Sarcopenia

Age related loss of muscle mass and strength, defined clinically by low strength first, with mass and physical performance used to confirm and stage it.

How it is defined

The 2019 European consensus made an important change: low muscle strength is the primary criterion, not low mass. Strength predicts outcomes better than mass, and it declines earlier and faster than mass does.

Low muscle quantity, from DEXA or another method, confirms the diagnosis. Poor physical performance, such as slow gait speed, marks severe sarcopenia.

The numbers

EWGSOP2 sets low grip strength below 27 kg in men and below 16 kg in women. For quantity, appendicular lean mass index thresholds are below 7.0 kg/m2 in men and below 5.5 kg/m2 in women.

Grip strength is measured with a hand dynamometer and takes about a minute. For a marker that predicts mortality, disability and hospital outcomes as well as it does, it is remarkably underused.

What actually works against it

Progressive resistance training is the intervention with the strongest evidence, at any age, including in people in their eighties and nineties. Adequate protein intake supports it and does not replace it.

This is also the reason lean mass deserves attention during weight loss. Rapid weight reduction without resistance training and protein takes muscle along with fat, and on a GLP-1 program that tradeoff is a design question rather than an afterthought.

Reference ranges

  • Low grip strength: below 27 kg men, below 16 kg women. EWGSOP2, Cruz-Jentoft et al., Age Ageing 2019. Screening cutoff, not a diagnosis on its own.
  • Low appendicular lean mass index: below 7.0 kg/m2 men, below 5.5 kg/m2 women. EWGSOP2. Confirms sarcopenia when strength is already low.

We recommend body composition and lean mass tracking alongside metabolic work, and our DEXA calculator reports the same indices these cutoffs use.

References

  1. Cruz-Jentoft AJ, et al. Sarcopenia: revised European consensus on definition and diagnosis (EWGSOP2). Age Ageing. 2019.
  2. Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev. 2009.
  3. Leong DP, et al. Prognostic value of grip strength: findings from the PURE study. Lancet. 2015.