Biomarkers for sarcopenia, muscle mass, muscle strength, and physical performance: an umbrella review.

BACKGROUND

Biomarkers in sarcopenia have garnered increasing interest. This study aims to systematically identify biomarkers with potential diagnostic significance for sarcopenia, as well as those exhibiting correlations with sarcopenia, particularly biomarkers reporting quantitative pooled data.

METHODS

This umbrella review adhered to the PRISMA 2020 guidelines. Data sources including PubMed, the Cochrane Library, Embase, Scopus, and Web of Science were searched from the inception of data to April 7, 2025. The AMSTAR 2 tool and QUADAS-2 tool was utilized to assess the methodological quality of including studies, while the GRADE approach was used to evaluate the quality of evidence in these studies.

RESULTS

A total of 22 studies were included. The identified biomarkers encompass inflammatory, metabolic, hormonal, amino acid-related, genetic, and other categories. The evidence quality for most biomarkers was rated as very low. The creatinine to cystatin C (Cr/CysC) ratio emerged as the most frequently utilized diagnostic biomarker, demonstrating moderate diagnostic accuracy. However, its diagnostic performance exhibited variability across different diagnostic criteria. Biomarkers associated with sarcopenia predominantly demonstrated weak or negligible inverse correlations. Inflammatory biomarkers underwent the most comprehensive investigation. Patients with sarcopenia exhibited elevated interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) levels compared to controls, with these markers showing post-intervention improvement. Some metabolic and amino acid biomarkers were found to be lower in patients with sarcopenia than in the control group.

CONCLUSION

The Cr/CysC ratio demonstrates moderate diagnostic accuracy and represents the most frequently utilized diagnostic biomarker for sarcopenia. Inflammatory biomarkers constitute the predominant biomarkers and exhibit general elevation in sarcopenia patients. Following sarcopenia interventions, alterations in biomarker expression levels are observed, suggesting novel therapeutic applications for these biomarkers.