The DOI matches its Crossref record; 117 of the 117 references it cites were found in a registry or an index; 2 of the 21 sources its claims cite were checked for support.
Critical appraisal of definitions and diagnostic criteria for sarcopenic obesity based on a systematic review
Open accessAbstract
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.
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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.
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Claims the paper makes
22 Own result · 11 Not checked yet · 8 Own interpretation · 7 No basis given · 2 Own method · 1 Supported so far
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Less frequently (only 3 studies [50,81,99]) sarcopenic obesity was defined by calculating the population distribution of the residuals of linear regression models applied to predict appendicular fat-free mass (AFFM) using independent variables such as height (in meters) and fat-mass (FM) (in kg).”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Definitions of sarcopenic obesity
What the sources say
- Not checked yetcites [50] dos Santos, 2014, Sarcopenia and sarcopenic obesity classifications and cardiometabolic risks in older women, Arch Gerontol Geriatr source
- Supportedcites [81] Oliveira, 2011, Identification of sarcopenic obesity in postmenopausal women: a cutoff proposal, Braz J Med Biol Res source
The ‘Definition of sarcopenic obesity’ section describes a linear regression predicting appendicular fat-free mass from height and whole-body fat mass. It defines sarcopenic obesity using residuals at or below two standard deviations beneath the young reference group's mean. This paper therefore supports its inclusion as one of the studies using that method; it does not itself establish the citing review's count of three studies. (LLM, conf=0.92)
- Supportedcites [99] Silva Neto, 2012, Association between sarcopenia, sarcopenic obesity, muscle strength and quality of life variables in elderly women, Rev Bras Fisioter source
The ‘Identificação de obesidade sarcopênica e sarcopenia’ section defines sarcopenic obesity using a residual cutoff from an equation predicting appendicular fat-free mass from height and total fat mass. The ‘Resultados’ section confirms that the study applied this classification. The count of three studies belongs to the citing paper’s survey, not to this individual source. (LLM, conf=0.93)
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In the paper
“Results indeed do not allow definitive conclusions on the prevalence and relevance of sarcopenic obesity from a clinical and functional standpoint.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DISCUSSION
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In the paper
“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).”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Diagnostic criteria and measurement methods
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“In addition, even the most utilized parameter, ASM, has been used with different normalization factors.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DISCUSSION
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In the paper
“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.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Search results
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In the paper
“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].”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Definitions of sarcopenic obesity
What the sources say
- Not checked yetcites [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 yetcites [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
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“the current systematic review demonstrated the profound inadequacy of available research on sarcopenic obesity in terms of consistency of definition, diagnostic criteria and methodological issues.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DISCUSSION
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In the paper
“For diagnosis of both obesity and sarcopenia, variable phenotypical components and criteria have been employed in analyzed papers.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DECLARATION OF INTEREST.
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In the paper
“The definition of sarcopenic obesity in the majority of the studies (66 studies) was based on the co-existence of obesity and sarcopenia (used as a synonymous of low or reduced skeletal muscle mass), which were regarded as two distinct categories (Table 2).”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Definitions of sarcopenic obesity
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“Most articles defined and stratified obesity based on BMI values, most likely for its simple evaluation and wide utilization.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DISCUSSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
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“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.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Quality assessment
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“The average score obtained from the application of the Newcastle-Ottawa scale (Table 5) was 8.3 (range: 6-10).”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Quality assessment
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“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).”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Diagnostic criteria and measurement methods
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“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.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Quality assessment
plain- Asserted: passes — The authors put it forward as true.
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“ASM/h 2 18”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DECLARATION OF INTEREST.
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“WC 10”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DECLARATION OF INTEREST.
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“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.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DISCUSSION
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“role of biological and lifestyle factors in the pathogenesis of SO risk of comorbidities impaired physical function muscoloskeletal disorders mental health”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DECLARATION OF INTEREST.
plainn = 75- Asserted: fails — The authors may not put it forward as true.
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In the paper
“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).”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DISCUSSION
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In the paper
“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.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Diagnostic criteria and measurement methods
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In the paper
“FM 19”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DECLARATION OF INTEREST.
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In the paper
“under the current exclusion criteria, the search still resulted in selection of a large number of papers with a large sample of subjects.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DISCUSSION
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In the paper
“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.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DISCUSSION
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“VFA 4”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DECLARATION OF INTEREST.
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In the paper
“for any increment in body fat, a parallel change in FFM occurs, corresponding approximately to 25%.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DISCUSSION
What the sources say
- Not checked yetcites [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 yetcites [112] Dulloo, 2018, Collateral fattening in body composition autoregulation: its determinants and significance for obesity predisposition, Eur J Clin Nutr source
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In the paper
“aging, inflammation, sedentary lifestyle, complex hormonal and metabolic derangements, genetics all seem to play a role [109, 110].”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DISCUSSION
What the sources say
- Not checked yetcites [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 yetcites [110] Batsis, 2018, Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies, Nat Rev Endocrinol source
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In the paper
“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).”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DISCUSSION
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In the paper
“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.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DECLARATION OF INTEREST.
What the sources say
- Not checked yetcites [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
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In the paper
“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].”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > BACKGROUND
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“the role of predictors may vary depending on how sarcopenic obesity is operationalized.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DISCUSSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“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).”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > MATERIALS AND METHODS
What the sources say
- Not checked yetcites [28] Shamseer, 2015, Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation, BMJ source
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In the paper
“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.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DISCUSSION
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In the paper
“it included literature from the last ten years.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DISCUSSION
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In the paper
“In addition, the quality of the studies was evaluated using the Newcastle-Ottawa Scale (NOS) adapted for cross sectional studies [29].”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Data extraction and quality assessment
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The above limitations negatively impact general awareness and implementation of the sarcopenic obesity concept.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DISCUSSION
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
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.”
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“Its results confirmed a marked heterogeneity in definitions and diagnostic approaches, due to different definitions 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 stratification methods).”
From Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement (2022) · cites this paper as [20]
In the citing paper
“In a recent systematic review, we found that unified parameters with both fat and muscle measurements related in a single criterion were used for SO definition in only 6 out of 75 selected studies.”
From Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement (2022) · cites this paper as [20]
In the citing paper
“Moreover, the unified 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]
In the citing paper
“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]
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.
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Definitions of sarcopenic obesity
“No study defined sarcopenia according to a co-existence of reduced muscle strength and mass [1].”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DECLARATION OF INTEREST.
“Sarcopenia: ASM/h 2 < 6.42 Kg/m 2 plus HGS < 20 kg or GS < 0.8 m/s;”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Study characteristics
“prospective cohort studies (6 studies) [33,40,43,52,92,93]”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > DECLARATION OF INTEREST.
“Batsis JA, et al. (2015) [39] USA 2025 756 1269 68.2 ±5.4 prospective cohort study Batsis JA, et al. (2016) [40] USA 4984 2452 2532 71.1 ±0.19 cross-sectional”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Additional information
“Kim H, et al. (2016) [58] Japan 307 168 139 > 70 RCT”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > References
“Exercise and Nutritional Supplementation on Community-Dwelling Elderly Japanese Women With Sarcopenic Obesity: A Randomized Controlled Trial.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Study characteristics
“effects of exercise and nutrition on recovery from sarcopenic obesity (2 studies) [58,80]”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Additional information
“Oh C., et al. (2015) [80] Korea 1433 658 775 > 60 cross-sectional”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Study characteristics
“with a sample size ranging from 17 to 15,132 participants.”
§ Critical appraisal of Definitions and diagnostic criteria for sarcopenic obesity based on A SYSTEMATIC REVIEW > Additional information
“Tyrovolas S, et al. (2015) [101] Finland, Poland, Spain, China, Ghana, India, Mexico, Russia, South Africa 18363 8303 10060 > 65 cross-sectional”
Citations
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Metadata
- 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
- Donini, Lorenzo M.
- Busetto, Luca
- Boirie, Yves
- Cederholm, Tommy
- Cruz-Jentoft, Alfonso J.
- Dicker, Dror
- Frühbeck, Gema
- Giustina, Andrea
- Han, Ho-Seong
- Heymsfield, Steven B.
- Laviano, Alessandro
- Lenzi, Andrea
- Parrinello, Edda
- Poggiogalle, Eleonora
- Prado, Carla M.
- Rolland, Yves
- Santini, Ferruccio
- Siervo, Mario
- Vettor, Roberto
- Yu, Jianchun
- Zamboni, Mauro
- Barazzoni, Rocco
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2020-08
- Volume
- 39
- Issue
- 8
- Pages
- 2368-2388
- ISSN
- 0261-5614 (ISSN-L)
- 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
- FWCI
- 4.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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 (medical) › Nutrition and Health in Aging
- Health Sciences › Medicine › Physiology (medical) › 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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