The effect of posture on body circumferences in older adults

Diagnostic performance of calf circumference, SARC-F, and SARC-CalF for possible sarcopenia screening in Indonesia

Asian working group for sarcopenia (AWGS) recently introduced "possible sarcopenia" diagnosis for early identification of sarcopenia in the primary healthcare. For initial screening, 3 modalities, i.e. calf circumference (CC) measurement, strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire, and a combination of both (SARC-CalF), are recommended. However, no validation study has been done until now. Therefore, this study aims to evaluate the diagnostic performance of the recommended screening modalities using data from Indonesia. This cross-sectional study included subjects aged ≥ 60 years old who visited primary healthcare in Surabaya, Indonesia. The diagnosis of possible sarcopenia was confirmed with hand-grip strength and repeated chair stand test. Receiver operating characteristic curve analysis was used to evaluate the diagnostic performance. Among 266 subjects, 186 (70%) were diagnosed with possible sarcopenia. Using the recommended cut-off, the area under the curve, sensitivity, and specificity were 0.511, 48.39% and 53.75% for CC, 0.543, 8.60% and 100% for SARC-F, and 0.572, 19.35% and 95% for SACRC-CalF. Our findings indicate that the diagnostic performance of the recommended screening modalities is poor. Multicenter studies from different areas in Indonesia should be done to confirm these findings.

Cut-offs for calf circumference as a screening tool for low muscle mass: WASEDA'S Health Study

Aim

To re‐evaluate the suitability of calf circumference as a surrogate marker of low muscle mass measured by both bioelectrical impedance analysis (BIA) and dual‐energy X‐ray absorptiometry (DXA). We also examined the effects of obesity and age on low muscle mass screening using calf circumference.

Methods

In total, 1239 adults participated in this cross‐sectional study. We measured the maximum calf circumference in a standing position and appendicular skeletal muscle mass (ASM) using BIA and DXA. We defined low muscle mass based on the Asian Working Group for Sarcopenia 2019 consensus.

Results

Calf circumference was positively correlated with BIA‐measured ASM/height² (men: r = 0.81, women: r = 0.73) and DXA‐measured ASM/height² (men: r = 0.78, women: r = 0.76). In the subgroup analyses by obesity and age, calf circumference was also positively correlated with ASM/height². The optimal calf circumference cut‐offs for low muscle mass screening measured by BIA and DXA were 35 cm (sensitivity 91%, specificity 84%) and 36 cm (sensitivity 82%, specificity 80%) for men, and 33 cm (sensitivity 82%, specificity 84%) and 34 cm (sensitivity 85%, specificity 72%) for women, respectively.

Conclusions

Calf circumference is positively correlated with BIA‐ and DXA‐measured muscle mass regardless of obesity and age and is a simple and accurate surrogate marker of muscle mass for diagnosing sarcopenia. Geriatr Gerontol Int 2020; 20: 943–950.

Effects of posture, side and dominant hand on calf circumference measurement in community-dwelling older adults

AIM

Calf circumference (CC) measurement has been used for assessing skeletal muscle mass and for screening sarcopenia. However, there is no gold standard method for CC assessment.

METHODS

We analyzed 1439 participants (mean age 75.9 ± 3.8 years, 47.7% men) from the 2017 baseline survey of the Korean Frailty and Aging Cohort Study. CC was measured, using a tape, on both sides in standing and sitting positions. For sarcopenia, the diagnostic criteria of the Asian Working Group for Sarcopenia 2019 was used.

RESULTS

The mean of CC on the left side (Lt.CC) was smaller than that on the right side (Rt.CC) in standing (Rt.CC 33.82 cm, Lt.CC 33.76 cm, P = 0.006) and sitting (Rt.CC 34.29 cm, Lt.CC 34.21 cm, P = 0.005) positions. The Lt.CC of right-handers, regardless of posture, was smaller than Rt.CC (standing: Rt.CC 33.83 cm, Lt.CC 33.76 cm, P = 0.006; sitting: Rt.CC 34.28 cm, Lt.CC 34.21 cm, P = 0.006). The Lt.CC of left-handers was non-significantly smaller than Rt.CC (standing: Rt.CC 33.77 cm, Lt.CC 33.75 cm, P = 0.896; sitting: Rt.CC 34.35 cm, Lt.CC 34.28 cm, P = 0.527). In the results of receiver operating characteristic analysis of CC for diagnosing sarcopenia based on the Asian Working Group for Sarcopenia 2019, Rt.CC in the standing posture showed the largest area under the curve (standing: Rt.CC 0.716, Lt.CC 0.714; sitting: Rt.CC 0.707, Lt.CC 0.703).

CONCLUSIONS

Our study shows that CC measurement on either side in the standing posture, regardless of the dominant hand, can be used as an optimal method for screening sarcopenia in community-dwelling older adults. Geriatr Gerontol Int 2020; 20: 822-827.

Association of higher waist circumference with milder stroke severity in acute ischaemic stroke

OBJECTIVES

Although higher body mass index (BMI) was reported to be associated with increased stroke incidence, having a higher BMI is known to be associated with better clinical outcomes after stroke. However, BMI has shown conflicting associations with baseline stroke severity. The aim of our study was to assess the relationship between waist circumference (WC) at admission and baseline stroke severity among patients with ischaemic stroke.

METHODS

The WC of acute stroke patients was divided into sex-specific quartiles. Baseline stroke severity was categorised as mild [National Institutes of Health Stroke Scale (NIHSS) score 0-4], moderate (NIHSS score 5-10), and severe (NIHSS score ≥11). Multinomial logistic regression was used and reference categories were men or women in the lowest sex-specific WC quartiles who had experienced a mild stroke.

RESULTS

A total of 637 female and 766 male patients were included. The adjusted OR of severe stroke were 1.3 (95% CI, 0.7-2.4) for male patients in the third WC quartile, 0.7 (95% CI, 0.3-1.5) for male patients in the second WC quartile, and 0.4 (95% CI, 0.2-0.8) for male patients in the top WC quartile. The adjusted OR of severe stroke for female patients in the third WC quartile, the second WC quartile, and the top WC quartile were 0.8 (95% CI, 0.4-1.5), 0.4 (95% CI, 0.2-0.9), and 0.7 (95% CI, 0.3-1.3), respectively.

DISCUSSION

Higher WC at admission is associated with milder baseline stroke severity among patients with acute ischaemic stroke.

ABBREVIATIONS

BMI: body mass index; CE: cardioembolism; CI: confidence interval; LAA: large-artery atherosclerosis; NIHSS: National Institutes of Health Stroke Scale; OR: odds ratio; SAO: small-artery occlusion; WC: waist circumference.

Predictive Accuracy of Calf Circumference Measurements to Detect Decreased Skeletal Muscle Mass and European Society for Clinical Nutrition and Metabolism-Defined Malnutrition in Hospitalized Older Patients

Background/Aims: The ability to readily diagnose sarcopenia and malnutrition in a clinical setting is essential. This study is aimed at clarifying the calf circumference (CC) cut-off values for decreased skeletal muscle mass (SMM), according to the Asian Work Group for Sarcopenia's criteria definition of sarcopenia, and those for European Society for Clinical Nutrition and Metabolism-defined malnutrition, in hospitalized Japanese patients. Methods: The study involved 1,164 patients aged ≥65 years. Predictive CC cut-off values were determined using receiver operating curve (ROC) analyses. The predictive validity of the cut-off values was confirmed against in-hospital mortality. Results: There were 654 females and 510 males (mean age, 83.5 ± 8.2 years). Decreased SMM and malnutrition were observed in 80.4 and 32.8% of all patients, respectively. ROC analyses identified CCs of ≤29 cm (female, area under the curve [AUC] 0.791) and ≤30 cm (male, AUC 0.832) as cut-off values for decreased SMM, and CCs of ≤26 cm (female, AUC 0.798) and ≤28 cm (male, AUC 0.837) for malnutrition. CC cut-off values for SMM and malnutrition were independently correlated with in-hospital mortality. Conclusions: The study determined appropriate cut-off values for CC to identify decreased SMM and malnutrition according to the relevant guidelines.

Nutritional Status of Maintenance Dialysis Patients: Low Lean Body Mass Index and Obesity Are Common, Protein-Energy Wasting Is Uncommon

BACKGROUND AND AIMS

Maintenance dialysis patients are at increased risk of abnormal nutritional status due to numerous causative factors, both nutritional and non-nutritional. The present study assessed the current prevalence of protein-energy wasting, low lean body mass index and obesity in maintenance dialysis patients, and compared different methods of nutritional assessment.

METHODS

In a cross-sectional study conducted in 2014 at Roskilde Hospital, Denmark, we performed anthropometry (body weight, skinfolds, mid-arm, waist, and hip circumferences), and determined plasma albumin and normalized protein catabolic rate in order to assess the prevalence of protein-energy wasting, low lean body mass index and obesity in these patients.

RESULTS

Seventy-nine eligible maintenance dialysis patients participated. The prevalence of protein-energy wasted patients was 4% (95% CI: 2-12) as assessed by the coexistence of low lean body mass index and low fat mass index. Low lean body mass index was seen in 32% (95% CI: 22-44). Obesity prevalence as assessed from fat mass index was 43% (95% CI: 32-55). Coexistence of low lean body mass index and obesity was seen in 10% (95% CI: 5-19). The prevalence of protein-energy wasting and obesity varied considerably, depending on nutritional assessment methodology.

CONCLUSIONS

Our data indicate that protein-energy wasting is uncommon, whereas low lean body mass index and obesity are frequent conditions among patients in maintenance dialysis. A focus on how to increase and preserve lean body mass in dialysis patients is suggested in the future. In order to clearly distinguish between shortage, sufficiency and abundance of protein and/or fat deposits in maintenance dialysis patients, we suggest the simple measurements of lean body mass index and fat mass index.

Effects of Posture and Body Mass Index on Body Girth Assessment

BACKGROUND

The present study aimed to evaluate the effect of posture on body girth assessment among hospitalized adults and older adults. We further explored the influence of body mass index (BMI) on this effect.

MATERIALS AND METHODS

A cross-sectional study was conducted among hospitalized adult patients. Arm, waist, hip, and calf girths were obtained for each patient in standing and supine positions. Body girths were obtained in the 2 body positions, and differences were compared according to BMI normal-weight and overweight categories.

RESULTS

In total, 123 patients (27.6% aged ≥65 years) composed the study sample. Significant differences were found between measurements obtained in standing and supine positions, ranging from 0.6-1.1 cm. Intraclass correlation coefficient (ICC) values were ≥0.97, and agreement ranged from 81.3%-87% (weighted κ ≥ 0.84). Similar results were found when differences were stratified by BMI categories.

CONCLUSION

Although body girth assessment in standing and supine positions in hospitalized adults and older adults differs, these differences are small and are not dependent on BMI categories.

Racial differences in adipose tissue distribution and risk of aggressive prostate cancer among men undergoing radiotherapy

BACKGROUND

Although elevated body mass index (BMI) has been associated with increased risk of aggressive prostate cancer, the importance of adipose tissue distribution is not well understood. We examined associations between overall and visceral obesity and aggressive prostate cancer risk. Moreover, given racial differences in adipose tissue distribution, we examined whether race modified these associations.

METHODS

We conducted a cross-sectional analysis of 308 radiotherapy-treated patients with prostate cancer within the Durham VA from 2005 to 2011. Multivariable logistic regression examined the association between BMI categories and tertiles of waist circumference (WC), visceral fat area (VFA), and periprostatic adipose tissue area (PPAT) with high-grade prostate cancer risk (Gleason score ≥7 vs. ≤6). Models stratified by race examined whether these associations differed between black and nonblack men.

RESULTS

Both elevated BMI (Ptrend = 0.054) and WC (Ptrend = 0.040) were associated with increased high-grade prostate cancer risk, with similar results between races, although the association with BMI was not statistically significant. In contrast, elevated VFA was associated with increased aggressive prostate cancer risk in black men (Ptrend = 0.002) but not nonblack men (Ptrend = 0.831), with a significant interaction between race and VFA (Pinteraction = 0.035). Though similar patterns were observed for PPAT, none was statistically significant.

CONCLUSIONS

Among men undergoing radiotherapy for prostate cancer, visceral obesity is associated with increased aggressive prostate cancer risk, particularly among black men. If confirmed in future studies, these results suggest that adipose tissue distribution differences may contribute to prostate cancer racial disparity.

IMPACT

These findings highlight the need to elucidate mechanisms contributing to racial differences in the association between visceral obesity and aggressive prostate cancer.