Calf circumference predicts mobility disability: A secondary analysis of the Mexican health and ageing study

Using magnetic resonance imaging to measure head muscles: An innovative method to opportunistically determine muscle mass and detect sarcopenia

BACKGROUND

Sarcopenia is associated with multiple adverse outcomes. Traditional methods to determine low muscle mass for the diagnosis of sarcopenia are mainly based on dual-energy X-ray absorptiometry (DXA), whole-body magnetic resonance imaging (MRI) and bioelectrical impedance analysis. These tests are not always available and are rather time consuming and expensive. However, many brain and head diseases require a head MRI. In this study, we aim to provide a more accessible way to detect sarcopenia by comparing the traditional method of DXA lean mass estimation versus the tongue and masseter muscle mass assessed in a standard brain MRI.

METHODS

The H70 study is a longitudinal study of older people living in Gothenburg, Sweden. In this cross-sectional analysis, from 1203 participants aged 70 years at baseline, we included 495 with clinical data and MRI images available. We used the appendicular lean soft tissue index (ALSTI) in DXA images as our reference measure of lean mass. Images from the masseter and tongue were analysed and segmented using 3D Slicer. For the statistical analysis, the Spearman correlation coefficient was used, and concordance was estimated with the Kappa coefficient.

RESULTS

The final sample consisted of 495 participants, of which 52.3% were females. We found a significant correlation coefficient between both tongue (0.26) and masseter (0.33) with ALSTI (P < 0.001). The sarcopenia prevalence confirmed using the alternative muscle measure in MRI was calculated using the ALSTI (tongue = 2.0%, masseter = 2.2%, ALSTI = 2.4%). Concordance between sarcopenia with masseter and tongue versus sarcopenia with ALSTI as reference has a Kappa of 0.989 (P < 0.001) for masseter and a Kappa of 1 for the tongue muscle (P < 0.001). Comorbidities evaluated with the Cumulative Illness Rating Scale were significantly associated with all the muscle measurements: ALSTI (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.07-1.26, P < 0.001), masseter (OR 1.16, 95% CI 1.07-1.26, P < 0.001) and tongue (OR 1.13, 95% CI 1.04-1.22, P = 0.002); the higher the comorbidities, the higher the probability of having abnormal muscle mass.

CONCLUSIONS

ALSTI was significantly correlated with tongue and masseter muscle mass. When performing the sarcopenia diagnostic algorithm, the prevalence of sarcopenia calculated with head muscles did not differ from sarcopenia calculated using DXA, and almost all participants were correctly classified using both methods.

The Impact of Sarcopenia Risk on Postoperative Walking Independence in Older Adults Undergoing Total Joint Arthroplasty

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.

Calf circumference change and all-cause mortality among community-dwelling Chinese older people

BACKGROUND

Previous studies have described an association between single time point calf circumference (CC) and mortality. Evidence of associations between CC change and mortality is lacking. We aimed to determine the relationship between the CC change over time and all-cause mortality.

METHODS

We conducted a retrospective cohort study of 906 participants in the 2014-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Restricted cubic splines were used to analyze associations between the relative CC change (exposure) and all-cause mortality (primary outcome). When there was evidence of non-linearity, a piecewise Cox regression model was next fitted, adjusting for sociodemographic characteristics, health behaviours, health status and baseline CC.

RESULTS

The mean (SD) age was 83.8 (12.2) years old, and 50.2% (455/906) of participants were male. We observed a U-shaped association between the relative CC change (%) and all-cause mortality (P for non-linearity <0.001). Participants with stable CC over time had the lowest risk of death. After adjusting for covariates, when CC decreased over time, the hazard ratio per 10% higher in CC change was 1.32 (1.01-1.69). When CC increased over time, the hazard ratio per 10% higher in CC change was 1.35 (1.10-1.66).

CONCLUSION

Stable CC over time was associated with the lowest mortality risk. Our findings indicate the practical significance of monitoring CC change in older adult.

Calf circumference predicts frailty in older adults: the Chinese longitudinal healthy longevity survey

BACKGROUND

Although frailty is a common geriatric syndrome in old adults, a simple method to assess the degree of frailty in a person has not yet been established. In this study we have tried to establish the association between calf circumference (CC) and frailty among older Chinese people.

METHODS

We used the data obtained from the 2014 edition of the Chinese Longitudinal Healthy Longevity Survey; 1216 participants aged ≥60 years were included for the study. Body mass index, CC and waist circumference measurement data, and laboratory test results were collected. Frailty status was measured using the frailty index (FI). Participants were then classified into non-frail (FI < 0.25) and frail (FI ≥ 0.25) groups.

RESULTS

There were 874 participants (71.9%) in the non-frail group and 342 (28.1%) in the frail group. The CC was significantly different between the two groups (31.54 ± 4.16 versus 28.04 ± 4.53, P < 0.001). Logistic regression analysis revealed that CC (odds ratio = 0.947, 95% confidence interval: 0.904-0.993, P = 0.023) was an independent impact factor associated with frailty. The CC value of 28.5 cm was considered the best cut-off value in women with area under the curve (AUC) was 0.732 (P < 0.001) and 29.5 cm in men with AUC was 0.592 (P = 0.004);We created a simple prediction model for frailty that included age,sex and CC:[Formula: see text]P = e^logit(P) /1 + e^logit(P), and AUC is 0.849 (P < 0.001).

CONCLUSIONS

CC is a convenient and predictable marker of frailty in older adults.

Calf Circumference, a Valuable Tool to Predict Sarcopenia in Older People Hospitalized with Hip Fracture

Sarcopenia is an important risk factor for hip fracture in older people. Nevertheless, this condition is overlooked in clinical practice. This study aimed to explore the factors associated with sarcopenia among older patients hospitalized for hip fracture, to identify a predictive model of sarcopenia based on variables related to this condition, and to evaluate the performance of screening tools in order to choose the most suitable to be adopted in routine care of older people with hip fracture. A cross-sectional study was undertaken with 90 patients (mean age 83.4 ± 7.2 years), by assessing sociodemographic and clinical characteristics, anthropometric measures, such as body mass index (BMI) and calf circumference (CC), the functional status (Barthel Index), the nutritional status (MNA-SF), and the adherence to the Mediterranean Diet (MEDAS). Diagnosis of sarcopenia was established according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). The analysis of variables associated with sarcopenia was performed using multivariate logistic regression models. Clusters of sarcopenia were explored with heatmaps and predictive risk models were estimated. Sarcopenia was confirmed in 30% of hip fracture patients. Variables with the strongest association with sarcopenia were BMI (OR = 0.79 [0.68−0.91], p < 0.05) and CC (OR = 0.64 [0.51−0.81], p < 0.01). CC showed a relatively high predictive capacity of sarcopenia (area under the curve: AUC = 0.82). Furthermore, CC could be a valuable tool to predict sarcopenia risk compared with the currently used screening tools, SARC-F and SARC-CalF (AUC, 0.819 vs. 0.734 and 0.576, respectively). More studies are needed to validate these findings in external study populations.

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

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.

Calf circumference refines sarcopenia in correlating with mortality risk

BACKGROUND

Recommendations in current guidelines on the use of calf circumference (CC) as a diagnostic measure in sarcopenia is conflicting. In this study, we incorporated CC into conventional models of sarcopenia and compared their predictive scores on mortality.

OBJECTIVE

To clarify the predictive capacity of CC-added models of sarcopenia on and establish the correlation of CC with mortality risk.

DESIGN, SETTING AND SUBJECTS

From the National Health and Nutrition Examination Survey 1999-2002, 2,532 participants aged 50-85 and comprising 51.7% male were included.

METHODS

Our definitions contained four sarcopenic components, low CC (C), low muscle strength (S), low muscle mass (M) and low gait speed (G). Cox proportional hazard models and the receiver-operator characteristic curves for all-cause, cardiovascular (CV) and cancer mortality were conducted to compare the different sarcopenia definitions.

RESULTS

For all-cause mortality, the hazard ratio (HR) of C + S + M + G was 15.062, which was substantially higher than the conventional definition S + M + G (HR = 6.433). Other CC-added definitions such as C + M (HR = 2.260), C + G (HR = 4.978), C + S + M (HR = 5.761) also revealed higher HR than their without-CC counterparts. Similar patterns were observed in CV mortality, for instance, HR of C + S + M + G was 31.812 comparing to the conventional definition S + M + G (HR = 18.434). Concerning accuracy in predicting mortality, the area under the curve (AUC) of CC + S + G + M (AUC = 0.702) and C + S + G (AUC = 0.708) were higher than the conventional definition S + G + M (AUC = 0.697). A significant correlation was found between CC and each of the three conventional components of sarcopenia.

CONCLUSIONS

CC-added definitions of sarcopenia correlated with higher all-cause and CV mortality risks. CC is potentially a simple but valuable screening tool for sarcopenia that could improve diagnostic accuracy when used with other parameters.

Calf Circumference and All-Cause Mortality: A Systematic Review and Meta-Analysis Based on Trend Estimation Approaches

OBJECTIVES

To perform a systematic review and meta-analysis and quantify the associations of total mortality with calf circumference (CC) in adults 18 years and older via combining various analyses based on empirical dichotomic CC, continuous CC, and dose-response CC.

METHODS

We conducted a systematic search of relevant studies in PubMed, EMBASE, Cochrane Library, and Web of Science published through April 12, 2022. This systematic review includes longitudinal observational studies reporting the relationships of total mortality with CC. We calculated the pooled relative risk (RR) and 95% confidence interval (CI) of total mortality with CC per 1 cm for each study and combined the values using standard meta-analysis approaches. Newcastle-Ottawa scale (NOS), Grading of Recommendations, Assessment, Development and Evaluations approach (GRADE), and the Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN) were assessed for meta-analyses.

RESULTS

Our analysis included a total of 37 cohort studies involving 62,736 participants, across which moderate heterogeneity was observed (I2=75.7%, P<0.001), but no publication bias was found. Study quality scores ranged from 6 to 9 (mean 7.7), with only three studies awarded a score of 6 (fair quality). We observed an inverse trend between total death risk and CC per 1 cm increase (RR, 0.95, 95% CI, 0.94-0.96; P<0.001; GRADE quality=high). Only a very slight difference was found among residents of nursing homes (6.9% mortality risk reduction per one cm CC increase), community-dwellers (5.4%), and those living in hospitals (4.8%), respectively (P for meta-regression=0.617). Low credible subgroup difference was found based on the ICEMAN tool.

CONCLUSIONS

Calf circumference is a valid anthropometric measure for mortality risk prediction in a community, nursing home, or hospital.

COVID-19 related mortality in older adults: analysis of the first wave in Colombia and Mexico

OBJECTIVE

The aim of this study is to describe the mortality among older adults in the first wave of COVID-19 in Colombia and Mexico.

METHODS

This is an observational, prospective study on data obtained from open data sets that are publicly available on the websites of the health ministries of the respective countries. COVID-19 cases, age, sex, date to mortality, and mortality itself were analyzed with Kaplan-Meier curves and Cox regressions.

RESULTS

Data on 1 779 877 individuals were analyzed, 58.2% from Mexico, with a higher frequency of men for both countries, and 11.7% were older adults. Survival curves show a continuous increase in mortality for Mexico, with higher rates for older adults, while for Colombia the mortality was observed up to 50 days of the follow-up. Finally, hazard ratios were higher for older adults in both countries. Colombia implemented a rigid curfew for older adults, and the effect on mortality is clear from the survival curves.

CONCLUSIONS

This finding shows the potential benefit that public policies could have on older adults.

Anthropometry as a readily accessible health assessment of older adults

Anthropometry (derived from the Greek Anthropos: human, and metron: measure) refers to the systematic collection, and measurement of the physical characteristics of the human body, primarily body weight, body size, and shape. Anthropometric values are closely related to genetic factors, environmental characteristics, social, and cultural conditions, lifestyle, functional status, and health. Anthropometric measurements can be used to assess risk of malnutrition, obesity, muscle wasting, increased fat mass, and maldistribution of adipose tissue. Potential modifiable factors include circumferences, skinfolds, and body weight. While are height, and the bone diameters are non-modifiable. Kinanthropometry is the study of size, shape, proportionality, composition, biological maturation, and body function, in order to understand the process of growth, exercise, sports performance, and nutrition. Aging of the population, which is associated with increased risk of chronic disease, and disability, is one of the most important demographic changes facing many countries. Anthropometric indicators are simple, portable, non-invasive, inexpensive, and easily applied measurements that can be readily applied in geriatric populations to guide preventative measures, and medical interventions in older adults.

Calf circumference positively correlates with calf muscle thickness and negatively correlates with calf subcutaneous fat thickness and percent body fat in non-obese healthy young adults

BACKGROUND

Calf circumference is measured for assessing sarcopenia, nutrition status, percent body fat or obesity. However, there has been no study that investigated the relationship between calf circumference and calf subcutaneous fat tissue thickness. Therefore, the purpose of this study was to investigate the relationship between calf circumference, calf muscle thickness, and calf subcutaneous fat tissue thickness in nonobese healthy young adults.

METHODS

The study participants were non-obese 22 women (20.1 ± 0.8 years) and 21 men (20.0 ± 0.8 years). The right calf circumference was measured in prone position at the point where the circumference was maximal by visual recognition using a measuring tape. Then, thickness of calf subcutaneous fat tissue and calf muscles were measured with an ultrasonic diagnostic equipment.

RESULTS

There was a positive relationship between calf circumference and calf muscle thickness both in women (r = 0.58, P < 0.01) and men (r = 0.46, P < 0.05), negative relathionship between calf circumference and calf subcutaneous fat tissue thickness both in women (r = -0.43, P < 0.05) and men (r = -0.67, P < 0.001), no correlation between calf circumference and percent body fat both in women (r = 0.04, P = 0.87) and men (r = 0.41, P = 0.06), and a negative relationship between calf subcutaneous fat tissue thickness and percent body fat both in women (r = -0.48, P < 0.05) and men (r = -0.46, P < 0.05).

CONCLUSIONS

Our present study showed that a larger calf indicated larger calf muscle thickness, and largely different from previous studies, a lower calf subcutaneous fat tissue thickness. That is because when the calf circumference increases, calf subcutaneous fat tissue thickness should be thinner to keep the percent body fat equal in non-obese healthy young adults. The finding will help to get a better understanding of the nature of the calf.

Normalizing calf circumference to identify low skeletal muscle mass in older women: a cross-sectional study

Introduction

Introduction: functional limitation is a result of sarcopenia and is associated with loss of skeletal muscle mass (SMM). Cost-effective methods are important for the identification of sarcopenia. Objective: to propose cutoff points for normalized calf circumference (CC) in order to identify low SMM in older women based on their functional limitation. Methods: in this descriptive, cross-sectional study the CC values of a young female sample (n = 78) were used to establish cutoff points (-2 SD) for low SMM in older women (n = 67). Functional limitation was identified by the six-minute walk test (≤ 400 m). CC was normalized by body mass, height, and BMI. The diagnostic accuracy of CC was calculated with a ROC curve, using functional limitation as standard. Results: cutoff points and area under the curve (AUC) were: CC (≤ 28.5; 0.62); CC·body mass-1 (≤ 0.40; 0.63); CC·height-2 (≤ 8.52; 0.55) and CC·BMI-1 (≤ 1.10; 0.73). Only CC·BMI-1 achieved a desirable accuracy (AUC > 0.7) to distinguish functional limitation. Conclusion: the accuracy attained supports the use of CC·BMI-1 to identify low SMM in older women. In the clinical context it is possible to predict the risk of sarcopenia when sophisticated methods for determining SMM are not available.

Patients with hip fracture and total hip arthroplasty surgery differ in anthropometric, but not cardiovascular screening abnormalities

Background

With the rising number of hip surgeries, simple and cost-effective tools for surgery risk assessment are warranted. The analysis of heart rate variability (HRV) may not only provide critical insights into the general frailty of patients with hip surgery, but also allow for better differentiation of health profiles in different hip surgery groups. Using HRV analysis, the present study compared cardiovascular as well as anthropometric parameters between patients with hip surgery, the hip fracture surgery group (HFS) and the total hip arthroplasty group (THA), and a control group.

Methods

71 participants (56.3% women), aged 60–85 years, took part, divided into three groups—patients after hip surgery (21 HFS and 30 THA patients) and a control group (20 participants). Electrocardiogram was recorded at baseline and after the application of a physical stressor (grip strength). A 3 (group) × 2 (time) repeated measures ANOVA, and a chi square test were carried out to test for group differences.

Results

Higher weight (p = .002), body mass index (p = .001), and systolic blood pressure (p = .034) were found in THA patients compared to HFS patients. Lower calf circumference (p = .009) and diastolic blood pressure (p = .048) were observed for the HFS group compared to the control group. For cardiovascular parameters, significant differences emerged between the HFS group and the control group in HR (p = .005), SDNN (p = .034) and SD2 (p = .012). No significant differences in cardiovascular parameters were observed between the two hip surgery groups: neither at baseline nor during stressor recovery.

Conclusions

While HRV seems to differentiate well between HFS patients and controls, more research with larger samples is needed to scrutinize similaritites and differences in cardiovascular profiles between HFS and THA patients.

Girth, strength, and flexibility of the calf muscle in patients with knee osteoarthritis: A case-control study

Objectives

Reduced strength and girth in thigh muscles such as the quadriceps and the hamstrings have been observed in patients with knee osteoarthritis (OA). However, studies on the characteristics of calf muscles in these patients are lacking. This study aimed to evaluate the girth, strength, and flexibility of the calf muscle of patients with knee OA.

Methods

In this case–control study, we recruited 15 patients with knee OA and 15 healthy control participants. The girth, strength, and flexibility of the calf muscle were evaluated in one session using a flexible non-elastic tape measure (centimetre), a handheld dynamometer (Newton), and a standard goniometer (degree) to measure ankle dorsiflexion.

Results

Strength of the calf muscle strength was significantly lower in the patients with knee OA comapred with the control group (−42.03; 95% CI: −73.9, −10.1; p = .012). No significant differences in calf muscle girth (.27; 95% CI: −2.63, 3.16; p = .852) or flexibility (−1.93; 95% CI: −4.8, .93; p = .177) were found between the two groups.

Conclusion

In our study, patients with knee OA demonstrated reduced calf muscle strength. We recommend that the management of patients with knee OA include strengthening the calf muscles.

•

Patients with knee OA did not have reduced girth or flexibility in the calf muscle.

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Patients with knee OA may demonstrate weakness in the calf muscle.

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Calf muscle strength should be included in the management of patients with knee OA.

Relationship between muscle thickness and calf circumference in healthy older women

BACKGROUND/OBJECTIVES

Calf circumference (CC) is an indirect method used to evaluate muscle mass in older adults. Ultrasound has also been studied as a method for measuring muscle mass. Therefore, the aim of the present study was to correlate CC and muscle thickness of the medial gastrocnemius muscle (MGM) in healthy older women.

METHODS

A cross-sectional study was conducted with 74 healthy older women. The MGM thickness was evaluated using an ultrasound device (Logiq Book XP, General Electric®). The reference value for adequate CC was ≥ 31 cm. Weight and height were measured for the calculation of the body mass index (BMI), which was dichotomized as with or without excess weight based on the cutoff points recommended by the World Health Organization (1995); Lipschitz (1994) and the Pan-American Health Organization (2001).

RESULTS

All participants were ≥ 64 years of age. Mean weight and height were 66.19 kg (SD: 10.48) and 1.55 m (SD: 0.06), respectively. Half of the participants had a BMI higher than 27.53 kg/m². Moderate positive correlations were found between CC and MGM thickness (ρ = 0.432; p < 0.001), MGM thickness and weight (r = 0.422; p < 0.001) and between MGM thickness and BMI (r = 0.438; p < 0.001). However, the correlation between CC and MGM thickness was non-significant among the women with excess weight.

CONCLUSIONS

A moderate positive correlation between MGM thickness and CC was found in healthy older women. However, this correlation was weak and non-significant among those with excess weight.

Prognostic value of a rapid sarcopenia measure in acutely ill older adults

BACKGROUND

Current recommendations to assess sarcopenia requiring specialized equipment hinder its use as a prognostic tool in busy acute settings.

AIMS

To investigate the prognostic value of a rapid sarcopenia measure in acutely ill older outpatients for 1-year adverse outcomes.

METHODS

Prospective study with 665 acutely ill older adults (mean age 78.7 ± 8.3 years; 63% women) in need of intensive management to avoid hospital admission. Sarcopenia was screened upon admission, defined as the presence of both low muscle strength and low muscle mass. Low muscle strength was determined by handgrip strength according to the cutoffs of the Foundation for the National Institutes of Health (<16 kg for women and <26 kg for men). Low muscle mass was assessed by calf circumference, a validated surrogate measure of skeletal muscle mass, using previously established thresholds (≤33 cm for women and ≤34 cm for men). Outcomes were time to hospitalization, new dependence in basic activities of daily living (ADL), worsening walking ability, and death. To investigate the association of sarcopenia and its components with outcomes we used hazard models, considering death as a competing risk, adjusted for sociodemographic factors, Charlson comorbidity index, cognitive impairment, depressive symptoms, and weight loss.

RESULTS

On admission, 203 (31%) patients had sarcopenia. Comparing 1-year adverse outcomes between older adults with and without sarcopenia, respectively, cumulative incidences for hospitalization were 46% vs 32% (adjusted sub-hazard ratio [sHR] = 1.53; 95% CI = 1.16-2.04), for new ADL dependence, 47% vs 24% (adjusted sHR = 1.78; 95% CI = 1.31-2.42), for worsening walking ability, 28% vs 13% (adjusted sHR = 1.93; 95% CI = 1.28-2.90), and for death, 22% vs 10% (adjusted HR = 1.69; 95% CI = 1.05-2.73). Low muscle strength alone was associated with all outcomes, and low muscle mass was associated with all outcomes except mortality.

CONCLUSION

Sarcopenia was a strong predictor of 1-year adverse outcomes among acutely ill older outpatients. Combining handgrip strength with calf circumference may be a practical and efficient approach to screen for sarcopenia, and thereby identify high-risk older adults in busy clinical settings.

Estimation of appendicular skeletal muscle: Development and validation of anthropometric prediction equations in Chinese patients with knee osteoarthritis

OBJECTIVE

To develop anthropometric prediction equations for estimating appendicular skeletal muscle (ASM) in Chinese knee osteoarthritis patients.

METHODS

Subjects were divided into the model development group (MD group: 104 cases, 47 men and 57 women) and cross-validation group (CV group: 69 cases, 38 men and 31 women). Stepwise multiple linear regression analyses were undertaken in the MD group to identify the best equations. Agreement between the estimated ASM and ASM measured by dual-energy X-ray absorptiometry (DXA) was tested in the CV group.

RESULTS

Two models were developed in the MD group. Validation in the CV group showed that our models (R²  = 0.83 and R²  = 0.90) had a high coefficient of determination. The mean bias of ASM estimated by the two models from the ASM measured by DXA in the CV group showed no significant difference (P > 0.05).

CONCLUSION

These models could be useful for older Chinese patients with knee osteoarthritis to estimate ASM.

Calf circumference: clinical validation for evaluation of muscle mass in the elderly

OBJECTIVE

To validate calf circumference as a technology for assessing muscle mass in the elderly.

METHOD

Cross-sectional study with 132 elderly people from Goiânia, Goiás, Brazil. Decreased muscle mass was determined by the skeletal muscle mass index (IME) using Dual Energy X-Ray Absortometry (DEXA). The cutoff circumferences (CC) cutoff points to indicate muscle mass decrease were estimated by ROC curve, sensitivity, specificity and accuracy.

RESULTS

The most accurate cut-off points for detecting decreased muscle mass in the elderly were 34 cm for men (sensitivity: 71.5%, specificity: 77.4%) and 33 cm for women (sensitivity: 80.0%; specificity: 84.6%).

CONCLUSION

CC can be used as a measure for early identification of muscle mass decrease in routine evaluations of the elderly in primary care.

Large calf circumference indicates non-sarcopenia despite body mass

[Purpose] The purpose of this study is to evaluate the applicability of the calf circumference as a tool for screening sarcopenia. [Subjects and Methods] One hundred sixteen community-dwelling elderly females were enrolled. Calf circumference of the dominant leg was measured using a plastic measuring tape. Subjects were divided into 3 groups based on body mass index (BMI); subjects with the values for BMI <18.5 kg/m²; those with BMI 18.5 to 25.0; those with BMI ≥25.0 kg/m². Positive predictive value and negative predictive value of sarcopenia were calculated based on the obtained cut off values of calf circumference and the diagnosis of sarcopenia in each group. [Results] Prevalence rate of sarcopenia was 9.4% (n=10). Cut off value of the calf circumference was 32.8 cm (sensitivity: 73.0%, specificity: 80.0%, AUC: 0.792). Each BMI group showed high negative predictive value of sarcopenia based on the calf circumference cut off value of 32.8 cm. [Conclusion] These results suggested that to identify non-sarcopenia by larger calf circumference is more reasonable and useful than to identify sarcopenia due to the smaller calf circumference regardless of BMI.