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Ann Geriatr Med Res > Volume 29(4); 2025 > Article
Won and Jung: 2025 AWGS Sarcopenia Guideline and Wake-up Call for Asian Gerontologists and Geriatricians
Recently, a new consensus paper presenting the updated Asian guideline for sarcopenia has been published.1) Intriguingly, the guideline expands the target population for sarcopenia diagnosis and management to include adults aged 50–64 years, emphasizing that disruptions in muscle health during midlife can readily progress to sarcopenia in older age. The 2025 Asian Working Group for Sarcopenia (AWGS) guideline emphasizes sarcopenia management through a life-course approach to muscle health promotion, adopting a framework aligned with the World Health Organization’s Integrated Care for Older People (ICOPE) by leveraging the natural overlap between muscle health and ICOPE’s intrinsic capacity domains.2) This guideline provides cutoff values for muscle mass, handgrip strength, and physical performance (gait speed and five-times chair stand test) for middle-aged Asian adults. To our knowledge, this is the first global sarcopenia guideline to offer recommendations for this age group. The 2019 AWGS guideline introduced the innovative concept of “possible sarcopenia” and proposed its diagnostic algorithm tailored for primary healthcare and preventive services.3) Since its publication, the 2019 AWGS guideline has been cited in 5,465 articles in the Web of Science database as of December 2, 2025. The outstanding success of the 2019 AWGS guideline is very encouraging to Korean researchers and, surely, to Asian researchers who have been timid and even shy in the international research field. Is this success merely the result of the leadership of the guideline authors? Recent bibliometric trends suggest another explanation. In a bibliometric analysis of global sarcopenia research from 2001 to 2020, the United States contributed the largest proportion of publications (25.7%), followed by Japan (13.4%), Italy (8.6%), England (7.5%), and South Korea (6.6%).4) However, based on our analysis of publications indexed in the Web of Science database, published between 2015 and 2025, with “sarcopenia” in the title, as of December 2, 2025, China now ranks first (20.2%), followed by the United States (12.7%), Japan (10.7%), South Korea (7.3%), and Italy (6.9%). Including the recent surge in sarcopenia publications from China, Asian research output as a whole has begun to dominate the global sarcopenia literature, whereas the relative contribution from Western countries has gradually declined (Fig. 1, Table 1). Importantly, this growth is not limited to publication volume. When we examined highly cited papers, defined by the Web of Science database as publications ranking within the top approximately 1% by citations within the same academic field and publication year, several of these influential studies originated from Asian countries, including China (25.7%), Japan (11.4%), South Korea (7.2%), and Taiwan (5.4%) (Table 2). These findings indicate that the increasing contribution of Asian research to the field of sarcopenia is accompanied by impactful scientific outputs.
Since 2021, the Global Leadership Initiative in Sarcopenia (GLIS) has been working to establish an international guideline for sarcopenia and formed a steering committee composed of experts nominated by related societies and organizations.5) Among the 22 steering committee members, only four are from Asia (Japan, Taiwan, Hong Kong, and Saudi Arabia), with the vast majority representing Western countries.6) It is regrettable that only a small number of Asian researchers constitute the GLIS steering committee, but this may come as no surprise considering that there are not many well-recognized societies or organizations in this field in Asia except for the AWGS. Though the Korean Working Group on Sarcopenia (KWGS) developed clinical practice guidelines for the diagnosis of sarcopenia in older Korean adults, but its scope is within a regional boundary.7) This implies that Asian researchers need to work together more than they do now, convene more frequently, and endeavor to develop consensus statements or guidelines that include Asian research outputs.
To date, Asian scientists have often been reserved and far behind on the global stage. That could be due to traditional cultural backgrounds or foreign language anxiety.8) However, when Asian researchers work together, these barriers can be more easily overcome, as we have seen from the success of the AWGS sarcopenia guidelines. Many Asian countries share the saying “silence is golden,” as was the case for me. However, Asian researchers, not to mention Korean researchers, need to develop scientific confidence in their achievements in sarcopenia research and to present their scientific evidence more actively in this field. We should communicate clearly to the global scientific community that we are ready to contribute. It is now time to say, “We are here, we are working to advance aging research, and we want to contribute to global initiatives.”

ACKNOWLEDGMENTS

CONFLICT OF INTEREST

The author claims no conflicts of interest.

FUNDING

None.

AUTHOR CONTRIBUTIONS

Conceptualization, CWW; Data curation, HJ; Investigation, CWW, HJ; Methodology, CWW, HJ; Project administration, CWW; Supervision, CWW; Formal analysis, HJ; Writing-original draft, CWW, HJ; Writing-review & editing, CWW, HJ.

Fig. 1.
Distribution of countries and regions publishing articles with “sarcopenia” in the title from 2015 to 2025. The search was conducted on December 2, 2025.
agmr-25-0207f1.jpg
Table 1.
Top 20 countries and regions ranked by the number of publications with “sarcopenia” in the title from 2015 to 2025
Countries/Regions Record count % of total publications (n=13,065)
China 2,645 20.245
USA 1,662 12.721
Japan 1,397 10.693
South Korea 959 7.340
Italy 904 6.919
England 731 5.595
Turkey 586 4.484
Spain 533 4.080
Australia 514 3.934
Germany 491 3.758
Brazil 483 3.697
Taiwan 393 3.008
Canada 329 2.518
France 302 2.312
Netherlands 294 2.250
Belgium 280 2.143
India 226 1.730
Switzerland 183 1.401
Sweden 149 1.140

The search was conducted on December 2, 2025.

Table 2.
Top 20 countries and regions ranked by the number of highly cited publications with “sarcopenia” in the title from 2015 to 2025
Countries/Regions Record count % of total publications (n=167)
China 43 25.749
USA 40 23.952
Italy 34 20.359
England 31 18.563
Australia 22 13.174
Netherlands 20 11.976
Japan 19 11.377
Spain 19 11.377
Belgium 18 10.778
Canada 15 8.982
France 15 8.982
Germany 14 8.383
South Korea 12 7.186
Sweden 12 7.186
Brazil 9 5.389
Taiwan 9 5.389
Singapore 6 3.593
Mexico 5 2.994
Switzerland 5 2.994

The search was conducted on December 2, 2025.

REFERENCES

1. Chen LK, Hsiao FY, Akishita M, Assantachai P, Lee WJ, Lim WS, et al. A focus shift from sarcopenia to muscle health in the Asian Working Group for Sarcopenia 2025 Consensus Update. Nat Aging 2025;5:2164-75.
crossref pmid pdf
2. World Health Organization. Integrated care for older people: guidelines on community-level interventions to manage declines in intrinsic capacity. Geneva, Switzerland: World Health Organization; 2017.

3. 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.
crossref pmid
4. Yuan D, Jin H, Liu Q, Zhang J, Ma B, Xiao W, et al. Publication trends for sarcopenia in the world: a 20-year bibliometric analysis. Front Med (Lausanne) 2022;9:802651.
crossref pmid pmc
5. Kirk B, Cawthon PM, Arai H, Avila-Funes JA, Barazzoni R, Bhasin S, et al. The conceptual definition of sarcopenia: Delphi consensus from the Global Leadership Initiative in Sarcopenia (GLIS). Age Ageing 2024;53:afae052.
crossref pmid pmc
6. Global Leadership Initiative in Sarcopenia (GLIS) Steering Committee members [Internet]. Liege, Belgium: ESCEO; 2025 [cited 2025 Dec 1]. Available from: https://www.esceo.org/glis.

7. 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;27:9-21.
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8. Wan Y. Why are they so quiet? Exploring reticent and passive east Asian ESL Students in the US classrooms. Open J Mod Linguist 2021;11:942-54.
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