Zusammenfassung
Sarkopenie, also der altersassoziierte, übermäßige Abbau von Muskelmasse, Muskelkraft und -funktion, hat seit 2016 mit M62.50 einen eigenen ICD-10-GM-Code (Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10. Revision, German Modification). Zur Diagnosestellung ist das kombinierte Vorliegen von verminderter Muskelkraft (z. B. Handkraft) und reduzierter Muskelmasse erforderlich. Plausible Ansätze zur Prävention und Behandlung von Sarkopenie sind individuell angepasste Trainingsprogramme – vor allem Kraft- und Ausdauertraining, aber auch Power-Training – sowie Ernährungsinterventionen, wenn möglich in Kombination. Dabei wird vor allem eine ausreichende Versorgung mit Proteinen als wichtig erachtet. Die Rolle anderer in den Muskelstoffwechsel involvierter Ernährungsfaktoren, beispielsweise Kreatin, Vitamin D, Antioxidanzien und Omega-3-Fettsäuren, wird aktuell noch kontrovers diskutiert. Der zukünftige Wert neuer pharmakologischer Ansätze kann derzeit noch nicht beurteilt werden. Prinzipiell gilt es festzustellen, dass zum heutigen Zeitpunkt nur wenige Interventionsstudien zu älteren Personen mit einer zuverlässigen Sarkopeniediagnose vorliegen. Daher werden weitere Studien zu dieser rasch wachsenden Population dringend benötigt.
Abstract
Since 2016 sarcopenia, the age-associated loss of muscle mass, strength and function, has the ICD-10-GM code M62.50 (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification). The diagnosis of sarcopenia requires the combined presence of low muscle strength and low muscle mass. Well-established approaches for the prevention and therapy of sarcopenia are exercise programs—in particular strength, endurance and power training—and nutritional interventions, preferably a combination of both. Adequate protein intake is considered highly relevant, while the role of other nutrients involved in muscle metabolism (e. g. creatine, vitamin D, antioxidants, omega-3 fatty acids) is less clear, being still the subject of controversial discussions. Innovative pharmacological therapies are currently under investigation and their future relevance for this indication is unclear. In general, it has to be stated that there are still only few intervention studies available that focused specifically on sarcopenia in older individuals. More studies in this rapidly increasing population are urgently needed.
Literatur
Cruz-Jentoft AJ, Bahat G, Bauer J et al (2018) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. https://doi.org/10.1093/ageing/afy169 (Epub ahead of print)
Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European working group on Sarcopenia in older people. Age Ageing 39:412–423
Fielding RA, Vellas B, Evans WJ et al (2011) Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. J Am Med Dir Assoc 12:249–256
Studenski SA, Peters KW, Alley DE et al (2014) The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci 69:547–558
Schaap LA, Van Schoor NM, Lips P et al (2018) Associations of Sarcopenia definitions, and their components, with the incidence of recurrent falling and fractures: the longitudinal aging study amsterdam. J Gerontol A Biol Sci Med Sci 73:1199–1204
Dent E, Morley JE, Cruz-Jentoft AJ et al (2018) International clinical practice guidelines for Sarcopenia (ICFSR): screening, diagnosis and management. J Nutr Health Aging 22:1148–1161
Pena Ordonez GG, Bustamante Montes LP, Ramirez Duran N et al (2017) Populations and outcome measures used in ongoing research in sarcopenia. Aging Clin Exp Res 29:695–700
Ziaaldini MM, Marzetti E, Picca A et al (2017) Biochemical pathways of Sarcopenia and their modulation by physical exercise: a narrative review. Front Med (lausanne) 4:167
Pillard F, Laoudj-Chenivesse D, Carnac G et al (2011) Physical activity and sarcopenia. Clin Geriatr Med 27:449–470
Deutz NE, Bauer JM, Barazzoni R et al (2014) Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr 33:929–936
Freiberger E, Sieber C, Pfeifer K (2011) Physical activity, exercise, and sarcopenia—future challenges. Wien Med Wochenschr 161:416–425
Goisser S, Kemmler W, Porzel S et al (2015) Sarcopenic obesity and complex interventions with nutrition and exercise in community-dwelling older persons—a narrative review. Clin Interv Aging 10:1267–1282
Martone AM, Lattanzio F, Abbatecola AM et al (2015) Treating sarcopenia in older and oldest old. Curr Pharm Des 21:1715–1722
Drey M, Zech A, Freiberger E et al (2012) Effects of strength training versus power training on physical performance in prefrail community-dwelling older adults. Gerontology 58:197–204
Vlietstra L, Hendrickx W, Waters DL (2018) Exercise interventions in healthy older adults with sarcopenia: A systematic review and meta-analysis. Australas J Ageing. https://doi.org/10.1111/ajag.12521
Pahor M, Guralnik JM, Ambrosius WT et al (2014) Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA 311:2387–2396
Landi F, Cesari M, Calvani R et al (2017) The „Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies“ (SPRINTT) randomized controlled trial: design and methods. Aging Clin Exp Res 29:89–100
Law TD, Clark LA, Clark BC (2016) Resistance exercise to prevent and manage Sarcopenia and Dynapenia. Annu Rev Gerontol Geriatr 36:205–228
Marzetti E, Calvani R, Tosato M et al (2017) Physical activity and exercise as countermeasures to physical frailty and sarcopenia. Aging Clin Exp Res 29:35–42
Bauer J, Biolo G, Cederholm T et al (2013) Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc 14:542–559
Bauer JM (2011) Nutrition in older persons. Basis for functionality and quality of life. Internist (Berl) 52:946–954
Kiesswetter E (2015) Optimierte Ernährung bei Sarkopenie. Schweiz Z Ernährungsmed 13(5):6–11
Deutsche Gesellschaft für Ernährung (DGE) (2016) Referenzwerte für die Nährstoffzufuhr: Protein. https://www.dge.de/wissenschaft/referenzwerte/protein/. Zugegriffen: 11. Dez. 2018
Cruz-Jentoft AJ, Landi F, Schneider SM et al (2014) Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing 43:748–759
Bauer JM, Verlaan S, Bautmans I et al (2015) Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc 16:740–747
Bo Y, Liu C, Ji Z et al (2018) A high whey protein, vitamin D and E supplement preserves muscle mass, strength, and quality of life in sarcopenic older adults: A double-blind randomized controlled trial. Clin Nutr. https://doi.org/10.1016/j.clnu.2017.12.020
Wakabayashi H, Sakuma K (2014) Comprehensive approach to sarcopenia treatment. Curr Clin Pharmacol 9:171–180
Luo D, Lin Z, Li S et al (2017) Effect of nutritional supplement combined with exercise intervention on sarcopenia in the elderly: a meta-analysis. Int J Nurs Sci 4:389–401
De Spiegeleer A, Beckwee D, Bautmans I et al (2018) Pharmacological interventions to improve muscle mass, muscle strength and physical performance in older people: an umbrella review of systematic reviews and Meta-analyses. Drugs Aging 35:719–734
Kilsby AJ, Sayer AA, Witham MD (2017) Selecting potential pharmacological interventions in Sarcopenia. Drugs Aging 34:233–240
Amato AA, Sivakumar K, Goyal N et al (2014) Treatment of sporadic inclusion body myositis with bimagrumab. Baillieres Clin Neurol 83:2239–2246
Becker C, Lord SR, Studenski SA et al (2015) Myostatin antibody (LY2495655) in older weak fallers: a proof-of-concept, randomised, phase 2 trial. Lancet Diabetes Endocrinol 3:948–957
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
J.M. Bauer: Förderung wissenschaftlicher Projekte: Nestlé, Nutricia DANONE. Vortragshonorare: Nestlé, Nutricia DANONE, Fresenius, Pfizer, Novartis, Bayer. S. Goisser, R. Kob und C.C. Sieber geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
Additional information
Redaktion
H. Lehnert, Lübeck
C.C. Sieber, Nürnberg
Rights and permissions
About this article
Cite this article
Goisser, S., Kob, R., Sieber, C.C. et al. Update zur Diagnose und Therapie der Sarkopenie. Internist 60, 141–148 (2019). https://doi.org/10.1007/s00108-018-0551-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00108-018-0551-x