Low calf circumference can predict nutritional risk and mortality in adults with metabolic syndrome aged over 80 years

Abstract

Background Metabolic disorders and malnutrition are a double burden worldwide. The aim was to determine whether low calf circumference (CC) could predict nutritional risk and the cut-off values of CC for predicting nutritional risk in metabolic syndrome (MetS) patients aged over 80 years. We aimed to evaluate the risk factors for predicting mortality in MetS. Methods A total of 514 patients aged over 80 years with MetS were enrolled and followed for 2.5 years. On admission, demographic data, CC, and laboratory parameters were obtained. Patients with a Nutritional Risk Screening 2002 (NRS 2002) total score ≥ 3 were considered to have nutritional risk. Results The CC level was significantly lower in the nutritional risk group than in the non-nutritional risk with MetS group (27.1 ± 4.0 cm vs. 30.8 ± 3.9 cm). Logistic regression analysis of nutritional risk revealed that increasing CC (adjusted OR, 0.81; 95% CI, 0.74–0.88) was an independent protective factor against nutrition risk. The best CC cut-off value for predicting nutritional risk according to the NRS 2002 was 28.8 cm. Cox regression multivariate models showed nutritional risk (HR, 2.48; 95% CI, 1.22–5.04) and decreased CC (HR, 2.78; 95% CI, 1.27–5.98) remained independent risk factors for mortality. Conclusion Decreased CC could predict not only nutritional risk but also mortality in MetS patients aged over 80 years. The elderly who had MetS with nutritional risk should be discovered early, early intervention and early treatment. CC may be a valuable index to screen out this population.

Absence of association between low calf circumference, adjusted or not for adiposity, and ICU mortality in critically ill adults: A secondary analysis of a cohort study

“…14 They observed that low unadjusted calf circumference at ICU admission increased the risk of ICU mortality by 2.63-fold in 249 patients with COVID-19. 14 However, their patient characteristics differed significantly from those in our sample, presenting higher severity with a mean SOFA score of 9.6 ± 3.5, median ICU stay of 14 days (range, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], and an ICU death rate of 48.6%. Notably, they examined unadjusted calf circumference in their analysis.…”

“…8 Moreover, low calf circumference has exhibited predictive value for adverse outcomes in hospitalized patients, including prolonged hospital LOS, [9][10][11] increased likelihood of readmission, 12,13 and higher risk of ICU mortality 14 and in-hospital mortality. 15 On the other hand, body fatness can confound calf circumference measurement, resulting in muscle mass overestimation. To address this issue, Gonzales et al recently recommended adjusting calf circumference for body mass index (BMI; calculated as weight [kg] divided by height squared [m 2 ]) to enhance its diagnostic accuracy, 16 specifically by providing subtraction values for individuals with BMI ≥25.…”

“…Calf circumference also is positively correlated with appendicular skeletal muscle (ASM) estimated by DXA 6,7 and total dissected muscle mass measured by MRI 8 . Moreover, low calf circumference has exhibited predictive value for adverse outcomes in hospitalized patients, including prolonged hospital LOS, 9–11 increased likelihood of readmission, 12,13 and higher risk of ICU mortality 14 and in‐hospital mortality 15 …”

Indicators predicting the development and improvement of sarcopenia in older adults requiring long-term care

“…Ren et al reported that calf circumference was significantly positively associated with albumin level, hemoglobin level, BMI, and abdominal circumference. Furthermore, they reported that a decrease in lower calf circumference predicts mortality as well as the risk of malnutrition 24 ) . The results of this study support previous studies and demonstrate that nutritional status is associated with sarcopenia prognosis even in a population of older adults requiring long-term care, suggesting that MNA-SF and calf circumference may be predictors of the development and improvement of sarcopenia.…”

Effectiveness of comparing calf circumference with neck circumference regarding their association with skeletal muscle indices in Japanese nursing home residents

“…Calf circumference (CC) is better than body mass index (BMI) or waist circumference in reflecting muscle loss in the lower extremities with aging or decreasing physical activity. In some studies, CC has been reported as a screening method for diagnosing sarcopenia, assessing nutritional status, and mortality in hospitalized patients, including those who are bedridden 5 , 6 , 7 , 8 , 9 ) .…”