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Ann Geriatr Med Res > Volume 27(1); 2023 > Article
Jung and Baek: New Clinical Practice Guidelines for Sarcopenia Screening and Diagnosis in Korean Older Adults: A Step Forward
Sarcopenia, the age-related loss of muscle mass, strength, and function, has become an increasingly prevalent condition as the global population ages.1,2) It is associated with a wide range of negative health outcomes including falls, disability, and mortality.3) In response to this growing problem, researchers and healthcare professionals have developed various guidelines and assessment tools for the diagnosis and management of sarcopenia. In Korea, the Korean Working Group on Sarcopenia (KWGS) has established new clinical practice guidelines for sarcopenia screening and diagnosis.4)
As Korea is one of the fastest-aging countries worldwide, preventing and treating sarcopenia in older adults to prevent further frailty and disabilities has become an overarching healthcare issue.5) Although international guidelines for sarcopenia have been previously established, several issues support country-specific guidelines for this condition.1,2) First, different populations may have varying characteristics that could affect the diagnosis of sarcopenia based on body composition and functional parameters. Second, healthcare systems vary among countries, which can affect sarcopenia diagnosis and management. For example, in Korea, the healthcare system is disease-oriented and specialty-centered, and the concepts of frailty and intrinsic capacity have been relatively less adopted by both the healthcare and welfare sectors.6) Finally, the regulatory conditions may differ among countries. Specifically, sarcopenia has been considered a disease since 2021, and diagnostic procedures for this condition have become eligible for medical reimbursement.
The KWGS guidelines incorporate a diverse range of screening tools, including questionnaires and physical examinations, for easier case-finding in different research and clinical settings. The guidelines also simplify the classification flow by combining the two existing steps suggested in other guidelines into one step to reduce confusion in the selection of diagnostic tools and increase the clinical uptake of sarcopenia diagnosis.
Apart from existing sarcopenia guidelines that consider muscle mass a pivotal parameter for defining sarcopenia,1,2) the KWGS experts determined that having low muscle strength with low physical performance also has clinical relevance, even in the absence of decreased muscle mass. Thus, the KWGS defines a state of “functional sarcopenia.” This expanded conceptual definition of sarcopenia as a state with complex pathophysiology is consistent with the concept of frailty.7)
The KWGS guidelines emphasize sarcopenia as a geriatric mobility condition with a complex pathophysiology rather than a single disease entity. Despite efforts to develop guidelines and assessment tools for sarcopenia, healthcare practitioners in Korea remain unfamiliar with diagnosing and setting up evaluation tools for sarcopenia in routine clinical practice, with inconsistencies in understanding the biological or clinical constructs of sarcopenia. Additionally, the geriatric domains of multimorbidity, polypharmacy, cognitive decline, depression, and social care needs are often overlooked in sarcopenia assessments and interventions.8) To address these problems, the KWGS’s new clinical guidelines aim to facilitate the early detection of sarcopenia by permitting diverse screening tools using a unified process. The KWGS recommendation expands the conceptual definition of sarcopenia and emphasizes the importance of designing holistic, personalized intervention plans based on comprehensive geriatric assessment (CGA), which embraces multiple domains. Hence, the KWGS recommends CGA to reveal the underlying and associated conditions of sarcopenia after making a diagnosis based on the diagnostic flow. This approach aims to ensure that healthcare professionals design holistic, personalized intervention plans based on CGA, embracing multiple domains, including not only nutrition and physical activity but also disability, medications, cognition, mood, and social support.9) As the published guidelines in this issue mainly focus on sarcopenia screening and diagnosis, a separate guideline on intervention will soon be developed.
In conclusion, the KWGS’s new clinical practice guidelines for sarcopenia diagnosis and management aim to reduce the gap between knowledge and practice and stimulate further active research on sarcopenia diagnosis and management in real-world clinical settings. These guidelines offer healthcare professionals a unified and simplified process for screening, diagnosing, and managing sarcopenia. This approach aims to reduce the pathophysiological burden of sarcopenia and improve the overall intrinsic capacity of community-dwelling older adults.10)
In addition to providing a framework for clinical practice, the KWGS guidelines offer opportunities for future research. As healthcare professionals gain more experience using the guidelines in real-world settings, the recommendations will likely require updating and refinement. Thus, future studies can explore the effectiveness of different interventions for sarcopenia, such as different types of physical activity or nutritional interventions. Additionally, researchers could investigate the relationship between sarcopenia and other geriatric syndromes such as frailty or cognitive impairment.
Overall, the KWGS guidelines represent an important step forward in the clinical diagnosis and management of sarcopenia in older Korean adults. Moreover, by encouraging further research in this area, these guidelines can pave the way for more effective and personalized interventions. As a country’s population continues to age, the importance of sarcopenia as a public health concern continues to increase. By directly addressing this issue with the new guidelines, healthcare professionals and policymakers can design effective measures to preserve the intrinsic capacity of older adults, encompassing the life course of aging, diseases, and frailty.

ACKNOWLEDGMENTS

CONFLICT OF INTEREST

Hee-Won Jung co-founded Dyphi Inc., a startup based on sensor technology. The other author claims no conflicts of interest.

FUNDING

None.

REFERENCES

1. Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc 2020 21:300–307. e2.
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2. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019;48:16–31.
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3. Jang IY, Lee E, Lee H, Park H, Kim S, Kim KI, et al. Characteristics of sarcopenia by European consensuses and a phenotype score. J Cachexia Sarcopenia Muscle 2020;11:497–504.
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4. Baek JY, Jung HW, Kim KM, Kim M, Park CY, Lee KP, et al. Korean Working Group on Sarcopenia guideline: expert consensus on sarcopenia screening and diagnosis by the Korean Society of Sarcopenia, the Korean Society for Bone and Mineral Research, and the Korean Geriatrics Society. Ann Geriatr Med Res 2023;27: – .
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5. Baek JY, Lee E, Jung HW, Jang IY. Geriatrics fact sheet in Korea 2021. Ann Geriatr Med Res 2021;25:65–71.
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6. Jung HW, Lim JY. Geriatric medicine, an underrecognized solution of precision medicine for older adults in Korea. Ann Geriatr Med Res 2018;22:157–8.
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7. Cesari M, Landi F, Vellas B, Bernabei R, Marzetti E. Sarcopenia and physical frailty: two sides of the same coin. Front Aging Neurosci 2014;6:192.
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8. Cesari M, Canevelli M, Calvani R, Aprahamian I, Inzitari M, Marzetti E. Editorial: The management of frailty: barking up the wrong tree. J Frailty Aging 2022;11:127–8.
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9. Oh G, Lee H, Park CM, Jung HW, Lee E, Jang IY, et al. Long-term effect of a 24-week multicomponent intervention on physical performance and frailty in community-dwelling older adults. Age Ageing 2021;50:2157–66.
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10. Cesari M, Araujo de Carvalho I, Amuthavalli Thiyagarajan J, Cooper C, Martin FC, Reginster JY, et al. Evidence for the domains supporting the construct of intrinsic capacity. J Gerontol A Biol Sci Med Sci 2018;73:1653–60.
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