Calf Circumference Measurement Protocols for Sarcopenia Screening: Differences in Agreement, Convergent Validity and Diagnostic Performance

Piodena-Aportadera, Melissa Rose Berlin; Lau, Sabrina; Chew, Justin; Lim, Jun Pei; Ismail, Noor Hafizah; Ding, Yew Yoong; Lim, Wee Shiong

doi:10.4235/agmr.22.0057

Cited by 23 publications

(15 citation statements)

References 30 publications

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“…With some studies finding the significant influence of posture on CC measurement 21 , 22 , standardization is needed to ensure the reliability of CC as the screening indicator for possible sarcopenia. For instance, since some studies found that CC measurement in a standing position has higher accuracy and lower overestimation 21 , 23 , we need to consider standardizing the CC measurement in a standing position.…”

Section: Discussionmentioning

confidence: 99%

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

Kandinata

Widajanti

Ichwani

et al. 2023

Sci Rep

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

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Section: Discussionmentioning

confidence: 99%

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

Kandinata

Widajanti

Ichwani

et al. 2023

Sci Rep

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“…Anthropometric measurements were recorded, including height, weight, body mass index (BMI), mid upper arm circumference, calf circumference, and waist circumference. Calf circumference was measured using non‐elastic tape at the widest part of the dominant calf in the seated position with the weight evenly distributed on both feet 20 . MAC was measured at the mid‐point between the acromial surface of the scapula and the olecranon process of the elbow over the dominant arm when bent at 90°.…”

Section: Methodsmentioning

confidence: 99%

“…Calf circumference was measured using non-elastic tape at the widest part of the dominant calf in the seated position with the weight evenly distributed on both feet. 20 MAC was measured at the midpoint between the acromial surface of the scapula and the olecranon process of the elbow over the dominant arm when bent at 90 . Waist circumference was measured using measuring tape 2.5 cm above the umbilicus in standing position.…”

Section: Data Collectionmentioning

confidence: 99%

SARC‐F and modified versions using arm and calf circumference: Diagnostic performance for sarcopenia screening and the impact of obesity

Lee,

Lim,

Tan

et al. 2023

Geriatrics Gerontology Int

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AimSARC‐F is limited by low sensitivity for sarcopenia identification. As surrogates of muscle mass, mid‐arm circumference (MAC) and/or calf circumference have been proposed as additions to SARC‐F to enhance sarcopenia identification. The aim of this study was to evaluate the diagnostic performance of SARC‐F, SARC‐CalF, SARC‐F + MAC, and SARC‐CalF + MAC in sarcopenia detection, and to assess the impact of obesity on their diagnostic performance.MethodsWe studied 230 healthy non‐frail community‐dwelling older adults age >50 years. We performed receiver operating characteristic curve analysis for SARC‐F, SARC‐CalF, SARC‐F + MAC and SARC‐CalF + MAC against sarcopenia diagnosed by the Asian Working Group for Sarcopenia (AWGS) 2019 as the reference standard. Obesity was defined by high waist circumference (men ≥90 cm, women ≥80 cm). We performed subgroup analysis to compare between obese and non‐obese groups.ResultsThe prevalence of sarcopenia was 27.0% by AWGS 2019. SARC‐CalF + MAC had the best diagnostic performance (area under the curve [AUC] 0.74, 95% confidence interval [CI] 0.67–0.81; sensitivity 66.1%; specificity 69.1%), followed by SARC‐CalF (AUC 0.70, 95% CI 0.62–0.78; sensitivity 21.0%; specificity 95.8%). SARC‐F (AUC 0.57, 95% CI 0.49–0.66; sensitivity 0%; specificity 100%) performed significantly worsethan its modified versions (P < 0.05). There was higher accuracy of sarcopenia identification in obese compared with non‐obese groups for SARC‐F + MAC (AUC 0.75, 95% CI 0.65–0.85 vs. 0.58, 95% CI 0.46–0.70) and SARC‐CalF + MAC (AUC 0.75, 95% CI 0.66–0.85 vs. 0.70, 95% CI 0.59–0.81).ConclusionsThe addition of arm circumference to SARC‐CalF confers better diagnostic accuracy for sarcopenia identification, especially in the obese group. Thus, MAC may complement SARC‐CalF for community screening of sarcopenia amongst healthy community‐dwelling older adults by increasing sensitivity for the detection of sarcopenic obesity. Geriatr Gerontol Int 2023; ••: ••–••.

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“…[7,[53][54][55] Additionally, questionnaires such as strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) and ring tests using the thumb and index finger to measure calf circumference are suggested. [10,56] Notably, SARC-F has limitations as a screening tool due to its low sensitivity and high specificity. [57] Consequently, case identification in clinical practices may heavily rely on clinical suspicion, considering factors such as significant weight loss, general weakness, or history of falls, regardless of age.…”

Section: Screening Testmentioning

confidence: 99%

Sarcopenia as the Mobility Phenotype of Aging: Clinical Implications

Ji,

Jung,

Baek

et al. 2024

J Bone Metab

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Sarcopenia, which is characterized by an age-related decline in muscle mass and function, poses significant challenges to geriatric care. Its definition has evolved from muscle-specific criteria to include muscle mass, muscle function, and physical performance, recognizing sarcopenia as a physical frailty. Sarcopenia is associated with adverse outcomes, including mortality, falls, fractures, cognitive decline, and admission to long-term care facilities. Neuromechanical factors, protein-energy balance, and muscle protein synthesis-breakdown mechanisms contribute to its pathophysiology. The identification of sarcopenia involves screening tests and a comprehensive assessment of muscle mass, strength, and physical function. Clinical approaches aligned with the principles of comprehensive geriatric assessment prioritize patient-centered care. This assessment aids in identifying issues related to activities of daily living, cognition, mood, nutrition, and social support, alongside other aspects. The general approach to factors underlying muscle loss and functional decline in patients with sarcopenia includes managing chronic diseases and evaluating administered medications, with interventions including exercise and nutrition, as well as evolving pharmacological options. Ongoing research targeting pathways, such as myostatin-activin and exercise mimetics, holds promise for pharmacological interventions. In summary, sarcopenia requires a multifaceted approach, acknowledging its complex etiology and tailoring interventions to individual patient needs.

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Calf Circumference Measurement Protocols for Sarcopenia Screening: Differences in Agreement, Convergent Validity and Diagnostic Performance

Cited by 23 publications

References 30 publications

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

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

SARC‐F and modified versions using arm and calf circumference: Diagnostic performance for sarcopenia screening and the impact of obesity

Sarcopenia as the Mobility Phenotype of Aging: Clinical Implications

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