Calf circumference has a positive correlation with physical performance among community-dwelling middle-aged, older women

Evaluation of sarcopenia diagnosis strategies in Chinese community-dwelling older adults based on the 2019 Asian Working Group guidelines: a cross-sectional study

BACKGROUND

Most diagnostic studies on sarcopenia in Asia follow the 2019 Asian Working Group for Sarcopenia (AWGS) guidelines, which recommend distinct diagnostic strategies for community and hospital settings due to challenges in measuring muscle mass in community environments. This study evaluates the screening-to-diagnosis process in community-based preventive services.

METHODS

This cross-sectional study utilized a questionnaire survey to evaluate SARC-F and SARC-CalF. Measurements included calf circumference (CC), handgrip strength, gait speed and bioelectrical impedance analysis (BIA). Participants were diagnosed according to the AWGS 2019 criteria. Four scenarios simulating the screening-to-diagnosis process in a community setting were evaluated. Sensitivity, specificity, and the area under the ROC curve (AUC) were calculated to assess diagnostic performance.

RESULTS

A total of 2453 community-dwelling older adults aged ≥60 years were included. The prevalence of sarcopenia was 14.1% (345/2453), with rates of 15.4%(160/1038) in males and 13.1% (185/1415) in females. In the simulated diagnostic scenarios, the number of confirmed cases was 218 (combination,Scenario1), 211 (CC,Scenario2), 60 (SARC-CalF,Scenario3) and 21 (SARC-F,Scenario4), respectively. In the case-finding step, the sensitivity for Scenarios1 to 4 was 0.86,0.84,0.23 and 0.07, respectively; specificity was 0.57,0.58,0.93 and 0.99, respectively; and the AUCs were 0.717,0.710,0.581 and 0.530, respectively. In the assessment step, the sensitivity for Scenarios 1 to 4 was 0.73,0.73,0.74 and 0.88, respectively; specificity was 0.81,0.82,0.68 and 0.24, respectively; and the AUCs were 0.774,0.774,0.712 and 0.557,respectively. The integrated sensitivity of the case-finding and assessment steps for Scenarios 1 to 4 was 0.63,0.61,0.17 and 0.06, respectively; integrated specificity was 0.92,0.92,0.98 and 0.99, respectively; and integrated AUCs were 0.776,0.768,0.575 and 0.523, respectively. The diagnostic performance of the entire procedure was better in females than in males.

CONCLUSIONS

In the case-finding step, the CC tool demonstrated superior performance compared to the combination tool, SARC-CalF, and SARC-F. In the assessment step, the muscle strength test was consistently performed with stability. The integrated performances of the case-finding and assessment steps exhibited moderate accuracy in Scenarios 1 and 2, but low accuracy in Scenarios 3 and 4. There is a pressing need to develop more accurate and user-friendly tools to improve sarcopenia detection among community-dwelling older adults in China.

A comparative analysis of sarcopenia screening methods in Thai people with type 2 diabetes mellitus in an outpatient setting

BACKGROUND

Type 2 Diabetes Mellitus (T2DM) is closely linked with sarcopenia. The lack of validated, easy, and effective sarcopenia screening tools for people with T2DM may result in underdiagnosis, delayed interventions, and worsening outcomes. This study evaluated and compared the diagnostic accuracy of various sarcopenia screening tools in T2DM outpatients.

METHODOLOGY

A cross-sectional study was conducted on 329 people with T2DM at Phramongkutklao Hospital, Thailand, between December 2023 and November 2024. This study compared eight sarcopenia screening tools. The Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria served as the reference standard. Sensitivity, Specificity, and diagnostic accuracy were evaluated using receiver operating characteristic (ROC) curve analysis. The optimal cutoffs were identified with the Youden index.

RESULTS

The prevalence of sarcopenia was 23.7%. Calf circumference showed the highest diagnostic accuracy at standard cutoff (AUC: 0.892), with optimised cutoff points of < 37.0 cm for males and < 36.0 cm for females, and achieved high sensitivity (90.1% for males, 91.1% for females) with acceptable specificity (77.2% for males, 67.8% for females). Neck circumference demonstrated diagnostic utility (AUC: 0.741) with proposed thresholds of < 39.5 cm (males) and < 36.5 cm (females), yielding moderate sensitivity (69.7% for males, 82.2% for females) and acceptable specificity (78.9% for males, 62.6% for females). Questionnaire-based tools showed limited diagnostic accuracy with SARC-CalF performing the best (AUC: 0.789, sensitivity: 48.7%, specificity: 93.2%). Among physical performance tests, handgrip strength was the most accurate (AUC: 0.716), although these tests generally exhibited high sensitivity, but lower specificity.

CONCLUSION

Calf circumference was the most effective screening tool for sarcopenia in people with T2DM. Neck circumference emerged as a promising alternative at optimal cutoff values, offering a simple, novel and practice screening tool option. These findings support the implementation of anthropometric measures for sarcopenia screening in clinical settings, particularly in outpatient care.

Gait Speed Reserve in the general population-based 'Good Aging in Skåne' cohort study-distribution and associated factors

Gait Speed Reserve (GSR) expresses a difference between fast and comfortable gait speed and may have an impact on everyday functioning. It was also hypothesized as a useful proxy measure of physiological reserve. However, height-normalizing values of GSR and its associated factors have not been evaluated in a general population of older adults. Therefore, we aimed to investigate the distribution of height-normalized GSR (HN-GSR) in an elderly population-based cohort from urban and rural areas (n = 4342) aged 60-93 years and evaluate associated physiological and lifestyle factors. Using linear mixed models, we identified gender and nine modifiable factors as significantly associated with HN-GSR across four age groups. Better handgrip strength, cognition and standing balance, higher physical activity level, larger calf circumference, and less smoking had positive associations with HN-GSR, while female gender, more leg pain, higher weight and, alcohol consumption had opposite effects. The Marginal R2 imply that this model explained 26% of the variance in HN-GSR. Physical activity and handgrip strength varied across age groups in impact on HN-GSR. The differences were however comparatively minor. In this large cohort study of older adults, we proposed for the first time that factors associated with HN-GSR represented multi-domain features that are in line with previous findings reported for GSR. Measuring HN-GSR/GSR may help clinicians identify early physiological impairments or unhealthy lifestyle habits, especially among older women, and may also have safety implications in daily life. Further work is needed to find out if measuring HN-GSR/GSR may be useful in identifying adverse health outcomes and overall physiological reserve.

Frailty prevalence and associated factors in community dwelling older adults: An examination of the frailty care model

BACKGROUND

Age-related changes put older adults at risk for frailty. The Frailty Care Model was created to inform the care of older adults with or at risk for frailty. The purpose was to test the Frailty Care Model.

METHODS

This was a cross-sectional study to identify associations between factors in the Frailty Care Model, and frailty components in older adults' strength, fatigue, ability to ambulate, and weight loss over the last year. Comparisons across frailty groups used Pearson's chi-square tests or Fisher's exact tests. ANOVA tests and Kruskal-Wallis tests were used. Multivariable ordinal regression models were fit.

RESULTS

Odds of frailty increased by 137% for those who lived alone, 20% for those who were depressed, and 433% for those who were classified as "at risk for malnutrition".

CONCLUSIONS

This study was the first to test the Frailty Care Model with a focus on modifiable factors that predict frailty.

Effects of soy protein-rich meals on muscle health of older adults in long-term care: A randomized clinical trial

OBJECTIVE

This study investigated the effects of a soy protein-rich meal intervention on the muscle health of older adults in long-term care facilities.

METHODS

A 12-week single-center randomized controlled trial with a control-group and open-label design was conducted. Eighty-four older adults from a long-term care facility participated in the study. The chefs at the facility cooked three meals using soy protein-rich recipes designed by dieticians. For 12 weeks, the intervention group participants consumed three meals with 30 g of soy protein (10 g/meal) per day, and the control group participants maintained their habitual diets.

RESULTS

The 84 participants (mean age, 84.9 ± 7.0 years; 61.9% female) were randomly assigned to an intervention group (43 participants) and a control group (41 participants). The intervention group exhibited significant increases in several lean mass indicators, namely soft lean mass (mean, 1.43 kg; 95% confidence interval [CI]: 0.20-1.65 kg), skeletal muscle mass (mean, 1.20 kg; 95% CI: 0.43-1.96 kg), appendicular skeletal muscle mass (mean, 0.79 kg; 95% CI: 0.07-1.52 kg), and skeletal muscle index (mean, 0.37 kg/m2; 95% CI: 0.05-0.68 kg/m2) (all P < 0.05). These changes were not observed in the control group (all P > 0.05). Notably, calf circumference decreased significantly in the control group (mean, -0.98 cm; 95% CI: -1.61 to -0.36 cm) but was maintained in the intervention group. The differences in the calf circumference and 6-m walk performance of the two groups were significant (P < 0.05).

CONCLUSIONS

The 12-week soy protein-rich meal intervention improved the muscle mass and 6-m walk performance of older adults in a long-term care facility.

Exploring the role of calf circumference as a predisposing factor for intra-hospital delirium: investigating potential gender differences: revealing potential gender variances

BACKGROUND

Malnutrition and sarcopenia significantly increase the risk of intra-hospital delirium, particularly among older adults. Given the potential correlation between calf circumference (CC) and these conditions, CC emerges as a promising predisposing factor for delirium. This study aims to investigate the independent association between delirium and anthropometric parameters, focusing on evaluating CC's predictive capacity for intra-hospital delirium risk. Additionally, it aims to compare CC's predictive performance with the widely used Mini Nutritional Assessment (MNA), while also considering potential gender disparities.

METHODS

This is a retrospective study which enrolled patients aged ≥ 65 years from September 2021 to March 2022 at the Padova Hospital (Italy). Physical characteristics, intra-hospital delirium incidence, and body composition were assessed. Sarcopenia was diagnosed using the 2019 European Consensus criteria.

RESULTS

Among 207 subjects, delirium affected 19% of patients. CC showed a significant association with intra-hospital delirium among the analyzed anthropometric parameters. ROC curves indicated that CC's predictive capacity for delirium onset was comparable to MNA (p = 0.98), particularly in women. In a multivariable logistic regression model, female gender and higher cognitive and CC scores emerged as protective factors against delirium onset, with each unit increase in CC associated with a 24% reduction in the odds of delirium. Conversely, sarcopenia did not significantly influence delirium onset.

CONCLUSIONS

CC shows promise as a predisposing factor for intra-hospital delirium, similar to MNA, albeit with significant gender differences. CC could serve as a valuable tool for assessing delirium risk among female patients. Further validation of these findings is necessary through larger-scale studies.

The Association between Anthropometric Measurements and Body Composition with Hand Grip Strength among the Elderly Population in Indonesia

Background/Objectives: Hand grip strength (HGS) is a crucial measure for evaluating muscle function and general physical ability, and it may be associated with several diseases. Previous studies have demonstrated inconsistent associations between anthropometric measurement and body composition with HGS. This study aims to investigate the association between anthropometric measurement and body composition with HGS in the elderly population residing in Indonesia. Methods: This is a cross-sectional study on older adults aged between 60 and 82 years who live in the community. Anthropometric parameters assessed in this study comprised the body mass index (BMI), mid-upper arm circumference (MUAC), calf circumference (CC), and waist circumference (WC). Subsequently, body composition measurements, including fat mass (FM), fat-free mass (FFM), muscle mass (MM), skeletal muscle mass (SMM), and the appendicular skeletal mass index (ASMI), were assessed using a body composition analyzer. Last, the measurement of HGS was conducted using a hand dynamometer. Results: A total of 109 participants were involved in this study. Our study demonstrates a significant association between anthropometric parameters, namely CC and HGS. Subsequently, several body composition parameters, including FFM, SMM, ASMI, and MM in the four extremities, are also significantly associated with HGS. However, in a multivariate analysis, only CC and FFM were able to significantly predict HGS. Conclusions: Improving CC and maintaining FFM may enhance muscle strength in older adults. This suggests that targeted exercise and nutrition programs could increase muscle mass and strength, thereby mitigating age-related decline and improving quality of life.

Aging-Related Sarcopenia: Metabolic Characteristics and Therapeutic Strategies

The proportion of the elderly population is gradually increasing as a result of medical care advances, leading to a subsequent surge in geriatric diseases that significantly impact quality of life and pose a substantial healthcare burden. Sarcopenia, characterized by age-related decline in skeletal muscle mass and quality, affects a considerable portion of older adults, particularly the elderly, and can result in adverse outcomes such as frailty, fractures, bedridden, hospitalization, and even mortality. Skeletal muscle aging is accompanied by underlying metabolic changes. Therefore, elucidating these metabolic profiles and specific mechanisms holds promise for informing prevention and treatment strategies for sarcopenia. This review provides a comprehensive overview of the key metabolites identified in current clinical studies on sarcopenia and their potential pathophysiological alterations in metabolic activity. Besides, we examine potential therapeutic strategies for sarcopenia from a perspective focused on metabolic regulation.

Insights into Pathogenesis, Nutritional and Drug Approach in Sarcopenia: A Systematic Review

Sarcopenia is a multifactorial condition related to the loss of muscle mass and strength due to aging, eating habits, physical inactivity, or even caused by another disease. Affected individuals have a higher risk of falls and may be associated with heart disease, respiratory diseases, cognitive impairment, and consequently an increased risk of hospitalization, in addition to causing an economic impact due to the high cost of care during the stay in hospitals. The standardization of appropriate treatment for patients with sarcopenia that could help reduce pathology-related morbidity is necessary. For these reasons, this study aimed to perform a systematic review of the role of nutrition and drugs that could ameliorate the health and quality of life of sarcopenic patients and PRISMA guidelines were followed. Lifestyle interventions have shown a profound impact on sarcopenia treatment but using supplements and different drugs can also impact skeletal muscle maintenance. Creatine, leucine, branched-chain amino acids, omega 3, and vitamin D can show benefits. Although with controversial results, medications such as Metformin, GLP-1, losartan, statin, growth hormone, and dipeptidyl peptidase 4 inhibitors have also been considered and can alter the sarcopenic's metabolic parameters, protect against cardiovascular diseases and outcomes, while protecting muscles.