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Cited by 326Nutrition and Health in AgingBody Composition Measurement TechniquesMuscle Physiology and Disorders

Critical appraisal of definitions and diagnostic criteria for sarcopenic obesity based on a systematic review

Open access
Donini, Lorenzo M., Busetto, Luca, Bauer, Juergen M., Bischoff, Stephan, Boirie, Yves, Cederholm, Tommy, Cruz-Jentoft, Alfonso J., Dicker, Dror +20 more·2020·Clinical Nutrition
DOI 10.1016/j.clnu.2019.11.024
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Abstract

BACKGROUND Sarcopenic obesity is a clinical and functional condition characterized by the coexistence of excess fat mass and sarcopenia. Currently, different definitions of sarcopenic obesity exist and its diagnostic criteria and cut-offs are not universally established. Therefore, the prevalence and sensitivity of this condition for any disease risk prediction is affected significantly. AIM This work was conducted under the auspices of the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO). An international expert panel performed a systematic review as an initial step to analyze and summarize the available scientific literature on the definitions and the diagnostic criteria for sarcopenic obesity proposed and/or applied in human studies to date. METHODS The present systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search was conducted in April 2018 in three databases (PubMed, Scopus, Web of Science). Human studies conducted in both sexes, irrespective of ethnicity, and published from 2007 to 2018 were included; cohorts of individuals with obesity and acute or chronic conditions and treatments reported to negatively influence skeletal muscle mass and function independently of obesity were excluded from final analyses. The quality of the studies was evaluated using the Newcastle-Ottawa Scale (NOS) adapted for cross sectional studies. RESULTS The electronic search retrieved 2335 papers of which 75 met the eligibility criteria. A marked heterogeneity in definitions and approaches to diagnose sarcopenic obesity was observed. This was mainly due to differences in the definitions of obesity and sarcopenia, in the methodologies used to assess body composition and physical function, and in the reference values for the variables that have been used (different cut-offs, interquartile analysis, diverse statistical stratification methods). This variability may be attributable, at least in part, to the availability of the methodologies in the different settings, to the variability in specialties and backgrounds of the researcher, and to the different settings (general population, clinical settings, etc.) where studies were performed. CONCLUSION The results of the current work support the need for consensus proposals on: 1) definition of sarcopenic obesity; 2) diagnostic criteria both at the level of potential gold-standards and acceptable surrogates with wide clinical applicability, and with related cut-off values; 3) methodologies to be used in actions 1 and 2. First steps should be aimed at reaching consensus on plausible proposals that would need subsequent validation based on homogeneous studies and databases, possibly based on analyses of existing cohorts, to help define the prevalence of the condition, its clinical and functional relevance as well as most effective prevention and treatment strategies.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review found that definitions and diagnostic criteria for sarcopenic obesity are highly inconsistent across human studies, preventing firm conclusions about prevalence or clinical relevance. The authors call for expert consensus on the definition, diagnostic standards and acceptable surrogates, and cutoff values.

Key findings

  • Across 75 included articles (217,973 participants; sample sizes 17–15,132; mean age 64.8±4.5 years; 54.3% women), most studies (66) defined sarcopenic obesity as coexisting obesity and sarcopenia, usually using low muscle mass alone; only 3 used regression residuals for appendicular fat-free mass, and 2 used fat-to-muscle or visceral fat-to-thigh muscle ratios.
  • Diagnostic heterogeneity was large: 19 different sarcopenia measurements and 10 adiposity measurements were used; ASM/weight or ASM/height² and BMI were most common. DXA was used for sarcopenia in 44 studies and adiposity in 17; BIA in 21 and 12; CT in 5 and 6; anthropometry for sarcopenia in 1 and adiposity in 44; hand dynamometry in 18.
  • No study defined sarcopenia by requiring both reduced muscle mass and reduced strength; dynapenic obesity was used in only 3 studies. Quality scores averaged 8.3 (range 6–10) on an adapted Newcastle-Ottawa Scale.
  • The search retrieved 2,335 references; after duplicate removal, 2,134 titles/abstracts were screened, 160 full texts were evaluated, and 75 articles were included. A meta-analysis was not performed because definitions, cutoffs, and body composition methods were too heterogeneous.

Methods

  • Systematic review registered in PROSPERO (CRD42019133328) and reported according to PRISMA; search conducted in April 2018 in PubMed, Scopus, and Web of Science, plus manual searching. Human adult studies published 2007–2018 in any language were eligible, excluding groups with acute or chronic conditions or treatments that could independently affect skeletal muscle.
  • Three-step screening of titles, abstracts, and full texts was done by two independent investigators, with a third resolving disagreements. Data were extracted on definitions, diagnostic criteria, cutoffs, measurement methods, and sample characteristics; quality was assessed with the Newcastle-Ottawa Scale adapted for cross-sectional studies.
  • Synthesis was narrative only; no quantitative pooling was possible because of heterogeneity in definitions, diagnostic cutoffs, and body composition methods.

Limitations

  • Stated: the review covered only the prior ten years and excluded studies in acute or chronic conditions or treatments that could independently affect muscle; the authors judged this did not compromise the aim of analyzing definitions and criteria. Stated strengths were the large selected sample and generally high study quality.
  • Evident: the marked heterogeneity in definitions, cutoffs, and measurement methods prevented meta-analysis and firm conclusions about prevalence or clinical relevance; most included studies were cross-sectional (64 of 75), limiting causal inference.
  • Evident: most studies relied on muscle mass surrogates rather than functional measures, and no included study operationalized sarcopenia as combined low mass plus low strength, so the terminology and construct validity of “sarcopenic obesity” remain questionable.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.clnu.2019.11.024

Cites

117 of 117 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 21 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The findings cannot support firm conclusions about how prevalent or clinically and functionally relevant sarcopenic obesity is.

    “Results indeed do not allow definitive conclusions on the prevalence and relevance of sarcopenic obesity from a clinical and functional standpoint.”
    Quote in the paperSubstantial claim
  • Findingown data

    The application of different cut-off points for the same measurements further increased the heterogeneity of diagnostic assessment.

    “the heterogeneity of the diagnostic assessment of sarcopenic obesity was further increased by the application of different cut-off points for the same measurements (Table 4).”
    Quote in the paperSubstantial claim
  • Findingnone given

    Even the most utilized parameter, ASM, has been used with different normalization factors.

    “In addition, even the most utilized parameter, ASM, has been used with different normalization factors.”
    Quote in the paperSubstantial claim
  • Findingown data

    A meta-analysis was not performed because the data did not allow a formal quantitative synthesis due to heterogeneity in definitions, cut-offs, and body composition methods.

    “A quantitative synthesis (meta-analysis) was not performed since the data did not allow conduct of a formal meta-analysis due to the heterogeneity in the definitions of sarcopenic obesity, application of diagnostic cut offs and use of different body composition methods.”
    Quote in the paperSubstantial claim
  • Findingcitation

    Two studies used the fat mass to fat-free mass ratio or the visceral adipose tissue area to thigh muscle area ratio to identify sarcopenic obesity.

    “Two studies used the FM to FFM or the visceral adipose tissue area to thigh muscle area ratios to identify cases of sarcopenic obesity [41,70].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [41] Biolo, 2015, Inverse relationship between “a body shape index” (ABSI) and fat-free mass in women and men: insights into mechanisms of sarcopenic obesity, Clin Nutr source

      Not checked in the free run.

    • cites [70] Lim, 2010, The association between the ratio of visceral fat to thigh muscle area and metabolic syndrome: the Korean Sarcopenic Obesity Study (KSOS), Clin Endocrinol (Oxf) source

      Not checked in the free run.

  • May combine two claims. 13
  • Classified as probably not a substantial claim. 15

  • May combine two claims.

    Findingnone given

    All included studies employed validated measurement procedures, provided a clear description of outcome assessment, and appropriately described their statistical approaches.

    “All studies employed validated measurement procedures, provided a clear description of assessment of the outcome and appropriately described the statistical approaches used to analyze the data.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The average Newcastle-Ottawa Scale score of the included studies was 8.3, with a range from 6 to 10.

    “The average score obtained from the application of the Newcastle-Ottawa scale (Table 5) was 8.3 (range: 6-10).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Cut-off points were often borrowed from established guidelines (e.g., BMI ≥30 kg/m2 for obesity) or derived from population-specific distributions using n-tiles, SDs, or z scores.

    “These cut off points were often borrowed from established guidelines (i.e., BMI ≥30 kg/m 2 for obesity), whereas in other studies population-specific cut-offs were derived by calculating specific parameters from the distributions of the individual measurements (i.e., n-tiles, SDs or z scores).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The majority of included studies adopted effective sampling strategies and controlled for the most important factor and confounding factors.

    “The majority of studies adopted effective sampling strategies to enhance the representativeness of the study population, the analysis controlled for both the most important factor and for confounding factors.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    ASM/h2 was used in 18 studies to define sarcopenia.

    “ASM/h 2 18”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    WC was used in 10 studies to define obesity.

    “WC 10”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Fat mass was employed in a number of studies using body composition analysis, and waist circumference was selected in studies supporting the assumption that excess visceral abdominal adiposity may directly contribute to low muscle mass and function through metabolic derangements.

    “FM was, however, employed in a number of studies implementing body composition analysis techniques, and WC was selected in studies supporting the assumption that excess visceral abdominal adiposity may directly contribute to low muscle mass and function through related metabolic derangements.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

    Findingnone given

    The 75 included studies aimed to examine biological and lifestyle factors in sarcopenic obesity pathogenesis, comorbidity risk, impaired physical function, musculoskeletal disorders, and mental health.

    “role of biological and lifestyle factors in the pathogenesis of SO risk of comorbidities impaired physical function muscoloskeletal disorders mental health”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Different body composition compartments (FFM, appendicular lean mass, ASM) were measured, and diverse terms (reduced FFM, lean mass, ASM) were used to define sarcopenia.

    “With regards to the analysis of body composition, different compartments were measured (FFM, appendicular lean mass, ASM) and diverse terms were used to define sarcopenia (reduced FFM, lean mass, ASM).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The included studies applied 19 different measurements of sarcopenia and 10 measurements of adiposity, with ASM/weight or ASM/height2 and BMI being the most frequent.

    “19 different measurements of sarcopenia and 10 measurement of adiposity were applied across the studies (Table 3) with appendicular skeletal muscle (ASM) divided by weight (ASM/wt) or adjusted by height in meters squared (ASM/h 2 ) and BMI being the most frequently applied measurements of sarcopenia and obesity, respectively.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    FM was used in 19 studies to define obesity.

    “FM 19”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Even with these exclusions, the search yielded many papers and a large total sample.

    “under the current exclusion criteria, the search still resulted in selection of a large number of papers with a large sample of subjects.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The systematic review demonstrated a lack of systematic approaches in the literature, with the vast majority of papers using muscle mass surrogates and very limited use of functional parameters.

    “The current systematic review, however, demonstrated lack of systematic approaches to these fundamental issues in the available literature: the vast majority of papers indeed utilized muscle mass surrogates, with very limited use of functional parameters.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    VFA was used in 4 studies to define obesity.

    “VFA 4”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    For every increase in body fat, fat-free mass changes in parallel by approximately 25% (the one quarter rule).

    “for any increment in body fat, a parallel change in FFM occurs, corresponding approximately to 25%.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [111] Dulloo, 2017, Passive and active roles of fat-free mass in the control of energy intake and body composition regulation, Eur J Clin Nutr source

      Not checked in the free run.

    • cites [112] Dulloo, 2018, Collateral fattening in body composition autoregulation: its determinants and significance for obesity predisposition, Eur J Clin Nutr source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Aging, inflammation, sedentary lifestyle, hormonal and metabolic derangements, and genetics appear to contribute to the pathogenesis of sarcopenic obesity.

    “aging, inflammation, sedentary lifestyle, complex hormonal and metabolic derangements, genetics all seem to play a role [109, 110].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [109] Kalinkovich, 2017, Sarcopenic obesity or obese sarcopenia: a cross talk between age-associated adipose tissue and skeletal muscle inflammation as a main mechanism of the pathogenesis, Ageing Res Rev source

      Not checked in the free run.

    • cites [110] Batsis, 2018, Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies, Nat Rev Endocrinol source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The authors restricted the review to obese people free of acute or chronic illnesses and treatments that are reported to affect muscle mass and function independently of obesity.

    “the authors decided to focus on studies in obese individuals in the absence of acute or chronic conditions and treatments reported to negatively influence skeletal muscle mass and function independently of obesity (such as surgery, cancer, kidney disease).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Consensus definitions from geriatrics, nutrition, and cachexia societies require both low muscle mass and impaired function for a sarcopenia diagnosis.

    “Widely accepted definitions and diagnostic algorithms for sarcopenia proposed by the geriatrics, nutrition and cachexia scientific communities [102], however, notably require coexistence of both low skeletal muscle mass and function for diagnosis.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [102] Muscaritoli, 2010, 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”, Clin Nutr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The prevalence of sarcopenic obesity reported in the literature varies between 2.75% and over 20%, with the variation depending on the diagnostic criteria and body composition methods applied.

    “the published prevalence of this condition ranges from 2.75% to over 20%, depending on the applied diagnostic criteria and the methods of body composition assessment [15,16].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] Waters, 2011, Sarcopenia and obesity, Clin Geriatr Med source

      Not checked in the free run.

    • cites [16] Prado, 2012, Sarcopenic obesity: a Critical appraisal of the current evidence, Clin Nutr source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    The predictive role of factors for sarcopenic obesity may differ according to how sarcopenic obesity is operationalized.

    “the role of predictors may vary depending on how sarcopenic obesity is operationalized.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The systematic review was registered in PROSPERO (CRD42019133328) and conducted according to PRISMA.

    “The present systematic review was registered in the PROSPERO database (https://www.crd.york.ac.uk/PROSPERO/) (registration number: CRD42019133328) and performed applying the following steps according to the PRISMA procedure (28).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Shamseer, 2015, Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation, BMJ source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Given the accepted requirement of both muscle mass and function impairment to define sarcopenia in aging, the term sarcopenic obesity is questionable when functional parameters are missing, and myopenic obesity would be more appropriate.

    “Based on commonly accepted requirement of both skeletal muscle mass and function impairment to define sarcopenia in aging (primary sarcopenia), the terms sarcopenic obesity would become highly questionable when functional parameters are missing; myopenic obesity would become more appropriate, thereby leading to a potential terminology issue.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The current systematic review included literature from the last ten years.

    “it included literature from the last ten years.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The quality of included studies was evaluated using the Newcastle-Ottawa Scale adapted for cross-sectional studies.

    “In addition, the quality of the studies was evaluated using the Newcastle-Ottawa Scale (NOS) adapted for cross sectional studies [29].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Modesti, 2016, ESH working group on CV risk in low resource settings. Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis, PLoS One source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The review's limitations reduce general awareness and uptake of the sarcopenic obesity concept.

    “The above limitations negatively impact general awareness and implementation of the sarcopenic obesity concept.”
    Quote in the paperSubstantial claim
25 of 25

  • The paper relies on this without support.

    Body composition is affected by ethnicity and sex.

    “Body composition is affected by ethnicity and sex.”

  • The paper relies on this without support.

    Age plays a pivotal role in body composition alterations.

    “Additionally, age plays a pivotal role in body composition alterations.”

  • The paper relies on this without support.

    All methods used for measuring or estimating skeletal muscle mass (anthropometry, DXA, BIA) have major limitations.

    “In fact, all methods used for the measurement/ estimation of skeletal muscle mass (anthropometry, DXA, BIA) have shown major limitations.”

  • The paper relies on this without support.

    The included studies are of overall high quality.

    “as well as the overall high study quality.”

  • The paper relies on this without support.

    The pathogenesis of sarcopenic obesity remains partially unknown or incompletely understood.

    “the pathogenesis of sarcopenic obesity is still partially unknown.”
    “Since pathogenetic mechanisms underlying the onset of sarcopenic obesity are still incompletely understood”

  • The paper relies on this without support.

    The term sarcopenia originally referred to a condition involving both low muscle mass and impaired function.

    “Although the term sarcopenia literally refers to lack of flesh (low muscle mass), from its inception it named a condition of low muscle mass and impaired function.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In a recent systematic review, unified parameters with both fat and muscle measurements related in a single criterion were used for sarcopenic obesity definition in only 6 out of 75 selected studies.

    “In a recent systematic review, we found that uni fi ed parameters with both fat and muscle measurements related in a single criterion were used for SO de fi nition in only 6 out of 75 selected studies. Moreover, the uni fi ed parameters differed in the respective studies [20].”

    From Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement (2022) · cites this paper as [20]

    The Discussion (page unavailable) says only a minority of studies used a single criterion combining fat and muscle measurements, and Search results says the review included 75 articles. Our copy does not give the claimed count of six studies; the cited passages therefore support the general finding but not that precise numerator. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • In 28 of the 75 studies selected in the recent sarcopenic obesity systematic review, the mean age of the studied population was below 65 years.

    “In 28 of the 75 studies selected in our recent SO systematic review [20], the mean age of the studied population was below 65 years.”

    From Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement (2022) · cites this paper as [20]

    The Study characteristics section says the review included 75 articles, and Table 1 lists numerous studies with mean ages below 65. Neither passage states that the count was 28; several Table 1 entries give age ranges or lower limits rather than means, so the precise figure is not established by our copy. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • The systematic review found marked heterogeneity in definitions and diagnostic approaches for sarcopenic obesity.

    “Its results con fi rmed a marked heterogeneity in de fi nitions and diagnostic approaches, due to different de fi nitions of obesity and sarcopenia, differences in methodologies to assess body composition and function, as well as in the applied reference values for the variables that have been used (different cut-offs and divergent statistical strati fi cation methods).”

    From Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement (2022) · cites this paper as [20]

  • There is currently insufficient clinical data to support an integrated index for sarcopenic obesity definition that simultaneously takes into account body fat and muscle mass.

    “Despite pathophysiological interactions that lead to vicious cycles with potential mutual synergistic worsening of both conditions, there is currently insuf fi cient clinical data to suggest and support an integrated index for SO De fi nition that simultaneously takes into account body fat and muscle mass.”

    From Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement (2022) · cites this paper as [20]

  • It is hard to generalize CT and MRI due to the high cost, and the risk of radiation (for CT).

    “However, it is hard to generalize CT and MRI due to the high cost, and the risk of radiation (for CT) (129).”

    From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [129]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Claim of no combined mass-and-strength definitions conflicts with Table 2

    Major

    The paper says none of the studies required both reduced muscle mass and strength. Table 2 lists a definition requiring low appendicular muscle mass plus low handgrip strength or gait speed.

  • Prospective-cohort citations disagree with the study-design table

    Minor

    The text counts study [40] among the prospective cohorts. Table 1 labels [40] cross-sectional and instead labels [39] a prospective cohort.

  • Male participants are listed for a women-only trial

    Minor

    Table 1 assigns 168 male participants to study [58], while its cited title describes a trial of elderly Japanese women.

  • A cross-sectional study is counted as an intervention study

    Minor

    Study [80] is counted among studies testing exercise and nutrition interventions, although Table 1 identifies it as cross-sectional.

  • Reported maximum sample size excludes the largest listed study

    Minor

    The stated upper limit is 15,132 participants, but Table 1 lists a study with 18,363.

5 of 5

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Authors
Donini, L. M., Busetto, L., Bauer, J. M., Bischoff, S., Boirie, Y., Cederholm, T., Cruz-Jentoft, A. J., Dicker, D., Frühbeck, G., Giustina, A., Gonzalez, M. C., Han, H.-S., Heymsfield, S. B., Higashiguchi, T., Laviano, A., Lenzi, A., Parrinello, E., Poggiogalle, E., Prado, C. M., Rodriguez, J. S., Rolland, Y., Santini, F., Siervo, M., Tecilazich, F., Vettor, R., Yu, J., Zamboni, M., & Barazzoni, R.
Affiliations
  • Sapienza University of Rome (IT)
  • University of Padua (IT)
  • University of Hohenheim (DE)
  • Uppsala University (SE)
  • Instituto Ramón y Cajal de Investigación Sanitaria (ES)
  • Tel Aviv University (IL)
  • Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (ES)
  • Vita-Salute San Raffaele University (IT)
  • Seoul National University Bundang Hospital (KR)
  • Pennington Biomedical Research Center (US)
  • Fujita Health University (JP)
  • University of Alberta (CA)
  • Université Toulouse III - Paul Sabatier (FR)
  • University of Pisa (IT)
  • University of Nottingham (GB)
  • Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
  • University of Verona (IT)
  • University of Trieste (IT)
Corresponding author
Donini, Lorenzo M.
ORCID
Venue
Clinical Nutrition
Publisher
Elsevier BV
Published
2020-08
Volume
39
Issue
8
Pages
2368-2388
ISSN
0261-5614 (ISSN-L)
DOI
10.1016/j.clnu.2019.11.024
OpenAlex
W2991498934
Semantic Scholar
712a1c652554567c0cac40068d7b3f013c15915f
Cited by
326
References
117
Citations by year
2026: 36 · 2025: 31 · 2024: 55 · 2023: 54 · 2022: 64 · 2021: 61 · 2020: 24 · 2012: 1
FWCI
4.38
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion)
  • ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, cc-by-nc-nd)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
  • Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Muscle Physiology and Disorders
Keywords
sarcopenic obesity, diagnostic criteria, definitions, cut-off values, sarcopenia, obesity, body composition, physical function, skeletal muscle mass, consensus, ESPEN, EASO, heterogeneity
MeSH terms
Adult, Aged, Aged, 80 and over, Body Composition, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Nutritional Status, Obesity, Prevalence, Muscle, Skeletal, Risk Assessment, Consensus, Sarcopenia, Symptom Assessment

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Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

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