Frailty, sarcopenia and cachexia in heart failure patients: Different clinical entities of the same painting

Table 1 Current definitions of frailty, cachexia and sarcopenia

Institution/authors, journal, year	Frailty	Institution/authors, journal, year	Cachexia	Institution/authors, journal, year	Sarcopenia
British Geriatrics Society, Age UK and Royal College of General Practitioners Report[7]. Age Aging 2014	(1) A gait speed < 0.8 m/s; (2) Timed-up-and-go test > 10 s; (3) Score of ≥ 3 on the PRISMA 7 questionnaire. Falls, delirium and sudden immobility can used to indicate the presence of frailty	Argilés et al[19]. Consensus on cachexia definitions. J Am Med Dir Assoc 2010	Weight loss > 5% of body weight (or BMI < 20 kg/m2) in ≤ 1 year in presence of chronic illness and three of five of these criteria. (1) Decreased muscle strength; (2) Fatigue; (3) Anorexia; (4) Low fat free mass index; (5) Anaemia (< 120 g/L), low serum albumin (< 32 g/L) and CRP > 5 mg/L, IL-6 > 4 pg/mL	Revised European consensus on definition and diagnosis[36]. Age Aging 2019	(1) Low muscle strength; (2) Evidence of low muscle quantity or quality; (3) Detection of low physical performance. The combination of three represent severe sarcopenia
Heart Failure Association/European Society of Cardiology position paper on frailty in patients with heart failure[10]. Eur J Heart Fail 2019	The frailty score in HF patients were built with the following variables: (1) Clinical: Comorbidities, weight loss, falls; (2) Psycho-cognitive: Cognitive impairment, dementia, depression; (3) Functional: ADL/IADL, mobility, balance; (4) Social: Living alone, no social support, institutionalisation	International Consensus on Cancer Cachexia Classification[65]. Lancet 2003	The agreed diagnostic criterion for cachexia was weight loss greater than 5%, or weight loss greater than 2% in individuals already showing depletion according to current bodyweight and height (BMI < 20 kg/m2) or skeletal muscle mass reduction	Society of Sarcopenia, Cachexia and Wasting Disorders[37]. J Am Med Dir Assoc 2011	Muscle loss with (1) walking speed equal or less than 1 m/s; (2) walks less than 400 m during a 6-minute walk. Appendicular lean mass/height2 > 2 SD below the mean mass of a healthy person (aged 20–30 yr)
Fried et al[4]. J Gerontol A Biol Sci Med Sci 2001	Frailty was defined with three or more of the following criteria: (1) Unintentional weight loss (4, 5 kgs in past year); (2) Self-reported exhaustion; (3) Weakness (reduced grip strength); (4) Slow walking speed; (5) Low physical activity. A pre-frail status is accordingly whit one or two criteria	SCRINIO working group[66]. JPEN J Parenter Enteral Nutr 2009	The patients were divided in 4 groups based on combinations of body weight loss < 10% in precachexia and ≥ 10% in cachexia; associated to the presence/absence of at least 1 symptom of anorexia, fatigue or early satiation	International working group on sarcopenia[39]. J Am Med Dir Assoc 2011	Gait speed of less than 1 ms (-1) and low muscle mass (appendicular mass relative to ht (2) that is ≤ 7.23 kg/m2 in men and ≤ 5.67 kg/m2 in women)
Canadian Study of Health and Aging[9]. CMAJ 2005	Clinical frailty scale is based on IADL, activity, mobility, energy, and symptoms all associated with clinical judgement			Special Interest Groups "Cachexia-Anorexia in Chronic wasting diseases" and "Nutrition in Geriatrics“[21]. Clin Nutr 2008	Reduced muscle mass, strength and function (low handgrip strength (men < 26 kg, women < 16 kg), gait speed ≤ 0.8 m/s, low appendicular lean mass/BMI)

BMI: Body mass index; IL-6: Interleukin-6; hg: Height; kgs: Kilograms; CRP: C-reactive protein; IADL: Instrumental activities of daily living.