Lorenzo M Donini1, Luca Busetto2, Stephan C Bischoff3, Tommy Cederholm4, Maria D Ballesteros-Pomar5, John A Batsis6, Juergen M Bauer7, Yves Boirie8, Alfonso J Cruz-Jentoft9, Dror Dicker10, Stefano Frara11, Gema Frühbeck12, Laurence Genton13, Yftach Gepner14, Andrea Giustina11, Maria Cristina Gonzalez15, Ho-Seong Han16, Steven B Heymsfield17, Takashi Higashiguchi18, Alessandro Laviano1, Andrea Lenzi1, Ibolya Nyulasi19, Edda Parrinello20, Eleonora Poggiogalle1, Carla M Prado21, Javier Salvador22, Yves Rolland23, Ferruccio Santini24, Mireille J Serlie25, Hanping Shi26, Cornel C Sieber27, Mario Siervo28, Roberto Vettor2, Dennis T Villareal29, Dorothee Volkert27, Jianchun Yu30, Mauro Zamboni31, Rocco Barazzoni32. 1. Sapienza University, Rome, Italy. 2. University of Padua, Padua, Italy. 3. University of Hohenheim, Stuttgart, Germany. 4. Uppsala University, Uppsala, Sweden. 5. Complejo Asistencial Universitario de León, Altos de Nava, León, Spain. 6. University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 7. University of Heidelberg, Heidelberg, Germany. 8. University of Clermont Auvergne, INRA, CRNH, CHU Clermont-Ferrand, Clermont-Ferrand, France. 9. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain. 10. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 11. San Raffaele, Vita-Salute University and IRCCS Hospital, Milan, Italy. 12. Clínica Universidad de Navarra, CIBEROBN, IdiSNA, Pamplona, Spain. 13. Hôpitaux Universitaires de Genève, Genève, Switzerland. 14. Tel-Aviv University, Tel-Aviv, Israel. 15. Catholic University of Pelotas (UCPEL), Pelotas, Brazil. 16. Seoul National University Bundang Hospital (SNUBH), Seoul, Republic of Korea. 17. Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA. 18. Fujita Health University School of Medicine, Aichi, Japan. 19. Monash University, Clayton, Victoria, Australia. 20. Sapienza University, Rome, Italy, eddaparrinello@hotmail.it. 21. University of Alberta, Edmonton, Alberta, Canada. 22. Universidad de Navarra, CIBEROBN, IdiSNA, Pamplona, Spain. 23. Gerontopole of Toulouse, INSERM 1027, Toulouse University Hospital, Toulouse, France. 24. University of Pisa, Pisa, Italy. 25. Amsterdam University Medical Centers, Amsterdam, The Netherlands. 26. Beijing Shijitan Hospital, Capital Medical University, Beijing, China. 27. Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany. 28. University of Nottingham, Nottingham, United Kingdom. 29. Baylor College of Medicine, Houston, Texas, USA. 30. Peking Union Medical College Hospital, Beijing, China. 31. University of Verona, Verona, Italy. 32. Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
Abstract
INTRODUCTION: Loss of skeletal muscle mass and function (sarcopenia) is common in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases) and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of a universally established SO definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes. AIMS AND METHODS: The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a definition and diagnostic criteria for SO. The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into stage I in the absence of clinical complications or stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction. CONCLUSIONS: ESPEN and EASO, as well as the expert international panel, advocate that the proposed SO definition and diagnostic criteria be implemented into routine clinical practice. The panel also encourages prospective studies in addition to secondary analysis of existing data sets, to study the predictive value, treatment efficacy and clinical impact of this SO definition.
INTRODUCTION: Loss of skeletal muscle mass and function (sarcopenia) is common in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases) and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of a universally established SO definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes. AIMS AND METHODS: The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a definition and diagnostic criteria for SO. The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into stage I in the absence of clinical complications or stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction. CONCLUSIONS: ESPEN and EASO, as well as the expert international panel, advocate that the proposed SO definition and diagnostic criteria be implemented into routine clinical practice. The panel also encourages prospective studies in addition to secondary analysis of existing data sets, to study the predictive value, treatment efficacy and clinical impact of this SO definition.
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