Letter to the editor: Case for validated instead of standard cut-offs for SARC-CalF

Gynoid lean muscle mass as mediator between menarche age, hand grip and bone mineral density in postmenopausal women

Numerous clinical studies indicate that reproductive factors and physical performance levels are significant predictors of bone mineral density (BMD) in postmenopausal women. However, research on the relationship between these factors and body composition remains limited, and the mediating role of body composition in the impact of these factors on BMD remains unclear. This cross-sectional study aims to explore the correlation between reproductive factors, physical performance levels, BMD, and body composition in postmenopausal women, and to further investigate the mediating role of body composition in these relationships. This study enrolled 102 postmenopausal women meeting predetermined criteria from the osteoporosis outpatient clinic of Huzhou Central Hospital, China. Data were collected through surveys, assessments of physical performance function, and dual-energy X-ray absorptiometry (DXA) measurements. Correlation analysis and multiple linear regression analysis were used to determine the relationships among factors. Mediation analysis was conducted to explore the mediating role of body composition, followed by logistic regression analysis to investigate risk factors for osteoporosis. Gynoid Lean Muscle Mass (GLM) emerged as an independent predictive factor for BMD of spine, hip, and total body, and a protective factor against osteoporosis. Hand grip and 6-meter gait speed were positively correlated with BMD at these skeletal sites and GLM, also serving as protective factors against osteoporosis. Conversely, menarche age and Time taken for 5 sit-ups exhibited negative correlations with BMD and GLM, concurrently representing risk factors for osteoporosis. GLM mediated the relationship between menarche age, hand grip, and hip BMD. Prolonged reproductive periods and enhanced physical performance appear beneficial in mitigating Lean Mass loss, particularly GLM, in postmenopausal women, thereby protecting BMD and effectively preventing osteoporosis.

Comparison of Screening Tools for Sarcopenia in Older Patients With Type 2 Diabetes Mellitus

BACKGROUND

The prevalence of sarcopenia is high in older patients with type 2 diabetes mellitus (T2DM).

OBJECTIVES

We evaluated the accuracy of the Strength, Assistance in Walking, Rise from a Chair, Climb Stairs, and Falls (SARC-F) questionnaire, the SARC-F combined with the Calf Circumference (SARC-CalF) questionnaire, the SARC-F incorporating Elderly and Body Mass Index Information (SARC-F+EBM) questionnaire, the MiniSarcopenia Risk Assessment 5-item (MSRA-5) questionnaire, the MiniSarcopenia Risk Assessment 7-item (MSRA-7) questionnaire, and the Ishii test score (Ishii) as screening tools for sarcopenia in older patients with T2DM.

METHODS

Patients with T2DM aged 60 years and older were enrolled. The Asian Working Group for Sarcopenia 2019 diagnostic criteria were used to determine the presence of sarcopenia in patients. The accuracy of the 6 screening methods was assessed using sensitivity, specificity, and area under the receiver operating characteristic curve (AUC).

RESULTS

In total, 225 older patients (111 men; 114 women) with T2DM participated in the study. The overall prevalence of sarcopenia was 24%, with 34.23% in men and 14.04% in women. Among all participants, the sensitivity of the 6 screening tools for sarcopenia was 18.52% to 92.59%, the specificity was 31.58% to 92.98%, and the AUC was 0.588 to 0.863. Among the 6 screening tools, the Ishii test has the highest AUC for screening both men and women, and its sensitivity and specificity are relatively balanced, both above 75%.

CONCLUSIONS

Of the 6 screening tools, the Ishii test proved to be the most suitable for early sarcopenia screening within this population.

Effect of the Finger-ring Test, compared with the standard test, as a predictor of sarcopenia in older adult patients: A systematic review and meta-analysis

AIM

The Finger-ring Test is valued for its simplicity and cost-effectiveness. This has prompted a systematic literature review to evaluate the effectiveness of the Finger-ring Test in the assessment of sarcopenia.

METHODS

Research studies in various online databases were accessed and perused, including PubMed, Web of Science, Scopus, Ovid, Embase, Medline and the Cochrane Database to identify relevant observational studies without any language restriction from database access to July 2024. To avoid missing any relevant matches, searches targeted specific words typically associated with the Finger-ring Test, such as Yubu-wakka Test and the Finger-circle Test. The research quality was evaluated using the ROBINS-E tool. A meta-analysis was performed using the SPSS software version 29. The review protocol was registered on PROSPERO, with the assigned ID CRD42024593561.

RESULTS

From a total of 286 studies, only four studies met the inclusion criteria. From a total of 2754 participants, the mean age of the participants was 68.35 ± 2.57 years. The pooled association of each group of the Finger-ring Test with sarcopenia showed the bigger group (OR 2.47; 95% CI 1.42-4.28; I2 = 64%), just fit group (OR 0.30; 95% CI 0.13-0.67; I2 = 75%) and the smaller group (OR 0.16; 95% CI 0.08-0.32; I2 = 62%).

CONCLUSIONS

This systematic review shows that the Finger-ring Test offers a practical method to identify older adults at risk of sarcopenia. These outcomes might serve as valuable indicators for creating public health initiatives in both the prevention and the management of sarcopenia. Geriatr Gerontol Int 2025; ••: ••-••.

Which pathway of the possible sarcopenia algorithm of the AWGS 2019 guideline is the best in Korean community-dwelling older men and women?

OBJECTIVE

To compare the diagnostic accuracy of possible sarcopenia identification pathways, as suggested by Asian Working Group for Sarcopenia (AWGS) in 2019, by gender among Korean community-dwelling older adults.

DESIGN

Cross-sectional analysis of data from 2,129 community-dwelling adults (70-84 years, 50.4% men) enrolled in Korean Frailty and Aging Cohort Study.

METHODS

Based on AWGS 2019 guideline, possible sarcopenia was defined by low handgrip strength (HGS) or slow five-times chair stand test (5CST) time, referred to as "assessments." "Case-findings" (low calf circumference [CC], SARC-F ≥4, or SARC-CalF ≥11) were recommended for screening 'possible sarcopenia' before assessment. For the six 'possible sarcopenia' pathways (combining three case-finding and two assessment tools), area under the curve (AUC) and F1 score are compared.

RESULTS

For case-finding in men, CC demonstrated the highest AUC (0.657) and F1 score (0.504) for predicting sarcopenia compared with SARC-F and SARC-CalF (p <0.001, =0.001). Among men with low CC, ΔAUC between HGS and 5CST was not significant as assessment (p=0.079) (AUCs: 0.763 vs. 0.707; F1 scores: 0.713 vs. 0.650). For case-finding in women, SARC-CalF demonstrated the highest AUC (0.631) and F1 score (0.389) compared with CC and SARC-F (p=0.012, <0.001). Subsequently, ΔAUC between HGS and 5CST was not significant in women (p=0.069) (AUCs: 0.566 vs. 0.636; F1 scores: 0.387 vs. 0.514).

CONCLUSIONS

Based on AWGS 2019 guideline, CC in men and SARC-CalF in women was the best case-finding tool for community-dwelling older adults. After the best case-finding in each gender, two assessment pathways demonstrated insignificant difference in both genders.

BRIEF SUMMARY

For case-finding of possible sarcopenia, using calf circumference in older men and using SARC-CalF in older women demonstrated the highest diagnostic accuracy for predicting sarcopenia. After the best case-finding in each gender, two assessment pathways (handgrip strength and five-times chair stand test) of possible sarcopenia demonstrated insignificant difference in both genders.

Sarcopenia: how to determine and manage

BACKGROUND

Understanding sarcopenia is becoming increasingly important as society ages. This comprehensive review covers the definition, epidemiology, causes, pathogenesis, diagnosis, prevention, management, and future directions for the management of sarcopenia, and the major issues related to sarcopenia in the knee joint.

MAIN TEXT

Sarcopenia, a condition related to aging, is characterized by decreased muscle mass and strength, which significantly affects physical function. Its prevalence may vary by region and age, with reports of up to 50% prevalence in the elderly population. The potential causes of sarcopenia include neurodegeneration, poor nutrition, changes in hormonal effects, elevated levels of proinflammatory cytokines, and reduced activation of muscle satellite cells. Various pathogeneses, such as apoptosis, proteolysis, and inhibition of the signaling for increasing muscle mass, contribute to the development of sarcopenia. Generally, the diagnostic criteria for sarcopenia are based on reduced muscle mass, reduced muscle strength, and decreased physical performance, and can be assessed using various equipment and clinical tests. A healthy lifestyle consisting of a balanced diet, sufficient protein intake, and regular exercise is recommended to prevent sarcopenia. The management of sarcopenia involves resistance exercise, proper nutrition, and deprescribing from polypharmacy. In the future, pharmacological treatment and personalized nutrition may become alternative management options for sarcopenia. Finally, since sarcopenia can be associated with knee osteoarthritis and poor outcomes after total knee arthroplasty, appropriate management of sarcopenia is important for physicians treating knee-related conditions.

CONCLUSIONS

Sarcopenia is a significant pathological condition that needs to be recognized, especially in the older population. Although sarcopenia is common as aging occurs, it can be prevented by a healthy lifestyle. Currently, there are no approved drugs for sarcopenia; however, resistance exercise and proper nutritional supplementation are essential methods for managing sarcopenic conditions. Given its diverse causes, a personalized approach may be necessary to effectively manage sarcopenia. Finally, appropriate management of sarcopenia can contribute to the prevention and effective treatment of knee osteoarthritis.

Association of possible sarcopenia with all-cause mortality in patients with solid cancer: A nationwide multicenter cohort study

OBJECTIVES

The concept of possible sarcopenia (PS) was recently introduced to enable timely intervention in settings without the technologies required to make a full diagnosis of sarcopenia. This study aimed to investigate the association between PS and all-cause mortality in patients with solid cancer.

DESIGN

Retrospective observational study.

SETTING AND PARTICIPANTS

13,736 patients with 16 types of solid cancer who were ≥18 years old.

MEASUREMENTS

The presence of both a low calf circumference (men <34 cm or women <33 cm) and low handgrip strength (men <28 kg or women <18 kg) was considered to indicate PS. Harrell's C-index was used to assess prognostic value and the association of PS with mortality was estimated by calculating multivariable-adjusted hazard ratios (HRs).

RESULTS

The study enrolled 7207 men and 6529 women (median age = 57.8 years). During a median follow-up of 43 months, 3150 deaths occurred. PS showed higher Harrell's C-index (0.549, 95%CI = [0.541, 0.557]) than the low calf circumference (0.541, 95%CI = [0.531, 0.551], P = 0.037) or low handgrip strength (0.542, 95%CI = [0.532, 0.552], P = 0.026). PS was associated with increased mortality risk in both univariate (HR = 1.587, 95%CI = [1.476, 1.708]) and multivariable-adjusted models (HR = 1.190, 95%CI = [1.094, 1.293]). Sensitivity analyses showed that the association of PS with mortality was robust in different covariate subgroups, which also held after excluding those patients who died within the first 3 months (HR = 1.162, 95%CI = [1.060, 1.273]), 6 months (HR = 1.150, 95%CI = [1.039, 1.274]) and 12 months (HR = 1.139, 95%CI = [1.002, 1.296]) after enrollment.

CONCLUSION

PS could independently and robustly predict all-cause mortality in patients with solid cancer. These findings imply the importance of including PS assessment in routine cancer care to provide significant prognostic information to help mitigate sarcopenia-related premature deaths.

The Impact of Sarcopenia Risk on Postoperative Walking Independence in Older Adults Undergoing Total Joint Arthroplasty

BACKGROUND AND PURPOSE

Sarcopenia is known to be associated with poor outcomes after arthroplasty; however, no study has reported the relationship between sarcopenia and postoperative walking independence. This study aimed to determine the impact of sarcopenia risk screening using the SARC-CalF questionnaire and calf circumference on the time to walk independently after total hip or knee arthroplasty in older patients.

METHODS

We included 599 nonobese patients aged 65 years and older who underwent unilateral and primary total hip or knee arthroplasty. Preoperative sarcopenia risk was assessed using the SARC-CalF or calf circumference. The outcome of this study was the time to independent walking after surgery; it was calculated as the number of days from the date of surgery to the date when the patient was able to walk independently. The association between preoperative sarcopenia risk and time to independent walking after surgery was analyzed using Kaplan-Meier curves and Cox proportional hazards models.

RESULTS

Among the 599 patients undergoing total joint arthroplasty, 175 (29.2%) were determined to be at risk of sarcopenia using SARC-CalF and 193 (32.2%) using calf circumference. The Kaplan-Meier curve showed that sarcopenia risk assessed by SARC-CalF or calf circumference was associated with a prolonged time to independent walking in patients undergoing hip arthroplasty (log-rank test, P < .001 and P < .001, respectively). In patients undergoing hip arthroplasty, the Cox proportional hazards model showed that SARC-CalF score of 11 points and greater or a calf circumference less than the cutoff was a risk factor for delayed time to independent walking (hazard ratios: 0.55 and 0.57, P < .001 and P = .001, respectively). There was no association between preoperative sarcopenia risk and postoperative time to independent walking in patients who underwent knee arthroplasty.

CONCLUSIONS

Sarcopenia screening tools, such as SARC-CalF or calf circumference, should be useful for planning postoperative rehabilitation in older adults scheduled for hip arthroplasty. However, the accuracy of SARC-CalF or calf circumference measurement in patients scheduled for knee arthroplasty may be low.

Brachial-Ankle Pulse Wave Velocity Mediates the Association between Increased Age and Risk of Sarcopenia among Chinese Patients with Type 2 Diabetes Mellitus

BACKGROUND AND AIMS

Arterial stiffness and sarcopenia are commonly seen in patients with type 2 diabetes mellitus (T2DM), and both are age-related diseases. However, few studies have addressed the causal relationship between age, arterial stiffness, and sarcopenia, especially in patients with T2DM. This study is aimed at investigating the relationship among age, arterial stiffness, and sarcopenia in patients with T2DM.

METHODS AND RESULTS

This cross-sectional study enrolled 557 inpatients with diabetes at the First Affiliated Hospital of Wenzhou Medical University, China, between June 2020 and July 2021. Patients who were diagnosed with T2DM and underwent examination of dual-energy X-ray absorptiometry, handgrip strength, 6-meter walk speed, and brachial-ankle pulse wave velocity (baPWV, a recognized indicator of arterial stiffness) were enrolled. A total of 447 patients were included. A dose-dependent relationship was found between age and sarcopenia. We also found a dose-dependent relationship between age and baPWV. Similarly, significant dose-dependent relationships were found across baPWV tertiles with higher prevalence of sarcopenia. Then, a mediation analysis was performed to explore the mediation effect of arterial stiffness on age-associated sarcopenia. We found that the prevalence of sarcopenia increased by 0.0115 (95% CI, 0.0028-0.0239) per 1 year increase in age by the mediation effect of baPWV and that the direct effect of aging on sarcopenia was 0.0441 (95% CI, 0.0101-0.0909) per 1 year older. baPWV mediated 20.5% of the positive relationship between increased age and the prevalence of sarcopenia.

CONCLUSIONS

Elevated baPWV partially mediates the association of age and sarcopenia among patients with T2DM.

Changes of sarcopenia case finding by different Asian Working Group for Sarcopenia in community indwelling middle-aged and old people

Sarcopenia is an emerging issue, but there is no universal consensus regarding its screening and diagnosis, especially regarding the influence of the Asian Working Group for Sarcopenia (AWGS) 2019 new definition on the prevalence of community-dwelling adults. To compare the prevalence of sarcopenia between the 2019 and 2014 definitions, a cross-sectional study including 606 normal nutritional status subjects (203 men/403 women; mean age 63.3 ± 10.0 years) was performed. Sarcopenic parameters, including calf circumference, grip strength, 6-m gait speed, and bioelectrical-impedance-analysis-derived skeletal mass index (SMI), were evaluated. According to the 2019 AWGS definition, the prevalence of possible sarcopenia and sarcopenia among community-dwelling adults was 7.4 and 2.8%, respectively. There were highly consistent findings regarding sarcopenia between the 2019 and 2014 AWGS definitions according to Cohen's kappa coefficient (0.668). However, the prevalence of possible sarcopenia according to 2014 and 2019 AWGS in males increased 7.9%; in contrast, sarcopenia decreased from 7.4 to 3.7% in females (p < 0.001). In conclusion, the AWGS 2019 definition is more convenient for sarcopenia case screening and remains considerably consistent in sarcopenia identification in community-dwelling adults in Taiwan. The discordance of possible sarcopenia and sarcopenia by sex is a concern.

Development of a risk prediction nomogram for sarcopenia in hemodialysis patients

Background

Sarcopenia is associated with various adverse outcomes in hemodialysis patients. However, current tools for assessing and diagnosing sarcopenia have limited applicability. In this study, we aimed to develop a simple and reliable nomogram to predict the risk of sarcopenia in hemodialysis patients that could assist physicians identify high-risk patients early.

Methods

A total of 615 patients undergoing hemodialysis at the First Affiliated Hospital College of Medicine Zhejiang University between March to June 2021 were included. They were randomly divided into either the development cohort (n = 369) or the validation cohort (n = 246). Multivariable logistic regression analysis was used to screen statistically significant variables for constructing the risk prediction nomogram for Sarcopenia. The line plots were drawn to evaluate the effectiveness of the nomogram in three aspects, namely differentiation, calibration, and clinical net benefit, and were further validated by the Bootstrap method.

Results

The study finally included five clinical factors to construct the nomogram, including age, C-reactive protein, serum phosphorus, body mass index, and mid-upper arm muscle circumference, and constructed a nomogram. The area under the ROC curve of the line chart model was 0.869, with a sensitivity and specificity of 77% sensitivity and 83%, the Youden index was 0.60, and the internal verification C-statistic was 0.783.

Conclusions

This study developed and validated a nomogram model to predict the risk of sarcopenia in hemodialysis patients, which can be used for early identification and timely intervention in high-risk groups.

Utility of SARC-F in daycare facilities for older people

AIM

SARC-F, a sarcopenia screening tool, has limited use but may be beneficial for detecting sarcopenia in frail older people. This study aimed to clarify the validity of the SARC-F questionnaire in older people.

METHODS

In this validation study, 74 (36 men; age, 81.9 ± 6.7 years, 38 women; age, 83 ± 6.2 years) community-dwelling older people who attended a daycare facility participated in our study. Participants completed the SARC-F and SARC-calf circumference (SARC-CalF) questionnaires, and their body composition, walk speed and grip strength were measured. Sarcopenia was determined using the Asian Working Group for Sarcopenia criteria, and the participants were divided into non-sarcopenia and sarcopenia groups. SARC-F and SARC-CalF scores were evaluated using receiver operating characteristic curve analysis for sarcopenia considering the area under the curve. Internal consistency was evaluated using Cronbach's alpha.

RESULTS

The prevalence of sarcopenia, defined by physical characteristics, was 60.0% in men and 48.1% in women. The area under the curve of the SARC-F for sarcopenia was 0.703 (95% confidence interval [CI]: 0.585-0.821, P = 0.001). Cronbach's alpha was 0.81, and the internal consistency was high. SARC-F had lower sensitivity (0.47; 95% CI: 0.31-0.64) but higher specificity (0.78; 95% CI: 0.60-0.89) than the sensitivity and specificity of SARC-CalF, respectively, and the sensitivity of SARC-F was higher than that reported in previous studies.

CONCLUSION

The SARC-F questionnaire is more sensitive in assessing sarcopenia in low-functioning populations and can be used as a screening tool for sarcopenia in long-term daycare facilities for older people rather than in community-based healthcare activities. Geriatr Gerontol Int 2022; ••: ••-••.

Development of a Simple and Practical Screening Tool for Detection of Sarcopenia in Older People: The Bushehr Elderly Health Program

Background: Sarcopenia is defined by the loss of muscle mass and function with a considerable prevalence which increases morbidity and mortality. We aimed to develop and validate a simple tool for screening of sarcopenia in Iranian older population.

Methods: In this study, we included 2,211 adults aged 60 years or older that participated in the stage II of Bushehr Elderly Health (BEH) program, a population-based prospective cohort study. We defined sarcopenia as reduced skeletal muscle strength plus low muscle mass. The study sample was divided into two parts; development set which were allocated to the development of the model (n = 1,499) and validation set (n = 712) were allocated to validation of the model.

Results: There were 22.9% of men and 23.2% women classified as having sarcopenia based on EWGSOP-2.After selection of variables, the final models named SarSA-Mod (Sarcopenia Scoring Assessment Models) were developed with area to under curves (AUC) of 0.82 (0.79–0.86) and 0.87 (0.84–0.90) in men and women, respectively. The final model included “age,” “weight,” and “calf circumference” in both sexes. The sensitivity and specificity and positive and negative predictive values for sarcopenia were 84.3, 76.0, 49.8, and 94.5% for women, 85.4, 64.8, 40.2, and 94.2% for men, respectively. The model performance was tested in the validation set with accuracy 91 and 84% among women and men, respectively.

Conclusions: Sarcopenia could be detected using SarSA-Mod, as a simple screening test with high accuracy among both sexes. Also, this screening test is valid, feasible, reliable and cost-effective compared to other tools.

Comparison of Diagnostic Performance of SARC-F and Its Two Modified Versions (SARC-CalF and SARC-F+EBM) in Community-Dwelling Older Adults from Poland

PURPOSE

Older adults should be routinely screened for sarcopenia, which threatens healthy, independent aging. The most popular screening tool is the SARC-F questionnaire. As its sensitivity is unsatisfactory, two modified versions of the questionnaire have been published: SARC-CalF (including calf circumference as an additional item) and SARC-F+EBM (assessing additionally age and Body Mass Index). The diagnostic performance of the three versions of the questionnaire has not been compared. The analysis aimed to assess the diagnostic value of SARC-F, SARC-CalF, and SARC-F+EBM questionnaires, and to compare their psychometric properties against two reference standards of sarcopenia diagnosis, ie, EWGSOP1 and modified EWGSOP2 criteria.

MATERIALS AND METHODS

We performed the sensitivity/specificity analysis and compared the overall diagnostic accuracy of SARC-F, SARC-CalF (31cm) (cut-off point 31 cm for both genders), SARC-CalF (33/34cm) (cut-off points: 33 cm for women and 34 cm for men), and SARC-F+EBM in 115 community-dwelling volunteers aged ≥ 65 yrs from Poland.

RESULTS

Depending on the version of the SARC-F questionnaire used, from 10.4% [SARC-CalF (31cm)] to 33.0% (SARC-F+EBM) were identified as having an increased risk of sarcopenia. Sarcopenia was identified in 17.4% by the EWGSOP1 criteria and in 13.9% by the modified EWGSOP2 criteria. With respect to the two reference standards used, the sensitivity of SARC-F, SARC-CalF (31cm), SARC-CalF (33/34cm), and SARC-F+EBM ranged 30.0-37.5%, 35.0-37.5%, 60.0-62.5%, 55.0% (the same value for both reference standards), respectively. The specificity ranged 85.3-85.9%, 93.9-94.7%, 88.4-86.9%, 70.7-71.6%, respectively. The AUC of SARC-F, SARC-CalF (31cm), SARC-CalF (33/34cm) and SARC-F+EBM ranged 0.644-0.693, 0.737-0.783, 0.767-0.804, 0.714-0.715, respectively.

CONCLUSION

The modified versions of SARC-F have better diagnostic performance as compared to the original questionnaire. Since an ideal screening tool should have reasonably high sensitivity and specificity, and an AUC value above 0.7, the SARC-CalF (33/34cm) seems to be the best screening tool for sarcopenia in community-dwelling older adults.

Comparison of four sarcopenia screening questionnaires in community-dwelling older adults from Poland using six sets of international diagnostic criteria of sarcopenia

INTRODUCTION

There are four screening sarcopenia questionnaires (SARC-F, SARC-CalF, MSRA-5, MSRA-7). To unambiguously determine which of them is the most effective tool in community-dwelling older adults, we performed a diagnostic accuracy study. The aim of the analysis was to assess the diagnostic values of SARC-F, SARC-CalF, MSRA-5, MSRA-7 and compare their psychometric properties against six criterion standards (EWGSOP1, EWGSOP2, FNIH, AWGS, IWGS, SCWD criteria).

MATERIALS AND METHODS

We included 100 community-dwelling volunteers aged ≥ 65yrs. The sensitivity/specificity analyses were performed. Receiver operating characteristic (ROC) curves and area under the ROC curves (AUC) were calculated to compare the overall diagnostic accuracy of the four questionnaires. Ideal screening tools should have reasonably high sensitivity and specificity, and an AUC value above 0.7.

RESULTS

With respect to the six criterion standards used, the sensitivity of SARC-F, SARC-CalF, MSRA-5, and MSRA-7 ranged 35.0-90.0%, 20.0-75.0%, 64.7-90.0%, 76.5-91.7%, respectively, whereas the specificity ranged 86.9-91.1%, 80.0-90.0%, 45.8-48.8%, 28.9-31.0% respectively. The AUCs of SARC-F, SARC-CalF, MSRA-5, and MSRA-7 ranged from 0.655-0.882, 0.711-0.874, 0.618-0.782 and 0.588-0.711 respectively. Only SARC-CalF had AUC >0.7 and <0.9 against the six criterion standards but obesity was a confounding factor, which may affect the diagnostic power of SARC-CalF. MSRA-7 had the smallest AUC of all the questionnaires and MSRA-5 had slightly larger AUC than MSRA-7.

CONCLUSION

Based on our analysis, the standard sarcopenia screening questionnaires deliver contradictory results in many practically occurring cases. It appears that SARC-CalF is an optimal choice for screening sarcopenia in community-dwelling older adults.

Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as "age-related loss of muscle mass, plus low muscle strength, and/or low physical performance" and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength <28 kg for men and <18 kg for women; criteria for low physical performance are 6-m walk <1.0 m/s, Short Physical Performance Battery score ≤9, or 5-time chair stand test ≥12 seconds. AWGS 2019 retains the original cutoffs for height-adjusted muscle mass: dual-energy X-ray absorptiometry, <7.0 kg/m2 in men and <5.4 kg/m2 in women; and bioimpedance, <7.0 kg/m2 in men and <5.7 kg/m2 in women. In addition, the AWGS 2019 update proposes separate algorithms for community vs hospital settings, which both begin by screening either calf circumference (<34 cm in men, <33 cm in women), SARC-F (≥4), or SARC-CalF (≥11), to facilitate earlier identification of people at risk for sarcopenia. Although skeletal muscle strength and mass are both still considered fundamental to a definitive clinical diagnosis, AWGS 2019 also introduces "possible sarcopenia," defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions. Although defining sarcopenia by body mass index-adjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, more evidence is needed before changing current recommendations. Lifestyle interventions, especially exercise and nutritional supplementation, prevail as mainstays of treatment. Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia in Asians.