C4- SARCOPENIA AND FRAILTY GUIDELINES UPDATE IN ASIA

Sarcopenia is a major challenge to healthy aging, and affected patients tend to have worse clinical outcomes and higher mortality than those without sarcopenia. The Asian Working Group for Sarcopenia (AWGS) published regional consensus guidelines in 2014, and many research studies from Asia have been published since then. After the introduction of the AWGS consensus, the reported prevalence of sarcopenia estimated by the AWGS criteria ranges between 4.1% and 11.5% of the general older population. Reported risk factors included age, sex, heart disease, hyperlipidemia, daily alcohol consumption, and low protein or vitamin intake, whereas physical activity is a protective factor. Although AWGS 2014 diagnostic cut-offs were generally well accepted, some may require further revision in light of conflicting evidence from outcome-based studies. Due to the great impact of sarcopenia, a life course program for good nutrition and physical activities would be of great benefit. However, various research challenges remain to be resolved in the future and more outcome-based trials are needed to formulate the most optimal strategy for sarcopenia in Asia. In 2016 we organized the clinical guideline committee in the Japanese Association on Sarcopenia and Frailty and tried to publish the guidelines for sarcopenia for Japanese patients. We systematically searched PubMed, the Cochrane Library, and Ichushi-Web for RCTs from January 2000 to December 2016. We meta-analyzed the outcomes with the net difference between-group treatment from baseline to the end of the study. We also developed evidence-based clinical practice guidelines for the identification and management of frailty in older adults. The guidelines were formed using an adapted GRADE methodology, and incorporated an extensive literature search paired with the expert knowledge and experience of international experts in gerontology and geriatrics. Strong recommendations were: (i) frailty should be identified using a validated screening tool; (ii) physical activity should be prescribed that includes a resistance training component; and (iii) polypharmacy should be addressed. These clinical practice guidelines can be used to support healthcare professionals in their recognition, care and management of older persons with sarcopenia and frailty.