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- HOME > Ann Clin Nutr Metab > Volume 18(2); 2026 > Article
- Editorial Acute sarcopenia in critically ill patients: an emerging intensive care unit challenge
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Kyu-Hyouck Kyoung
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Annals of Clinical Nutrition and Metabolism 2026;18(2):63-64.
DOI: https://doi.org/10.15747/ACNM.26.0060
Published online: July 31, 2026
Department of Trauma Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- Corresponding author: Kyu-Hyouck Kyoung, e-mail: traumacrew@uuh.ulsan.kr
• Received: June 10, 2026 • Accepted: June 14, 2026
© 2026 The Korean Society of Surgical Metabolism and Nutrition · The Korean Society for Parenteral and Enteral Nutrition · Asian Society of Surgical Metabolism and Nutrition
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Sarcopenia is a syndrome characterized by progressive, generalized loss of skeletal muscle mass and strength, which is associated with adverse outcomes such as physical disability, poor quality of life, and death [1]. Current diagnostic criteria include low muscle strength, low muscle quantity or quality, and poor physical performance [2]. Sarcopenia has multifactorial causes and may be classified as primary when related to aging or secondary when associated with inactivity, disease, or malnutrition [2].
In critical care and severe trauma settings, sarcopenia extends beyond age-related muscle loss and has substantial clinical relevance. Sarcopenia may be acute or chronic. Acute sarcopenia is defined as the rapid deterioration of muscle health secondary to an illness or injury lasting less than 6 months [3].
Critically ill patients experience physiological stressors that promote muscle wasting, with endocrine dysregulation among the principal contributors. Hypercortisolemia also contributes to the loss of muscle mass and strength. Cortisol is a stress hormone involved in protein metabolism, and serum cortisol concentrations increase in critically ill patients; in some patients, hydrocortisone is administered to compensate for adrenal insufficiency [4]. In acute systemic inflammation, elevated concentrations of proinflammatory cytokines, including interleukin-6, interleukin-8, and tumor necrosis factor-α, dysregulate pathways involved in protein synthesis and degradation, thereby promoting proteolysis [5]. Physical inactivity and muscle disuse can further accelerate sarcopenia. Together, these mechanisms may contribute to the loss of 2% of skeletal muscle mass per day during the first week of critical illness [6]. The prevalence of sarcopenia among adults older than 60 years ranges from 10% to 27% [7]. In older adults, critical illness related to sepsis or trauma may further accelerate sarcopenia progression and has been associated with a 30-day mortality rate of 28.6% [8]. Therefore, preventing and treating sarcopenia is important not only for preserving physical function but also for improving survival.
Several tests and tools are used to screen for sarcopenia, including handgrip strength testing, the chair stand test, physical performance testing, and muscle mass measurement. However, except for direct assessment of muscle mass, these tests are often impractical in acute critical illness because patient participation and cooperation are difficult to obtain. Radiological assessments performed to evaluate disease or injury can also be used to estimate muscle mass. Well-validated anatomical sites that reflect whole-body muscle mass include the third lumbar vertebra, mid-thigh, and psoas muscle. Muscle mass can be measured using computed tomography or magnetic resonance imaging [2,5]. Although these imaging modalities are frequently used in critically ill patients, muscle-mass assessment is limited by the need for specialized software, and repeated imaging to evaluate progression is often constrained by patient safety considerations and cost. Even when sarcopenia is identified, clinicians face a major challenge: no established treatment reliably reverses it.
In clinical practice, prevention and treatment of sarcopenia require particular attention. The foremost priority is rapid correction of the precipitating causes to reduce the intensity and duration of the systemic inflammation that initially triggered acute sarcopenia. Malnutrition is also a central contributor to sarcopenia pathophysiology. Although guidelines for preventing sarcopenia during the acute phase of critical illness have not yet been established, available recommendations emphasize early enteral nutrition and a protein intake of 1.2–1.5 g/kg/day. A caloric intake of 25–35 kcal/kg/day has been recommended, depending on the patient’s condition. Because vitamin D deficiency is associated with muscle fiber atrophy, vitamin D replacement is recommended [4,9]. Physical activity interventions may appear impractical in critically ill patients because of patient vulnerability and healthcare workload. Nevertheless, early mobilization should be considered as soon as clinically feasible because physical activity interventions support muscle mass recovery and reduce the risk of pressure ulcers, venous thromboembolism, and pneumonia [4].
Sarcopenia remains a persistent challenge in intensive care, and no single definitive treatment is available. Management therefore requires a multifaceted approach that includes prompt treatment of the underlying disease, adequate nutritional support, and comprehensive rehabilitation. Effective prevention and treatment depend on close collaboration among all members of the multidisciplinary healthcare team.
Authors’ contribution
All work was done by Kyu-Hyouck Kyoung.
Conflict of interest
The author of this manuscript has no conflicts of interest to disclose.
Funding
None.
Data availability
Not applicable.
Acknowledgments
None.
Supplementary materials
None.
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