The Different Diagnostic Criteria for Sarcopenia
By Dr. Yi-Cheng Wu · Reviewed June 21, 2026
There are at least five sets of diagnostic criteria for sarcopenia worldwide. The three main assessment domains are muscle mass, muscle strength, and physical performance. In Taiwan the most commonly referenced values are from the Asian Working Group for Sarcopenia (AWGS).
Sarcopenia is common in adults over 65, but there is no single global definition. At present there are at least five sets of criteria, from Europe (EWGSOP), the United States (FNIH, SDOC), Asia (AWGS), and an international group (IWGS), each setting its own values to suit its context. Diagnosis mainly considers three items: low muscle mass, low muscle strength, and poor physical performance. Using the AWGS criteria commonly applied in Taiwan as an example, grip strength under 28 kg for men and under 18 kg for women, and a 6-metre walking speed under 1.0 metre per second, are considered low; calf circumference or the finger-ring test are often used for screening. Because different criteria use different tools and cut-off points, whether someone meets the definition of sarcopenia and how it should actually be managed still depend on an individual assessment by a physician.
Sarcopenia is common in adults over 65. Unlike many diseases, its definition is not the same in every country.
Abnormal kidney function can be staged by the estimated glomerular filtration rate (eGFR), a clotting disorder means clotting times exceed a certain threshold, and most cancer diagnoses require a pathology report for confirmation — for these, most countries around the world refer to consistent standards. For sarcopenia, however, there are currently at least five sets of criteria worldwide, and the one most often heard of in Taiwan is the set produced by the Asian Working Group for Sarcopenia.
These diagnostic criteria were in fact worked out through expert consensus meetings in different countries, including the European Working Group on Sarcopenia in Older People (EWGSOP), the US National Institutes of Health Foundation (FNIH), the Asian Working Group for Sarcopenia (AWGS), the Sarcopenia Definitions and Outcomes Consortium (SDOC), and the International Working Group on Sarcopenia (IWGS). Each expert meeting had its own context-specific considerations and reference studies, and set its criteria accordingly.
Diagnosis of sarcopenia currently rests mainly on three items: low muscle mass, low muscle strength, and poor physical performance. The values used for these three categories differ by country or region.
Muscle mass
Muscle mass can be measured by CT, MRI, DXA, or BIA. Measuring muscle mass is difficult for the general public, and bioimpedance analysis (BIA) is one of the relatively easier options. The tools recommended by the Asian Working Group for Sarcopenia include DXA and BIA measurement; among these, AWGS recommends multi-frequency BIA, while the less accurate home-use BIA devices are not recommended. The values referenced by each country’s criteria are derived from ASM, ASM/height², ALM/BMI, ALM/height², and similar calculations. ASM refers to unadjusted skeletal muscle mass, while SMI and similar indices represent values adjusted for body weight or height.
At present the AWGS definition of low muscle mass is: DXA measurement under 7.0 kg/m² for men and under 5.4 kg/m² for women; BIA measurement under 7.0 kg/m² for men and under 5.7 kg/m² for women.
Muscle strength
With the exception of IWGS, which does not use it, all the criteria use upper-limb grip strength as their standard. Most grip dynamometers in use are spring-type, followed by hydraulic types. Spring-type measurement is recommended in a standing position with the elbow fully relaxed and extended, while hydraulic measurement is recommended in a seated position with the elbow flexed to 90 degrees.
The two types differ slightly in reliability and validity, but both are accepted by the Asian Working Group for Sarcopenia, which set diagnostic cut-offs of under 28 kg for men and under 18 kg for women. Europe uses under 27 kg for men and under 16 kg for women, and FNIH uses 26 kg for men and 16 kg for women.
Physical performance
This can be assessed using the 6-metre usual walking speed, the five-times sit-to-stand test, or the Short Physical Performance Battery (SPPB). Walking speed is the most commonly used measure; AWGS recommends measuring from a non-static start, taking two measurements and averaging them. The current AWGS thresholds for low physical performance are a 6-metre walking speed under 1.0 metre per second, a five-times sit-to-stand test of 12 seconds or more, or an SPPB of 9 points or less; some guidelines use a walking speed of 0.8 metre per second or less.
Quick screening and intervention
For screening, we often use calf circumference (under 34 cm for men, under 33 cm for women) or the Yubi-wakka test (ringing the index finger around the calf), but diagnosing sarcopenia requires returning to the three items of muscle mass, muscle strength, and physical performance.
By severity, sarcopenia can be divided into possible sarcopenia, sarcopenia, and severe sarcopenia. For possible sarcopenia, dietary and exercise intervention and lifestyle change are recommended, along with inclusion in a chronic-disease management care plan. If sarcopenia is already present, screening for possible causes is recommended, together with a comprehensive programme of exercise training and nutritional intervention, and addressing any reversible causes.
Summary
Whether the different clinical definitions of sarcopenia change the progression and prognosis of the condition needs more research to confirm. Diagnostic cut-off values are important for subsequent disease management in some situations, such as cancer, hypertension, and diabetes. Because the interventions for sarcopenia are exercise and nutrition — both of which can bring many benefits without causing harm — it may make sense to intervene earlier rather than waiting until the condition is confirmed before taking action. In the future, if medications and more research become available for sarcopenia, there should be a more consistent consensus on the diagnostic criteria.
Further reading
Exercise doesn’t automatically mean muscle strength: an exercise prescription for sarcopenia
Screening and diagnosis of sarcopenia
Comparing devices for measuring body muscle mass
References
- Sarcopenia definition: Does it really matter? Implications for resistance training. Ageing Res Rev. 2022 Jun;78:101617. doi: 10.1016/j.arr.2022.101617.
- DXA-Derived Indices in the Characterisation of Sarcopenia. Nutrients. 2022 Jan; 14(1): 186.
- 台北市醫師公會會刊 亞洲肌少症診治共識：2019年更新介紹
Frequently asked questions
How is muscle strength assessed for sarcopenia, and what are the cut-offs?
Most criteria use upper-limb grip strength, usually measured with a spring-type or hydraulic dynamometer. Using the Asian Working Group for Sarcopenia (AWGS) as an example, grip strength under 28 kg for men and under 18 kg for women is considered low; the cut-offs used in Europe and by the US FNIH differ slightly.
What methods are used to assess physical performance?
Options include the 6-metre usual walking speed, the five-times sit-to-stand test, or the Short Physical Performance Battery (SPPB). The AWGS low-performance thresholds are a walking speed under 1.0 metre per second, a sit-to-stand test of 12 seconds or more, or an SPPB of 9 points or less; some guidelines use 0.8 metre per second.
How can sarcopenia be quickly screened at home or in the community?
Common initial screens include calf circumference (under 34 cm for men, under 33 cm for women) or the Yubi-wakka test, in which the index finger and thumb are ringed around the calf. A definitive diagnosis, however, still requires returning to the three assessments of muscle mass, muscle strength, and physical performance.
Do the different diagnostic criteria affect treatment?
The main interventions for sarcopenia are exercise and nutrition. Research suggests both are generally beneficial and unlikely to cause harm, so earlier intervention may be considered rather than waiting for a confirmed diagnosis. Whether the different criteria affect prognosis still needs more research, and actual management still depends on an individual assessment by a physician.
This article is also available in the original Chinese, with the full reference list.
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