An Evidence-Based Comparison of Operational Criteria for the Presence of Sarcopenia

Abstract

Several consensus groups have previously published operational criteria for sarcopenia, incorporating lean mass with strength and/or physical performance. The purpose of this manuscript is to describe the prevalence, agreement, and discrepancies between the Foundation for the National Institutes of Health (FNIH) criteria with other operational definitions for sarcopenia.
The FNIH Sarcopenia Project used data from nine studies including: Age, Gene and Environment Susceptibility-Reykjavik Study; Boston Puerto Rican Health Study; a series of six clinical trials from the University of Connecticut; Framingham Heart Study; Health, Aging, and Body Composition Study; Invecchiare in Chianti; Osteoporotic Fractures in Men Study; Rancho Bernardo Study; and Study of Osteoporotic Fractures. Participants included in these analyses were aged 65 and older and had measures of body mass index, appendicular lean mass, grip strength, and gait speed.
The prevalence of sarcopenia and agreement proportions was higher in women than men. The lowest prevalence was observed with the FNIH criteria (1.3% men and 2.3% women) compared with the International Working Group and the European Working Group for Sarcopenia in Older Persons (5.1% and 5.3% in men and 11.8% and 13.3% in women, respectively). The positive percent agreements between the FNIH criteria and other criteria were low, ranging from 7% to 32% in men and 5% to 19% in women. However, the negative percent agreement were high (all >95%).
The FNIH criteria result in a more conservative operational definition of sarcopenia, and the prevalence was lower compared with other proposed criteria. Agreement for diagnosing sarcopenia was low, but agreement for ruling out sarcopenia was very high. Consensus on the operational criteria for the diagnosis of sarcopenia is much needed to characterize populations for study and to identify adults for treatment.

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Special Article
An Evidence-Based Comparison of Operational Criteria
for the Presence of Sarcopenia
Thuy-TienDam,1 Katherine W.Peters,2 MarenFragala,3 Peggy M.Cawthon,2 Tamara B.Harris,4
RobertMcLean,5,6 MichelleShardell,7 Dawn E.Alley,7 AnneKenny,8 LuigiFerrucci,4 JackGuralnik,7
Douglas P.Kiel,5,6 SteveKritchevsky,9 Maria T.Vassileva,10 and StephanieStudenski11
1Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
2California Pacic Medical Center Research Institute, San Francisco.
3Department of Educational and Human Sciences, University of Central Florida, Orlando.
4Intramural Research Program, National Institute of Aging, National Institutes of Health, Bethesda, Maryland.
5Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts.
6Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
7Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore.
8Center on Aging, University of Connecticut Health Center, Farmington.
9The Sticht Center on Aging and Department of Internal Medicine,
Wake Forest University School of Medicine, Winston-Salem, North Carolina.
10The Biomarkers Consortium, Foundation for the National Institutes of Health, Bethesda, Maryland.
11Department of Medicine, School of Medicine, University of Pittsburgh, Pennsylvania.
Address correspondence to Thuy-Tien Dam, MD, Columbia University, 5141 Broadway Avenue, 3 Field West, Room 13, New York,
NY 10034. Email: td2265@columbia.edu
Background. Several consensus groups have previously published operational criteria for sarcopenia, incorporat-
ing lean mass with strength and/or physical performance. The purpose of this manuscript is to describe the prevalence,
agreement, and discrepancies between the Foundation for the National Institutes of Health (FNIH) criteria with other
operational denitions for sarcopenia.
Methods. The FNIH Sarcopenia Project used data from nine studies including: Age, Gene and Environment
Susceptibility-Reykjavik Study; Boston Puerto Rican Health Study; a series of six clinical trials from the University of
Connecticut; Framingham Heart Study; Health, Aging, and Body Composition Study; Invecchiare in Chianti; Osteoporotic
Fractures in Men Study; Rancho Bernardo Study; and Study of Osteoporotic Fractures. Participants included in these anal-
yses were aged 65 and older and had measures of body mass index, appendicular lean mass, grip strength, and gait speed.
Results. The prevalence of sarcopenia and agreement proportions was higher in women than men. The lowest preva-
lence was observed with the FNIH criteria (1.3% men and 2.3% women) compared with the International Working
Group and the European Working Group for Sarcopenia in Older Persons (5.1% and 5.3% in men and 11.8% and 13.3%
in women, respectively). The positive percent agreements between the FNIH criteria and other criteria were low, rang-
ing from 7% to 32% in men and 5% to 19% in women. However, the negative percent agreement were high (all >95%).
Conclusions. The FNIH criteria result in a more conservative operational denition of sarcopenia, and the prevalence
was lower compared with other proposed criteria. Agreement for diagnosing sarcopenia was low, but agreement for rul-
ing out sarcopenia was very high. Consensus on the operational criteria for the diagnosis of sarcopenia is much needed
to characterize populations for study and to identify adults for treatment.
Key Words: Muscle—Sarcopenia—Lean mass.
Received June 19, 2013; Accepted January 14, 2014
Decision Editor: Roger Fielding, PhD
LOW muscle mass and weakness are potential
contributors to disability in older persons. Although the
term “sarcopenia” has become widespread, the criteria for
an operational denition vary among studies and experts.
Initial work on dening sarcopenia was based on measures
of muscle mass alone, and the prevalence of sarcopenia
when compared with a young reference population ranged
between 13% and 24% among adults younger than 70years
to more than 50% among adults older than 80 years (1).
However, a growing body of research suggests that there
is a disconnect between muscle mass and strength. Thus,
recent denitions of sarcopenia have incorporated elements

OPERATIONAL CRITERIA FOR THE PRESENCE OF SARCOPENIA 585
of strength and physical performance in addition to muscle
mass in the criteria for sarcopenia (2–5). However, these
consensus statements were based on expert opinions and
lacked access to large data sets to validate their recommen-
dations. Thus, the goal of the Foundation for the National
Institutes of Health (FNIH) Sarcopenia Project was to cre-
ate a data-driven set of criteria for clinically relevant weak-
ness and low lean mass using pooled data from multiple
studies.
This is the fth report of the FNIH Sarcopenia Project.
The rst manuscript describes the rationale for the FNIH
Sarcopenia Project and characteristics of the participating
studies. The second and third manuscripts describe in detail
the development of cutpoints for weakness and low lean
mass; and the fourth manuscript demonstrates the predic-
tive validity of these cutpoints. The purpose of the analyses
presented here is to compare the criteria developed by the
FNIH project to other published criteria, in order to assess
prevalence, agreement, and discrepancies between candi-
date criteria. Our goal is to provide data-driven evidence to
the eld in order to advance professional consensus regard-
ing clinically relevant cutpoints and terminology.
Methods
Participants
The studies participating in the FNIH Sarcopenia Project
are described in the rst manuscript in this series (6).
They include: Age, Gene and Environment Susceptibility-
Reykjavik Study (AGES) (7); Boston Puerto Rican Health
Study (BPRHS) (8); six clinical trials at University of
Connecticut (UCONN) (9–14); Framingham Heart Study
(FHS) Original cohort (15) and the Offspring cohort (16);
Health, Aging, and Body Composition Study (HABC)
(17); Invecchiare in Chianti (InChianti) (18); Osteoporotic
Fractures in Men Study (MrOS) (19,20); Rancho Bernardo
Study (RBS) (21); and Study of Osteoporotic Fractures
(SOF) (22,23). To be included in these analyses, partici-
pants must be aged 65 and older and must have completed,
at a single time point, the following measures: objectively
measured body mass index (BMI), appendicular lean
mass (ALM: sum of lean mass in the arms and legs), grip
strength, and gait speed. Participants from RBS and AGES
were excluded because RBS did not measure walking speed
and AGES measured body composition with bioelectrical
impedance (BIA). Atotal of 7,113 men and 2,950 women
were included in the analyses presented here.
Measurement of Lean Mass, Strength, and Performance
Gait speed was measured as the length of the walking
course (4 or 6 m) divided by the time it took participants
to walk the course at their usual pace. Walking courses that
were longer or shorter were converted to a speed that would
have been achieved on a 4- or 6-m course using previously
published equations (24). If more than one test was admin-
istered, the average gait speed (m/s) was used. Grip strength
was measured by a handheld dynamometer, and the maxi-
mum value of either hand was analyzed. Total body fat mass
and total bone-free lean mass (kg) were acquired using dual
energy x-ray absorptiometry (DXA) on Hologic (Waltham,
MA) or Lunar/GE Healthcare (Madison, WI) machines.
Operational Denitions of Lean Mass, Strength, and
Other Factors
The FNIH cutpoints for grip strength and lean mass,
derived from classication and regression tree analysis, were
reported in two accompanying articles (25,26). Participants
with gait speed less than or equal to 0.8 m/s were classied
as having slow walking speed. Men with grip strength less
than 26 kg and women with a grip strength less than 16 kg
were dened as weak (25). We used ALM divided by body
size (ALMBMI) to determine lean mass; men with ALMBMI
less than 0.789 and women with ALMBMI less than 0.512
were classied as low lean mass (26). We also examined
our alternative denitions for low lean mass using absolute
ALM (not corrected for body size); men with ALM less
than 19.75 kg and women with ALM less than 15.02 were
classied as low lean mass (data not shown). Using these
cutpoints, we examined two possible FNIH denitions: (i)
clinically relevant weakness and low lean mass (low grip
strength + low ALMBMI) or (ii) clinically relevant slowness
with weakness and low lean mass (slow gait speed + low
grip strength + low ALMBMI). These denitions were used
to compare with other proposed denitions for sarcopenia.
Several groups have previously published operational
criteria to dene sarcopenia, including: (i) International
Working Group (IWG) (4); (ii) European Working Group
on Sarcopenia Older Persons (EWGSOP) (3); (iii) European
Society for Clinical Nutrition and Metabolism Special
Interest Group on cachexia-anorexia in chronic wasting
diseases (ESPEN) (2); and (iv) Society of Sarcopenia,
Cachexia, and Wasting Disorders (SCWD) (5). These rec-
ommendations combined lean mass with a strength and/or
physical performance measure. The EWGSOP suggested
that sarcopenia be dened as low lean mass + low strength
and/or low performance. The EWGSOP differentiated pre-
sarcopenia (low mass) from sarcopenia (low mass + low
strength or low performance) and severe sarcopenia (low
mass + low strength + low performance). Several pos-
sible performance measures (grip strength, chair stand,
gait speed), lean mass assessment methods (DXA, bioim-
pedance, computed tomography, and magnetic resonance
imaging), and different cutpoints were suggested by the
EWGSOP. For the FNIH analyses, we used ALM by DXA,
grip strength, and gait speed as measures of muscle mass,
strength, and physical performance (3) and used similar
cutpoints that were recently published to operationalize the
EWGSOP criteria (27–29). The IWG recommended gait

586 DAM ETAL.
speed as a measure of physical performance and dened
gait speed less than 1 m/s as slow (4). The recommenda-
tions for ESPEN and SCWD were similar to EWGSOP and
IWG, thus were not analyzed separately. The operational
cutpoints used in these analyses are summarized in Table1.
Statistical Analysis
Data were analyzed for men and women separately.
Descriptive statistics were examined across sets of criteria.
Sensitivity and specicity were not determined because
they are not applicable in the absence of a gold standard
criterion to dene sarcopenia. Furthermore, positive pre-
dictive value, negative predictive value, and likelihood
ratios cannot be computed because a participant’s sta-
tus (as determined by a reference standard) is unknown.
Therefore, we described the agreement between the FNIH
criteria with other proposed criteria using several differ-
ent statistical measures (30), including: (i) positive percent
agreement: the proportion of participants who were cat-
egorized as having the condition by both the FNIH criteria
and a second set of criteria divided by the number of par-
ticipants who were categorized as having the condition by
the second set of criteria. This is analogous to a sensitivity
calculation; (ii) negative percent agreement: the propor-
tion of participants who were categorized as not having the
condition by both the FNIH criteria and a second set of
criteria divided by the number of participants who were
categorized as not having the condition by the second set of
criteria. This is analogous to a specicity calculation; and
(iii) Cohen’s kappa (κ). Kappa (κ) values less than 0.40 are
considered poor reliability, 0.40–0.75 are considered fair-
to-good reliability, and greater than 0.75 are considered
excellent reliability (30).
Results
These analyses included 10,063 participants (7,113
men and 2,950 women). Mean ± SD for gait speeds were
1.23 ± 0.24 m/s and 0.97 ± 0.24 m/s; grip strengths were
40.7 ± 8.8 kg and 21.1 ± 5.9 kg; ALMBMI were 0.88 ± 0.11
kg and 0.60 ± 0.10 kg; and ALM were 40.23 ± 8.92 kg and
20.58 ± 5.81kg, for men and women, respectively. The pro-
portion of participants who fell below the FNIH cutpoints
for gait speed, grip strength, lean mass, and the multiple
combinations are presented in Figure 1. Compared with
ALM divided by height squared (ALM/ht2), participants
with low lean mass by the FNIH criteria (ALMBMI) were
heavier with higher BMI and ALM; more participants were
overweight or obese and reported a history of diabetes and
heart failure (Supplementary Table 1). Despite their larger
body size, adults with low lean mass by the FNIH ALMBMI
cutpoint had poorer physical function including weaker
grip strength, slower mean walking speed, and a higher per-
centage with walking speed less than or equal to 0.8 m/s
compared with participants with low lean mass dened by
ALM/ht2.
The various proposed operational denitions and prev-
alence of sarcopenia are presented in Table 1. Note that
primary indicator of lean mass for the FNIH project was
ALMBMI, whereas all other proposed criteria used ALM/
ht2. These sets of candidate denitions largely differed from
Table1. Summary of Operational Denitions for Sarcopenia and Prevalence by Gender
Criteria
Operational Denition Prevalence (%)
Physical
Performance
Muscle
Strength ALM
Men
(n = 7,113)
Women
(n = 2,950)
Foundation of NIH Sarcopenia Project
Weakness and low lean mass — Grip strength ALMBMI 1.3 2.3
Men: <26kg Men: <0.789
Women: <16kg Women: <0.512
Slowness with weakness
and low lean mass
Gait speed: ≤0.8 m/s Grip strength ALMBMI 0.5 1.8
Men: <26kg Men: <0.789
Women: <16kg Women: <0.512
International Working
Group
Gait speed: <1.0 m/s — ALM/ht25.1 11.8
Men: ≤7.23 kg/m2
Women: ≤5.67 kg/m2
European Working Group on Sarcopenia Older Persons
Sarcopenia Gait speed: <0.8 m/s or ALM/ht25.3 13.3
Grip strength Men: ≤7.23 kg/m2
Men: <30kg Women: ≤5.67 kg/m2
Women: <20kg
Severe sarcopenia Gait speed: <0.8 m/s Grip strength ALM/ht20.7 2.9
Men: <30kg Men: ≤7.23 kg/m2
Women: <20kg Women: ≤5.67 kg/m2
Note: ALMBMI = ratio of appendicular lean mass over body mass index; ALM/ht2 = ratio of appendicular lean mass over height squared.

OPERATIONAL CRITERIA FOR THE PRESENCE OF SARCOPENIA 587
each other in regards to the cutpoint for slow gait speed
and whether or not to include a measure of weakness. The
prevalence of sarcopenia was higher in women than men. In
men, the prevalence was 1.3% for the FNIH criteria, 5.1%
for IWG, and 5.3% for EWGSOP. In women, the preva-
lence was 2.3% for FNIH, 11.8% for IWG, and 13.3% for
EWGSOP. When we included gait speed with grip strength
and lean mass in the FNIH denition, the proportion of par-
ticipants who met all three was lower: 0.5% in men and
1.8% in women. Furthermore, the prevalence of severe sar-
copenia by the EWGSOP was 0.7% in men and 2.9% in
women. In general, the FNIH criteria, compared with other
proposed denitions, identied participants who were older
with higher BMI and higher lean mass, but were function-
ally more impaired, including a higher proportion with slow
gait and inability to rise from a chair (Supplementary Tables
2 and 3).
Table2 presents agreement proportions between the vari-
ous criteria. In general, agreement was higher in men than
in women and higher between the FNIH and EWGSOP cri-
teria. The positive percent agreements between the FNIH
criteria and other criteria were low, ranging from 4.3%
Table2. Agreement Comparing the FNIH Criteria With Other Operational Criteria for Sarcopenia
IWG
EWGSOP
Sarcopenia
EWGSOP
Severe Sarcopenia
PPA (%) NPA (%) κPPA (%) NPA (%) κPPA (%) NPA (%) κ
Men
FNIH weakness and low lean mass 9.0 98.5 0.14 19.1 99.1 0.53 32.0 98.3 0.23
FNIH slowness with weakness and
low lean mass
7.1 99.7 0.11 4.3 99.7 0.07 32.0 99.7 0.17
Women
FNIH weakness and low lean mass 9.0 97.8 0.12 11.4 96.8 0.14 18.9 97.0 0.17
FNIH slowness with weakness and
low lean mass
4.5 99.6 0.04 4.0 98.5 0.04 19.9 99.7 0.17
Note: EWGSOP = European Working Group on Sarcopenia Older Persons; FNIH = Foundation of the National Institute of Health; IWG = International Working
Group on Sarcopenia; NPA = negative percent agreement: the proportion of participants who were categorized as not having the condition by both the FNIH criteria
and a second set of criteria divided by the number of participants who were categorized as not having the condition by the second set of criteria; PPA = positive percent
agreement: the proportion of participants who were categorized as having the condition by both the FNIH criteria and a second set of criteria divided by the number
of participants who were categorized as having the condition by the second set of criteria.
Figure1. Independence and overlap of prevalent FNIH criterion (slowness, weakness, and low lean mass) among men (n=7,113) and women (n=2,950) in the
pooled data set. Descriptions of the criterion are described in Methods section. Numbers in the circle represent the percentage of the sample with each of these criteria.
Numbers in the areas of overlap indicate the percentage of the sample that has more than criterion. Only 0.5% men and 1.8% women share all criteria.

588 DAM ETAL.
to 32% in men and 4.0% to 19.9% in women. However,
the negative percent agreement was very high (all >95%).
Our results demonstrated that kappa values were modest,
with a range of 0.11–0.53 in men and 0.04–0.17 in women.
Between the IWG and EWGSOP denitions, the positive
percent agreement for sarcopenia was 52.1% and 61.7% in
men and women, respectively. The negative percent agree-
ment for sarcopenia was 97.1% and 96.4% in men and
women, respectively.
Discussion
The prevalence of sarcopenia varies greatly depending
on the criteria used for diagnosis. Based on the presence
of lean mass alone, initial prevalence of sarcopenia ranged
between 7% and 50%. The large range was due to differ-
ences in the criterion used to diagnose sarcopenia, including
(i) denitions that only included lean mass with or with-
out correction for height (1,31), body mass (32), or body
height and body fat (33); (ii) methodological differences to
measure muscle mass (DXA or BIA) (1,32–35); and (iii)
differences in the reference population used to establish
normative data. In this study, the prevalence of sarcopenia
incorporating both low lean mass and poor function were
much lower—between 0.5% and 5.3% in men and 1.8%
and 13.3% in women compared with denitions based on
muscle massalone.
When comparing the FNIH, EWGSOP, and IWG criteria
in this pooled sample, the positive percent agreements were
low, but the negative percent agreements were high (all
>95%), suggesting that there was good agreement on the
absence of the condition. The prevalence of sarcopenia was
highest with the EWGSOP criteria in both men and women
(5.3% and 13.3%, respectively). Given that the FNIH crite-
ria were more restrictive, it was not surprising that the prev-
alence of sarcopenia was lower than either the EWGSOP
or IWG criteria. Adults considered sarcopenic by both the
FNIH and EWGSOP or by both FNIH and IWG criteria had
little overlap as evidenced by the modest positive percent
agreement and kappa values. However, the FNIH criteria
had better concordance with the EWGSOP criteria. This
was because the FNIH and EWGSOP had similar concep-
tual frameworks and both included measures of lean mass,
strength, and/or performance. We believe the lack of agree-
ment between these two criteria is explained by differences
in the participants categorized as having low lean mass: The
FNIH criteria used ALMBMI, whereas both EWGSOP and
IWG criteria used ALM/ht2. Although adults with ALM/ht2
less than 5.67 kg/m2 in women and less than 7.23 kg/m2 in
men did have low lean mass relative to a young reference
population, this amount of lean mass was associated with
faster gait speeds, stronger grip strength, and lower rates
of obesity compared with participants who had low lean
mass by ALMBMI. On the other hand, adults who met the
FNIH criteria for low lean mass (ALMBMI) were slightly
more impaired with slower walking speeds and lower grip
strength even though they had higher BMI and ALM, and
proportionately more obesity. These data suggests that
ALMBMI, lean mass corrected for body size, is a good dis-
criminator for low lean mass and is likely capturing adults
who were unable to generate enough strength or function
relative to their body size (sarcopenic obesity), and ALMBMI
may be a good measure for low muscle quality or efciency.
In this study, there were several limitations. In particular,
the prevalence and agreement rates may have been affected
by several factors, including (i) the conceptual model, (ii)
the strength or performance measure and cutpoints used,
(iii) the method of assessment, and (iv) the study popula-
tion. First, mobility is an important predictor and indicator
of functional independence and disability. Therefore, our
conceptual framework and statistical approach was based
on using mobility impairment as the clinically relevant
functional state to determine meaningful weakness and
low lean mass. In this series, we provided two different
possible FNIH criteria: (i) weakness + low lean mass or
(ii) slowness + weakness + low lean mass. Although this
framework resulted in a low prevalence of sarcopenia, we
chose to combine gait speed with grip strength and lean
mass because the goal of the FNIH Sarcopenia Project was
to develop criteria that were conservative with few false
positives in order to identify individuals who were clearly
abnormal. Second, there were many different measures of
strength or performance that could have been used (eg, grip
strength, leg power, dynamic leg strength, short physical per-
formance, gait speed, and chair stand). However, we chose
gait speed as a measure of mobility because it was avail-
able in all but one of the pooled studies, it has been reliably
measured in clinical studies, and has been closely linked
to function. Additionally, we chose gait speed less than or
equal to 0.8 m/s because it has been associated with survival
(36), and the prevalence of gait speed less than or equal to
0.6 m/s was very rare in our pooled sample. In one study,
among 70- to 80-year-old Finnish women, the prevalence
of sarcopenia was 2.7% vs. 0.9% when gait speed less than
1.0 m/s was used instead of gait speed less than 0.8 m/s
(28). We chose grip strength as a measure for muscle
strength because it is easy to use in both clinical and com-
munity settings and was available across all of the studies
participating. Selection of other measures like short physi-
cal performance battery or chair stand could have increased
or decreased the prevalence. However, among the partici-
pating studies that had chair stands in our pooled data set,
the proportion of participants unable to complete a chair
stand was similar to the proportion with gait speed less
than or equal to 0.8 m/s. Since the EWGSOP consensus
statement recommended several different cutpoints for dif-
ferent measures and did not mandate specic measures or
cutpoints, the prevalence of sarcopenia using the EWGSOP
criteria could have been inuenced by our operational
decisions. In fact, recent publications operationalizing the

OPERATIONAL CRITERIA FOR THE PRESENCE OF SARCOPENIA 589
EWGSOP and IWG criteria have reported different preva-
lence rates. For example, Landi and coworkers used the
lowest tertile of skin fold thickness for low lean mass, the
prevalence was 21.8% among Italians aged 80–85years
(29). In another study, among 103 community-dwelling
men in the UK Hertfordshire Sarcopenia Study, the preva-
lence for sarcopenia was 6.8% and 7.8% when the lowest
tertile of DXA-based lean mass was used instead of the
lowest tertile of skin fold–based fat free mass, respectively
(27). Furthermore, the positive percent agreement between
the FNIH and EWGSOP are likely overestimated because
we used similar gait speeds (<0.8 m/s) and grip strength
cutpoints (<26 vs <30 kg in men and <16 vs <20 kg in
women). Third, different brands/methods of DXA were
used in the studies participating in the FNIH Sarcopenia
Project, and therefore potential bias may lead to different
results. However, we tried to account for these differences
between studies by using a random effects term in all our
analyses that evaluated the association between our deni-
tions and outcomes.
Finally, the FNIH Sarcopenia Project pooled data sets
from nine different studies for pooled analyses—the larg-
est to ever be studied in this area and are generalizable
because the data set had broad representation of commu-
nity-dwelling older adults. However, the pooled data set
included primarily healthy community-dwelling popula-
tions with few comorbidities. This prevalence may be lower
compared with more vulnerable populations (eg, assisted
living, nursing home, or hospitalized adults), where disabil-
ity rates are higher. However, these vulnerable populations
are more heterogenous, and the factors contributing to slow
gait are more numerous including cognition, osteoarthritis,
pain, disuse atrophy, and cachexia. Whether the relationship
between lean mass, strength, and mobility are the same in
more vulnerable populations is notknown.
This large variation in the prevalence may lead to dif-
ferent conclusions and implications for treatment. In par-
ticular, it is not clear whether treatment of weakness and
low lean mass, especially with interventions that only target
improving muscle strength and mass, in different popula-
tions is benecial. Thus, the work presented in this series
is a work in progress, and many more questions and studies
are needed. However, the FNIH Sarcopenia Project provides
evidence-based and data-driven cutpoints that will help the
eld come to a consensus on a diagnostic criteria. Future
studies will need to address whether: (i) the prevalence of
low lean mass, weakness, and poor physical performance
with the FNIH criteria is higher among different popula-
tions; (ii) the associations between mass, strength, and
disability are similar or stronger in more disabled or sick
populations; (iii) the FNIH criteria is useful in identifying
participants for clinical trials; and (iv) these criteria allow
clinicians to recognize and potentially treat this disabling
condition. We envision that the FNIH criteria for clinically
relevant weakness and low lean mass might be used to plan
prevention studies in which older persons with weakness
and low lean mass, but have not yet developed mobility lim-
itations, would receive interventions designed to reduce the
incidence or increase the time to onset of mobility impair-
ment. Alternatively, the FNIH criteria for clinically relevant
slowness with weakness and low lean mass may be used to
identify candidates who already have mobility impairment,
weakness, and low lean mass for recruitment in treatment
studies that may look at outcomes like maintaining inde-
pendence, preventing disability, delaying transitions from
home to long-term care, quality of life, and/or survival.
In conclusion, the current work taps into the expertise
in the eld and utilizes the largest sample of community-
dwelling older adults to build upon and validate prior
recommendations. These data provide comparison of the
different denitions and suggest that the denitions have
good negative, but poor positive agreement. Thus, future
studies should examine the predictive validity of these dif-
ferent denitions with important clinical outcomes (eg,
disability, mortality) among different populations that may
benet from the diagnoses of sarcopenia.
S M
Supplementary material can be found at: http://biomedgerontology.
oxfordjournals.org/
F
Funding support for the conference and the work of the consortium
was provided by the National Institute on Aging (U13AG04158 and P30
AG024827), the Food and Drug Administration, and through grants from the
Foundation of the National Institute of Health (FNIH) made possible by fund-
ing from Abbot Nutrition, Amgen, Eli Lilly, Merck, Novartis, and the Dairy
Research Institute. This research was supported in part by the Intramural
Program of the NIH, National Institute on Aging. Additional acknowledg-
ments for each contributing cohort and members of the FNIH Sarcopenia
Project can be found in an online supplement. Dr. Dam was supported by the
National Institute on Aging through grant number K23 AG040168.
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