The demographic shift toward aging populations in developing countries has intensified the prevalence of sarcopenia, creating unique challenges for healthcare systems already limited in resources (1). In regions like Southeast Asia, Latin America, and sub-Saharan Africa, life expectancy has risen steadily, leading to larger elderly populations than ever before. However, unlike in high-income countries, healthcare infrastructure in many lower- and middle-income nations often lacks adequate diagnostic facilities and trained personnel to address age-related conditions effectively (2, 3). This gap in healthcare capacity leaves older adults at greater risk for untreated muscle degeneration, which can lead to increased disability, decreased quality of life, and a greater financial burden on families and communities (4). The rising burden of sarcopenia in these regions underscores an urgent need for scalable, cost-effective interventions that consider local constraints.

Research employing the Asian Working Group for Sarcopenia (AWGS) criteria has revealed a prevalence of 27.7%, while the revised European consensus (EWGSOP2) reported prevalence rates of 18.18%. A study from a tertiary hospital revealed a higher prevalence of 73.33% (5). Collectively, these findings suggest that sarcopenia is prevalent among Filipino adults aged 60 and older, influenced by various sociodemographic and physiological factors. Current research identifies age, waist circumference, smoking, and alcohol consumption as significant predictors of sarcopenia (6). Sarcopenia is closely associated with reduced physical function and diminished quality of life, underscoring the necessity for national guidelines to address this pressing issue. At the March 2023 Asia-Pacific conference on muscle health and sarcopenia, a multinational panel, including Filipino experts, proposed five core pillars: awareness, education, initiatives, engagement, and research. These pillars are designed to address the gaps and challenges in implementing muscle health assessments and management within clinical practice (7). Additionally, the country launched its first longitudinal study on health and aging (LSHAP) in 2018, using a nationally representative sample and recommending further research on sarcopenia and healthy life expectancy to enhance understanding of the health characteristics of Filipino older adults. A review of studies on sarcopenia in Filipinos aged 60 and above conducted between 2013 and 2023 revealed that most research has been hospital-based and involved patients with comorbidities. Sarcopenia remains inadequately integrated into routine clinical practice. The Geriatric Health-Research Institute (NCGH-RI) has incorporated sarcopenia screening into the Comprehensive Geriatric Assessment (CGA), emphasizing the need for further research and implementation to address this escalating public health concern. Table 1 summarized sarcopenia-related research conducted in the Philippines.

Sarcopenia is a complex muscle disorder characterized by the progressive loss of muscle mass, strength, and function, predominantly affecting older adults (8). This condition is influenced by a combination of genetic, biological, environmental, and lifestyle factors. The pathogenesis of sarcopenia is multifactorial, involving a combination of genetic predisposition, biological processes, environmental influences, and lifestyle factors. Research has shown that various signaling pathways, such as those involving protein metabolism, muscle regeneration, and inflammation, are crucial in the development of sarcopenia (9, 10). Aging results in the atrophy of fast-twitch type II muscle fibers, which are essential for generating force and power. This leads to a reduction in muscle size and strength, particularly in response to diminished satellite cell activity and impaired muscle regeneration (8). Concurrently, muscle protein synthesis declines with age, exacerbating the negative protein balance. This decline is partly due to reduced activity of the mTOR signaling pathway, which plays a key role in muscle protein synthesis and growth (9, 10). Additionally, aging promotes an increase in muscle protein breakdown, which is further exacerbated by chronic inflammation, oxidative stress, and physical inactivity. This process is mediated by upregulated proteolytic pathways, such as the ubiquitin-proteasome system and autophagy (11, 12). Hormonal changes, including declines in testosterone, growth hormone, and insulin-like growth factor 1 (IGF-1), further exacerbate the loss of muscle mass and strength. These hormonal alterations impair muscle regeneration and increase protein catabolism (13). Chronic low-grade inflammation, a hallmark of aging, is associated with sarcopenia. Pro-inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), play a crucial role in muscle wasting by increasing muscle protein breakdown and inhibiting muscle protein synthesis. Inflammation also disrupts the balance of muscle repair and regeneration (14, 15). Physical inactivity is one of the most significant accelerators of sarcopenia, driving the rapid decline in muscle mass, strength, and functionality. It results in decreased muscle protein synthesis, impaired mitochondrial function, and muscle fiber atrophy, all of which contribute to the progression of sarcopenia (16, 17).

The European Working Group on Sarcopenia in Older People (EWGSOP) and the Asian Working Group for Sarcopenia (AWGS) have established diagnostic algorithms for sarcopenia that include assessments of muscle mass, strength, and physical performance (18, 19). These algorithms are widely applied in clinical and research settings, including in countries like the Philippines, where sarcopenia research is becoming more prevalent. In EWGSOP1, the criteria for diagnosing sarcopenia include low muscle mass in conjunction with either low muscle strength or low physical performance (20), with muscle mass being the primary component of sarcopenia. These criteria have been widely studied in European and Asian populations, but there is a need to determine whether these criteria are appropriate for Filipino populations, considering potential ethnic and environmental differences. EWGSOP2, however, prioritizes muscle strength, defining sarcopenia as low muscle strength combined with low muscle quantity or low muscle quality (19), where muscle strength becomes the predominant component. This approach may need modification when applied to the Filipino population, as studies suggest variations in muscle strength and mass across ethnic groups. AWGS2019 also emphasizes the importance of muscle strength. Consequently, these differing criteria may result in variations in the reported prevalence of sarcopenia. A systematic review indicates that the prevalence of sarcopenia in older adults is lower when diagnosed using EWGSOP2 compared to EWGSOP1 (21). A similar trend has been observed in some studies conducted in Southeast Asia, but further research is needed to apply these findings to the Filipino population. A comparative study of sarcopenia prevalence in a large multinational European population sample using various diagnostic criteria (22) revealed similar findings, suggesting that prevalence estimates based on EWGSOP1 tend to be higher than those based on EWGSOP2. However, AWGS2 criteria show a similarly lower prevalence to EWGSOP2, likely due to their shared reliance on muscle mass and muscle strength. Baumgartner et al. (23) emphasized the significance of employing “population-specific diagnostic criteria” for sarcopenia. This is particularly relevant for the Filipino population, where unique genetic, dietary, and environmental factors may influence sarcopenia characteristics. They delineated a methodology for estimating the prevalence of “deficient” relative muscle mass, or sarcopenia, in population-based studies. Consequently, numerous sarcopenia criteria have incorporated the concept of “relative muscle mass.” Therefore, identifying suitable measurement tools and establishing cut-off values in the Philippines that align with international standards will enable researchers and policymakers to adapt actions and recommendations as proposed by organizations such as the EWGSOP.

Dual-energy X-ray absorptiometry (DXA) is a widely accepted and reliable method for assessing muscle mass in older adults and is endorsed by international organizations for diagnosing sarcopenia. However, the applicability of DXA in the Filipino population, due to differences in body composition, requires further validation. Bioelectrical impedance analysis (BIA) provides a portable, non-invasive, and cost-effective alternative to DXA. Recent studies have confirmed BIA as a dependable tool for diagnosing sarcopenia in older adults (23). Handgrip strength serves as a straightforward and cost-effective screening tool for muscle strength. Decreased handgrip strength is a significant predictor of adverse outcomes in older adults, including disability, falls, and mortality (24). Physical performance, especially gait speed, is another crucial diagnostic criterion for sarcopenia (25). Research indicates that gait speed is a dependable measure of muscle function in older adults and is correlated with adverse health outcomes, including disability, falls, and mortality.

Despite the availability of diagnostic tools, no established normative reference exists for diagnosing sarcopenia in the Philippines. A scoping review has highlighted the use of various assessment methods in sarcopenia studies among elderly Filipinos, including the EWGSOP and AWGS criteria, magnetic resonance imaging (MRI), and psoas muscle thickness divided by height (PMTH) (5). These studies have identified potential cut-off values for muscle mass, strength, and performance tailored to the Filipino population. Given the variability in population characteristics across countries, there is an urgent need for studies to establish appropriate cut-off points specific to the Filipino population. This would facilitate the development of local health promotion and sarcopenia management programs. Tee and Tee (26) aimed to establish normative data for muscle mass and physical performance among young Filipinos to enhance the applicability of EWGSOP criteria. Their study provides reference values for normal muscle mass, strength, and physical performance, thereby contributing to more accurate diagnosis and preventive strategies for sarcopenia. The cut-off points specific to Filipinos derived from this study have been cited in subsequent sarcopenia research in the Philippines, including studies on the association between obesity and sarcopenia and sarcopenia with osteoporosis in patients with chronic obstructive pulmonary disease (25, 26, 52). The diagnostic standards are as follows: (I) Low muscle mass is defined as a lean tissue index of <12.50 kg/m² for males and < 8.33 kg/m² for females using the Fresenius Body Composition Monitor. (II) Low muscle strength is defined as grip strength of <24.54 kg for males and < 16.10 kg for females, measured with a JAMAR dynamometer. (III) Low physical performance is assessed using Usual Gait Speed and Timed Get Up and Go. Usual Gait Speed is measured with the 4-m walk test, with values <0.55 m/s for males and < 0.65 m/s for females considered low. For the Timed Get Up and Go, times >8.31 s for males and > 8.74 s for females are considered indicative of low physical performance. Further research is needed to validate these reference values, specifically in diverse Filipino subpopulations, and to optimize diagnostic criteria.

As highlighted in the review by Gay-as et al. (5), most of the existing research on sarcopenia among older Filipinos focuses on determining the prevalence and associated factors of sarcopenia in hospitalized individuals (secondary prevention). Some studies address the development of consensus on the prevention and management of sarcopenia and its associated factors, while few explore educational initiatives on sarcopenia for healthcare professionals. There is a significant gap in research on the treatment of sarcopenia within the Filipino population. Therefore, this review summarizes current global treatment approaches for sarcopenia to offer guidance for managing sarcopenia in the Philippines, with the goal of enabling older individuals to lead healthy and productive lives in accordance with the Philippine government’s vision for its elderly citizens.

The rising prevalence of sarcopenia in the Philippines, driven by the aging population, highlights the urgent need for effective diagnostic, preventive, and treatment strategies. Despite the growing body of research, there remains a significant gap in the application of sarcopenia research to clinical practice and public health initiatives. Establishing localized diagnostic criteria and expanding treatment options are vital steps in tackling this emerging health challenge. Enhanced awareness, research, and implementation of evidence-based practices are essential to improving outcomes for older adults with sarcopenia in the Philippines.