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Calf Circumference as an Optimal Choice of Four Screening Tools for Sarcopenia Among Ethnic Chinese Older Adults in Assisted Living

Authors Chen CY, Tseng WC, Yang YH, Chen CL, Lin LL, Chen FP, Wong AMK

Received 16 October 2020

Accepted for publication 1 December 2020

Published 23 December 2020 Volume 2020:15 Pages 2415—2422


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Prof. Dr. Zhi-Ying Wu

Chung-Yao Chen,1,2 Wen-Chun Tseng,1 Yao-Hung Yang,1 Chia-Ling Chen,3,4 Lain-Li Lin,5 Fang-Ping Chen,2,6,7 Alice MK Wong2,3,8

1Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung 204, Taiwan; 2Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; 3Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou 333, Taiwan; 4Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; 5Department of Tourism Leisure and Health, Ching Kuo Institute of Management and Health, Keelung 204, Taiwan; 6Keelung Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital, Keelung 204, Taiwan; 7Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung 204, Taiwan; 8Healthy Aging Research Center, Chang Gung University, Taoyuan 333, Taiwan

Correspondence: Chung-Yao Chen
Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, No. 200, Ln. 208, Jijin 1st Road, Anle District, Keelung City 204, Taiwan
Tel +886-2-2432-9292 #2725

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.

Keywords: sarcopenia, calf circumference, SARC-F, SARC-CalF, MSRA, assisted-living

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