Produção Nacional
Revisado por pares
Commentaries on Viewpoint: Rejuvenation of the term sarcopenia
2019; American Physiological Society; Volume: 126; Issue: 1 Linguagem: Inglês
10.1152/japplphysiol.00816.2018
ISSN8750-7587
AutoresHenning T. Langer, Agata A. Mossakowski, Keith Baar, Julián Alcázar, Marcos Martín-Rincón, Luis M. Alegre, Ignacio Ara, José A. L. Calbet, J. Matthew Hinkley, Paul M. Coen, Brian A. Irving, Timothy D. Allerton, G Anil Kumar, Ricardo Moreno Lima, Juan Pablo Rey-López, David Scott, Robin M. Daly, Peter R. Ebeling, Alan Hayes, Anne‐Julie Tessier, Stéphanie Chevalier, Brandon A. Yates, LeAndra R Brown, Thomas W. Storer, Wayne L. Westcott, Artemissia‐Phoebe Nifli, Robert V. Musci, Adam R. Konopka, Karyn L. Hamilton, Russell T. Hepple,
Tópico(s)Body Composition Measurement Techniques
ResumoViewpointCommentaries on Viewpoint: Rejuvenation of the term sarcopeniaPublished Online:29 Jan 2019https://doi.org/10.1152/japplphysiol.00816.2018MoreSectionsPDF (88 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat A MORE DYNAMIC NAME FOR AGE-RELATED FUNCTIONAL IMPAIRMENTSHenning T. Langer,1 Agata A. Mossakowski,2 and Keith Baar13.Author Affiliations1Department of Physiology and Membrane Biology, University of California, Davis.2Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health.3Department of Neurobiology, Physiology and Behavior, University of California, Davis.to the editor: We agree with Bulow and colleagues (2) that “sarcopenia” should only be used to indicate the loss of muscle mass. Per the etymology of the word and its original intent, physical function should not be included within the definition. The loss of strength needs to be considered an independent measure so that clinicians can determine whether the muscle or its capacity for force generation is key for healthy aging. We suggest separating the terms, because in humans, muscle strength is lost three times faster than mass (3). Furthermore, in animal studies, old animals lose five times more strength than adult animals even when the decrease in muscle fiber cross-sectional area is identical (1). This suggests that muscle mass and strength are not directly related in old individuals. For force, we suggest the use of the term “dynopenia” from the Greek “dýnamis,” meaning power and “penia” meaning poverty or loss. Strength appears to have the greatest predictive capacity for longevity (5), possibly because older muscle loses innervation and force transfer (1, 4), which decreases specific force. Therefore, we agree with Bulow and colleagues that sarcopenia needs to continue to define only the loss of skeletal muscle mass. Furthermore, we propose that “dynopenia” be used to define the strength loss with age. Lastly, we endorse the notion that clinical practice should return to reliable measures of strength such as leg press or squat as opposed to simple functional tests (6-min walking) that do not accurately measure either strength or mass.REFERENCES1. Baehr LM, West DW, Marcotte G, Marshall AG, De Sousa LG, Baar K, Bodine SC. Age-related deficits in skeletal muscle recovery following disuse are associated with neuromuscular junction instability and ER stress, not impaired protein synthesis. Aging (Albany NY) 8: 127–146, 2016. doi:10.18632/aging.100879. Crossref | PubMed | Google Scholar2. Bulow J, Ulijaszek SJ, Holm L. Rejuvenation of the term sarcopenia. J Appl Physiol (1985); doi:10.1152/japplphysiol.00400.2018. Link | ISI | Google Scholar3. Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV, Simonsick EM, Tylavsky FA, Visser M, Newman AB. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci 61: 1059–1064, 2006. doi:10.1093/gerona/61.10.1059. Crossref | PubMed | ISI | Google Scholar4. Hughes DC, Marcotte GR, Baehr LM, West DWD, Marshall AG, Ebert SM, Davidyan A, Adams CM, Bodine SC, Baar K. Alterations in the muscle force transfer apparatus in aged rats during unloading and reloading: impact of microRNA-31. J Physiol 596: 2883–2900, 2018. doi:10.1113/JP275833. Crossref | PubMed | ISI | Google Scholar5. Rantanen T, Masaki K, He Q, Ross GW, Willcox BJ, White L. Midlife muscle strength and human longevity up to age 100 years: a 44-year prospective study among a decedent cohort. Age (Dordr) 34: 563–570, 2012. doi:10.1007/s11357-011-9256-y. Crossref | PubMed | Google ScholarREFERENCES1. Baehr LM, West DW, Marcotte G, Marshall AG, De Sousa LG, Baar K, Bodine SC. Age-related deficits in skeletal muscle recovery following disuse are associated with neuromuscular junction instability and ER stress, not impaired protein synthesis. Aging (Albany NY) 8: 127–146, 2016. doi:10.18632/aging.100879. Crossref | PubMed | Google Scholar2. Bulow J, Ulijaszek SJ, Holm L. Rejuvenation of the term sarcopenia. J Appl Physiol (1985); doi:10.1152/japplphysiol.00400.2018. Link | ISI | Google Scholar3. Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV, Simonsick EM, Tylavsky FA, Visser M, Newman AB. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci 61: 1059–1064, 2006. doi:10.1093/gerona/61.10.1059. Crossref | PubMed | ISI | Google Scholar4. Hughes DC, Marcotte GR, Baehr LM, West DWD, Marshall AG, Ebert SM, Davidyan A, Adams CM, Bodine SC, Baar K. Alterations in the muscle force transfer apparatus in aged rats during unloading and reloading: impact of microRNA-31. J Physiol 596: 2883–2900, 2018. doi:10.1113/JP275833. Crossref | PubMed | ISI | Google Scholar5. Rantanen T, Masaki K, He Q, Ross GW, Willcox BJ, White L. Midlife muscle strength and human longevity up to age 100 years: a 44-year prospective study among a decedent cohort. Age (Dordr) 34: 563–570, 2012. doi:10.1007/s11357-011-9256-y. Crossref | PubMed | Google ScholarTHE LACK OF COMMON DENOMINATORS DOES NOT PERMIT A BROADER DEFINITION OF SARCOPENIAJulian Alcazar,1 Marcos Martin-Rincon,2 Luis M. Alegre,3 Ignacio Ara,4 and Jose A. L. Calbet5.Author Affiliations1Universidad de Castilla-La Mancha and CIBER of Frailty and Healthy Aging (CIBERFES; CB16/10/00477), Spain.2University of Las Palmas de Gran Canaria and Research Institute of Biomedical and Health Sciences (IUIBS), Spain.3Universidad de Castilla-La Mancha and CIBER of Frailty and Healthy Aging (CIBERFES; CB16/10/00477), Spain.4Universidad de Castilla-La Mancha and CIBER of Frailty and Healthy Aging (CIBERFES; CB16/10/00477), Spain.5University of Las Palmas de Gran Canaria, Spain.to the editor: As noted by Bulow, Ulijaszek, and Holm (3), we support the return to the original definition of sarcopenia, giving it the clinical relevance it has. Skeletal muscle power (i.e., force × velocity) is a crucial muscle function biomarker associated with physical function in older people. Besides muscle size, factors such as motor unit recruitment and firing frequency, muscle fiber phenotype, muscle architecture, and tendon properties contribute to muscle power generation. Impaired muscle function can be caused by a decreased contraction velocity, which is not associated with muscle size (1). The evolution of the term sarcopenia has complicated the adequate identification of these mechanisms, their regulatory pathways and its association with other clinical outcomes (e.g., frailty), with sarcopenia prevalence among frail people ranging 40–72% with distinct operational definitions (4). This fact would also entangle the differentiation among age-, disuse-, and disease-related muscle loss. Since muscle mass net loss depends upon the balance between protein synthesis-degradation, the problem becomes apparent as the specific role played by the major proteolytic pathways remains broadly inconsistent. While the ubiquitin-proteasome system seems to contribute primarily to muscle loss under disuse (5) and pathologic conditions, other systems predominate in the healthy aging muscle (2). Additionally, how exercise and other potential therapies could revert/compensate for the loss of muscle mass with age requires the identification of the molecular mechanisms regulating the muscle mass that are altered by aging. This task would be jeopardized by an overcomplicated term where distinct phenomena not inherently linked are present.REFERENCES1. Alcazar J, Rodriguez-Lopez C, Ara I, Alfaro-Acha A, Rodríguez-Gómez I, Navarro-Cruz R, Losa-Reyna J, García-García FJ, Alegre LM. Force-velocity profiling in older adults: An adequate tool for the management of functional trajectories with aging. Exp Gerontol 108: 1–6, 2018. doi:10.1016/j.exger.2018.03.015. Crossref | PubMed | ISI | Google Scholar2. Bowen TS, Schuler G, Adams V. Skeletal muscle wasting in cachexia and sarcopenia: molecular pathophysiology and impact of exercise training. J Cachexia Sarcopenia Muscle 6: 197–207, 2015. doi:10.1002/jcsm.12043. Crossref | PubMed | ISI | Google Scholar3. Bulow J, Ulijaszek SJ, Holm L. Rejuvenation of the term sarcopenia. J Appl Physiol (1985); doi:10.1152/japplphysiol.00400.2018. Link | ISI | Google Scholar4. Davies B, García F, Ara I, Artalejo FR, Rodriguez-Mañas L, Walter S. Relationship between sarcopenia and frailty in the Toledo study of healthy aging: a population based cross-sectional study. J Am Med Dir Assoc 19: 282–286, 2018 [Erratum. J Am Med Dir Assoc 19: 566, 2018]. doi:10.1016/j.jamda.2017.09.014. Crossref | PubMed | ISI | Google Scholar5. Rudrappa SS, Wilkinson DJ, Greenhaff PL, Smith K, Idris I, Atherton PJ. Human skeletal muscle disuse atrophy: effects on muscle protein synthesis, breakdown, and insulin resistance-a qualitative review. Front Physiol 7: 361, 2016. doi:10.3389/fphys.2016.00361. Crossref | PubMed | ISI | Google ScholarREFERENCES1. Alcazar J, Rodriguez-Lopez C, Ara I, Alfaro-Acha A, Rodríguez-Gómez I, Navarro-Cruz R, Losa-Reyna J, García-García FJ, Alegre LM. Force-velocity profiling in older adults: An adequate tool for the management of functional trajectories with aging. Exp Gerontol 108: 1–6, 2018. doi:10.1016/j.exger.2018.03.015. Crossref | PubMed | ISI | Google Scholar2. Bowen TS, Schuler G, Adams V. Skeletal muscle wasting in cachexia and sarcopenia: molecular pathophysiology and impact of exercise training. J Cachexia Sarcopenia Muscle 6: 197–207, 2015. doi:10.1002/jcsm.12043. Crossref | PubMed | ISI | Google Scholar3. Bulow J, Ulijaszek SJ, Holm L. Rejuvenation of the term sarcopenia. J Appl Physiol (1985); doi:10.1152/japplphysiol.00400.2018. Link | ISI | Google Scholar4. Davies B, García F, Ara I, Artalejo FR, Rodriguez-Mañas L, Walter S. Relationship between sarcopenia and frailty in the Toledo study of healthy aging: a population based cross-sectional study. J Am Med Dir Assoc 19: 282–286, 2018 [Erratum. J Am Med Dir Assoc 19: 566, 2018]. doi:10.1016/j.jamda.2017.09.014. Crossref | PubMed | ISI | Google Scholar5. Rudrappa SS, Wilkinson DJ, Greenhaff PL, Smith K, Idris I, Atherton PJ. Human skeletal muscle disuse atrophy: effects on muscle protein synthesis, breakdown, and insulin resistance-a qualitative review. Front Physiol 7: 361, 2016. doi:10.3389/fphys.2016.00361. Crossref | PubMed | ISI | Google ScholarEVOLUTION OF THE DEFINITION OF SARCOPENIAJ. Mathew Hinkley, and Paul M. Coen.Author AffiliationsTranslational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida.to the editor: Baumgartner et al.(1), defined sarcopenia as the age-associated loss of skeletal muscle mass two standard deviations below a healthy population. Subsequent investigations using this definition more clearly described associations of sarcopenia with mobility disability, increased risk of falls, and reduced ability to perform activities of daily living (4). This complex, multifactorial etiology has led some to recognize sarcopenia as a geriatric syndrome rather than a traditional disease state (3). Like a geriatric syndrome, sarcopenia is caused by poorly understood interactions of age and disease that impacts multiple systems, resulting in a distinct pattern of clinical symptoms. While Baumgartner’s definition furthered our scientific understanding of sarcopenia, it has proved less useful for clinicians and for development of therapeutic strategies, as regulatory agencies have not recognized low muscle mass alone as a valid indication for treatment. For these reasons, the definition of sarcopenia needed to evolve. The contemporary definitions facilitated designation of an ICD-10 code in 2016, which will encourage wider adoption in clinical practice and has facilitated the development of therapeutics by the pharmaceutical industry. In their Viewpoint, Bülow et al. (2), argue that sarcopenia is caught in a tautological wrangle. We respectfully refute this suggestion as each element of sarcopenia (muscle mass, physical function, and muscle strength) is clearly distinct. A return to the original description focused exclusively on skeletal muscle mass, at a time when there is growing consensus on the contemporary definition of sarcopenia, would impede the development of effective therapeutic strategies for this serious health condition.GRANTSPMC is supported by research grants K01-AG044437 and R01-AG060153 from the National Institute on Aging.DISCLOSURESP.M.C. is a scientific consultant for Mitobridge Inc., an Astellas company. No other conflicts of interest, financial or otherwise, are declared by the authors.REFERENCES1. Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, Garry PJ, Lindeman RD. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147: 755–763, 1998. doi:10.1093/oxfordjournals.aje.a009520. Crossref | PubMed | ISI | Google Scholar2. Bulow J, Ulijaszek SJ, Holm L. Rejuvenation of the term sarcopenia. J Appl Physiol (1985); doi:10.1152/japplphysiol.00400.2018. Link | ISI | Google Scholar3. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel J-P, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M; European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 39: 412–423, 2010. doi:10.1093/ageing/afq034. Crossref | PubMed | ISI | Google Scholar4. Rolland Y, Czerwinski S, Abellan Van Kan G, Morley JE, Cesari M, Onder G, Woo J, Baumgartner R, Pillard F, Boirie Y, Chumlea WMC, Vellas B. Sarcopenia: its assessment, etiology, pathogenesis, consequences and future perspectives. J Nutr Health Aging 12: 433–450, 2008. doi:10.1007/BF02982704. Crossref | PubMed | ISI | Google ScholarREFERENCES1. Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, Garry PJ, Lindeman RD. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147: 755–763, 1998. doi:10.1093/oxfordjournals.aje.a009520. Crossref | PubMed | ISI | Google Scholar2. Bulow J, Ulijaszek SJ, Holm L. Rejuvenation of the term sarcopenia. J Appl Physiol (1985); doi:10.1152/japplphysiol.00400.2018. Link | ISI | Google Scholar3. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel J-P, Rolland Y, Schneider SM, Topinková E, Vandewoude M, Zamboni M; European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 39: 412–423, 2010. doi:10.1093/ageing/afq034. Crossref | PubMed | ISI | Google Scholar4. Rolland Y, Czerwinski S, Abellan Van Kan G, Morley JE, Cesari M, Onder G, Woo J, Baumgartner R, Pillard F, Boirie Y, Chumlea WMC, Vellas B. Sarcopenia: its assessment, etiology, pathogenesis, consequences and future perspectives. J Nutr Health Aging 12: 433–450, 2008. doi:10.1007/BF02982704. Crossref | PubMed | ISI | Google ScholarSARCOPENIA IN THE ERA OF PRECISION MEDICINEBrian A. Irving,12 Timothy D. Allerton,2 and K. Sreekumaran Nair3.Author Affiliations1Department of Kinesiology, Louisiana State University, Baton Rouge, Louisiana.2Pennington Biomedical Research Center, Baton Rouge, Louisiana.3Mayo Clinic, Rochester, Minnesota.to the editor: From a purist’s perspective, “sarcopenia” refers to the progressive loss of muscle mass that directly contributes to age-related declines in strength and power. The progressive nature of sarcopenia differentiates itself from other myopathies (i.e., cachexia, etc.).However, declines in muscle mass, strength, and power do not follow the same trajectories with age. Indeed, the loss of muscle strength is more rapid than the reduction in muscle mass, which is not prevented when muscle mass is maintained (1).Sarcopenia profoundly impacts muscle strength and power, but also fits nicely into the broader picture of the muscle’s biological age (2). Indeed, aging is associated with declines in the number and cross sectional area of individual muscle fibers, especially type II fibers, declines in protein synthesis, and motor unit innervation and firing rates (2, 3). Collectively, these declines in neuromuscular function also contribute to reductions in muscle strength and power. Moreover, aging in sedentary people is accompanied by the loss of mitochondrial density, mtDNA abundance, oxidative capacity, and protein synthesis, which are highly associated with reduced exercise capacity (5). Age-related loss of muscle strength combined with the loss of muscle contractile units and mitochondrial function creates a perfect storm leading to the loss of independence in a rapidly aging population. Most age–related changes in muscle are reversible with rigorous exercise training demonstrating highly specific phenotype and molecular changes (4). Targeted interventions directed to the loss of muscle mass and the loss muscle function represent the future of precision medicine in this field.REFERENCES1. Delmonico MJ, Harris TB, Visser M, Park SW, Conroy MB, Velasquez-Mieyer P, Boudreau R, Manini TM, Nevitt M, Newman AB, Goodpaster BH, Health A; Health, Aging, and Body. Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr 90: 1579–1585, 2009. doi:10.3945/ajcn.2009.28047. Crossref | PubMed | ISI | Google Scholar2. Irving BA, Robinson MM, Nair KS. Age effect on myocellular remodeling: response to exercise and nutrition in humans. Ageing Res Rev 11: 374–389, 2012. doi:10.1016/j.arr.2011.11.001. Crossref | PubMed | ISI | Google Scholar3. Manini TM, Clark BC. Dynapenia and aging: an update. J Gerontol A Biol Sci Med Sci 67: 28–40, 2012. doi:10.1093/gerona/glr010. Crossref | PubMed | ISI | Google Scholar4. Robinson MM, Dasari S, Konopka AR, Johnson ML, Manjunatha S, Esponda RR, Carter RE, Lanza IR, Nair KS. Enhanced protein translation underlies improved metabolic and physical adaptations to different exercise training modes in young and old humans. Cell Metab 25: 581–592, 2017. doi:10.1016/j.cmet.2017.02.009. Crossref | PubMed | ISI | Google Scholar5. Short KR, Bigelow ML, Kahl J, Singh R, Coenen-Schimke J, Raghavakaimal S, Nair KS. Decline in skeletal muscle mitochondrial function with aging in humans. Proc Natl Acad Sci USA 102: 5618–5623, 2005. doi:10.1073/pnas.0501559102. Crossref | PubMed | ISI | Google ScholarREFERENCES1. Delmonico MJ, Harris TB, Visser M, Park SW, Conroy MB, Velasquez-Mieyer P, Boudreau R, Manini TM, Nevitt M, Newman AB, Goodpaster BH, Health A; Health, Aging, and Body. Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr 90: 1579–1585, 2009. doi:10.3945/ajcn.2009.28047. Crossref | PubMed | ISI | Google Scholar2. Irving BA, Robinson MM, Nair KS. Age effect on myocellular remodeling: response to exercise and nutrition in humans. Ageing Res Rev 11: 374–389, 2012. doi:10.1016/j.arr.2011.11.001. Crossref | PubMed | ISI | Google Scholar3. Manini TM, Clark BC. Dynapenia and aging: an update. J Gerontol A Biol Sci Med Sci 67: 28–40, 2012. doi:10.1093/gerona/glr010. Crossref | PubMed | ISI | Google Scholar4. Robinson MM, Dasari S, Konopka AR, Johnson ML, Manjunatha S, Esponda RR, Carter RE, Lanza IR, Nair KS. Enhanced protein translation underlies improved metabolic and physical adaptations to different exercise training modes in young and old humans. Cell Metab 25: 581–592, 2017. doi:10.1016/j.cmet.2017.02.009. Crossref | PubMed | ISI | Google Scholar5. Short KR, Bigelow ML, Kahl J, Singh R, Coenen-Schimke J, Raghavakaimal S, Nair KS. Decline in skeletal muscle mitochondrial function with aging in humans. Proc Natl Acad Sci USA 102: 5618–5623, 2005. doi:10.1073/pnas.0501559102. Crossref | PubMed | ISI | Google ScholarCOMMENTARY ON VIEWPOINT: REJUVENATION OF THE TERM SARCOPENIARicardo M. Lima.Author AffiliationsUniversidade de Brasília, Campus Universitário, Darcy Ribeiro Faculdade de Educação Física, Brasília – Distrito Federal – Brazil.to the editor: Bulow et al. (1) are to be congratulated for their insightful commentary regarding the use of the term sarcopenia, which was introduced to describe the age-related decline in skeletal muscle mass (5) and has since become widely used. Currently, there is broad support for the concept that strength and function are more clinically meaningful than is muscle mass (2–4), and hence these measures were incorporated into sarcopenia definitions. Based on this background, Bulow et al. (1) postulate that the use of the term sarcopenia rests upon tautological association and suggest a return to its original definition (i.e., solely loss of muscle mass).Although I entirely agree with the framework raised by our well-respected colleagues (1), I believe that changing sarcopenia definition now would lead to further confusion in research and clinical settings. Since its first description (5), numerous research has emerged and tremendous advances have been made in understanding the link between muscle-related phenotypes and outcomes in older people. At least two annual conferences and one peer-reviewed journal aim at advancing the state of knowledge in the field. Therefore, sarcopenia is already a widely known entity. Other conditions have emerged from it, for example, sarcopenic obesity (3) and osteosarcopenia (4). Perhaps more important than redefining terminology would be to disseminate effectively the latest knowledge, including that sarcopenia is not characterized only in terms muscle mass. Increased awareness of sarcopenia signs will optimize detection and treatment of this disabling condition and ultimately contribute to improve quality of life in the elderly population.REFERENCES1. Bulow J, Ulijaszek SJ, Holm L. Rejuvenation of the term sarcopenia. J Appl Physiol (1985); doi:10.1152/japplphysiol.00400.2018. Link | ISI | Google Scholar2. dos Santos EP, Gadelha AB, Safons MP, Nóbrega OT, Oliveira RJ, Lima RM. Sarcopenia and sarcopenic obesity classifications and cardiometabolic risks in older women. Arch Gerontol Geriatr 59: 56–61, 2014. doi:10.1016/j.archger.2014.03.012. Crossref | PubMed | ISI | Google Scholar3. Lima RM, Bezerra LM, Rabelo HT, Silva MA, Silva AJ, Bottaro M, de Oliveira RJ. Fat-free mass, strength, and sarcopenia are related to bone mineral density in older women. J Clin Densitom 12: 35–41, 2009. doi:10.1016/j.jocd.2008.10.003. Crossref | PubMed | ISI | Google Scholar4. Menant JC, Weber F, Lo J, Sturnieks DL, Close JC, Sachdev PS, Brodaty H, Lord SR. Strength measures are better than muscle mass measures in predicting health-related outcomes in older people: time to abandon the term sarcopenia? Osteoporos Int 28: 59–70, 2017. doi:10.1007/s00198-016-3691-7. Crossref | PubMed | ISI | Google Scholar5. Rosenberg IH. Summary comments. Am J Clin Nutr 50: 1231–1233, 1989. doi:10.1093/ajcn/50.5.1231.Crossref | ISI | Google ScholarREFERENCES1. Bulow J, Ulijaszek SJ, Holm L. Rejuvenation of the term sarcopenia. J Appl Physiol (1985); doi:10.1152/japplphysiol.00400.2018. Link | ISI | Google Scholar2. dos Santos EP, Gadelha AB, Safons MP, Nóbrega OT, Oliveira RJ, Lima RM. Sarcopenia and sarcopenic obesity classifications and cardiometabolic risks in older women. Arch Gerontol Geriatr 59: 56–61, 2014. doi:10.1016/j.archger.2014.03.012. Crossref | PubMed | ISI | Google Scholar3. Lima RM, Bezerra LM, Rabelo HT, Silva MA, Silva AJ, Bottaro M, de Oliveira RJ. Fat-free mass, strength, and sarcopenia are related to bone mineral density in older women. J Clin Densitom 12: 35–41, 2009. doi:10.1016/j.jocd.2008.10.003. Crossref | PubMed | ISI | Google Scholar4. Menant JC, Weber F, Lo J, Sturnieks DL, Close JC, Sachdev PS, Brodaty H, Lord SR. Strength measures are better than muscle mass measures in predicting health-related outcomes in older people: time to abandon the term sarcopenia? Osteoporos Int 28: 59–70, 2017. doi:10.1007/s00198-016-3691-7. Crossref | PubMed | ISI | Google Scholar5. Rosenberg IH. Summary comments. Am J Clin Nutr 50: 1231–1233, 1989. doi:10.1093/ajcn/50.5.1231.Crossref | ISI | Google ScholarSHOULD WE REJUVENATE THE (ROSENBERG) DEFINITION OF SARCOPENIA? A RESPONSE BASED ON THE POPULATION HEALTH SCIENCEJuan Pablo Rey-López.Author AffiliationsPrevention Research Collaboration. School of Public Health, University of Sydney, NSW, Australia.to the editor: Bullow et al. (2) make a case for bringing back the original term of sarcopenia, whereby a decline in lean body mass may exceed a critical threshold that lead to poor health. Before expressing my comments about the piece of Bullow et al. (2), I was astonished that the original definition of sarcopenia proposed by Rosenberg (5) (which has received 395 cites in Web of Science) did not include any scientific reference to support their arguments. Thus, the criticisms raised by Bullow et al. (2) in relation to the lack of clear theoretical frameworks contained in recent definitions of sarcopenia, should also be extensive to the first definition coined by Rosenberg (5). Nonetheless, I agree with the suggestion that the current algorithms used to identify sarcopenia are misleading for three reasons: First, sarcopenia is used to describe both the loss of function and muscle mass, which is intrinsically inaccurate. Second, rather than thinking in sarcopenia as a dichotomous category, clinicians should not overlook that most health indicators are distributed along a continuum (4). This approach forces us to downplay any quest for accurately defining sarcopenia as what matters most is to optimize the functional capability and muscle mass maintenance of the entire population (population strategy) (4). Critically, these efforts should start early in life (1). Finally, in a world where one-third of the global population exceeds normal weight (3), body fat loss remains our most important public and clinical health priority. For all the reasons above, a rejuvenated definition of sarcopenia is largely irrelevant.GRANTSJ.P.R.L. is supported by a post-doctoral fellowship from the University of Sydney (Australia).REFERENCES1. A Sayer A, Stewart C, Patel H, Cooper C. The developmental origins of sarcopenia: from epidemiological evidence to underlying mechanisms. J Dev Orig Health Dis 1: 150–157, 2010. doi:10.1017/S2040174410000097. Crossref | PubMed | ISI | Google Scholar2. Bulow J, Ulijaszek SJ, Holm L. Rejuvenation of the term Sarcopenia. 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