Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement

Abstract

<b><i>Introduction:</i></b> 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. <b><i>Aims and Methods:</i></b> 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. <b><i>Conclusions:</i></b> 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.

Usefulness of Muscle Ultrasound to Study Sarcopenic Obesity: A Pilot Case-Control Study

“…The latest consensus by ESPEN and EASO defends that the diagnosis of SO will be performed in two steps by sequentially assessing (a) functional parameters (strength) and (b) body composition by DXA, BIA, or CT [ 7 ]. Our results point to US as a new, simple, and useful tool to be incorporated in the study of body composition.…”

“…Indeed, we know that weight gain in obese people is mainly caused by an increase in FM; however, a contemporary reduction in SM is often observed. No universally accepted validated cut-offs for SMI are currently available [ 7 ], and even the use of those proposed by the European Working Group on Sarcopenia in Older People (EWGSOP) in obese people may be misleading. For this reason, we considered in the present study that the sarcopenic group would be the tertile of our population with the lowest SMI.…”

“…Although there are different definitions of sarcopenic obesity (SO) and its diagnostic criteria and cut-offs are not universally established, this entity can cause metabolic disorders and physical disability [ 1 , 2 ] and is characterized by the combination of low muscle mass and strength with increased fat mass (FM) [ 3 , 4 , 5 ]. In the latest consensus by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO), SO was defined as the coexistence of excess adiposity and low muscle/mass function [ 6 , 7 ].…”

“…Loss of muscle mass and function is not exclusive of the elderly and is commonly accompanied by relative or absolute body fat gain. Therefore, sarcopenia may arise in individuals with obesity at any age, and it can not only significantly affect health outcomes, but also influence the evolution after bariatric surgery (BS) [ 1 , 7 ]. There is emerging evidence indicating that SO may be associated with an increased risk of global mortality and cardiovascular risk factors compared to sarcopenia or obesity alone [ 8 , 9 ].…”

Multimodal Diagnostic Approaches to Advance Precision Medicine in Sarcopenia and Frailty

“…While the prevalence rates of sarcopenia, sarcopenic obesity, and frailty vary widely because of differing definitions [ 11 ], their increased recognition and clinical importance has led to a critical gap in translating research findings into practice. Sarcopenic obesity can be determined by defining sarcopenia using strength (measured by grip strength, chair stand) or muscle mass (lean body mass, appendicular lean mass) measured using body composition modalities (e.g., dual energy x-ray absorptiometry [DEXA], magnetic resonance imaging [MRI]), and obesity using body mass index, waist circumference, or body fat [ 12 , 13 ]. It is notable, there are a number of different definitions that can be considered.…”