Cancer. Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. 2018 Sep:107(3):244-251. doi: 10.1177/1457496917748221. Epub 2017 Dec 28 [PubMed PMID: 29284364]

[4]

Rangel EL, Rios-Diaz AJ, Uyeda JW, Castillo-Angeles M, Cooper Z, Olufajo OA, Salim A, Sodickson AD. Sarcopenia increases risk of long-term mortality in elderly patients undergoing emergency abdominal surgery. The journal of trauma and acute care surgery. 2017 Dec:83(6):1179-1186. doi: 10.1097/TA.0000000000001657. Epub [PubMed PMID: 28777289]

[5]

El Amrani M, Vermersch M, Fulbert M, Prodeau M, Lecolle K, Hebbar M, Ernst O, Pruvot FR, Truant S. Impact of sarcopenia on outcomes of patients undergoing pancreatectomy: A retrospective analysis of 107 patients. Medicine. 2018 Sep:97(39):e12076. doi: 10.1097/MD.0000000000012076. Epub [PubMed PMID: 30278487]

Level 2 (mid-level) evidence

[6]

Kaido T, Hamaguchi Y, Uemoto S. Significance of preoperative sarcopenia to liver surgery. Hepatobiliary surgery and nutrition. 2019 Feb:8(1):59-62. doi: 10.21037/hbsn.2018.11.05. Epub [PubMed PMID: 30881967]

[7]

Huang DD,Wang SL,Zhuang CL,Zheng BS,Lu JX,Chen FF,Zhou CJ,Shen X,Yu Z, Sarcopenia, as defined by low muscle mass, strength and physical performance, predicts complications after surgery for colorectal cancer. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2015 Nov; [PubMed PMID: 26194849]

[8]

Yeung SSY, Reijnierse EM, Pham VK, Trappenburg MC, Lim WK, Meskers CGM, Maier AB. Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta-analysis. Journal of cachexia, sarcopenia and muscle. 2019 Jun:10(3):485-500. doi: 10.1002/jcsm.12411. Epub 2019 Apr 16 [PubMed PMID: 30993881]

Level 1 (high-level) evidence

[9]

Dos Santos L, Cyrino ES, Antunes M, Santos DA, Sardinha LB. Sarcopenia and physical independence in older adults: the independent and synergic role of muscle mass and muscle function. Journal of cachexia, sarcopenia and muscle. 2017 Apr:8(2):245-250. doi: 10.1002/jcsm.12160. Epub 2016 Nov 8 [PubMed PMID: 27897417]

[10]

Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, Abellan van Kan G, Andrieu S, Bauer J, Breuille D, Cederholm T, Chandler J, De Meynard C, Donini L, Harris T, Kannt A, Keime Guibert F, Onder G, Papanicolaou D, Rolland Y, Rooks D, Sieber C, Souhami E, Verlaan S, Zamboni M. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. Journal of the American Medical Directors Association. 2011 May:12(4):249-56. doi: 10.1016/j.jamda.2011.01.003. Epub 2011 Mar 4 [PubMed PMID: 21527165]

Level 3 (low-level) evidence

[11]

Lexell J, Henriksson-Larsén K, Winblad B, Sjöström M. Distribution of different fiber types in human skeletal muscles: effects of aging studied in whole muscle cross sections. Muscle & nerve. 1983 Oct:6(8):588-95 [PubMed PMID: 6646161]

[12]

Visser M, Harris TB, Langlois J, Hannan MT, Roubenoff R, Felson DT, Wilson PW, Kiel DP. Body fat and skeletal muscle mass in relation to physical disability in very old men and women of the Framingham Heart Study. The journals of gerontology. Series A, Biological sciences and medical sciences. 1998 May:53(3):M214-21 [PubMed PMID: 9597054]

[13]

Morley JE. Hormones and the aging process. Journal of the American Geriatrics Society. 2003 Jul:51(7 Suppl):S333-7 [PubMed PMID: 12823664]

[14]

Vermeulen A, Goemaere S, Kaufman JM. Testosterone, body composition and aging. Journal of endocrinological investigation. 1999:22(5 Suppl):110-6 [PubMed PMID: 10442580]

[15]

Schrager MA, Metter EJ, Simonsick E, Ble A, Bandinelli S, Lauretani F, Ferrucci L. Sarcopenic obesity and inflammation in the InCHIANTI study. Journal of applied physiology (Bethesda, Md. : 1985). 2007 Mar:102(3):919-25 [PubMed PMID: 17095641]

[16]

Dickinson JM, Volpi E, Rasmussen BB. Exercise and nutrition to target protein synthesis impairments in aging skeletal muscle. Exercise and sport sciences reviews. 2013 Oct:41(4):216-23. doi: 10.1097/JES.0b013e3182a4e699. Epub [PubMed PMID: 23873131]

[17]

Granic A, Mendonça N, Sayer AA, Hill TR, Davies K, Siervo M, Mathers JC, Jagger C. Effects of dietary patterns and low protein intake on sarcopenia risk in the very old: The Newcastle 85+ study. Clinical nutrition (Edinburgh, Scotland). 2020 Jan:39(1):166-173. doi: 10.1016/j.clnu.2019.01.009. Epub 2019 Jan 21 [PubMed PMID: 30709690]

[18]

Kim SH, Shin MJ, Shin YB, Kim KU. Sarcopenia Associated with Chronic Obstructive Pulmonary Disease. Journal of bone metabolism. 2019 May:26(2):65-74. doi: 10.11005/jbm.2019.26.2.65. Epub 2019 May 31 [PubMed PMID: 31223602]

[19]

Abdul Aziz SA, Mcstea M, Ahmad Bashah NS, Chong ML, Ponnampalavanar S, Syed Omar SF, Sulaiman H, Azwa I, Tan MP, Kamarulzaman A, Rajasuriar R, Kamaruzzaman SB. Assessment of sarcopenia in virally suppressed HIV-infected Asians receiving treatment. AIDS (London, England). 2018 May 15:32(8):1025-1034. doi: 10.1097/QAD.0000000000001798. Epub [PubMed PMID: 29547442]

[20]

Curcio F, Testa G, Liguori I, Papillo M, Flocco V, Panicara V, Galizia G, Della-Morte D, Gargiulo G, Cacciatore F, Bonaduce D, Landi F, Abete P. Sarcopenia and Heart Failure. Nutrients. 2020 Jan 14:12(1):. doi: 10.3390/nu12010211. Epub 2020 Jan 14 [PubMed PMID: 31947528]

[21]

Souza VA, Oliveira Dd, Mansur HN, Fernandes NM, Bastos MG. Sarcopenia in chronic kidney disease. Jornal brasileiro de nefrologia. 2015 Jan-Mar:37(1):98-105. doi: 10.5935/0101-2800.20150014. Epub [PubMed PMID: 25923756]

[22]

Dunne RF, Loh KP, Williams GR, Jatoi A, Mustian KM, Mohile SG. Cachexia and Sarcopenia in Older Adults with Cancer: A Comprehensive Review. Cancers. 2019 Nov 25:11(12):. doi: 10.3390/cancers11121861. Epub 2019 Nov 25 [PubMed PMID: 31769421]

[23]

Mesinovic J, Zengin A, De Courten B, Ebeling PR, Scott D. Sarcopenia and type 2 diabetes mellitus: a bidirectional relationship. Diabetes, metabolic syndrome and obesity : targets and therapy. 2019:12():1057-1072. doi: 10.2147/DMSO.S186600. Epub 2019 Jul 8 [PubMed PMID: 31372016]

[24]

Friedman PJ, Campbell AJ, Caradoc-Davies TH. Prospective trial of a new diagnostic criterion for severe wasting malnutrition in the elderly. Age and ageing. 1985 May:14(3):149-54 [PubMed PMID: 4013900]

[25]

Chindapasirt J. Sarcopenia in Cancer Patients. Asian Pacific journal of cancer prevention : APJCP. 2015:16(18):8075-7 [PubMed PMID: 26745041]

[26]

von Haehling S, Morley JE, Anker SD. An overview of sarcopenia: facts and numbers on prevalence and clinical impact. Journal of cachexia, sarcopenia and muscle. 2010 Dec:1(2):129-133 [PubMed PMID: 21475695]

Level 3 (low-level) evidence

[27]

Shafiee G, Keshtkar A, Soltani A, Ahadi Z, Larijani B, Heshmat R. Prevalence of sarcopenia in the world: a systematic review and meta- analysis of general population studies. Journal of diabetes and metabolic disorders. 2017:16():21. doi: 10.1186/s40200-017-0302-x. Epub 2017 May 16 [PubMed PMID: 28523252]

Level 1 (high-level) evidence

[28]

Evans WJ, Campbell WW. Sarcopenia and age-related changes in body composition and functional capacity. The Journal of nutrition. 1993 Feb:123(2 Suppl):465-8. doi: 10.1093/jn/123.suppl_2.465. Epub [PubMed PMID: 8429405]

[29]

Yuki A, Otsuka R, Kozakai R, Kitamura I, Okura T, Ando F, Shimokata H. Relationship between low free testosterone levels and loss of muscle mass. Scientific reports. 2013:3():1818. doi: 10.1038/srep01818. Epub [PubMed PMID: 23660939]

[30]

Welle S, Thornton C, Statt M, McHenry B. Growth hormone increases muscle mass and strength but does not rejuvenate myofibrillar protein synthesis in healthy subjects over 60 years old. The Journal of clinical endocrinology and metabolism. 1996 Sep:81(9):3239-43 [PubMed PMID: 8784075]

[31]

Scicchitano BM, Rizzuto E, Musarò A. Counteracting muscle wasting in aging and neuromuscular diseases: the critical role of IGF-1. Aging. 2009 May 13:1(5):451-7 [PubMed PMID: 20157530]

[32]

Baumgartner RN, Waters DL, Gallagher D, Morley JE, Garry PJ. Predictors of skeletal muscle mass in elderly men and women. Mechanisms of ageing and development. 1999 Mar 1:107(2):123-36 [PubMed PMID: 10220041]

[33]

Shin MJ, Jeon YK, Kim IJ. Testosterone and Sarcopenia. The world journal of men's health. 2018 Sep:36(3):192-198. doi: 10.5534/wjmh.180001. Epub 2018 May 11 [PubMed PMID: 29756416]

[34]

Stenholm S, Harris TB, Rantanen T, Visser M, Kritchevsky SB, Ferrucci L. Sarcopenic obesity: definition, cause and consequences. Current opinion in clinical nutrition and metabolic care. 2008 Nov:11(6):693-700. doi: 10.1097/MCO.0b013e328312c37d. Epub [PubMed PMID: 18827572]

Level 3 (low-level) evidence

[35]

Zamboni M, Mazzali G, Fantin F, Rossi A, Di Francesco V. Sarcopenic obesity: a new category of obesity in the elderly. Nutrition, metabolism, and cardiovascular diseases : NMCD. 2008 Jun:18(5):388-95. doi: 10.1016/j.numecd.2007.10.002. Epub 2008 Apr 18 [PubMed PMID: 18395429]

[36]

Srikanthan P, Karlamangla AS. Relative muscle mass is inversely associated with insulin resistance and prediabetes. Findings from the third National Health and Nutrition Examination Survey. The Journal of clinical endocrinology and metabolism. 2011 Sep:96(9):2898-903. doi: 10.1210/jc.2011-0435. Epub 2011 Jul 21 [PubMed PMID: 21778224]

Level 3 (low-level) evidence

[37]

Guillet C, Boirie Y. Insulin resistance: a contributing factor to age-related muscle mass loss? Diabetes & metabolism. 2005 Dec:31 Spec No 2():5S20-5S26 [PubMed PMID: 16415762]

[38]

Boirie Y, Gachon P, Cordat N, Ritz P, Beaufrère B. Differential insulin sensitivities of glucose, amino acid, and albumin metabolism in elderly men and women. The Journal of clinical endocrinology and metabolism. 2001 Feb:86(2):638-44 [PubMed PMID: 11158022]

[39]

Chow LS, Albright RC, Bigelow ML, Toffolo G, Cobelli C, Nair KS. Mechanism of insulin's anabolic effect on muscle: measurements of muscle protein synthesis and breakdown using aminoacyl-tRNA and other surrogate measures. American journal of physiology. Endocrinology and metabolism. 2006 Oct:291(4):E729-36 [PubMed PMID: 16705065]

[40]

Malafarina V, Uriz-Otano F, Iniesta R, Gil-Guerrero L. Sarcopenia in the elderly: diagnosis, physiopathology and treatment. Maturitas. 2012 Feb:71(2):109-14. doi: 10.1016/j.maturitas.2011.11.012. Epub 2011 Dec 6 [PubMed PMID: 22153348]

[41]

Kwon YN, Yoon SS. Sarcopenia: Neurological Point of View. Journal of bone metabolism. 2017 May:24(2):83-89. doi: 10.11005/jbm.2017.24.2.83. Epub 2017 May 31 [PubMed PMID: 28642851]

[42]

Thomas DR. Sarcopenia. Clinics in geriatric medicine. 2010 May:26(2):331-46. doi: 10.1016/j.cger.2010.02.012. Epub [PubMed PMID: 20497850]

[43]

Reid MB, Li YP. Tumor necrosis factor-alpha and muscle wasting: a cellular perspective. Respiratory research. 2001:2(5):269-72 [PubMed PMID: 11686894]

Level 3 (low-level) evidence

[44]

Haddad F, Zaldivar F, Cooper DM, Adams GR. IL-6-induced skeletal muscle atrophy. Journal of applied physiology (Bethesda, Md. : 1985). 2005 Mar:98(3):911-7 [PubMed PMID: 15542570]

[45]

Londhe P, Guttridge DC. Inflammation induced loss of skeletal muscle. Bone. 2015 Nov:80():131-142. doi: 10.1016/j.bone.2015.03.015. Epub [PubMed PMID: 26453502]

[46]

Malmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. Journal of cachexia, sarcopenia and muscle. 2016 Mar:7(1):28-36. doi: 10.1002/jcsm.12048. Epub 2015 Jul 7 [PubMed PMID: 27066316]

[47]

Malmstrom TK, Morley JE. SARC-F: a simple questionnaire to rapidly diagnose sarcopenia. Journal of the American Medical Directors Association. 2013 Aug:14(8):531-2. doi: 10.1016/j.jamda.2013.05.018. Epub 2013 Jun 25 [PubMed PMID: 23810110]

[48]

Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A Jr, Orlandini A, Seron P, Ahmed SH, Rosengren A, Kelishadi R, Rahman O, Swaminathan S, Iqbal R, Gupta R, Lear SA, Oguz A, Yusoff K, Zatonska K, Chifamba J, Igumbor E, Mohan V, Anjana RM, Gu H, Li W, Yusuf S, Prospective Urban Rural Epidemiology (PURE) Study investigators. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet (London, England). 2015 Jul 18:386(9990):266-73. doi: 10.1016/S0140-6736(14)62000-6. Epub 2015 May 13 [PubMed PMID: 25982160]

[49]

Ibrahim K, May C, Patel HP, Baxter M, Sayer AA, Roberts H. A feasibility study of implementing grip strength measurement into routine hospital practice (GRImP): study protocol. Pilot and feasibility studies. 2016:2():27 [PubMed PMID: 27965846]

Level 2 (mid-level) evidence

[50]

Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C, Sayer AA. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age and ageing. 2011 Jul:40(4):423-9. doi: 10.1093/ageing/afr051. Epub 2011 May 30 [PubMed PMID: 21624928]

Level 2 (mid-level) evidence

[51]

Sipers WM, Verdijk LB, Sipers SJ, Schols JM, van Loon LJ. The Martin Vigorimeter Represents a Reliable and More Practical Tool Than the Jamar Dynamometer to Assess Handgrip Strength in the Geriatric Patient. Journal of the American Medical Directors Association. 2016 May 1:17(5):466.e1-7. doi: 10.1016/j.jamda.2016.02.026. Epub [PubMed PMID: 27107163]

[52]

Dodds RM, Syddall HE, Cooper R, Benzeval M, Deary IJ, Dennison EM, Der G, Gale CR, Inskip HM, Jagger C, Kirkwood TB, Lawlor DA, Robinson SM, Starr JM, Steptoe A, Tilling K, Kuh D, Cooper C, Sayer AA. Grip strength across the life course: normative data from twelve British studies. PloS one. 2014:9(12):e113637. doi: 10.1371/journal.pone.0113637. Epub 2014 Dec 4 [PubMed PMID: 25474696]

[53]

Cesari M, Kritchevsky SB, Newman AB, Simonsick EM, Harris TB, Penninx BW, Brach JS, Tylavsky FA, Satterfield S, Bauer DC, Rubin SM, Visser M, Pahor M, Health, Aging and Body Composition Study. Added value of physical performance measures in predicting adverse health-related events: results from the Health, Aging And Body Composition Study. Journal of the American Geriatrics Society. 2009 Feb:57(2):251-9. doi: 10.1111/j.1532-5415.2008.02126.x. Epub [PubMed PMID: 19207142]

[54]

Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Research quarterly for exercise and sport. 1999 Jun:70(2):113-9 [PubMed PMID: 10380242]

[55]

Studenski SA, Peters KW, Alley DE, Cawthon PM, McLean RR, Harris TB, Ferrucci L, Guralnik JM, Fragala MS, Kenny AM, Kiel DP, Kritchevsky SB, Shardell MD, Dam TT, Vassileva MT. The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. The journals of gerontology. Series A, Biological sciences and medical sciences. 2014 May:69(5):547-58. doi: 10.1093/gerona/glu010. Epub [PubMed PMID: 24737557]

[56]

Gould H, Brennan SL, Kotowicz MA, Nicholson GC, Pasco JA. Total and appendicular lean mass reference ranges for Australian men and women: the Geelong osteoporosis study. Calcified tissue international. 2014 Apr:94(4):363-72. doi: 10.1007/s00223-013-9830-7. Epub 2014 Jan 5 [PubMed PMID: 24390582]

[57]

Maden-Wilkinson TM, Degens H, Jones DA, McPhee JS. Comparison of MRI and DXA to measure muscle size and age-related atrophy in thigh muscles. Journal of musculoskeletal & neuronal interactions. 2013 Sep:13(3):320-8 [PubMed PMID: 23989253]

[58]

Beaudart C, McCloskey E, Bruyère O, Cesari M, Rolland Y, Rizzoli R, Araujo de Carvalho I, Amuthavalli Thiyagarajan J, Bautmans I, Bertière MC, Brandi ML, Al-Daghri NM, Burlet N, Cavalier E, Cerreta F, Cherubini A, Fielding R, Gielen E, Landi F, Petermans J, Reginster JY, Visser M, Kanis J, Cooper C. Sarcopenia in daily practice: assessment and management. BMC geriatrics. 2016 Oct 5:16(1):170 [PubMed PMID: 27716195]

[59]

Prado CM, Heymsfield SB. Lean tissue imaging: a new era for nutritional assessment and intervention. JPEN. Journal of parenteral and enteral nutrition. 2014 Nov:38(8):940-53. doi: 10.1177/0148607114550189. Epub 2014 Sep 19 [PubMed PMID: 25239112]

[60]

Kerr JD. MRI safety: everyone's job. Radiology management. 2001 Nov-Dec:23(6):36-9 [PubMed PMID: 11793561]

[61]

Zumsteg DM, Chu CE, Midwinter MJ. Radiographic assessment of sarcopenia in the trauma setting: a systematic review. Trauma surgery & acute care open. 2020:5(1):e000414. doi: 10.1136/tsaco-2019-000414. Epub 2020 Mar 15 [PubMed PMID: 32201738]

Level 1 (high-level) evidence

[62]

Zhang S, Tan S, Jiang Y, Xi Q, Meng Q, Zhuang Q, Han Y, Sui X, Wu G. Sarcopenia as a predictor of poor surgical and oncologic outcomes after abdominal surgery for digestive tract cancer: A prospective cohort study. Clinical nutrition (Edinburgh, Scotland). 2019 Dec:38(6):2881-2888. doi: 10.1016/j.clnu.2018.12.025. Epub 2018 Dec 29 [PubMed PMID: 30630709]

[63]

Okamura H, Kimura N, Tanno K, Mieno M, Matsumoto H, Yamaguchi A, Adachi H. The impact of preoperative sarcopenia, defined based on psoas muscle area, on long-term outcomes of heart valve surgery. The Journal of thoracic and cardiovascular surgery. 2019 Mar:157(3):1071-1079.e3. doi: 10.1016/j.jtcvs.2018.06.098. Epub 2018 Jul 27 [PubMed PMID: 30139644]

[64]

Fairchild B, Webb TP, Xiang Q, Tarima S, Brasel KJ. Sarcopenia and frailty in elderly trauma patients. World journal of surgery. 2015 Feb:39(2):373-9. doi: 10.1007/s00268-014-2785-7. Epub [PubMed PMID: 25249011]

[65]

Bokshan SL, Han AL, DePasse JM, Eltorai AE, Marcaccio SE, Palumbo MA, Daniels AH. Effect of Sarcopenia on Postoperative Morbidity and Mortality After Thoracolumbar Spine Surgery. Orthopedics. 2016 Nov 1:39(6):e1159-e1164. doi: 10.3928/01477447-20160811-02. Epub 2016 Aug 18 [PubMed PMID: 27536954]

[66]

Messina C, Maffi G, Vitale JA, Ulivieri FM, Guglielmi G, Sconfienza LM. Diagnostic imaging of osteoporosis and sarcopenia: a narrative review. Quantitative imaging in medicine and surgery. 2018 Feb:8(1):86-99. doi: 10.21037/qims.2018.01.01. Epub [PubMed PMID: 29541625]

Level 3 (low-level) evidence

[67]

Abellan van Kan G, Rolland Y, Andrieu S, Bauer J, Beauchet O, Bonnefoy M, Cesari M, Donini LM, Gillette Guyonnet S, Inzitari M, Nourhashemi F, Onder G, Ritz P, Salva A, Visser M, Vellas B. Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. The journal of nutrition, health & aging. 2009 Dec:13(10):881-9 [PubMed PMID: 19924348]

[68]

Maggio M, Ceda GP, Ticinesi A, De Vita F, Gelmini G, Costantino C, Meschi T, Kressig RW, Cesari M, Fabi M, Lauretani F. Instrumental and Non-Instrumental Evaluation of 4-Meter Walking Speed in Older Individuals. PloS one. 2016:11(4):e0153583. doi: 10.1371/journal.pone.0153583. Epub 2016 Apr 14 [PubMed PMID: 27077744]

[69]

Rydwik E, Bergland A, Forsén L, Frändin K. Investigation into the reliability and validity of the measurement of elderly people's clinical walking speed: a systematic review. Physiotherapy theory and practice. 2012 Apr:28(3):238-56. doi: 10.3109/09593985.2011.601804. Epub 2011 Sep 19 [PubMed PMID: 21929322]

Level 1 (high-level) evidence

[70]

Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M, European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age and ageing. 2010 Jul:39(4):412-23. doi: 10.1093/ageing/afq034. Epub 2010 Apr 13 [PubMed PMID: 20392703]

Level 3 (low-level) evidence

[71]

Pavasini R, Guralnik J, Brown JC, di Bari M, Cesari M, Landi F, Vaes B, Legrand D, Verghese J, Wang C, Stenholm S, Ferrucci L, Lai JC, Bartes AA, Espaulella J, Ferrer M, Lim JY, Ensrud KE, Cawthon P, Turusheva A, Frolova E, Rolland Y, Lauwers V, Corsonello A, Kirk GD, Ferrari R, Volpato S, Campo G. Short Physical Performance Battery and all-cause mortality: systematic review and meta-analysis. BMC medicine. 2016 Dec 22:14(1):215. doi: 10.1186/s12916-016-0763-7. Epub 2016 Dec 22 [PubMed PMID: 28003033]

Level 1 (high-level) evidence

[72]

Bischoff HA, Stähelin HB, Monsch AU, Iversen MD, Weyh A, von Dechend M, Akos R, Conzelmann M, Dick W, Theiler R. Identifying a cut-off point for normal mobility: a comparison of the timed 'up and go' test in community-dwelling and institutionalised elderly women. Age and ageing. 2003 May:32(3):315-20 [PubMed PMID: 12720619]

[73]

Newman AB, Simonsick EM, Naydeck BL, Boudreau RM, Kritchevsky SB, Nevitt MC, Pahor M, Satterfield S, Brach JS, Studenski SA, Harris TB. Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA. 2006 May 3:295(17):2018-26 [PubMed PMID: 16670410]

[74]

Dent E, Morley JE, Cruz-Jentoft AJ, Arai H, Kritchevsky SB, Guralnik J, Bauer JM, Pahor M, Clark BC, Cesari M, Ruiz J, Sieber CC, Aubertin-Leheudre M, Waters DL, Visvanathan R, Landi F, Villareal DT, Fielding R, Won CW, Theou O, Martin FC, Dong B, Woo J, Flicker L, Ferrucci L, Merchant RA, Cao L, Cederholm T, Ribeiro SML, Rodríguez-Mañas L, Anker SD, Lundy J, Gutiérrez Robledo LM, Bautmans I, Aprahamian I, Schols JMGA, Izquierdo M, Vellas B. International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management. The journal of nutrition, health & aging. 2018:22(10):1148-1161. doi: 10.1007/s12603-018-1139-9. Epub [PubMed PMID: 30498820]

Level 1 (high-level) evidence

[75]

Beckwée D, Delaere A, Aelbrecht S, Baert V, Beaudart C, Bruyere O, de Saint-Hubert M, Bautmans I. Exercise Interventions for the Prevention and Treatment of Sarcopenia. A Systematic Umbrella Review. The journal of nutrition, health & aging. 2019:23(6):494-502. doi: 10.1007/s12603-019-1196-8. Epub [PubMed PMID: 31233069]

Level 1 (high-level) evidence

[76]

Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Current opinion in clinical nutrition and metabolic care. 2009 Jan:12(1):86-90. doi: 10.1097/MCO.0b013e32831cef8b. Epub [PubMed PMID: 19057193]

Level 3 (low-level) evidence

[77]

Yanai H. Nutrition for Sarcopenia. Journal of clinical medicine research. 2015 Dec:7(12):926-31. doi: 10.14740/jocmr2361w. Epub 2015 Oct 23 [PubMed PMID: 26566405]

[78]

Damanti S, Azzolino D, Roncaglione C, Arosio B, Rossi P, Cesari M. Efficacy of Nutritional Interventions as Stand-Alone or Synergistic Treatments with Exercise for the Management of Sarcopenia. Nutrients. 2019 Aug 23:11(9):. doi: 10.3390/nu11091991. Epub 2019 Aug 23 [PubMed PMID: 31443594]

[79]

Cesari M, Landi F, Vellas B, Bernabei R, Marzetti E. Sarcopenia and physical frailty: two sides of the same coin. Frontiers in aging neuroscience. 2014:6():192. doi: 10.3389/fnagi.2014.00192. Epub 2014 Jul 28 [PubMed PMID: 25120482]

[80]

Dodds R, Sayer AA. Sarcopenia and frailty: new challenges for clinical practice. Clinical medicine (London, England). 2016 Oct:16(5):455-458 [PubMed PMID: 27697810]

[81]

Aoyagi T, Terracina KP, Raza A, Matsubara H, Takabe K. Cancer cachexia, mechanism and treatment. World journal of gastrointestinal oncology. 2015 Apr 15:7(4):17-29. doi: 10.4251/wjgo.v7.i4.17. Epub [PubMed PMID: 25897346]

[82]

Douglas E, McMillan DC. Towards a simple objective framework for the investigation and treatment of cancer cachexia: the Glasgow Prognostic Score. Cancer treatment reviews. 2014 Jul:40(6):685-91. doi: 10.1016/j.ctrv.2013.11.007. Epub 2013 Nov 28 [PubMed PMID: 24321611]

[83]

Francis P, Toomey C, Mc Cormack W, Lyons M, Jakeman P. Measurement of maximal isometric torque and muscle quality of the knee extensors and flexors in healthy 50- to 70-year-old women. Clinical physiology and functional imaging. 2017 Jul:37(4):448-455. doi: 10.1111/cpf.12332. Epub 2016 Jan 7 [PubMed PMID: 26749301]

Level 2 (mid-level) evidence

[84]

Han A, Bokshan SL, Marcaccio SE, DePasse JM, Daniels AH. Diagnostic Criteria and Clinical Outcomes in Sarcopenia Research: A Literature Review. Journal of clinical medicine. 2018 Apr 8:7(4):. doi: 10.3390/jcm7040070. Epub 2018 Apr 8 [PubMed PMID: 29642478]

Level 2 (mid-level) evidence

[85]

Cosquéric G, Sebag A, Ducolombier C, Thomas C, Piette F, Weill-Engerer S. Sarcopenia is predictive of nosocomial infection in care of the elderly. The British journal of nutrition. 2006 Nov:96(5):895-901 [PubMed PMID: 17092379]

[86]

Kang SH, Park JW, Yoon KW, Do JY. Limb/trunk lean mass ratio as a risk factor for mortality in peritoneal dialysis patients. Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation. 2013 Jul:23(4):315-23. doi: 10.1053/j.jrn.2012.09.004. Epub 2012 Nov 8 [PubMed PMID: 23141559]

[87]

Narumi T, Watanabe T, Kadowaki S, Takahashi T, Yokoyama M, Kinoshita D, Honda Y, Funayama A, Nishiyama S, Takahashi H, Arimoto T, Shishido T, Miyamoto T, Kubota I. Sarcopenia evaluated by fat-free mass index is an important prognostic factor in patients with chronic heart failure. European journal of internal medicine. 2015 Mar:26(2):118-22. doi: 10.1016/j.ejim.2015.01.008. Epub 2015 Feb 3 [PubMed PMID: 25657117]

[88]

Huillard O, Mir O, Peyromaure M, Tlemsani C, Giroux J, Boudou-Rouquette P, Ropert S, Delongchamps NB, Zerbib M, Goldwasser F. Sarcopenia and body mass index predict sunitinib-induced early dose-limiting toxicities in renal cancer patients. British journal of cancer. 2013 Mar 19:108(5):1034-41. doi: 10.1038/bjc.2013.58. Epub 2013 Mar 5 [PubMed PMID: 23462722]

[89]

Mir O, Coriat R, Blanchet B, Durand JP, Boudou-Rouquette P, Michels J, Ropert S, Vidal M, Pol S, Chaussade S, Goldwasser F. Sarcopenia predicts early dose-limiting toxicities and pharmacokinetics of sorafenib in patients with hepatocellular carcinoma. PloS one. 2012:7(5):e37563. doi: 10.1371/journal.pone.0037563. Epub 2012 May 30 [PubMed PMID: 22666367]

[90]

Prado CM, Baracos VE, McCargar LJ, Reiman T, Mourtzakis M, Tonkin K, Mackey JR, Koski S, Pituskin E, Sawyer MB. Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clinical cancer research : an official journal of the American Association for Cancer Research. 2009 Apr 15:15(8):2920-6. doi: 10.1158/1078-0432.CCR-08-2242. Epub 2009 Apr 7 [PubMed PMID: 19351764]

[91]

Du Y, Karvellas CJ, Baracos V, Williams DC, Khadaroo RG, Acute Care and Emergency Surgery (ACES) Group. Sarcopenia is a predictor of outcomes in very elderly patients undergoing emergency surgery. Surgery. 2014 Sep:156(3):521-7. doi: 10.1016/j.surg.2014.04.027. Epub 2014 Jun 12 [PubMed PMID: 24929435]

[92]

Englesbe MJ, Patel SP, He K, Lynch RJ, Schaubel DE, Harbaugh C, Holcombe SA, Wang SC, Segev DL, Sonnenday CJ. Sarcopenia and mortality after liver transplantation. Journal of the American College of Surgeons. 2010 Aug:211(2):271-8. doi: 10.1016/j.jamcollsurg.2010.03.039. Epub 2010 Jun 26 [PubMed PMID: 20670867]

[93]

Reisinger KW, van Vugt JL, Tegels JJ, Snijders C, Hulsewé KW, Hoofwijk AG, Stoot JH, Von Meyenfeldt MF, Beets GL, Derikx JP, Poeze M. Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery. Annals of surgery. 2015 Feb:261(2):345-52. doi: 10.1097/SLA.0000000000000628. Epub [PubMed PMID: 24651133]

[94]

Liguori I, Russo G, Aran L, Bulli G, Curcio F, Della-Morte D, Gargiulo G, Testa G, Cacciatore F, Bonaduce D, Abete P. Sarcopenia: assessment of disease burden and strategies to improve outcomes. Clinical interventions in aging. 2018:13():913-927. doi: 10.2147/CIA.S149232. Epub 2018 May 14 [PubMed PMID: 29785098]