Sarcopenia

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The sarcopenia refers to the increasing with age breakdown of muscle mass and muscle strength, and the associated functional limitations of the elderly. For those affected, this leads to an increase in falls and related injuries. Due to the demographic development with a steadily growing group of older people, sarcopenia will play an increasingly sociological and economic role in the industrialized nations. The term sarcopenia was coined in 1988 by Irwin H. Rosenberg at a conference in Albuquerque , New Mexico . It is a word formation from the Greek - sarx stands for 'meat' and penia for 'lack'.

causes

Age-related muscle wasting can start at the age of 50, but the process accelerates from the age of 70. From the age of around 50, muscle mass decreases by around 0.8 percent annually. The loss of muscle strength between the ages of 50 and 60 is around 1.5% per year, after that even around 3% per year. The causes of the increasing muscle breakdown are assumed to be the age-related reduction in anabolic (muscle-building) and predominance of catabolic (muscle-breaking) processes as well as malfunctions of cellular processes in the muscle fibers. Men and women are affected roughly equally. Malnutrition, which is common in old age, as well as a lack of exercise and immobilization (e.g. in the case of illness-associated bed rest ) are further causes and favor sarcopenia. Therefore, the elderly are affected differently by sarcopenia. The need for protein seems to increase with age, so it is assumed that the protein deficiency is a major factor in the development and progression of sarcopenia. A variety of changes in skeletal muscle play a role in causing sarcopenia. Functional units of the muscle (motor units) are decoupled from the nerve supply and the muscle is infiltrated by fat and connective tissue. Overall, the number and size of muscle fibers decrease. In addition, there is a deposit of age pigment ( lipofuscin ) in the muscle. Overall, however, these changes do not lead to unwanted weight loss ( cachexia ) despite the loss of muscle mass .

Diagnostic criteria

The diagnosis of sarcopenia was rarely made in medical practice until 2017. This also means that the frequency of sarcopenia and its consequences have been underestimated in everyday clinical practice. Epidemiological studies show that around 5–13% of all 60–70 year olds and up to 50% of all over 80 year olds are affected by sarcopenia. Sarcopenia often leads to frailty , but only about half of those affected by sarcopenia can also be classified as frail. For the analysis of body composition and therefore muscle mass, dual X-ray absorptiometry ( DXA ) is currently considered the gold standard, but it is often not available as standard. Another method often used in diagnosing sarcopenia is bioelectrical impedance analysis (BIA). Also computed tomography (CT) and magnetic resonance imaging (MRI) are considered reliable, but expensive aids in diagnosis. Two definitions have recently been proposed by European and international expert bodies. Both use decreased muscle mass and reduced walking speed to diagnose sarcopenia. If the muscle mass of the person concerned, which was determined using the methods mentioned above, is 2 standard deviations below the mean value of a healthy young reference group of the same sex and ethnic background and there is a slowdown in walking speed to less than 0.8 m / s, then the Make a diagnosis of sarcopenia.

Sarcopenia can be coded in ICD-10-GM (German modification) with M62.50, in ICD-9-CM (clinical modification) with M62.84.

Therapeutic approaches

The treatment of sarcopenia is still a challenge in everyday clinical practice. Strength training is considered suitable to prevent the development of sarcopenia. In addition, strength training is suitable for improving walking speed and overall muscle strength. The disadvantage is that the training leads to an improvement in these parameters, but a plateau is reached quickly and further training does not lead to any further success. The administration of steroid hormones can reduce the regression of the muscles, but undesirable side effects often occur. Various studies have shown that increasing protein intake and, above all, the amount of branched-chain amino acids leucine , isoleucine or valine are beneficial for the prevention and treatment of sarcopenia. By increasing the formation of new protein in the muscle, an increase in body lean mass can be achieved. A number of independent studies have shown that a supplementary balanced diet with essential amino acids, which also include the aforementioned branched-chain amino acids, can have beneficial effects on muscle strength, running speed and also heart muscle strength. A precise adjustment of the ratio of the various amino acids is essential. Further therapies, including drug treatments, are currently being developed.

credentials

  1. ↑ Spira, D .; Noman, K. et al: Prevalence and definition of sarcopenia in community dwelling older people. In: Zeitschrift für Gerontologie und Geriatrie Vol. 49, 2, Feb. 2016, pp. 94–99 (definition in German summary, p. 96)
  2. ↑ SM Phillips: Nutritional supplements in support of resistance exercise to counter age-related sarcopenia. In: Advances in nutrition. Volume 6, Number 4, July 2015, pp 452-460, doi : 10.3945 / an.115.008367 , PMID 26178029 , PMC 4496741 (free full text) (Review).
  3. ↑ a b S. von Haehling: Supplementary balanced diet with essential amino acids for chronic diseases and in advanced age. In: Aktuel Ernahrungsmed 35, 2010, pp. 115–123. doi : 10.1055 / s-0030-1248415
  4. ↑ a b K. Norman, J. Bauer, C. Smoliner, H. Lochs, M. Pirlich: Importance of protein intake in the development and treatment of sarcopenia. In: Aktuel Ernahrungsmed 34, 2009, pp. 171–177. doi : 10.1055 / s-0029-1220334
  5. ^ JE Morley, MJ Kim, MT Haren, R. Kevorkian, WA Banks: Frailty and the aging male. In: Aging Male 8, 2005, pp. 135-140. doi : 10.1080 / 13685530500277232
  6. ↑ AJ Cruz-Jentoft, JP Baeyens, JM Bauer, Y. Boirie, T. Cederholm, F. Landi, FC Martin, JP Michel, Y. Rolland, SM Schneider, E. Topinková, M. Vandewoude, M. Zamboni, 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. In: Age Aging 39, 2010, pp. 412-423. doi : 10.1093 / aging / afq034
  7. ↑ M. Muscaritoli, SD Anker, J. Argilés, Z. Aversa, JM Bauer, G. Biolo, Y. Boirie, I. Bosaeus, T. Cederholm, P. Costelli, KC Fearon, A. Laviano, M. Maggio, F. Rossi Fanelli, SM Schneider, A. Schols, CC Sieber: Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) "cachexia-anorexia in chronic wasting diseases" and "nutrition in geriatrics ". In: Clin Nutr 29, 2010, pp. 154-159. doi : 10.1016 / j.clnu.2009.12.004
  8. ↑ S. Goisser, R. Kob, CC Sieber, JM Bauer, update the diagnosis and treatment of sarcopenia . The internist, issue 2/2019.
  9. ↑ SD Anker, JE Morley, S. von Haehling: Welcome to the ICD-10 code for sarcopenia . In: Journal of Cachexia, Sarcopenia and Muscle . tape 7 , no. 5 , December 2016, p. 512-514 , doi : 10.1002 / jcsm.12147 , PMID 27891296 , PMC 5114626 (free full text).

literature

  • IH Rosenberg: Sarcopenia: origins and clinical relevance. In: J Nutr 127, 1997, pp. 990S-991S. PMID 9164280
  • R. Roubenoff and VA Hughes: Sarcopenia: current concepts. In: J Gerontol A Biol Sci Med Sci 55, 2000, pp. M716-724. PMID 11129393
  • JM Bauer, R. Wirth, D. Volker, C. Sieber: Malnutrition, sarcopenia and cachexia around old age - from pathophysiology to therapy. In: German Medical Weekly. Volume 133, 2008, pp. 305-310.