What is Sarcopenia and how is it classified?
Sarcopenia is a progressive and generalized skeletal muscle disorder, characterized by the gradual reduction of muscle mass, muscle strength and overall body functionality. According to the modern international guidelines of EWGSOP2, low muscle strength is now the primary criterion for its diagnosis. Regarding its etiology, the condition is distinguished into primary, which is due exclusively to the normal aging process, and secondary. The second form is triggered by exogenous factors, such as underlying chronic diseases, inadequate nutrition, but also intense physical inactivity or prolonged bed rest that often follows a sudden fracture.
Figure 1: The stages of the diagnostic process according to EWGSOP2.

• Find: Identifying suspicious symptoms in everyday life.
• Assess: Checking muscle strength (indicating possible sarcopenia).
• Confirm: Checking the quantity or quality of muscle mass (confirmed disease).
• Stage: Checking physical performance and functionality (severe sarcopenia).

What is Osteosarcopenia and what are the risks?
When sarcopenia coexists with osteoporosis in the same person, we refer to osteosarcopenia syndrome, a term that highlights the close biological interaction between muscle and bone. The loss of one tissue accelerates the deterioration of the other, creating a harmful vicious cycle. This combination deprives the body of its stability, leading to increased instability, frequent falls and, ultimately, serious fragility fractures, such as hip fractures. These patients face a multiple risk of prolonged disability, which makes immediate treatment of musculoskeletal flexion an imperative need to maintain their autonomy.

What are the stages of integrated Nutritional Care?
The integrated management of the elderly by the Clinical Dietitian is systematically organized into four basic stages. Initially, screening is carried out using the validated SARC-F questionnaire to immediately identify individuals at risk. This is followed by specialized nutritional assessment and diagnosis, which is based on anthropometric measurements, biochemical indicators and international criteria such as GLIM and MNA. At this stage, special attention is required for sarcopenic obesity, an insidious condition where severe muscle loss is hidden behind increased body fat. Then, the personalized nutritional intervention is designed and the process is completed with continuous monitoring of the patient’s progress.

How is the specialized Nutritional Intervention designed?
The nutritional strategy focuses on anabolic support of muscle tissue and bone healing. According to recent ESPEN guidelines, high biological value protein intake should be increased to 1.2 to 1.5 grams per kilogram of body weight per day, while energy coverage should reach 25 to 35 calories per kilogram of body weight per day.
To achieve these goals, the Clinical Dietitian employs specialized clinical solutions. In “anorexia of aging”, small, frequent and calorie-dense meals are applied, while the taste is enhanced with natural herbs and spices to stimulate the appetite. Caloric and protein enrichment is ideally achieved with natural, economical products, such as egg, cheese, olive oil or nut butters, or where necessary, with specialized medical nutritional supplements (ONS) of small volume. In cases of dysphagia, the texture of meals is appropriately modified to be safe without losing its nutritional value and attractiveness. If oral feeding remains insufficient, artificial enteral nutrition is employed.

Maria Voutsina, MSc Clinical Dietitian – Nutritionist
Member of the Greek Federation of Nutritionists (FFN Gr)