Sarcopenia is a serious disease and should be taken seriously

Sarcopenia is an age-related disease, defined as low muscle mass, low muscle strength and impaired physical function. The risk for individuals with sarcopenia to fall, to sustain a fracture and to die is doubled compared with individuals without sarcopenia. Sarcopenia occurs most frequently as a comorbid disease and comorbidities such as diabetes, cardiovascular disease, dementia and chronic obstructive pulmonary disease are highly prevalent in patients with unfavourable outcomes after surgery. Therefore, there is an urgent need to optimize perioperative strategies, particularly for the group of patients with sarcopenia. Diagnosing and intervening on sarcopenia could be a strategy to mitigate the negative risk. Sarcopenia has been an official disease since 2016, when it was granted an International Classification of Disease (ICD) code. Since then, expert groups have published a diagnostic algorithm. As stated by Wong et al. in this issue, the latest consensus by the European Working Group on Sarcopenia (EWGSOP2) uses low muscle strength as the primary parameter of sarcopenia and not muscle mass, which is also an important determinant of physical function, such as activities of daily living. Muscle mass can be accurately measured by dual-energy X-ray absorptiometry (DEXA) and bioelectrical impedance analysis (BIA), but also by magnetic resonance imaging (MRI) and computed tomography (CT) scanning. Using CT to estimate muscle mass has been proposed to be a viable option to indicate muscle health in patients with existing diseases, as CT scans are often readily available and software programs to automate measuring muscle mass progressed rapidly. In this issue, Ming et al. reported comparable associations between three surgical risk assessment tools (NELA, P-POSSUM and ACSNSQIP) and a CT-assessed ratio of total psoas muscle area (PM) divided by the L3 vertebral body cross sectional area (PM: L3) with shortas well as long-term mortality in patients undergoing emergency laparotomy (EL), indicating that a measure of muscle mass could be used to predict patients outcomes. The power of muscle mass in predicting an adverse outcome following EL is evaluated in the systematic review and meta-analysis including 12 studies by Ng et al. Patients with sarcopenia had unfavourable functional outcomes at discharge and a 3.5 times higher risk of short-term mortality following EL. It is important to note, that despite diagnosing low muscle mass, it requires both muscle strength and muscle mass to diagnose sarcopenia. However, muscle mass measured by CT scanning is a promising diagnostic tool to identify patients undergoing surgery at risk of adverse outcomes. Sarcopenia diagnostics are not yet widely implemented in clinical practice despite clear clinical guidelines. This is mainly due to a lack of knowledge, equipment, time and prioritization to diagnose sarcopenia and treat this disease. Often, healthcare professionals wish to screen and diagnose sarcopenia in a simplified and fast way; therefore, the use of risk screening tools and blood biomarkers has been investigated, but their validity is limited. Neither the screening tool SARC-F nor its adapted versions have sufficient accuracy to be implemented for clinical care. On the other hand, the search for blood markers to diagnose sarcopenia is progressing. Markers are predominantly related to the pathophysiology of sarcopenia, such as inflammation. Higher classical complement cascade factor C1q has been associated with muscle fibrosis and sarcopenia, whereas resistance exercise training in mice and humans has been shown to lower C1q levels. Senanayake et al. also in this issue studied C1q in a relatively small population of colorectal cancer patients undergoing surgery. Most likely due to the small sample size, no statistically significant association was found. Healthcare professionals should be allowed to invest time in education and implementation of sarcopenia diagnostics and interventions, which include the purchase of equipment to measure muscle mass and strength. Diagnostics of muscle health should be integrated in primary care to enable early diagnoses and interventions to counteract sarcopenia. In cases of planned surgical interventions or emergencies, muscle parameters should be remeasured, taking any previous measures (and interventions) into account. CT is a promising tool to measure muscle mass in surgical patients, but it is important to add a muscle strength measure (e.g., handgrip strength or sit-to-stand test) to be able to diagnose sarcopenia. Continuity of care to optimize muscle health is of utmost importance as muscle mass and muscle strength decline over time during the ageing process. The decline is even more pronounced during acute illness and hospitalization, and the decline continues after hospital discharge. Sarcopenia is a serious disease and should be taken seriously!