Clinical implementation of ESPEN-EASO criteria for diagnosis and staging of sarcopenic obesity

(Provvisorio) The decline of lean body mass and skeletal muscle functionality (namely, sarcopenia) is common and is exacerbated in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases), either extreme or repeated weight loss, and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of a universally established SO Definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes (1-5). The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a Definition and diagnostic criteria for SO (6). The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (e.g. risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into Stage I in the absence of clinical complications, or Stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction. ESPEN and EASO represented by the expert panel advocate that the proposed SO Definition and diagnostic criteria be implemented in clinical practice and in interventional RCTs aimed in particular at exploring the impact of specific interventions on SO. In addition, they strongly encourage validation and prospective follow up studies as well as secondary analysis of existing cohorts with the aim to increase the scientific evidence needed to identify and treat SO patients. Hence, the aim of the present study is, as suggested in the ESPEN-EASO consensus, to assess the validity of the entire diagnostic process, the need to include any other variables (e.g. calf circumference, visceral fat), the possibility to adopt a unified parameter (e.g. a body composition index) with both fat and skeletal muscle measurements related in a single criterion. The implementation of the decision algorithm for the screening and diagnosis of SO proposed by ESPEN and EASO will contribute to "enhance the capacity for prevention" and "guarantee widespread access to care" as it is asked in the 6th mission of the PNRR (Piano Nazionale di Ripresa e Resilienza), by helping to the "creation of proximity networks and telemedicine structures" for use by local medicine based in particular on the "digitization of the SSN" (Servizio Sanitario Nazionale) with automatic processing of the collected data.

(Provvisorio) The decline of lean body mass and skeletal muscle functionality (namely, sarcopenia) is common and is exacerbated in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases), either extreme or repeated weight loss, and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of a universally established SO Definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes (1-5). The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a Definition and diagnostic criteria for SO (6). The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (e.g. risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into Stage I in the absence of clinical complications, or Stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction. ESPEN and EASO represented by the expert panel advocate that the proposed SO Definition and diagnostic criteria be implemented in clinical practice and in interventional RCTs aimed in particular at exploring the impact of specific interventions on SO. In addition, they strongly encourage validation and prospective follow up studies as well as secondary analysis of existing cohorts with the aim to increase the scientific evidence needed to identify and treat SO patients. Hence, the aim of the present study is, as suggested in the ESPEN-EASO consensus, to assess the validity of the entire diagnostic process, the need to include any other variables (e.g. calf circumference, visceral fat), the possibility to adopt a unified parameter (e.g. a body composition index) with both fat and skeletal muscle measurements related in a single criterion. The implementation of the decision algorithm for the screening and diagnosis of SO proposed by ESPEN and EASO will contribute to "enhance the capacity for prevention" and "guarantee widespread access to care" as it is asked in the 6th mission of the PNRR (Piano Nazionale di Ripresa e Resilienza), by helping to the "creation of proximity networks and telemedicine structures" for use by local medicine based in particular on the "digitization of the SSN" (Servizio Sanitario Nazionale) with automatic processing of the collected data.