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de Sousa IM, Fayh APT, Gonzalez MC, Silva FM. Prevalence of low calf circumference in hospitalized patients classified by raw or body mass index-adjusted values. Nutr Clin Pract 2024; 39:611-618. [PMID: 38443160 DOI: 10.1002/ncp.11138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/02/2024] [Accepted: 01/20/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Adiposity can influence the estimation of muscle mass using calf circumference (CC) and underestimate the frequency of low CC. An adjustment for CC using body mass index (BMI) was proposed to reduce this effect. We aimed to compare the low CC frequency in hospitalized patients when considering raw and BMI-adjusted values and explore data by sex, age, and race (white and non-white). METHODS Secondary analysis from two cohort studies conducted with adult hospitalized patients using BMI and CC data collected in the first 72 h after hospital admission. We classified low CC by two approaches: (1) raw CC; (2) BMI-adjusted CC for patients with BMI ≥ 25. Cutoff values for low CC were ≤34 cm (men) and ≤33 cm (women). RESULTS Among 1272 patients (54.1 ± 15.3 years old; 51.7% women; 82.1% White race), low CC frequency was 30.6% and low BMI-adjusted CC was 68.9%. For all elevated BMI categories, the low CC frequency was higher when considering BMI-adjusted values (P < 0.001). Low CC was more frequent (P < 0.001) in older adults (38.7% by raw; 79.1% by BMI-adjusted value) than in younger adults (27.6% by raw; 65.2% by BMI-adjusted value) and it was not associated with race. Low CC by raw values was more frequent in men than in women (35.0% versus 26.4%; P = 0.001), but did not differ between sexes when classified by BMI-adjusted values (70.7% versus 67.1%; P = 0.184). CONCLUSION Low CC BMI adjusted was 2.2 times more frequent in comparison with raw CC values, and it was identified in >60% of patients with BMI ≥ 25.
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Affiliation(s)
- Iasmin M de Sousa
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ana Paula Trussardi Fayh
- Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Maria Cristina Gonzalez
- Postgraduate Program in Nutrition and Food, Federal University of Pelotas, Rio Grande do Sul, Brazil
| | - Flávia M Silva
- Nutrition Science Postgraduation Program of Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Barry DJ, Farragher JB, Betik AC, Fyfe JJ, Convit L, Cooke MB. Investigating the effects of synbiotic supplementation on functional movement, strength and muscle health in older Australians: a study protocol for a double-blind, randomized, placebo-controlled trial. Trials 2024; 25:307. [PMID: 38715143 PMCID: PMC11077830 DOI: 10.1186/s13063-024-08130-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Aging has been associated with a progressive loss of skeletal muscle quality, quantity and strength, which may result in a condition known as sarcopenia, leading to a decline in physical performance, loss of independence and reduced quality of life. While the cause of impaired physical functioning observed in elderly populations appears to be multifactorial, recent evidence suggests that age-associated alterations in gut microbiota could be a contributing factor. The primary objective will be to assess the effects of a dietary synbiotic formulation on sarcopenia-related functional outcomes such as handgrip strength, gait speed and physical performance within older individuals living independently. The secondary objective will be to examine associations between changes in gut microbiota composition, functional performance and lean muscle mass. METHODS Seventy-four elderly (60-85 years) participants will be randomized in a double-blind, placebo-controlled fashion to either an intervention or control group. The intervention group (n = 37) will receive oral synbiotic formulation daily for 16 weeks. The control group (n = 37) will receive placebo. Assessments of physical performance (including Short Physical Performance Battery, handgrip strength and timed up-and-go tests) and muscle ultrasonography will be performed at 4 time points (baseline and weeks 8, 16 and 20). Likewise, body composition via bioelectric impedance analysis and blood and stool samples will be collected at each time point. Dual-energy X-ray absorptiometry will be performed at baseline and week 16. The primary outcomes will be between-group changes in physical performance from baseline to 16 weeks. Secondary outcomes include changes in body composition, muscle mass and architecture, fecal microbiota composition and diversity, and fecal and plasma metabolomics. DISCUSSION Gut-modulating supplements appear to be effective in modifying gut microbiota composition in healthy older adults. However, it is unclear whether these changes translate into functional and/or health improvements. In the present study, we will investigate the effects of a synbiotic formulation on measures of physical performance, strength and muscle health in healthy older populations. TRIAL REGISTRATION This study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000652774) in May 2022.
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Affiliation(s)
- David J Barry
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Joshua B Farragher
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Andrew C Betik
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Jackson J Fyfe
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Lilia Convit
- Centre for Sports Research (CSR), School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Matthew B Cooke
- Sport, Performance and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia.
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Sun Y, Yin T, Li M, Wang F, Qi J, Zhang H, Wang L, Zhao J, Zhang Y. Development and Validation of Estimation Equations for Appendicular Skeletal Muscle Mass in Chinese Community-Dwelling Older Adults. Clin Interv Aging 2024; 19:265-276. [PMID: 38384404 PMCID: PMC10880553 DOI: 10.2147/cia.s440967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/17/2024] [Indexed: 02/23/2024] Open
Abstract
Purpose This study aimed to establish equations for estimating muscle mass through anthropometric parameters or together with physical function parameters in the community-dwelling older adults, providing a simple way of muscle mass assessment. Methods In this cross-sectional descriptive study, a total of 1537 older adults were recruited from the community and accepted the measurements of height, weight, upper arm and calf circumferences, grip strength, and walking speed. Body composition including appendicular skeletal muscle mass (ASM) was measured using bioelectrical impedance analysis (BIA). Participants were randomly divided into the development or validation group. Stepwise multiple linear regression was applied to develop equations in the development group. Thereafter, Pearson correlation coefficients, Bland-Altman plots, paired t-test, intraclass correlation coefficient (ICC) and paired-samples t-tests were used to assess the validity of the equations. Results All parameters were significantly correlated with ASM (r = 0.195~0.795, P < 0.001) except for the age in the validation group (P = 0.746). The most optimal anthropometric equation was: [adjusted R2 = 0.911, standard error of the estimate (SEE) = 1.311, P < 0.001]. Comparatively speaking, this equation showed high correlation coefficient (r = 0.951, P < 0.001) and ICC (ICC = 0.950, P < 0.001). No significant differences were found between BIA-measured ASM and the estimated ASM. The Bland-Altman plot showed that the mean difference between the estimated ASM and BIA-measured ASM was 0 kg and the limits of agreement of ASM was -2.70~2.60 kg. Furthermore, inclusion of physical function did not significantly improve the adjusted R2 and SEE. Conclusion The anthropometric equation offers a practical alternative simple and dependable method for estimating ASM in community-dwelling older adults.
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Affiliation(s)
- Yun Sun
- Department of Oncology, Suzhou BenQ Medical Center, Suzhou, Jiangsu, People’s Republic of China
| | - Tongtong Yin
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Mengli Li
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- School of Nursing, Hong Kong Polytechnic University, Hongkong, People’s Republic of China
| | - Fangfang Wang
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jiaying Qi
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Hui Zhang
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- School of Nursing, Vocational Health College, Suzhou, Jiangsu, People’s Republic of China
| | - Li Wang
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jiehua Zhao
- Department of Nursing, Suzhou BenQ Medical Center, Suzhou, Jiangsu, People’s Republic of China
| | - Yu Zhang
- Department of Nursing, Suzhou BenQ Medical Center, Suzhou, Jiangsu, People’s Republic of China
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Martone AM, Ciciarello F, Galluzzo V, Calvani R, Zazzara MB, Tosato M, Coelho‐Junior HJ, Marzetti E, Landi F. A simple medical device development according to normative values of calf circumference across ages: results from the Italian Longevity Check-up 7+ (Lookup 7+) project. J Cachexia Sarcopenia Muscle 2024; 15:36-44. [PMID: 38053516 PMCID: PMC10834319 DOI: 10.1002/jcsm.13286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/27/2023] [Accepted: 05/22/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Wide consensus exists on the notion that low muscle mass is a predictor of negative health-related events, such as disability, morbidity, and mortality. Indeed, the European Working Group on Sarcopenia in Older People 2 had identified muscle mass as the key component to confirm the diagnosis of sarcopenia. However, the lack of normative values for muscle mass across ages hampers the practical assessment of this important parameter. The aim of the present study was to produce cross-sectional centile and normative values for calf circumference (a surrogate estimation of muscle mass) across a wide spectrum of ages using a large and unselected sample of community-dwellers enrolled in the Longevity Check-up 7+ (Lookup 7+) project. METHODS This is a cross-sectional study using the data of Lookup 7+ project, an ongoing study started in June 2015 and conducted in unconventional settings (i.e., exhibitions, malls, and health promotion campaigns). Candidate participants were considered eligible for enrolment if they were at least 45 years of age and provided written informed consent. Calf circumference was measured using an inextensible but flexible plastic tape in a sitting position with the knee and ankle at a right angle and the feet resting on the floor. Normative values for calf circumference from ages 45 to 80 + years were generated. RESULTS A total of 11 814 participants were enrolled from 1 June 2015 to 30 September 2022. The mean age of participants included in the analyses was 61.8 years (standard deviation; 10.2 years; range: 45-98 years), and 6686 (57%) were women. Normative values for calf circumference were obtained for men and women, stratified by age groups. Accordingly, a calf circumference tape, with colour bands that demarcate the centiles range into which the patient falls, was created and validated. CONCLUSIONS Our study established age- and gender-specific centile reference values for calf circumference. The calf circumference tape can be used to easily interpret the assessment in every-day practice for the early detection of individuals with or at risk of sarcopenia and malnutrition.
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Affiliation(s)
- Anna Maria Martone
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCSRomeItaly
- Department of Geriatrics, Orthopedics and RheumatologyUniversità Cattolica del Sacro CuoreRomeItaly
| | | | - Vincenzo Galluzzo
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCSRomeItaly
| | - Riccardo Calvani
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCSRomeItaly
- Department of Geriatrics, Orthopedics and RheumatologyUniversità Cattolica del Sacro CuoreRomeItaly
| | | | - Matteo Tosato
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCSRomeItaly
| | - Hélio José Coelho‐Junior
- Department of Geriatrics, Orthopedics and RheumatologyUniversità Cattolica del Sacro CuoreRomeItaly
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCSRomeItaly
- Department of Geriatrics, Orthopedics and RheumatologyUniversità Cattolica del Sacro CuoreRomeItaly
| | - Francesco Landi
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCCSRomeItaly
- Department of Geriatrics, Orthopedics and RheumatologyUniversità Cattolica del Sacro CuoreRomeItaly
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Nanri Y, Shibuya M, Nozaki K, Takano S, Iwase D, Aikawa J, Fukushima K, Uchiyama K, Takahira N, Fukuda M. The Impact of Sarcopenia Risk on Postoperative Walking Independence in Older Adults Undergoing Total Joint Arthroplasty. J Geriatr Phys Ther 2024; 47:28-35. [PMID: 36728546 DOI: 10.1519/jpt.0000000000000368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Yuta Nanri
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Manaka Shibuya
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Shotaro Takano
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Dai Iwase
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Jun Aikawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kensuke Fukushima
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Katsufumi Uchiyama
- Department of Patient Safety and Healthcare Administration, Kitasato University School of Medicine, Sagamihara, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Michinari Fukuda
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
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Champaiboon J, Petchlorlian A, Manasvanich BA, Ubonsutvanich N, Jitpugdee W, Kittiskulnam P, Wongwatthananart S, Menorngwa Y, Pornsalnuwat S, Praditpornsilpa K. Calf circumference as a screening tool for low skeletal muscle mass: Cut-off values in independent Thai older adults. BMC Geriatr 2023; 23:826. [PMID: 38066438 PMCID: PMC10709895 DOI: 10.1186/s12877-023-04543-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Calf circumference is recommended as a marker for low muscle mass and as a case finding in the diagnosis of sarcopenia. However, the cut-off value differed by ethic and region. Currently there is no study among Thai population. Therefore, we aimed to identify the optimal cutoff value of calf circumference as a screening tool for low skeletal muscle mass in independent Thai older adults. Subgroup analysis was performed for obesity and adults over 75 years. METHODS This cross-sectional cohort studied in an outpatient geriatric check-up clinic. Participants, aged 60 and above, needed to be independent in basic activities of daily living to meet the inclusion criteria. Exclusion criteria comprised active malignancy, cardiac, pulmonary, or neurovascular diseases necessitating hospitalization in the preceding three months, chronic renal diseases requiring renal replacement therapy, and unstable psychiatric disorders. We measured the maximum calf circumference and appendicular skeletal muscle mass (ASMI) using bioelectrical impedance analysis (BIA). Low muscle mass is defined according to the Asian Working Group of Sarcopenia (AWGS) 2019 consensus. RESULTS We enrolled 6,404 elderly adults (mean age 67.3 ± 5.1 years), with a 47% prevalence of low muscle mass in women and 25% in men. Lower muscle mass significantly correlated with reduced BMI and waist circumference in both genders (p < 0.001). Optimal cut-off values for low muscle mass screening were < 33 cm (sensitivity 80.1%, specificity 60.5%) for women and < 34 cm (sensitivity 85.4%, specificity 70.2%) for men. Subgroup analysis for those with BMI ≥ 25 kg/m² suggested raising the cut-off for women to < 34 cm (sensitivity 80.6%, specificity 54.0%) and for men to < 35 cm (sensitivity 88.7%, specificity 55.2%) to enhance specificity without substantial sensitivity loss. In the older-old adult subgroup (≥ 75 years), optimal cut-off values were < 33 cm (sensitivity 84.6%, specificity 79.9%) for women and < 34 cm (sensitivity 75.6%, specificity 87.0%) for men. CONCLUSIONS There is a strong correlation between calf circumference and ASMI in independent Thai older adults. Calf circumference can serve as a screening tool for identifying low muscle mass. The recommended cut-off values for men and women are 34 cm and 33 cm, respectively in alignment with AWGS 2019 recommendation. Incorporating a 1-cm higher cut-off value for obese older adults improves the accuracy of muscle mass screening. TRIAL REGISTRATION Thai clinical trial registry: TCTR20200511003.
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Affiliation(s)
- Jirapa Champaiboon
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Aisawan Petchlorlian
- Geriatric Excellence Centre, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Bhorn-Ake Manasvanich
- Geriatric Excellence Centre, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Department of Family Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Nattaphon Ubonsutvanich
- Geriatric Excellence Centre, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Weerachai Jitpugdee
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Piyawan Kittiskulnam
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supharada Wongwatthananart
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Yupaporn Menorngwa
- Geriatric Excellence Centre, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Department of Nursing, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sasitorn Pornsalnuwat
- Geriatric Excellence Centre, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Kearkiat Praditpornsilpa
- Geriatric Excellence Centre, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Hsu YT, Lin JY, Lin CJ, Lee YJ, Chang WH. Association of Possible Sarcopenia or Sarcopenia with Body Composition, Nutritional Intakes, Serum Vitamin D Levels, and Physical Activity among Patients with Type 2 Diabetes Mellitus in Taiwan. Nutrients 2023; 15:3892. [PMID: 37764676 PMCID: PMC10535053 DOI: 10.3390/nu15183892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/26/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
This study estimates the association between sarcopenia and blood biochemical parameters, nutritional intake, anthropometric measurements, physical performance, and physical activity in patients with type 2 diabetes mellitus (T2DM). Participants were recruited from a primary care clinic in Kaohsiung City. According to the diagnosis criteria of the Asian Working Group for Sarcopenia (AWGS) in 2019, 110 patients with T2DM (aged 50-80 years) were divided into three groups: non-sarcopenia (n = 38), possible sarcopenia (n = 31), and sarcopenia (n = 41). Blood samples were collected, and nutritional intake was evaluated by a registered dietitian. A food frequency questionnaire and a Godin leisure-time exercise questionnaire were used to assess their daily vitamin D intake and physical activity. There were significant differences in age, serum vitamin D levels, nutritional intake, anthropometric measurements, and physical performance between the three groups. In elderly patients with T2DM, reduced serum 25-hydroxyvitamin D [25(OH)D] levels and daily energy intake were significantly associated with possible sarcopenia. Age, lower BMI, reduced serum 25(OH)D, and reduced dietary protein and vitamin D intake were significantly associated with sarcopenia. These findings may serve as the basis for intervention trials to reduce the prevalence of sarcopenia.
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Affiliation(s)
- Yu-Ting Hsu
- Nutrition and Food Service Department, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan; (Y.-T.H.); (J.-Y.L.)
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kaohsiung City 80708, Taiwan
| | - Jian-Yu Lin
- Nutrition and Food Service Department, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan; (Y.-T.H.); (J.-Y.L.)
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kaohsiung City 80708, Taiwan
| | - Chien-Ju Lin
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kaohsiung City 80708, Taiwan;
| | - Yau-Jiunn Lee
- Lee’s Endocrinology Clinic, No. 396, Guangdong Road, Pingtung City 90028, Taiwan;
| | - Wen-Hsin Chang
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kaohsiung City 80708, Taiwan
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Abdalla PP, da Silva LSL, Venturini ACR, Júnior MFT, Schneider G, Dos Santos AP, Gomide EBG, Carvalho ADS, Bohn L. Anthropometric equations to estimate appendicular muscle mass from dual-energy X-ray absorptiometry (DXA): A scoping review. Arch Gerontol Geriatr 2023; 110:104972. [PMID: 36893510 DOI: 10.1016/j.archger.2023.104972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Appendicular skeletal muscle mass (ASM) obtained from dual-energy x-ray absorptiometry (DXA) is recommended to quantify sarcopenia, but has limited availability in disadvantaged-income countries, moreover in an epidemiological context. Predictive equations are easier and less costly to apply, but a review of all available models is still lacking in the scientific literature. The objective of this work is to map, with a scoping review, the different proposed anthropometric equations to predict ASM measured by DXA. METHODS Six databases were searched without restriction on publication date, idiom, and study type. A total of 2,958 studies were found, of which 39 were included. Eligibility criteria involved ASM measured by DXA, and equations proposed to predict ASM. RESULTS predictive equations (n = 122) were gathered for 18 countries. The development phase involves sample size, coefficient of determination (r2), and a standard error of estimative (SEE) varying between 15 and 15,239 persons, 0.39 and 0.98, 0.07 and 3.38 kg, respectively. The validation phase involves a sample size, accuracy, and a SEE between 15 and 3,003 persons, 0.61 and 0.98, 0.09 and 3.65 kg, respectively. CONCLUSIONS The different proposed predictive anthropometric equations of ASM DXA were mapped, including validated pre-existing equations, offering an easy-to-use referential article for clinical and research applications. It is necessary to propose more equations for other continents (Africa and Antarctica) and specific health-related conditions (e.g., diseases), once the equations can only have sufficient validity and accuracy to predict ASM generally when applied to the same population.
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Affiliation(s)
- Pedro Pugliesi Abdalla
- Study and Research Group in Anthropometry, Training, and Sport (GEPEATE), University of São Paulo, School of Physical Education and Sport of Ribeirão Preto, Ribeirão Preto SP, Brazil.
| | - Leonardo Santos Lopes da Silva
- Study and Research Group in Anthropometry, Training, and Sport (GEPEATE), University of São Paulo, School of Physical Education and Sport of Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Ana Claudia Rossini Venturini
- Study and Research Group in Anthropometry, Training, and Sport (GEPEATE), University of São Paulo, School of Physical Education and Sport of Ribeirão Preto, Ribeirão Preto SP, Brazil; Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto SP, Brazil
| | - Márcio Fernando Tasinafo Júnior
- Study and Research Group in Anthropometry, Training, and Sport (GEPEATE), University of São Paulo, School of Physical Education and Sport of Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Guilherme Schneider
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto SP, Brazil
| | - André Pereira Dos Santos
- Study and Research Group in Anthropometry, Training, and Sport (GEPEATE), University of São Paulo, School of Physical Education and Sport of Ribeirão Preto, Ribeirão Preto SP, Brazil; Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto SP, Brazil
| | - Eurípedes Barsanulfo Gonçalves Gomide
- Study and Research Group in Anthropometry, Training, and Sport (GEPEATE), University of São Paulo, School of Physical Education and Sport of Ribeirão Preto, Ribeirão Preto SP, Brazil; Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto SP, Brazil; Claretiano - University Center, Batatais SP, Brasil
| | | | - Lucimere Bohn
- Lusófona University of Porto, Faculty of Psychology, Education and Sport, Porto, Portugal; Research Center in Physical Activity, Health and Leisure (CIAFEL) and Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports; University of Porto, Porto, Portugal
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Tung HT, Chen KM, Chou CP, Belcastro F, Hsu HF, Kuo CF. Acupunch Exercise Improved Muscle Mass, Hand Grip Strength, and Sleep Quality of Institutional Older Adults with Probable Sarcopenia. J Appl Gerontol 2022; 42:888-897. [PMID: 36448359 DOI: 10.1177/07334648221141413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
This study tested the effectiveness of a 6-month vitality acupunch (VA) exercise program on muscle mass, hand grip strength, and sleep quality in institutional older adults with probable sarcopenia. A cluster randomized controlled trial was conducted. A total of 103 older adults were assigned to the experimental group ( n = 52) and control group ( n = 51) according to the institution they inhabited. After the 6-month VA exercise intervention, the experimental group showed significant increases in muscle mass ( F = 5.93, p = .017), hand grip strength ( F = 56.73, p < .001), and improved sleep quality ( F = 23.20, p < .001) compared to the control group. Based on the meridian theory that promotes qi and blood circulation, VA exercise has positive effects on muscle mass, hand grip strength, and sleep quality in older adults with probable sarcopenia.
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Affiliation(s)
| | - Kuei-Min Chen
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Long-term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chia-Pei Chou
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- College of Medicine, Chang Gung University
| | - Frank Belcastro
- Department of Education and Psychology, University of Dubuque, Dubuque, Iowa, USA
| | - Hui-Fen Hsu
- Center for Long-term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chuan-Feng Kuo
- Center for Long-term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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10
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Ko CH, Chuang HY, Wu SJ, Yu SC, Chang YF, Chang CS, Wu CH. Changes of sarcopenia case finding by different Asian Working Group for Sarcopenia in community indwelling middle-aged and old people. Front Med (Lausanne) 2022; 9:1041186. [PMID: 36425107 PMCID: PMC9680091 DOI: 10.3389/fmed.2022.1041186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/24/2022] [Indexed: 07/28/2023] Open
Abstract
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.
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Affiliation(s)
- Chun-Hung Ko
- Department of Family Medicine, Chi Mei Medical Center, Tainan, Taiwan
- Department of Food and Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Hua-Ying Chuang
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Shin-Jiuan Wu
- Department of Food and Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Shou-Chun Yu
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Yin-Fan Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Sung Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsing Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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11
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Rose Berlin Piodena-Aportadera M, Lau S, Chew J, Lim JP, Ismail NH, Ding YY, Lim WS. Calf Circumference Measurement Protocols for Sarcopenia Screening: Differences in Agreement, Convergent Validity and Diagnostic Performance. Ann Geriatr Med Res 2022; 26:215-224. [PMID: 36031936 PMCID: PMC9535367 DOI: 10.4235/agmr.22.0057] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although recommended by the Asian Working Group for Sarcopenia 2019 consensus (AWGS’19) as a screening tool for sarcopenia, there remains no consensus regarding the position (sitting, standing) or laterality (right, left) for the measurement of calf circumference (CC). This study aimed to determine the agreement between CC measurements, correlations with muscle mass and function, and diagnostic performance for sarcopenia screening. Methods We studied 176 healthy community-dwelling older adults (mean age, 66.8±7.1 years) from the GERILABS-2 study. CC was measured using non-elastic tape in four ways: left and right sides in the sitting and standing positions. Sarcopenia was diagnosed using the AWGS’19 criteria. We produced Bland-Altman plots to assess the agreement, partial correlations for muscle mass and function to compare convergent validity, and area under the receiver operating characteristic curve (AUC) to compare diagnostic performance. Results The prevalence rate of sarcopenia was 17.4%. Sitting CC was larger than standing regardless of laterality (right 35.31±2.95 cm vs. 34.61±2.74 cm; left 35.37±2.96 cm vs. 34.70±2.83 cm; both p<0.001), consistent with the systematic bias on Bland-Altman plots showing the overestimation of sitting over standing measurements (right bias=0.70 cm; 95% confidence interval [CI], -0.48–1.88; left bias=0.67 cm, 95% CI, -0.35–1.68). After adjusting for age and sex, CC was significantly correlated with appendicular skeletal mass, hand grip strength, knee extension, gait speed, chair stand, and short physical performance battery. Although right-sided CC measurements had better diagnostic performance (AUC=0.817), the difference was not statistically significant compared to the other positions (p>0.05). The optimal cutoff was <34 cm for all measurements, except for the left standing position (cutoff <35 cm). Conclusion Standing CC measurements are recommended for sarcopenia screening in community-dwelling older adults because of their good agreement without systematic bias, convergent validity, and diagnostic performance.
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Affiliation(s)
| | - Sabrina Lau
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
- Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore
| | - Justin Chew
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
- Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore
| | - Jun Pei Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
- Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore
| | - Noor Hafizah Ismail
- Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore
- Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore
| | - Yew Yoong Ding
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
- Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
- Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore
- Corresponding Author: Wee Shiong Lim, MBBS, MRCP, MMed, MHPEd, AGSF, FAMS Department of Geriatric Medicine, Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Novena, Singapore 308433 E-mail:
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12
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Chen L, Arai H, Assantachai P, Akishita M, Chew ST, Dumlao LC, Duque G, Woo J. Roles of nutrition in muscle health of community-dwelling older adults: evidence-based expert consensus from Asian Working Group for Sarcopenia. J Cachexia Sarcopenia Muscle 2022; 13:1653-1672. [PMID: 35307982 PMCID: PMC9178363 DOI: 10.1002/jcsm.12981] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/15/2022] [Indexed: 12/29/2022] Open
Abstract
General muscle health declines with age, and in particular, sarcopenia-defined as progressive loss of muscle mass and strength/physical performance-is a growing issue in Asia with a rising population of community-dwelling older adults. Several guidelines have addressed early identification of sarcopenia and management, and although nutrition is central to treatment of sarcopenia, there are currently few guidelines that have examined this specifically in the Asian population. Therefore, the Asian Working Group for Sarcopenia established a special interest group (SIG) comprising seven experts across Asia and one from Australia, to develop an evidence-based expert consensus. A systematic literature search was conducted using MEDLINE on the topic of muscle health, from 2016 (inclusive) to July 2021, in Asia or with relevance to healthy, Asian community-dwelling older adults (≥60 years old). Several key topics were identified: (1) nutritional status: malnutrition and screening; (2) diet and dietary factors; (3) nutritional supplementation; (4) lifestyle interventions plus nutrition; and (5) outcomes and assessment. Clinical questions were developed around these topics, leading to 14 consensus statements. Consensus was achieved using the modified Delphi method with two rounds of voting. Moreover, the consensus addressed the impacts of COVID-19 on nutrition, muscle health, and sarcopenia in Asia. These statements encompass clinical expertise and knowledge across Asia and are aligned with findings in the current literature, to provide a practical framework for addressing muscle health in the community, with the overall aim to encourage and facilitate broader access to equitable care for this target population.
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Affiliation(s)
- Liang‐Kung Chen
- Center for Healthy Longevity and Aging SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Center for Geriatrics and GerontologyTaipei Veterans General HospitalTaipeiTaiwan
- Taipei Municipal Gan‐Dau HospitalTaipeiTaiwan
| | - Hidenori Arai
- National Center for Geriatrics and GerontologyObuJapan
| | | | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Samuel T.H. Chew
- Department of Geriatric MedicineChangi General Hospital, SingHealthSingapore
| | | | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS)The University of Melbourne and Western HealthMelbourneVictoriaAustralia
| | - Jean Woo
- Chinese University of Hong KongHong Kong
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13
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Yao R, Yao L, Yuan C, Gao BL. Accuracy of Calf Circumference Measurement, SARC-F Questionnaire, and Ishii's Score for Screening Stroke-Related Sarcopenia. Front Neurol 2022; 13:880907. [PMID: 35572926 PMCID: PMC9099210 DOI: 10.3389/fneur.2022.880907] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/01/2022] [Indexed: 12/21/2022] Open
Abstract
Objective The purpose of this study was to investigate the accuracy of sarcopenia diagnosis in patients with stroke using calf circumference (CC), SARC-F questionnaire, and Ishii's score in comparison with the Asian Working Group for Sarcopenia 2019 (AWGS) sarcopenia diagnostic criteria. Materials and Methods In this cross-sectional study, a total of 364 consecutive patients with stroke were enrolled and evaluated with the CC measurement, SARC-F questionnaire, and Ishii's score. The diagnostic accuracy was analyzed. Results Based on the AWGS criteria, sarcopenia was present in 180 (49.5%) patients, with an age range of 49–74 (mean 63 ± 14.7) years. In all patients, the cutoff value of CC in the accuracy of diagnosing sarcopenia was 30.5 cm, with an AUC of 0.85, sensitivity of 81.8%, specificity of 90.1%, Kappa value of 0.72, and Youden index of 0.72. In the accuracy of diagnosing sarcopenia in all patients, Ishii's score had a cutoff value of 118, AUC of 0.78, sensitivity of 90.1%, specificity of 36.0%, Kappa value of 0.4, and Youden index of 0.55. For accuracy of diagnosing sarcopenia, the SARC-F questionnaire had a cutoff value of 5, AUC of 0.731, sensitivity of 94.7%, specificity of 40%, Kappa value of 0.34, and Youden index of 0.41. Conclusions Based on the AWGS criteria, calf circumference measurement has the optimal performance in screening stroke-related sarcopenia compared with the SARC-F questionnaire and Ishii's score. In patients with stroke, the cutoff value of calf circumference for sarcopenia is < 31 cm in men and 30 cm in women, and with an AUC of 0.85.
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Affiliation(s)
- Ruihong Yao
- Medical Imaging Department, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Liqing Yao
- Rehabilitation Medicine Department, Second Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Liqing Yao
| | - Changli Yuan
- Rehabilitation Medicine Department, Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bu-Lang Gao
- Medical Imaging Department, First Affiliated Hospital of Kunming Medical University, Kunming, China
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14
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Tey SL, Huynh DTT, Berde Y, Baggs G, How CH, Low YL, Cheong M, Chow WL, Tan NC, Chew STH. Prevalence of low muscle mass and associated factors in community-dwelling older adults in Singapore. Sci Rep 2021; 11:23071. [PMID: 34845250 PMCID: PMC8630119 DOI: 10.1038/s41598-021-02274-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 11/08/2021] [Indexed: 12/25/2022] Open
Abstract
The population is rapidly aging worldwide, and there is an age-related decline in muscle mass. Therefore, it is important to examine the prevalence and associated factors of low appendicular skeletal muscle mass index (ASMI) in older adults. The objectives of this cross-sectional study were (i) to determine the prevalence of low ASMI (ASM/height2) and (ii) to identify factors associated with low ASMI. This study included 1211 community-dwelling adults aged ≥ 65 years. Low ASMI was defined as < 7.0 kg/m2 in males and < 5.7 kg/m2 in females (bioelectrical impedance analysis). Gender-specific cut-off values of calf circumference for low ASMI were determined. The prevalence of low ASMI in the overall cohort was 59.9%, i.e., 57.0% among males and 61.8% among females, with no significant difference between genders (P = 0.1068). The prevalence of low ASMI was 81.3% in individuals at risk of malnutrition compared to 20.6% in their counterparts with normal nutritional status (P < 0.0001). Participants with low ASMI were older, had lower physical activity scores, and greater likelihood of hospitalization in prior 6 months compared with normal ASMI (all P < 0.0001). Low ASMI was associated with risk of malnutrition (odds ratio: 3.58 for medium risk, odds ratio: 12.50 for high risk), older age, smoking, drinking, smaller calf circumference, and lower bone mass (all P ≤ 0.0328). Cut-off values of calf circumference for low ASMI for males was 33.4 cm and for females was 32.2 cm. In conclusion, we found that low ASMI was highly prevalent among community-dwelling older adults at risk of malnutrition. Other significant factors associated with low ASMI were age, smoking, drinking, calf circumference, and bone mass. Screening community-dwelling older adults for risk of malnutrition can prevent or delay onset of low ASMI.
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Affiliation(s)
- Siew Ling Tey
- Abbott Nutrition Research and Development, Asia-Pacific Center, Singapore, 138668, Singapore.
| | - Dieu Thi Thu Huynh
- Abbott Nutrition Research and Development, Asia-Pacific Center, Singapore, 138668, Singapore
| | - Yatin Berde
- Statistical Services, Cognizant Technologies Solution Pvt. Ltd., Mumbai, India
| | - Geraldine Baggs
- Abbott Nutrition Research and Development, Columbus, OH, 43219, USA
| | - Choon How How
- Care and Health Integration, Changi General Hospital, Singapore, 529889, Singapore.,SingHealth-Duke NUS Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Yen Ling Low
- Abbott Nutrition Research and Development, Asia-Pacific Center, Singapore, 138668, Singapore
| | - Magdalin Cheong
- Department of Dietetic & Food Services, Changi General Hospital, Singapore, 529889, Singapore
| | - Wai Leng Chow
- Health Services Research, Changi General Hospital, Singapore, 529889, Singapore
| | - Ngiap Chuan Tan
- SingHealth-Duke NUS Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore, 169857, Singapore.,SingHealth Polyclinics, Singapore, 150167, Singapore
| | - Samuel Teong Huang Chew
- Department of Geriatric Medicine, Changi General Hospital, Singapore, 529889, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
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Kawakami R, Miyachi M, Tanisawa K, Ito T, Usui C, Midorikawa T, Torii S, Ishii K, Suzuki K, Sakamoto S, Higuchi M, Muraoka I, Oka K. Development and validation of a simple anthropometric equation to predict appendicular skeletal muscle mass. Clin Nutr 2021; 40:5523-5530. [PMID: 34656948 DOI: 10.1016/j.clnu.2021.09.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/21/2021] [Accepted: 09/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND & AIMS A limited number of studies have developed simple anthropometric equations that can be implemented for predicting muscle mass in the local community. Several studies have suggested calf circumference as a simple and accurate surrogate maker for muscle mass. We aimed to develop and cross-validate a simple anthropometric equation, which incorporates calf circumference, to predict appendicular skeletal muscle mass (ASM) using dual-energy X-ray absorptiometry (DXA). Furthermore, we conducted a comparative validity assessment of our equation with bioelectrical impedance analysis (BIA) and two previously reported equations using similar variables. METHODS ASM measurements were recorded for 1262 participants (837 men, 425 women) aged 40 years or older. Participants were randomly divided into the development or validation group. Stepwise multiple linear regression was applied to develop the DXA-measured ASM prediction equation. Parameters including age, sex, height, weight, waist circumference, and calf circumference were incorporated as predictor variables. Total error was calculated as the square root of the sum of the square of the difference between DXA-measured and predicted ASMs divided by the total number of individuals. RESULTS The most optimal ASM prediction equation developed was: ASM (kg) = 2.955 × sex (men = 1, women = 0) + 0.255 × weight (kg) - 0.130 × waist circumference (cm) + 0.308 × calf circumference (cm) + 0.081 × height (cm) - 11.897 (adjusted R2 = 0.94, standard error of the estimate = 1.2 kg). Our equation had smaller total error and higher intraclass correlation coefficient (ICC) values than those for BIA and two previously reported equations, for both men and women (men, total error = 1.2 kg, ICC = 0.91; women, total error = 1.1 kg, ICC = 0.80). The correlation between DXA-measured ASM and predicted ASM by the present equation was not significantly different from the correlation between DXA-measured ASM and BIA-measured ASM. CONCLUSIONS The equation developed in this study can predict ASM more accurately as compared to equations where calf circumference is used as the sole variable and previously reported equations; it holds potential as a reliable and an effective substitute for estimating ASM.
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Affiliation(s)
- Ryoko Kawakami
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan.
| | - Motohiko Miyachi
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan; Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan
| | - Kumpei Tanisawa
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Tomoko Ito
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Chiyoko Usui
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Taishi Midorikawa
- College of Health and Welfare, J. F. Oberlin University, 3758 Tokiwa-machi, Machida-shi, Tokyo, 194-0294, Japan
| | - Suguru Torii
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Kaori Ishii
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Shizuo Sakamoto
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Mitsuru Higuchi
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Isao Muraoka
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
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16
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Fernandes DPDS, Juvanhol LL, Lozano M, Ribeiro AQ. Calf circumference is an independent predictor of mortality in older adults: An approach with generalized additive models. Nutr Clin Pract 2021; 37:1190-1198. [PMID: 34648208 DOI: 10.1002/ncp.10780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND There is a wide variation in the cutoff points of body mass index (BMI) and calf circumference (CC) , and it is necessary to assess their adequacy in predicting mortality, especially in the older adults in the community. This study aimed to investigate the association of low muscle mass and underweight with mortality in older adults, comparing different cutoff points. METHODS This was a prospective study that included 796 older adults, not institutionalized, from a Brazilian city. Generalized additive models (GAMs) were used to identify cutoff points for CC and BMI, which were compared with values available in the literature. Survival analysis using Cox regression models was used to assess the independent association between these nutrition indicators and mortality. RESULTS Over the 9 years of follow-up, 197 deaths (24.7%) occurred. Cutoff points established for CC and BMI as predictors of mortality were, respectively, <34.5 cm and <24.5. In the adjusted Cox models, older adults with a BMI <18.5 showed a significant increase in the risk of death (hazard ratio [HR], 2.57; 95% CI, 1.23-5.35). Higher mortality was observed among older adults with CC <34.5 cm (HR, 1.72; 95% CI, 1.27-2.33) and CC <31 cm (HR, 2.11; 95% CI, 1.44-3.10). CONCLUSION CC was an independent predictor of mortality, and the cutoff point identified by GAMs was higher than recommended by literature (31 cm). This study suggests a review of cutoff points for CC currently adopted to assess low muscle mass in older adults.
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Affiliation(s)
| | | | - Manuel Lozano
- Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, University of Valencia, Valencia, Spain
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Hu FJ, Liu H, Liu XL, Jia SL, Hou LS, Xia X, Dong BR. Mid-Upper Arm Circumference as an Alternative Screening Instrument to Appendicular Skeletal Muscle Mass Index for Diagnosing Sarcopenia. Clin Interv Aging 2021; 16:1095-1104. [PMID: 34163153 PMCID: PMC8214542 DOI: 10.2147/cia.s311081] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/20/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose Mid-upper arm circumference (MUAC) is a simple, noninvasive anthropometric indicator. This study evaluated the applicability of MUAC as an alternative screening instrument to appendicular skeletal muscle mass index (ASMI) for detecting sarcopenia, and determined the optimal MUAC cutoff values. Patients and Methods A total of 4509 subjects ≥50 years of age from the West China Health and Aging Trend study were included in the present study. ASM was measured by bioelectrical impedance analysis. MUAC, calf circumference (CC), and grip strength were evaluated and the Short Physical Performance Battery and 3-m timed up-and-go test were administered. Low muscle mass was diagnosed based on Asian Working Group for Sarcopenia 2019 (AWGS2019) and updated European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Results ASMI was positively correlated with MUAC in both men (r=0.726, P<0.001) and women (r=0.698, P<0.001). The area under the receiver operating characteristic curve (AUC) for MUAC as an indicator of low muscle mass in men and women was 0.86 (95% confidence interval [CI]: 0.85–0.88) and 0.85 (95% CI: 0.84–0.86), respectively, according to AWGS2019 criteria; and 0.86 (95% CI: 0.85–0.88) and 0.86 (95% CI: 0.85–0.88), respectively, according to EWGSOP2 criteria. Optimal MUAC cutoff values for predicting low muscle mass were ≤28.6 cm for men and ≤27.5 cm for women. There was no significant difference between the AUCs of MUAC and CC in men according to the 2 reference standards (P=0.809), whereas the AUC of CC was superior to that of MUAC in women according to AWGS2019 (P<0.001) and EWGSOP2 (P=0.008) criteria. Conclusion MUAC is strongly correlated with ASMI among community-dwelling middle-aged and older adults in China. MUAC can be used as a simple screening instrument to ASMI for diagnosing sarcopenia, especially in men.
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Affiliation(s)
- Feng-Juan Hu
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hu Liu
- Department of Liver Surgery, Liver Transplantation Division, Laboratory of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiao-Lei Liu
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Shu-Li Jia
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Li-Sha Hou
- National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xin Xia
- National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Bi-Rong Dong
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Gonzalez MC, Mehrnezhad A, Razaviarab N, Barbosa-Silva TG, Heymsfield SB. Calf circumference: cutoff values from the NHANES 1999-2006. Am J Clin Nutr 2021; 113:1679-1687. [PMID: 33742191 PMCID: PMC8433492 DOI: 10.1093/ajcn/nqab029] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/28/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Calf circumference (CC) is used in geriatric studies as a simple and practical skeletal muscle (SM) marker for diagnosing low SM and sarcopenia. Currently applied CC cutoff points were developed in samples including older participants; values representative of the full adult lifespan are lacking. OBJECTIVES We aimed to develop CC cutoff points and to identify relevant confounding factors from the large and diverse NHANES 1999-2006 population sample. METHODS Demographic, anthropometric, and imaging data (DXA, appendicular lean mass) from the adult (age ≥18 y) NHANES sample were partitioned into subgroups according to sex, age, ethnicity, and race. Adults aged 18-39 y and BMI (in kg/m2) 18.5-24.9 were set as a reference population; CC cutoff points were derived at 1 and 2 SDs below the mean. RESULTS The sample included 17,789 participants, 51.3% males and 48.7% females, with respective ages (mean ± SD) of 43.3 ± 16.1 y and 45.5 ± 16.9 y. CC was strongly correlated with appendicular lean mass, r = 0.84 and 0.86 for males and females (both P < 0.001), respectively. Significant differences in mean CC were present across sex, ethnic, self-reported race, and BMI groups. Adjusting CC for adiposity using BMI revealed a decrease in CC beginning after the second decade in males and third decade in females. Rounded CC cutoff values for moderately and severely low CC were 34 cm and 32 cm (males), and 33 cm and 31 cm (females), respectively. Our findings support the use of BMI-adjusted CC values for participants outside the normal-weight BMI range (18-24.9). CONCLUSIONS This study defined CC values in a diverse population sample along with a BMI-adjustment approach that helps to remove the confounding effects of adiposity and thereby improves CC as a useful clinical estimate of SM mass.
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Affiliation(s)
- Maria Cristina Gonzalez
- Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
- Pennington Biomedical Research Center, LSU System, Baton Rouge, LA, USA
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Silveira EA, da Silva Filho RR, Spexoto MCB, Haghighatdoost F, Sarrafzadegan N, de Oliveira C. The Role of Sarcopenic Obesity in Cancer and Cardiovascular Disease: A Synthesis of the Evidence on Pathophysiological Aspects and Clinical Implications. Int J Mol Sci 2021; 22:4339. [PMID: 33919368 DOI: 10.3390/ijms22094339] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/14/2021] [Accepted: 04/18/2021] [Indexed: 12/20/2022] Open
Abstract
Obesity is globally a serious public health concern and is associated with a high risk of cardiovascular disease (CVD) and various types of cancers. It is important to evaluate various types of obesity, such as visceral and sarcopenic obesity. The evidence on the associated risk of CVD, cancer and sarcopenic obesity, including pathophysiological aspects, occurrence, clinical implications and survival, needs further investigation. Sarcopenic obesity is a relatively new term. It is a clinical condition that primarily affects older adults. There are several endocrine-hormonal, metabolic and lifestyle aspects involved in the occurrence of sarcopenic obesity that affect pathophysiological aspects that, in turn, contribute to CVD and neoplasms. However, there is no available evidence on the role of sarcopenic obesity in the occurrence of CVD and cancer and its pathophysiological interplay. Therefore, this review aims to describe the pathophysiological aspects and the clinical and epidemiological evidence on the role of sarcopenic obesity related to the occurrence and mortality risk of various types of cancer and cardiovascular disease. This literature review highlights the need for further research on sarcopenic obesity to demonstrate the interrelation of these various associations.
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20
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Endo K, Sato T, Kakisaka K, Takikawa Y. Calf and arm circumference as simple markers for screening sarcopenia in patients with chronic liver disease. Hepatol Res 2021; 51:176-189. [PMID: 33141991 DOI: 10.1111/hepr.13589] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/05/2020] [Accepted: 10/28/2020] [Indexed: 12/11/2022]
Abstract
AIM To prevent the progression of sarcopenia, early identification is important. We investigated the usefulness of sarcopenia screening tests using the arm and calf circumferences in patients with chronic liver disease. METHODS This was a single-center cross-sectional study based on data collected from a university hospital. We analyzed simple anthropometric data and sarcopenia-related chemical data or imaging data between April and December 2019. Sarcopenia was defined according to the Japan Society of Hepatology guidelines. RESULTS In total, 661 patients participated. Low muscle mass and low muscle strength were found in 245 (37.1%) and 153 (23.1%) patients, respectively. Ultimately, 90 (13.6%) patients were diagnosed with sarcopenia. The sarcopenia group was significantly older and had a higher cirrhosis ratio and poorer liver function than the non-sarcopenia group. The sarcopenia group had a significantly lower body mass index, arm circumferences and calf circumferences than the non-sarcopenia group. A receiver operating characteristics analysis for diagnosing sarcopenia by arm and calf circumferences showed respective areas under the curve of 0.89 and 0.91 for men and 0.84 and 0.89 for women. The optimal cut-off values of arm and calf circumferences were respectively determined to be 25.0 and 32.6 cm for men (sensitivity 88.4% and 83.7%; specificity 74.0% and 84.7%) and 22.7 and 32.1 cm for women (sensitivity 66.0% and 85.1%; specificity 90.0% and 81.3%). CONCLUSIONS The arm and calf circumferences seem useful as simple surrogate markers for screening sarcopenia in patients with chronic liver disease.
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Affiliation(s)
- Kei Endo
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Takuro Sato
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Keisuke Kakisaka
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Yasuhiro Takikawa
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
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21
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Chen CY, Tseng WC, Yang YH, Chen CL, Lin LL, Chen FP, Wong AMK. Calf Circumference as an Optimal Choice of Four Screening Tools for Sarcopenia Among Ethnic Chinese Older Adults in Assisted Living. Clin Interv Aging 2020; 15:2415-2422. [PMID: 33380792 PMCID: PMC7767718 DOI: 10.2147/cia.s287207] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction Sarcopenia is highly prevalent among residents of assisted-living facilities. However, the optimal screening tools are not clear. Therefore, we compared the performance of four recommended screening tools for predicting sarcopenia. Methods The study recruited 177 people over 65 years of age in assisted-living facilities. Appendicular muscle mass index was measured using bioelectrical impedance analysis. Calf circumference (CC), handgrip, six-meters walking speed, and screening questionnaires including SARC-CalF, SARC-F and 5-item Mini Sarcopenia Risk Assessment (MSRA-5) were evaluated. The diagnosis criteria for sarcopenia were based on the Asian Working Group for Sarcopenia 2019 consensus. The area under the receiver operating characteristic curves (AUC) was used to contrast the diagnostic accuracy of screening tools. Results The prevalence of sarcopenia was 52.7% among men and 51.2% among women. After adjusting for age, sex, body mass index and SARC-CalF score, CC remained significantly associated with sarcopenia in logistic regression analysis. The prediction model for sarcopenia based on CC alone had the highest accuracy compared to SARC-CalF, MSRA-5 and SARC-F (AUC, 0.819 vs 0.734 vs 0.600 vs 0.576; sensitivity/specificity, 80.4%/71.8% vs 38.0%/80.0% vs 60.7%/54.2% vs 10.9%/91.8%). Differences in AUCs between the prediction models were statistically significant (CC vs. SARC-CalF, P = 0.0181; SARC-CalF vs. MSRA-5, P = 0.0042). Optimal cutoff values for predicting sarcopenia were CC <34 cm in men and <33 cm in women. Conclusion To predict sarcopenia based on low CC alone is accurate, easy and inexpensive for use in assisted-living facility settings. Further validation studies in different populations are suggested.
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Affiliation(s)
- Chung-Yao Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung 204, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wen-Chun Tseng
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Yao-Hung Yang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou 333, Taiwan.,Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Lain-Li Lin
- Department of Tourism Leisure and Health, Ching Kuo Institute of Management and Health, Keelung 204, Taiwan
| | - Fang-Ping Chen
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.,Keelung Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Alice M K Wong
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou 333, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan 333, Taiwan
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Li C, Kang B, Zhang T, Gu H, Man Q, Song P, Liu Z, Chen J, Wang X, Xu B, Zhao W, Zhang J. High Visceral Fat Area Attenuated the Negative Association between High Body Mass Index and Sarcopenia in Community-Dwelling Older Chinese People. Healthcare (Basel) 2020; 8:healthcare8040479. [PMID: 33198340 PMCID: PMC7712146 DOI: 10.3390/healthcare8040479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 01/05/2023] Open
Abstract
The association between obesity and sarcopenia remains controversial. The present study was conducted to explore the associations among body mass index (BMI), visceral fat area (VFA), and sarcopenia in older people and analyze their potential mechanisms. This cross-sectional study included 861 community-dwelling older Chinese people from three regions of China. BMI, VFA, muscle mass, muscle strength, physical performance, body composition, and metabolic markers were measured. Muscle mass and muscle strength were positively correlated with BMI, but were negatively correlated with VFA. Simple overweight/obesity was negatively associated with sarcopenia (OR = 0.07, 95% CI = 0.03~0.18), and the OR value was lower than combined obesity (OR = 0.16, 95% CI = 0.09~0.28). Fat free mass and total body protein were positively associated with high BMI but negatively associated with high VFA. Furthermore, high VFA was adversely associated with some metabolic risk factors of sarcopenia. Combination of BMI and VFA increased diagnostic efficiency of low muscle mass and sarcopenia. In conclusion, high BMI was negatively associated with sarcopenia, while high VFA attenuated the negative association between high BMI and sarcopenia. The opposite association may partially be attributed to their different associations with body composition and metabolic risk factors of sarcopenia. Therefore, bedsides BMI, VFA and its interaction with BMI should be considered in sarcopenia prevention.
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Affiliation(s)
- Cheng Li
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (C.L.); (Q.M.); (P.S.); (Z.L.); (J.C.); (W.Z.)
| | - Bingxian Kang
- Wuyuan County Center for Disease Control and Prevention, 105 Shiji Road, Wuyuan, Inner Mongolia 015100, China; (B.K.); (X.W.)
| | - Ting Zhang
- Yuexiu District Center for Disease Control and Prevention, 23 Jiaochang West Road, Guangzhou 510030, China; (T.Z.); (B.X.)
| | - Hongru Gu
- Taicang City Center for Disease Control and Prevention, 36 Xianfu West Street, Taicang 215400, China;
| | - Qingqing Man
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (C.L.); (Q.M.); (P.S.); (Z.L.); (J.C.); (W.Z.)
| | - Pengkun Song
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (C.L.); (Q.M.); (P.S.); (Z.L.); (J.C.); (W.Z.)
| | - Zhen Liu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (C.L.); (Q.M.); (P.S.); (Z.L.); (J.C.); (W.Z.)
| | - Jingyi Chen
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (C.L.); (Q.M.); (P.S.); (Z.L.); (J.C.); (W.Z.)
| | - Xile Wang
- Wuyuan County Center for Disease Control and Prevention, 105 Shiji Road, Wuyuan, Inner Mongolia 015100, China; (B.K.); (X.W.)
| | - Bin Xu
- Yuexiu District Center for Disease Control and Prevention, 23 Jiaochang West Road, Guangzhou 510030, China; (T.Z.); (B.X.)
| | - Wenhua Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (C.L.); (Q.M.); (P.S.); (Z.L.); (J.C.); (W.Z.)
| | - Jian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing 100050, China; (C.L.); (Q.M.); (P.S.); (Z.L.); (J.C.); (W.Z.)
- Correspondence: ; Tel.: +86-10-6623-7174
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Inoue T, Maeda K, Shimizu A, Nagano A, Ueshima J, Sato K, Murotani K. Calf circumference value for sarcopenia screening among older adults with stroke. Arch Gerontol Geriatr 2020; 93:104290. [PMID: 33171328 DOI: 10.1016/j.archger.2020.104290] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/29/2020] [Accepted: 10/26/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE The Asia Working Group for Sarcopenia 2019 (AWGS) recommended using the calf circumference (CC) cut-off values to facilitate the case-finding of sarcopenia. However, the validity of the proposed cut-offs has not been examined in older patients with stroke. This study investigated the validity of the AWGS-recommended CC cut-off values for identifying sarcopenia among older patients with stroke. MATERIALS AND METHODS This cross-sectional study enrolled consecutive patients with stroke, aged 65 years and older, admitted to a convalescent rehabilitation ward. Sarcopenia was diagnosed based on the AWGS 2019 criteria. We drew a receiving operating characteristic curve to assess the ability of CC to predict sarcopenia diagnosis. Subsequently, we estimated the sensitivity, specificity, accuracy, F-value, and Matthews correlation coefficient (MCC) of the considered cut-off values. RESULTS We enrolled 256 patients (43 % women) (mean age, 76.6 ± 7.5 years). The prevalence of sarcopenia was 63.7 %. Among men who presented with CC < 34 cm (the AWGS-recommended cut-off value), sensitivity and specificity were 85 % and 66 %, respectively. Concurrently, estimates of accuracy, F-value, and MCC were the highest at cut-off value <34 cm. Among women, at <33 cm of the AWGS-recommended cut-off value, the sensitivity and specificity were 91 % and 28 %, respectively. At cut-off value <32 cm, sensitivity was maintained at 80 %, while specificity increased to 56 %; suggesting that this cut-off value might be a useful indicator for the case-finding of sarcopenia. CONCLUSIONS The AWGS-recommended CC cut-off values are valid. The predictive characteristics of sarcopenia differed among men and women with stroke.
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Affiliation(s)
- Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata City, 950-3198, Japan
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka, Obu, Aichi, 474-8511, Japan; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Akio Shimizu
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan; Department of Nutrition, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Naka-ku, Hamamatsu, Shizuoka, 433-8127, Japan
| | - Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, 11-1 Imazuyamanaka-cho, Nishinomiya, Hyogo, 663-8211, Japan
| | - Junko Ueshima
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan; Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Keisuke Sato
- Okinawa Chuzan Clinical Research Center, Chuzan Hospital, 6-2-1, Matsumoto, Okinawa, Okinawa, 904-2151, Japan
| | - Kenta Murotani
- Biostatistics Center, Kurume University, Asahi Machi, 67, Kurume, Fukuoka, 830-0011, Japan
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Sousa IM, Bielemann RM, Gonzalez MC, da Rocha IMG, Barbalho ER, de Carvalho ALM, Dantas MAM, de Medeiros GOC, Silva FM, Fayh APT. Low calf circumference is an independent predictor of mortality in cancer patients: A prospective cohort study. Nutrition 2020; 79-80:110816. [DOI: 10.1016/j.nut.2020.110816] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/07/2019] [Accepted: 03/06/2020] [Indexed: 12/27/2022]
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Nishioka S, Yamanouchi A, Matsushita T, Nishioka E, Mori N, Taguchi S. Validity of calf circumference for estimating skeletal muscle mass for Asian patients after stroke. Nutrition 2020; 82:111028. [PMID: 33139149 DOI: 10.1016/j.nut.2020.111028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/25/2020] [Accepted: 09/20/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aims of this study was to determine the optimal cutoff values of non-paretic calf circumference (CC) that are indicative of low skeletal muscle mass and examine the association between a low CC and rehabilitation outcomes. METHODS This was a retrospective cohort study that included 628 patients in convalescent rehabilitation wards in Japan. Patients in post-stroke rehabilitation who were ≥20 y of age were included. We examined the agreement between CC on the non-paretic side and a low skeletal muscle mass index (SMI) measured by bioelectrical impedance analysis. We also confirmed the correlation between sarcopenia defined by CC and handgrip strength, and sarcopenia according to Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Functional Independent Measure (FIM) at discharge and discharge to home outcomes were compared between patients with a high CC and those with a low CC. RESULTS Of the 628 patients included in the study, 408 (170 women; mean age, 72 y) were analyzed. The optimal cutoff values of CC were 33 cm for men (sensitivity and specificity, 0.798 and 0.840, respectively) and 32 cm for women (0.847 and 0.818, respectively). The sensitivity and specificity of CC-based sarcopenia against the AWGS criteria were 0.752 and 1.000 for men and 0.800 and 1.000 for women, respectively. Patients with a low CC had a significantly lower FIM and proportion of home discharge than those with a high CC. CONCLUSIONS The optimal cutoff values of non-paretic CC for a low SMI were 33 cm for male and 32 cm for female Asian stroke rehabilitation patients. Sarcopenia can be defined using CC instead of SMI.
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Affiliation(s)
- Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan.
| | - Anna Yamanouchi
- Department of Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Tatsuya Matsushita
- Department of Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Emi Nishioka
- Department of Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Natsumi Mori
- Department of Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Shiori Taguchi
- Department of Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
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Kawakami R, Miyachi M, Sawada SS, Torii S, Midorikawa T, Tanisawa K, Ito T, Usui C, Ishii K, Suzuki K, Sakamoto S, Higuchi M, Muraoka I, Oka K. Cut-offs for calf circumference as a screening tool for low muscle mass: WASEDA'S Health Study. Geriatr Gerontol Int 2020; 20:943-950. [PMID: 32886830 PMCID: PMC7590124 DOI: 10.1111/ggi.14025] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/29/2020] [Accepted: 08/13/2020] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Ryoko Kawakami
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Motohiko Miyachi
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Susumu S Sawada
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Suguru Torii
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Taishi Midorikawa
- College of Health and Welfare, J. F. Oberlin University, Tokyo, Japan
| | - Kumpei Tanisawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Tomoko Ito
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Chiyoko Usui
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Kaori Ishii
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | | | - Shizuo Sakamoto
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Mitsuru Higuchi
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Isao Muraoka
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
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27
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Lim WS, Lim JP, Chew J, Tan AWK. Calf Circumference as a Case-Finding Tool for Sarcopenia: Influence of Obesity on Diagnostic Performance. J Am Med Dir Assoc 2020; 21:1359-1361. [DOI: 10.1016/j.jamda.2020.03.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 01/10/2023]
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Lim JY, Low NA, Merchant RA. Prevalence of sarcopenia in pre-frail community dwelling older adult and utility of SARC-F, SARC-CalF and calf circumference in case finding. J Frailty Sarcopenia Falls 2020; 5:53-56. [PMID: 32885101 PMCID: PMC7461355 DOI: 10.22540/jfsf-05-053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To determine the prevalence of sarcopenia in the pre-frail community dwelling older adults based on the Asian Workgroup for Sarcopenia (AWGS 2019) criteria. In addition, the utility of case finding using the SARC-F, SARC-CalF and calf circumference on impact of prevalence was explored. METHODS 75 older adults ≥65 years old were recruited between October 2019 and March 2020. The algorithms of AWGS 2019 was applied retrospectively to pre-frail participants recruited for an intervention study in primary care setting. In addition to demographics, SARC-F, calf circumference (CC), muscle mass, grip strength, gait speed, 5-time chair stand timing and short physical performance battery test (SPPB) were measured, to determine sarcopenia using AWGS 2019. SARC-CalF was determined using SARC-F and CC. RESULTS The prevalence of sarcopenia based on AWGS 2019 algorithm was 16.0%, possible sarcopenia 73.3% and severe sarcopenia 12.0%. Using SARC-F for case finding reduced the overall prevalence of sarcopenia to 4.0%, possible sarcopenia to 12.0% and severe sarcopenia to 4.0%. Positive percentage agreement of case finding criteria of SARC-F, SARC-CaIF and calf circumference for sarcopenia was 33%, 42% and 58% respectively. CONCLUSIONS Using the AWGS 2019 without case finding, the prevalence of sarcopenia was 16%. However, using SARC-F for case finding underestimated prevalence in this group by 75%. Utility of SARC-F for case finding in pre-frail requires further evaluation.
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Affiliation(s)
- Jia Yi Lim
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore
| | - Nethania Ann Low
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore
| | - Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore
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Mo YH, Zhong J, Dong X, Su YD, Deng WY, Yao XM, Liu BB, Wang XQ, Wang XH. Comparison of Three Screening Methods for Sarcopenia in Community-Dwelling Older Persons. J Am Med Dir Assoc 2020; 22:746-750.e1. [PMID: 32669238 DOI: 10.1016/j.jamda.2020.05.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The 2019 Asian Working Group on Sarcopenia in Older People (AWGS 2019) recommends using either calf circumference or the strength, assistance in walking, rising from a chair, climbing stairs, and falls (SARC-F) or SARC-F combined with calf circumference (SARC-CalF) questionnaires for sarcopenia screening. The aim of this study was to compare the ability and applicability of calf circumference, SARC-F, and SARC-CalF for screening sarcopenia among community-dwelling older adults. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 1050 community-dwelling older people were enrolled. METHODS Sarcopenia was diagnosed according to the AWGS 2019 criteria: bioimpedance analysis for appendicular skeletal muscle index, hand grip, and 6-m gait speed test. Participants also completed the SARC-F questionnaire and calf circumference measurement. The screening tools' performances were evaluated through receiver operating characteristic (ROC) curves, area under the ROC curves (AUC), and sensitivity/specificity analyses. RESULTS Sarcopenia was identified in 263 (25.0%) participants by the AWGS 2019 criteria. Calf circumference had a sensitivity of 81.4% and a specificity of 77.0%. Sensitivity and specificity of SARC-F for screening sarcopenia were 17.9% and 93.7%, respectively. SARC-CalF improved the sensitivity of SARC-F (47.5%) while keeping similar specificity (92.0%). The AUCs of calf circumference, SARC-F, and SARC-CalF were 0.79 [95% confidence interval (CI), 0.77-0.82], 0.56 (95% CI, 0.52-0.59), and 0.70 (95% CI, 0.67-0.73), respectively. The differences across ROC curves were statistically significant among 3 screening tools (P < .001). CONCLUSIONS AND IMPLICATIONS The overall screening ability of calf circumference was better than that of SARC-F and SARC-CalF for sarcopenia in community-dwelling older persons despite gender, age, and cognitive function. SARC-F and SARC-CalF have high specificity but are susceptible to the preceding factors.
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Affiliation(s)
- Yi-Han Mo
- Xiang Ya Nursing School, The Central South University, Changsha, China
| | - Jing Zhong
- Xiang Ya Nursing School, The Central South University, Changsha, China
| | - Xin Dong
- Xiang Ya Nursing School, The Central South University, Changsha, China
| | - Yi-Dong Su
- Xiang Ya Nursing School, The Central South University, Changsha, China
| | - Wen-Yu Deng
- Xiang Ya Nursing School, The Central South University, Changsha, China
| | - Xue-Mei Yao
- Xiang Ya Nursing School, The Central South University, Changsha, China
| | - Bei-Bei Liu
- Xiang Ya Nursing School, The Central South University, Changsha, China
| | - Xiao-Qin Wang
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Changsha, China.
| | - Xiu-Hua Wang
- Xiang Ya Nursing School, The Central South University, Changsha, China.
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Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, Jang HC, Kang L, Kim M, Kim S, Kojima T, Kuzuya M, Lee JSW, Lee SY, Lee WJ, Lee Y, Liang CK, Lim JY, Lim WS, Peng LN, Sugimoto K, Tanaka T, Won CW, Yamada M, Zhang T, Akishita M, Arai H. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc 2020; 21:300-307.e2. [PMID: 32033882 DOI: 10.1016/j.jamda.2019.12.012] [Citation(s) in RCA: 2422] [Impact Index Per Article: 605.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R., China.
| | - Prasert Assantachai
- Division of Geriatric Medicine, Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tung-Wai Auyeung
- The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong S.A.R, China
| | - Ming-Yueh Chou
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College Hospital, Beijing, China
| | - Miji Kim
- Department of Biomedical Science and Technology, College of Medicine, East-West Medical Research Institute, Kyung Hee University, Seoul, Korea
| | - Sunyoung Kim
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Jenny S W Lee
- The S. H. Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong S.A.R, China
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Wei-Ju Lee
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yilan, Taiwan
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea
| | - Chih-Kuang Liang
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Wee Shiong Lim
- Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ken Sugimoto
- Department of Geriatric Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoki Tanaka
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chang Won Won
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Teimei Zhang
- Beijing Institute of Geriatrics, Beijing Hospital, Ministry of Health, Beijing, China
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
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Tarnowski M, Stein E, Marcadenti A, Fink J, Rabito E, Silva FM. Calf Circumference Is a Good Predictor of Longer Hospital Stay and Nutritional Risk in Emergency Patients: A Prospective Cohort Study. J Am Coll Nutr 2020; 39:645-649. [PMID: 32083521 DOI: 10.1080/07315724.2020.1723452] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: This study aimed to evaluate the validity of calf circumference (CC) in identifying malnourished patients and patients at nutritional risk and determine the association between CC and clinical outcomes of hospitalized patients.Methods: A prospective cohort study was conducted involving patients admitted to the emergency department of a tertiary hospital in the first 48 hours of admission. Nutritional risk was determined using Nutritional Risk Screening, malnutrition was diagnosed using subjective global assessment, and CC was manually measured. Brazilian cutoff points for CC were used to identify low muscle mass. The outcomes of interest were length of emergency care and hospital stay, occurrence of infection, and death, besides nutritional risk and malnutrition.Results: In total, 528 patients (52.76 ± 16.18 years; 54.6% females) were followed up for 9.0 (3.0-19.0) days; 39.6% of them had reduced CC values. The accuracy of CC in identifying patients at nutritional risk and malnourished patients was 67.7% and 54.1%, respectively. The cutoff value of 36.5 cm was highly accurate in identifying nutritional risk [AUC-ROC curve = 0.764 (95% CI: 0.704-0.825) for men, and AUC-ROC curve = 0.716 (95% CI: 0.659-0.774) for women]. Patients with low CC had a 1.59-fold (95% CI: 1.07-2.36) greater likelihood of a long hospital stay than patients with normal CC.Conclusions: Low CC values have satisfactory validity in identifying nutritional risk and are associated with long hospital stay.
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Affiliation(s)
- Micheli Tarnowski
- Department of Nutrition Science, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Elana Stein
- Department of Nutrition Science, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Aline Marcadenti
- Institute of Research of the Heart Hospital (IP-HCor), São Paulo, Brazil.,Postgraduate Program in Health Sciences: Cardiology, Institute of Cardiology/University Foundation of Cardiology (IC/FUC), Porto Alegre, Brazil.,Postgraduate Program in Nutrition Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Jaqueline Fink
- Division of Nutrition, Dietetics of Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil
| | - Estela Rabito
- Department of Nutrition, Postgraduate Program in Food and Nutrition, Federal University of Paraná, Curitiba, Brazil
| | - Flávia Moraes Silva
- Department of Nutrition, Postgraduate Program in Nutrition, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
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Yang M, Lu J, Jiang J, Zeng Y, Tang H. Comparison of four sarcopenia screening tools in nursing home residents. Aging Clin Exp Res 2019; 31:1481-1489. [PMID: 30539542 DOI: 10.1007/s40520-018-1083-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/21/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Several screening tools have been developed for identifying sarcopenia in elderly nursing home residents. OBJECTIVE To compare the diagnostic accuracy of four sarcopenia screening tools in nursing homes: Mini Sarcopenia Risk Assessment full version (MSRA-7) and short version (MSRA-5), SARC-F, and SARC-F combined with calf circumference (SARC-CalF). METHODS Elderly nursing home residents (aged ≥ 65 years) were recruited. Four common diagnostic criteria (EWGSOP, AWGS, IWGS, and FNIH) were separately applied as the "gold standard". The sensitivity/specificity analyses of the four tools were calculated. Receiver operating characteristic (ROC) curves and area under the ROC curves (AUC) were applied to compare the overall diagnostic accuracy. RESULTS We included 277 participants aged 81.6 ± 3.3 years. Using different "gold standards", the sensitivity of SARC-CalF, SARC-F, MSRA-7, and MSRA-5 ranged from 55.7 to 64.4%, from 17.0 to 21.8%, from 53.3 to 57.8%, and from 49.1 to 56.7%, respectively, whereas the specificity ranged from 84.5 to 86.5%, from 96.8 to 98.4%, from 80.2 to 84.2%, and from 82.8 to 84.1%, respectively. Regardless of the "gold standard", SARC-CalF had the largest AUC (from 0.816 to 0.867) among the tools; the AUC of SARC-F (from 0.769 to 0.791) and MSRA-5 (from 0.713 to 0.767) was not significantly different; whereas MSRA-7 had the smallest AUC (from 0.681 to 0.746). CONCLUSION Among the four screening tools, SARC-CalF appears to be an optimal choice for screening sarcopenia in nursing home residents. SARC-F and MSRA-5 are alternatives, of which, SARC-F has a better specificity and MSRA-5 has a better sensitivity.
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Affiliation(s)
- Ming Yang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China
- Precision Medicine Research Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China
| | - Jing Lu
- Department of Pharmacy, West China Hospital, Sichuan University, No 37 Guoxue Lane, Chengdu, Sichuan, China
| | - Jiaojiao Jiang
- The Center of Rehabilitation, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China
| | - Yanli Zeng
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, Sichuan, China
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Huairong Tang
- Health Management Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China.
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Santos LP, Gonzalez MC, Orlandi SP, Bielemann RM, Barbosa‐Silva TG, Heymsfield SB. New Prediction Equations to Estimate Appendicular Skeletal Muscle Mass Using Calf Circumference: Results From NHANES 1999–2006. JPEN J Parenter Enteral Nutr 2019; 43:998-1007. [DOI: 10.1002/jpen.1605] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/22/2019] [Indexed: 01/13/2023]
Affiliation(s)
| | - Maria Cristina Gonzalez
- Postgraduate Program in Health and BehaviorCatholic University of Pelotas Pelotas Brazil
- Pennington Biomedical Research CenterLouisiana State University Baton Rouge Louisiana USA
| | | | - Renata Moraes Bielemann
- Nutrition CollegeFederal University of Pelotas Pelotas Brazil
- Postgraduate Program in Health and Behavior and in EpidemiologyFederal University of Pelotas Pelotas Brazil
| | - Thiago G. Barbosa‐Silva
- Postgraduate Program in Health and Behavior and in EpidemiologyFederal University of Pelotas Pelotas Brazil
| | - Steven B. Heymsfield
- Pennington Biomedical Research CenterLouisiana State University Baton Rouge Louisiana USA
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Abstract
Little is known about the prognostic value of the strength, assistance walking, rise from a chair, climb stairs, and falls questionnaire (SARC-F) and SARC-F combined with calf circumference (SARC-CalF) among elderly nursing home residents.To compare the prognostic value of SARC-F and SARC-CalF for mortality in this population.We conducted a prospective study in four nursing homes in western China. Sarcopenia was estimated using SARC-F and SARC-CalF, respectively. Nutrition status, activities of daily living, and other covariates were evaluated. The survival status was collected via medical records and telephone interviews at the 12th month after the baseline investigation. We used multivariate Cox proportional-hazard models to calculate the hazard ratio (HR) and 95% confidence interval (CI) for 1-year all-cause mortality by SARC-F-defined sarcopenia and SARC-CalF-defined sarcopenia, separately.We included 329 participants (median age: 85 years). The prevalences of SARC-F-defined sarcopenia and SARC-CalF-defined sarcopenia were 39.8% and 46.8%, respectively. During the 1-year follow-up period, 73 participants (22.7%) died. The mortality was 29.0% and 18.3% in the participants with or without SARC-F-defined sarcopenia, respectively (P = .025). The mortality was 26.6% and 19.0% in the participants with or without SARC-CalF-defined sarcopenia, respectively (P = .105). After adjusted for the relevant confounders including malnutrition, SARC-F-defined sarcopenia was independently associated with an increased risk of 1-year mortality (adjusted HR: 2.08; 95% CI: 1.27-3.42). However, SARC-CalF-defined sarcopenia was not an independent predictor of 1-year mortality (adjusted HR: 1.54; 95% CI: 0.95-2.47).Sarcopenia is highly prevalent in Chinese elderly nursing home residents according to SARC-F or SARC-CalF. SARC-F-defined sarcopenia appears to be better for predicting the 1-year mortality of Chinese nursing home residents than SARC-CalF-defined sarcopenia.
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Affiliation(s)
- Ming Yang
- The Center of Gerontology and Geriatrics, West China Hospital
- Precision Medicine Research Center, West China Hospital
| | | | - Yanli Zeng
- Institute for Disaster Management and Reconstruction, Sichuan University
- School of Nursing, Chengdu University of Traditional Chinese Medicine
| | - Huairong Tang
- Health Management Center, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China
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Tseng SH, Liu LK, Peng LN, Wang PN, Loh CH, Chen LK. Development and Validation of a Tool to Screen for Cognitive Frailty among Community-Dwelling Elders. J Nutr Health Aging 2019; 23:904-909. [PMID: 31641743 DOI: 10.1007/s12603-019-1235-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Reciprocal age-related impairments in physical and cognitive functioning have been termed 'cognitive frailty', which is associated with adverse health outcomes and is a potential target for preventing or delaying the onset of disability in older people. However, cognitive frailty as currently defined is challenging to diagnose. To facilitate earlier diagnosis and intervention, we conducted this study to develop and validate a simple evidence-based instrument to identify community-dwelling elders at risk of cognitive frailty. DESIGN Retrospective analyses of data from the I-Lan Longitudinal Aging Study (ILAS) to develop a prediction model, and from the Longitudinal Aging Study of Taipei (LAST) for external validation. SETTING Community-dwelling adults from Taipei City, New Taipei City and Yilan (I-Lan) County, Taiwan. PARTICIPANTS 1271 community residents ≥65 years old, without impaired global cognition or dependency for activities of daily living/instrumental activities of daily living. MEASUREMENTS Demographic characteristics, anthropometric measurements, medical history, Mini-Mental State Examination, Montreal Cognitive Assessment, Functional Autonomy Measuring System, Functional Assessment Staging Test, Center for Epidemiologic Studies Depression Scale, handgrip strength, 6-metre walk speed. METHODS Baseline characteristics of groups with/without cognitive frailty were analyzed and factors differing significantly in univariate analysis input to binary logistic regression to develop a cognitive frailty risk (CFR) score. RESULTS The prevalence of cognitive frailty was 15.8% overall; ILAS 21.4%, LAST 8.4%. Predictors of CFR comprised: age ≥75 years; female sex; waist circumference ≥90 cm (male), ≥80 cm (female); calf circumference <33 cm (male), <32 cm (female); memory deficits; and diabetes mellitus. CFR ≥5/14 had sensitivity of 70%, specificity of 60%, and predictive accuracy of 72%. CONCLUSIONS A CFR score based on simple history-taking and anthropometric measurements integrates age, sex, cardiometabolic risk, memory deficits, sarcopenia, and nutrition, with validated predictive accuracy, and could be performed easily in community settings to identify seniors with cognitive frailty for appropriate interventions.
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Affiliation(s)
- S-H Tseng
- Liang-Kung Chen, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei 11217, Taiwan, ; Or Li-Ning Peng, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei 11217, Taiwan, E-mail address:
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Affiliation(s)
- W S Lim
- W.S. Lim,Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
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Real GG, Frühauf IR, Sedrez JHK, Dall'Aqua EJF, Gonzalez MC. Calf Circumference: A Marker of Muscle Mass as a Predictor of Hospital Readmission. JPEN J Parenter Enteral Nutr 2018; 42:1272-1279. [DOI: 10.1002/jpen.1170] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/19/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Gustavo Gonzales Real
- Internist and Gastroenterologist, Postgraduate Program in Health and Behavior; Universidade Católica de Pelotas (UCPel); Pelotas RS Brazil
| | | | | | | | - Maria Cristina Gonzalez
- Postgraduate Program in Health and Behavior; Universidade Católica de Pelotas; (UCPel), Pelotas RS Brazil
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