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Reply to Gulistan Bahat: Significance of population differences and the methodology in determining the muscle mass cut‐off points for sarcopenia

We thank Gulistan Bahat and co-authors for the valuable comments made about our published paper, and we appreciate the time and effort taken to express their concerns regarding sarcopenia diagnosis and cut-off points, as it is a very important research topic. We consider the points raised in the Letter to the Editor to be essential in expanding the general understanding of the prevalence of sarcopenia based on different suggested definitions of sarcopenia currently available in the literature. The article introduced in the letter by Bahat et al. is of vital importance to the definition of sarcopenia and cutoff points, as it reports values higher than we have previously seen, in a Turkish population. As stated in our publication and in the letter, indeed, these cut-off points should be recognized and applied carefully in research. This research paper introduced would have been a valuable contribution to our review had it been available at the time of drafting and revision. Future review articles should include the publication by Bahat et al., and readers should be aware that in light of this new study, the muscle mass cut-off points for sarcopenia measured by bioelectrical impedance analysis is 7.00–9.20kg/m and 5.75–7.40kg/m in men and women, respectively. We have created a new table including the publication by Bahat, as well as other studies to correct the original article based on the suggestions made by Dr Bahat in the Letter to the Editor. Generally, the large range of cut-off points available for defining sarcopenia in the literature is due to the differences in reference population and ethnicities in each study. The reference population used in the study by Bahat et al. included students and medical faculty and staff, and as mentioned in the limitations by the authors themselves, whether the sample was representative of the general Turkish population cannot be confirmed. Readers should also take into account that the older reference population were outpatients of the hospital, and although they might not have been very ill, it seems unlikely that this group would be representative of the healthy community-dwelling elderly population. Furthermore, there might be discrepancies in the skeletal muscle mass (SMM) used in the study by Bahat et al. because of the use of the skeletal muscle mass formula (SMM=0.566× fat-free mass), and whether there were individual differences between the calculated appendicular SMM and measured SMM is unknown. Nevertheless, the purpose of our published review was to illustrate that the use of different cut-off points in one Japanese population resulted in varying prevalence rates as well as associated risk factors. Bahat et al. further added some important cut-off values for Turkish people, and researchers should be aware and mindful in applying