Towards a diagnosis of sarcopenia: collaboration with the FNIH

描述（由申请人提供）：肌肉减少症，此处定义为肌肉质量减少，常见于老年人。这是一个潜在的可修改的贡献者肌肉无力，这是密切相关的身体性能下降和残疾。肌肉减少症仍然难以诊断，部分原因是拟议的标准尚未基于临床结果，在数据集之间进行比较和/或正式评估诊断测试特征。对于新的病症或治疗，需要广泛的结构化证据来支持正式的共识过程。在此之前，肌肉减少症的诊断仍然悬而未决。虽然肌肉减少症的诊断尚不清楚，但潜在的干预措施正在迅速出现，但许多试验在明确定义合格性之前无法实施。因此，肌肉减少症明确诊断标准的进展可能有助于评估现有文献，指导未来研究的合格性和测量，并有助于在实践中创建临床治疗指征。为了满足对肌肉质量、力量和衰老的进一步证据的需求，在美国国立卫生研究院基金会（FNIH）的支持下，制定了一项倡议。代表9项研究和超过23，000名不同老年人的研究人员被选中加入肌肉减少症项目组，该项目组根据与行动能力残疾相关的并发和预测准确性进行了汇总分析，以支持临床重要的虚弱和低肌肉质量的标准。作为建立证据基础的下一步，对肌肉减少症的诊断达成共识，我们建议提出我们的工作，从相关专业的学者和卫生保健专业人员的反馈和建议。基于2/12天的会议，我们将介绍我们的概念框架，方法和发现，以及与其他诊断方法的潜在关系。我们将使用结构化调查和互动小组方法来评估与我们初步建议的一致性，指导进一步分析，生成出版物并寻求卫生专业组织的书面评论。因此，U13提案是NIA、FNIH和多个研究者的共同倡议，其目的是：1）与广泛的相关方介绍并讨论肌肉减少症项目组进行的数据分析的过程和结果，2）获得关于协议领域、知识中的剩余差距和进一步研究的建议，3）为年轻的研究人员提供一个从事衰老研究的场所，肌肉减少症和诊断测试开发，以及4）传播我们的工作成果。我们的短期目标是逐步达成共识，以证据为基础的标准，诊断肌肉减少症，并建立一个合作的过程，以证据为基础的诊断其他重要的老年健康问题。我们的长期目标是实现肌肉减少症的临床识别，并最终为其他复杂的衰老问题制定循证临床诊断指南。

DESCRIPTION (provided by applicant): Sarcopenia, defined here as reduced muscle mass, is common in older adults. It is a potentially modifiable contributor to muscle weakness, which is strongly related to decreased physical performance and disability. Sarcopenia remains difficult to diagnose, in part because proposed criteria have not been based on clinical outcomes, compared across data sets and/or formally evaluated for diagnostic test characteristics. For a novel condition or treatment, extensive structured evidence is needed to support formal consensus processes. Until then, the diagnosis of sarcopenia remains in limbo. While the diagnosis of sarcopenia is unclear, potential interventions are emerging rapidly, but many trials cannot be implemented until eligibility can be clearly defined. Thus progress toward clear diagnostic criteria for sarcopenia might aid in appraisal of existing literature, guide eligibility and measurement in future studies and help create indications for clinical treatments in practice. In order to address the need for further evidence about muscle mass, strength and aging, an initiative was developed under the aegis of the Foundation of the NIH (FNIH). Investigators representing nine studies and over 23,000 diverse older adults were selected to join the Sarcopenia Project Team, which has performed pooled analyses in support of criteria for clinically important weakness and low muscle mass, based on concurrent and predictive accuracy related to mobility disability. As a next step in building the evidence-base toward consensus on the diagnosis of sarcopenia, we propose to present our work for feedback and suggestions from scholars and health care professionals in relevant specialties. Based on a 2/12 day conference, we will present our conceptual framework, methods and findings, as well as potential relationships to other diagnostic approaches. We will use both structured surveys and interactive group approaches to assess agreement with our preliminary recommendations, guide further analyses, generate publications and seek written commentary by health professional organizations. Therefore the aims of this U13 proposal, a shared initiative of NIA, FNIH and multiple investigators, are to: 1) Present and discuss with a wide range of interested parties, the processes and results of the data analyses performed by the Sarcopenia Project Team, 2) Obtain recommendations for areas of agreement, remaining gaps in knowledge and further research, 3) Provide a venue for young investigators to engage in research on aging, sarcopenia, and diagnostic test development, and 4) Disseminate the results of our work. Our short term goals are to progress toward consensus on evidence-based criteria for the diagnosis of sarcopenia and to model a collaborative process for evidence-based diagnoses of other important geriatric health problems. Our long term goal is to achieve clinical recognition of sarcopenia and ultimately to define a pathway toward evidence-based clinical diagnostic guidelines for other complex problems of aging.