Sarcopenia: revised European consensus on definition and diagnosis
Open accessAbstract
Background: in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives: to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations: sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions: EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.
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GS, TUG, SPPB, and 5STS are critical indicators of mobility, independence, and fall risk in older adults.
“These variables are critical indicators of mobility, independence, and fall risk in older adults [3].”
From Efficacy of Power Training on Sarcopenic Obesity in Community-Dwelling Older Women: A 32-Week Randomized Clinical Trial (2025) · cites this paper as [3]
In “Measuring sarcopenia parameters” (page unavailable), the paper describes gait speed, SPPB and TUG as physical-performance or function tests, and the five-rise chair stand test as a measure of leg strength. It specifically links gait speed to disability and falls, but does not establish all four tests as indicators of independence and fall risk. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIndividuals with obesity and low muscle mass, especially women and those with type 2 diabetes, prediabetes, or metabolic dysfunction-associated steatotic liver disease, are at high risk of sarcopenia, sarcopenic obesity, and serious negative health outcomes.
“These individuals—and especially women and those with T2D, prediabetes, or metabolic dysfunction‐associated steatotic liver disease (MASLD)—are already at high risk of sarcopenia (age‐related loss of skeletal muscle function and mass), 30 , 31 sarcopenic obesity (the co‐existence of excess adiposity and low muscle mass/function, which can occur at any age 32 ), and the serious negative health out”
From Strategies for minimizing muscle loss during use of incretin‐mimetic drugs for treatment of obesity (2025) · cites this paper as [28]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredSarcopenia definitions have evolved through European and Asian consensus updates that place greater emphasis on muscle strength and physical performance, while the ESPEN and EASO consensus and the Sarcopenic Obesity Global Leadership Initiative have attempted to standardize SO diagnosis and research priorities.
“Sarcopenia definitions have evolved through European and Asian consensus updates that place greater emphasis on muscle strength and physical performance, while the ESPEN and EASO consensus and the Sarcopenic Obesity Global Leadership Initiative have attempted to standardize SO diagnosis and research priorities (2, 7–9).”
From Exercise-based interventions for sarcopenic obesity in middle-aged and older adults: an umbrella review of systematic reviews with pairwise meta-analyses and network meta-analyses (2026) · cites this paper as [7]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredA major reason for variation in sarcopenic obesity prevalence is the method of adjusting muscle quantity for body size.
“Indeed, a major reason for the variation in sarcopenic obesity prevalence is the method of adjusting muscle quantity for body size.46,47,55,57”
From Changes in lean body mass with <scp>glucagon‐like peptide</scp> ‐1‐based therapies and mitigation strategies (2024) · cites this paper as [46]
The Measuring sarcopenia parameters section (page not supplied) describes several ways to adjust muscle quantity for body size. The Sarcopenic obesity section (page not supplied) discusses prevalence but does not say that adjustment method is a major reason prevalence estimates vary. (LLM, conf=0.82)
Experimental — accuracy not yet measuredAll regional working groups on the definition of sarcopenia have moved from recommending using lean mass alone to adding muscle strength and function, and switching focus from lean mass to muscle strength and function.
“All regional working groups on the definition of sarcopenia have moved from recommending using lean mass alone to adding muscle strength and function, and switching the focus of the definition from lean mass to muscle strength and function.[46][47][48]”
From Changes in lean body mass with <scp>glucagon‐like peptide</scp> ‐1‐based therapies and mitigation strategies (2024) · cites this paper as [46]
The Sarcopenia: operational definition section says the earlier European definition added muscle function to definitions based only on low muscle mass, and that EWGSOP2 now places muscle strength at the forefront. But it uses physical performance to classify severity, not as a coequal focus of the core definition. This European consensus also does not establish what all regional working groups recommend. (LLM, conf=0.85)
Experimental — accuracy not yet measured
The updated definition of sarcopenia elevated low muscle strength to the forefront as a primary indicator of sarcopenia and identified poor physical performance as indicative of severe sarcopenia.
“The updated definition of sarcopenia elevated low muscle strength to the forefront as a primary indicator of sarcopenia and identified poor physical performance as indicative of severe sarcopenia (52).”
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [52]
In the revised EWGSOP2 consensus, low physical performance is proposed as an indicator of severe sarcopenia.
“In this revised consensus, low physical performance is proposed as an indicator of severe sarcopenia.”
From Health Consequences of Sarcopenic Obesity: A Narrative Review (2020) · cites this paper as [19]
The EWGSOP2 reported low muscle strength as a key characteristic of sarcopenia to facilitate prompt identification of sarcopenia in practice.
“Notably, the EWGSOP2 reported low muscle strength as a key characteristic of sarcopenia to facilitate the prompt identification of sarcopenia in practice (19).”
From Health Consequences of Sarcopenic Obesity: A Narrative Review (2020) · cites this paper as [19]
EWGSOP2 guidelines focus on low muscle strength using grip strength as a central factor for diagnosing sarcopenia, because muscle strength better predicts poor outcomes than muscle mass.
“the updated EWGSOP2 guidelines that focused on low muscle strength using grip strength as a central factor for diagnosing sarcopenia, as muscle strength has been shown to better predict poor outcomes than muscle mass in sarcopenia (3–5).”
From Sarcopenic obesity: epidemiology, pathophysiology, cardiovascular disease, mortality, and management (2023) · cites this paper as [3]
The adverse effects of sarcopenia on quality of life, health care demand, morbidity, and mortality can affect both middle-aged and older-aged adults.
“Therefore, the adverse effects of sarcopenia on quality of life, health care demand, morbidity, and mortality can affect both middle‐aged and older‐aged adults. 1 , 2 , 6”
From Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta‐analysis (2022) · cites this paper as [1]
The decline in muscle mass starts from approximately 40 years onwards.
“but the decline in muscle mass starts from ~40 years onwards. 1”
From Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta‐analysis (2022) · cites this paper as [1]
Sarcopenia is a progressive and complex disease associated with a higher burden of morbidity and mortality.
“Sarcopenia is a progressive and complex disease associated with a higher burden of morbidity and mortality. 1 , 2 , 6”
From Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta‐analysis (2022) · cites this paper as [1]
The revised EWGSOP2 emphasizes that severe sarcopenia should be based on the combination of sarcopenia plus a low physical performance, such as slow gait speed.
“The revised EWGSOP2 emphasizes that severe sarcopenia should be based on the combination of sarcopenia plus a low physical performance, such as slow gait speed. 1”
From Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta‐analysis (2022) · cites this paper as [1]
The decrease in muscle mass function and quality starts at approximately 40 years, and sarcopenia often appears earlier in life.
“Nowadays, it is known that the decrease in muscle mass function and quality start at ~40 years and that sarcopenia often appears earlier in life. 1 , 2”
From Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta‐analysis (2022) · cites this paper as [1]
The biggest impact of not including more recent studies is likely to be on prevalence estimated using EWGSOP2 and the AWGS, which updated its sarcopenia definition and cut-off points in March 2020.
“the biggest impact is likely to be on prevalence estimated using EWGSWOP2 1 as well as the AWGS that updated its sarcopenia definition and its cut‐off points in March 2020. 33”
From Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta‐analysis (2022) · cites this paper as [1]
The effect of obesity on years-of-life-lost is greatest in younger adults, and the magnitude of years lost with obesity decreases with ageing, irrespective of sex, smoking status, physical activity level, or socioeconomic status.
“although the effect of obesity on years-of-life-lost is greatest in younger adults, and the magnitude of years lost with obesity decreases with ageing [16], irrespective of sex, smoking status, physical activity level, or socioeconomic status [35]”
From Obesity pharmacotherapy in older adults: a narrative review of evidence (2025) · cites this paper as [35]
Sarcopenia is a geriatric syndrome with a multifactorial aetiology whose prevalence increases with age.
“Sarcopenia, defined as low skeletal muscle mass and function, has been identified and described as a geriatric syndrome with a multifactorial aetiology whose prevalence increases with age [3-5].”
From Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement (2022) · cites this paper as [5]
Sarcopenia was revised in 2019 to be described as a muscle disease originating from adverse muscle changes that accumulate over a lifetime.
“This definition was revised in 2019 to describe sarcopenia as “a muscle disease originating from adverse muscle changes that accumulate over a lifetime”.”
From Imaging of Sarcopenia in Type 2 Diabetes Mellitus (2024) · cites this paper as [1]
EWGSOP guidelines propose an ALMI < 5.5 kg/m2 in women and ALMI < 7.0 kg/m2 in men as criteria for defining low muscle mass.
“The recent guidelines from EWGSOP have made slight modifications to previous diagnostic cutoff values, proposing an ALMI < 5.5 kg/m2 in women and ALMI < 7.0 kg/m2 in men be used as criteria for defining low muscle mass (1).”
From Imaging of Sarcopenia in Type 2 Diabetes Mellitus (2024) · cites this paper as [1]
EWGSOP proposes a screening and diagnostic approach for sarcopenia termed Find-Assess-Confirm-Severity (F-A-C-S).
“EWGSOP proposes a screening and diagnostic approach for sarcopenia termed “Find-Assess-Confirm-Severity” (F-A-C-S; Figure 1).1”
From Imaging of Sarcopenia in Type 2 Diabetes Mellitus (2024) · cites this paper as [1]
Resistance-based training is a reliable approach for preserving muscle quantity and quality.
“Among the strategies for preserving muscle quantity and quality, resistance exercise training is a reliable approach.1”
From Imaging of Sarcopenia in Type 2 Diabetes Mellitus (2024) · cites this paper as [1]
In older adults, muscle loss contributes to frailty, impaired glucose regulation, increased fall risk, and decreased quality of life.
“This is of particular concern in older adults, where muscle loss contributes to frailty, impaired glucose regulation, increased fall risk, and decreased quality of life [33].”
From Unintended Consequences of Obesity Pharmacotherapy: A Nutritional Approach to Ensuring Better Patient Outcomes (2025) · cites this paper as [33]
Fatigue and grip strength are well-established measures of sarcopenia and physical frailty and are commonly used to assess pathological impairment of quality of life in older people in clinical practice.
“fatigue and grip strength are also well-established measures of sarcopenia and physical frailty54,55 and are commonly used to assess the pathological impairment of quality of life in older people in clinical practice.”
From Trigonelline Is an NAD+ Precursor That Improves Muscle Function during Ageing and Is Reduced in Human Sarcopenia (2024) · cites this paper as [54]
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- Authors
- Cruz-Jentoft, A. J., Bahat, G., Bauer, J., Boirie, Y., Bruyère, O., Cederholm, T., Cooper, C., Landi, F., Rolland, Y., Sayer, A. A., Schneider, S. M., Sieber, C. C., Topinkova, E., Vandewoude, M., Visser, M., Zamboni, M., Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), A. T. E. G. F. E., Bautmans, I., Baeyens, J.-P., Cesari, M., Cherubini, A., Kanis, J., Maggio, M., Martin, F., Michel, J.-P., Pitkala, K., Reginster, J.-Y., Rizzoli, R., Sánchez-Rodríguez, D., & Schols, J.
- Affiliations
- Instituto Ramón y Cajal de Investigación Sanitaria (ES)
- Istanbul University (TR)
- Heidelberg University (DE)
- Research Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- University of Liège (BE)
- Uppsala University (SE)
- University of Oxford (GB)
- Università Cattolica del Sacro Cuore (IT)
- Université de Toulouse (FR)
- Newcastle upon Tyne Hospitals NHS Foundation Trust (GB)
- Université Côte d'Azur (FR)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Department of Geriatrics, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
- University of Antwerp (BE)
- Amsterdam Public Health (NL)
- University of Verona (IT)
- University of Geneva (CH)
- Vrije Universiteit Brussel (BE)
- University of Luxembourg (LU)
- University of Milan (IT)
- Istituto Nazionale di Riposo e Cura per Anziani (IT)
- University of Parma (IT)
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Central Hospital, Unit of Primary Health Care; Helsinki, Finland
- Geriatrics Department, Parc Salut Mar. Rehabilitation Research Group, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM). Universitat Autònoma de Barcelona, Universitat Pompeu Fabra; Barcelona, Spain
- Maastricht University (NL)
- Corresponding author
- Cruz-Jentoft, Alfonso J
- ORCID
- Cruz-Jentoft, Alfonso J
- Bahat, Gülistan
- Bauer, Jürgen
- Bruyère, Olivier
- Cederholm, Tommy
- Cooper, Cyrus
- Landi, Francesco
- Rolland, Yves
- Sayer, Avan Aihie
- Schneider, Stéphane M
- Sieber, Cornel C
- Vandewoude, Maurits
- Visser, Marjolein
- Zamboni, Mauro
- Bautmans, Ivan
- Baeyens, Jean-Pierre
- Cesari, Matteo
- Cherubini, Antonio
- Kanis, John
- Maggio, Marcello
- Martin, Finbarr
- Michel, Jean-Pierre
- Reginster, Jean-Yves
- Rizzoli, René
- Schols, Jos
- Venue
- Age and Ageing
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-09-24
- Volume
- 48
- Issue
- 1
- Pages
- 16-31
- ISSN
- 0002-0729 (ISSN-L)
- 1468-2834
- PMC
- PMC6322506
- OpenAlex
- W2897513125
- Semantic Scholar
- ccbd36e412f2f03b0db9d7628ea646fb57c093c9
- Cited by
- 13,818
- References
- 156
- Citations by year
- 2026: 1514 · 2025: 2382 · 2024: 2262 · 2023: 2122 · 2022: 1909 · 2021: 1759 · 2020: 1234 · 2019: 580 · 2018: 25 · 2017: 2 · 2014: 2 · 2013: 3 · 2012: 6
- FWCI
- 616.75
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Age and Ageing (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- VU Research Portal (publishedVersion, other-oa)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, cc-by-nc)
- Työväentutkimus Vuosikirja (submittedVersion)
- Università Politecnica delle Marche (Università Politecnica delle Marche) (submittedVersion)
- Lirias (submittedVersion)
- ORBi (University of Liège) (submittedVersion)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Newcastle University ePrints (Newcastle Univesity) (cc-by-nc)
- Funders
- European Working Group on Sarcopenia in Older People 2
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Muscle Physiology and Disorders
- Keywords
- sarcopenia, sarcopenia definitions, sarcopenia diagnosis, muscle weakness, muscle mass, muscle quality, physical performance, sarcopenia severity, case-finding algorithms, cut-off values, older adults, EWGSOP2 criteria
- MeSH terms
- Europe, Humans, Biomarkers, Muscle, Skeletal, Biomedical Research, Muscle Strength, Sarcopenia
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