Validating the SARC-F: A Suitable Community Screening Tool for Sarcopenia?

Development of a Screening Tool for Oral Frailty in Community-Dwelling Older Adults: A Cross-Sectional Study

OBJECTIVES

To develop a Screening for Oral Frailty Tool (SOFT) and evaluate its reliability and validity among Chinese community-dwelling older adults.

DESIGN

Cross-sectional analysis.

SETTING AND PARTICIPANTS

The study was conducted as part of an ongoing community-based prospective study in Shanghai. A total of 307 older adults, aged between 60 and 96 years, participated in the study.

METHODS

This study was conducted in 3 stages: item development, scale development, and scale evaluation. This study was based on a visual model depicting the deterioration of oral function, and a draft scale was generated based on a literature review, existing scales, expert consultations, and cognitive interviews. Between December 2023 and February 2024, the validity and reliability of the SOFT were evaluated using a questionnaire administered to 307 community-dwelling older adults. Data including demographics, frailty, and sarcopenia were collected.

RESULTS

The oral frailty scale comprises 6 items, including number of teeth, difficulty in swallowing, difficulty in chewing, difficulty in articulatory oral motor, dry mouth, and oral pain, and is assessed using a yes or no question. The correlations ranged from 0.40 to 0.66 when correlating each item with the total score of the scale. Using frailty and sarcopenia as criteria, the area under the curve for the SOFT was 0.71. The optimal cutoff for the SOFT was 2, using frailty as a criterion, with a higher Youden index and a high negative predictive value (94.9%), but a low positive predictive value (19.3%). The SOFT showed low internal consistency (Kuder-Richardson formula 20 coefficients 0.50) and good test-retest reliability (intraclass correlation coefficients 0.86).

CONCLUSIONS AND IMPLICATIONS

The SOFT does not require specialized equipment and is not affected by cultural differences. It can be used for oral frailty screening in Chinese community-dwelling older adults and is simple and rapid.

Implant-related and medical complications in patients with sarcopenia undergoing total shoulder arthroplasty: A retrospective matched-cohort analysis

Background

In the continually aging United States population, the number of patients with sarcopenia who undergo shoulder arthroplasty may concomitantly increase. This retrospective cohort study aims to evaluate the rates of short-term implant-related and medical complications following shoulder arthroplasty in patients with and without a recent diagnosis of sarcopenia.

Methods

An exact 1:3 matched analysis of 4177 patients was performed using the PearlDiver database. Multivariable logistic regression was used to compare complications, Kaplan-Meier failure analysis was used to compare the cumulative hospital readmission rates. Two-sample T-testing was used to compare the 90-day cost of care.

Results

Sarcopenic patients were significantly more likely to experience postoperative shoulder instability (odds ratio (OR) = 2.32, 95% confidence interval (CI), 1.21-4.39) and periprosthetic infection (OR = 3.83, 95% CI, 1.74-8.67) within 1 year of their arthroplasty. Sarcopenic patients were at 25% and 41% greater risk of emergency department presentation and hospital readmission 1-year post-arthroplasty, respectively. Ninty-day total costs were greater among sarcopenics ($16 112.23 vs. 10 679.58, p < 0.001).

Conclusion

These results are important for orthopaedic surgeons counselling patients with a low muscle mass on the potential for increased complications after undergoing a total shoulder arthroplasty procedure.

Exploring the role of body mass index-adjusted calf circumference within the SARC-CalF screening tool among older patients with cancer

OBJECTIVES

This study aimed to assess and compare the frequency of positive scores using unadjusted SARC-CalF with the scores derived from SARC-CalF after adjusting calf circumference (CC) for body mass index (BMI). The secondary aim was to assess the prognostic value of SARC-CalF after BMI adjustment, for length of hospital stay (LOS) and mortality.

DESIGN, SETTING, AND PARTICIPANTS

This secondary analysis of a prospective cohort study, included both outpatients and inpatients of an oncology unit hospital in Brazil.

MEASUREMENTS

BMI and CC were measured. Patients with excess weight had their CC adjusted for BMI by subtracting 3 cm, 7 cm, and 12 cm from the unadjusted CC values for respective BMI categories. SARC-CalF was used to screen for sarcopenia. Scores ≥11 were indicative of sarcopenia, considering both unadjusted and BMI-adjusted CC values. Clinical outcomes included prolonged LOS and both short- and long-term mortality.

RESULTS

Our study included 206 subjects, with a median age of 69 years, and the majority were males (52.1%). The prevalence of low CC increased from 65% to 84% after BMI adjustment. Positive unadjusted SARC-CalF scores (≥11) were observed in 51% of the population and this prevalence increased to 65% using BMI-adjusted SARC-CalF criteria (≥11). Higher scores on BMI-adjusted SARC-CalF but not unadjusted SARC-CalF were independently associated with prolonged LOS [adjusted HR: 1.26 (1.03-1.53)], and 6-month mortality [adjusted HR: 1.42 (1.07-1.87)]. Both unadjusted and BMI-adjusted SARC-CalF were independently associated with 12-month mortality.

CONCLUSION

BMI-adjusted SARC-CalF may be a promising strategy to enhance the detection of older patients with cancer and excess weight at risk of sarcopenia, and it may serve a dual role as a prognostic tool, as it was independently associated with prolonged LOS and mortality.

The 10-Item Physical Function Scale as a Sarcopenia Screening Tool for Patients on Hemodialysis

OBJECTIVE

We investigated the accuracy of the 10-item Physical Function (PF-10) questions of the SF-36 quality of life questionnaire as a sarcopenia screening tool among patients on hemodialysis.

METHODS

A cross-sectional, multicenter study that included adult patients on hemodialysis. The revised European Working Group on Sarcopenia in Older People was used to diagnose sarcopenia. The 10 questions about daily activities from the SF-36 quality of life questionnaire were used to appoint the PF-10, where the final score could range from 10 to 30, and the lower the worse the physical function. The PF-10 accuracy to identify confirmed sarcopenia (low muscle strength + low muscle mass) was assessed through a receiver operating characteristic curve and the cutoff was calculated using the Youden index.

RESULTS

One hundred eighty-five patients were included (median 59 years; 45% female). Prevalence of confirmed sarcopenia was 31.4%. The median PF-10 score was 23 (interquartile range: 17-27) and a significant association with all sarcopenia measurements was found (all P < .05). The best cutoff calculated from the receiver operating characteristic curve was ≤26 points (area under the curve = 0.69, 95% confidence interval 0.61-0.77) with sensitivity and specificity of 96.6% and 71.0%, respectively. Moreover, patients with ≤26 points (n = 133, 72%) had a higher prevalence of low muscle strength by handgrip (53 vs. 19%; P < .001) and 5-time sit-to-stand (41 vs. 10%; P < .001), low gait speed (44 vs. 19%; P = .002), confirmed sarcopenia (39 vs. 11%; P < .001), and severe sarcopenia (26 vs. 4%; P = .001), but not low muscle mass (49 vs. 35%; P = .08), in comparison with those >26 points (n = 52, 28%).

CONCLUSION

The PF-10 may be a useful physical dysfunction and sarcopenia screening tool in patients on hemodialysis. A PF-10 threshold of around 26 points appeared to display the fairest accuracy for diagnosing sarcopenia.

Prevalence and clinical characteristics of Sarcopenia in older adult patients with stable chronic obstructive pulmonary disease: a cross-sectional and follow-up study

BACKGROUND

The relationship between sarcopenia and chronic obstructive pulmonary disease (COPD) has been increasingly reported, and there is some overlap regarding their clinical features and pulmonary rehabilitation (PR) strategies. No Korean study has reported the actual prevalence of sarcopenia in patients with stable COPD who are recommended for pulmonary rehabilitation. This study evaluated the prevalence and clinical features of sarcopenia in older adult outpatients with stable COPD and the changes after 6 months.

METHODS

In this cross-sectional and 6-month follow-up study, we recruited 63 males aged ≥ 65 diagnosed with stable COPD. Sarcopenia was diagnosed using the AWGS 2019 criteria, which included hand grip strength testing, bioelectrical impedance analysis, Short Physical Performance Battery administration, and Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falling screening tool administration. A 6-minute walk test (6 MWT) was conducted, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), maximal inspiratory and expiratory pressures (MIP and MEP, respectively) and peak expiratory flow (PEF) were assessed, and patient-reported questionnaires were administered.

RESULTS

At baseline, 14 (22%) patients were diagnosed with possible sarcopenia, and eight (12.6%) were diagnosed with sarcopenia. There were significant differences in the age; body mass index; Body mass index, airflow Obstruction, Dyspnea, and Exercise index; modified Medical Research Council dyspnea scores; and International Physical Activity Questionnaire scores between the normal and sarcopenia groups. Whole-body phase angle, MIP, MEP, PEF, and 6-minute walk distance (6 MWD) also showed significant differences. Over 6 months, the proportion of patients with a reduced FEV1 increased; however, the proportion of patients with sarcopenia did not increase.

CONCLUSION

A relatively low prevalence of sarcopenia was observed in older adult outpatients with stable COPD. No significant change in the prevalence of sarcopenia was found during the 6-month follow-up period.

TRIAL REGISTRATION

The study was registered with the Clinical Research Information Service (KCT0006720). Registration date: 30/07/2021.

Definition and evolution of the concept of sarcopenia

Sarcopenia and dynapenia are two terms associated with ageing that respectively define the loss of muscle mass and strength. In 2018, the European Working Group on Sarcopenia in Older People (EWGSOP) introduced the EWGSOP2 diagnostic algorithm for sarcopenia, which integrates both concepts. It consists of 4 sequential steps: screening for sarcopenia, examination of muscle strength, assessment of muscle mass and physical performance; depending on these last 3 aspects sarcopenia is categorised as probable, confirmed, and severe respectively. In the absence of validation of the EWGSOP2 algorithm in various clinical contexts, its use in haemodialysis poses several limitations: (a) low sensitivity of the screening, (b) the techniques that assess muscle mass are not very accessible, reliable, or safe in routine clinical care, (c) the sequential use of the magnitudes that assess dynapenia and muscle mass do not seem to adequately reflect the muscular pathology of the elderly person on dialysis. We reflect on the definition of sarcopenia and the use of more precise terms such as "myopenia" (replacing the classic concept of sarcopenia to designate loss of muscle mass), dynapenia and kratopenia. Prospective evaluation of EWGSOP2 and its comparison with alternatives (i.e. assessment of kratopenia and dynapenia only; steps 2 and 4) is proposed in terms of its applicability in clinical routine, resource consumption, identification of at-risk individuals and impact on events.

SARC-F Score: A Quick Bedside Tool to Screen Sarcopenia in Patients With Cirrhosis

Background

Sarcopenia is often ignored in clinical practice despite being an important prognostic marker. SARC-F is a simple bedside score to assess muscle abnormalities in cirrhosis patients. However, there is limited Indian data on the validity of this score. Hence, we aimed to assess the validity of SARC-F score in a tertiary care center.

Methods

A prospective observational study including consecutive 100 cirrhosis patients attending the gastroenterology outpatient department in Osmania Medical College and Hospital, Hyderabad, India, was conducted from Jan 2018 to Dec 2019. The primary aim was to assess the mean muscle volume loss (MVL) by computed tomography and handgrip (HG) strength for muscle strength decline (MSD) and compare the SARC-F score with standard cut-off values.

Results

We included 100 cirrhosis patients (mean age: 45 years; males: 86%; child-pugh class B/C: 42/58). Sixty-nine percent of the patients had a SARC-F score of ≥4, whereas MVL and MSD were noted in 62% and 86% patients, respectively. Mid-arm circumference, skin-fold thickness, mid-arm muscle circumference (MAMC), and HG strength were significantly lower in patients with SARC-F score ≥4 than in those with SARC-F score <4 (P < 0.05). The Pearson correlation plot suggested a significant inverse correlation between the SARC-F score and MSD and SARC-F score and MVL. A SARC-F score of ≥4 had a sensitivity and specificity of 80.7% and 50% for MVL and 75.6% and 71.4% for MSD, respectively, whereas it was 83.3% and 52.5% for MSD and MVL combined, respectively. Area under the receiver operating characteristic curve for SARC-F as a predictor of MVL was 0.75 (95% confidence interval: 0.64-0.82; P=<0.001). On multivariate analysis, a high SARC-F score and low MAMC were predictive of MVL in cirrhosis patients.

Conclusion

SARC-F score has good sensitivity as a bedside screening tool for sarcopenia in patients with cirrhosis. A high SARC-F score and low MAMC indicates the presence of MVL and warrants further evaluation for sarcopenia.

Sarcopenia in peripheral arterial disease: Establishing and validating a predictive nomogram based on clinical and computed tomography angiography indicators

Purpose

To establish, validate, and clinically evaluate a nomogram for predicting the risk of sarcopenia in patients with peripheral arterial disease (PAD) based on clinical and lower extremity computed tomography angiography (LE-CTA) imaging characteristics.

Methods

Clinical data and CTA imaging features from 281 PAD patients treated between January 1, 2019, and May 1, 2023, at two hospitals were retrospectively analyzed using binary logistic regression to identify the independent risk factors for sarcopenia. These identified risk factors were used to develop a predictive nomogram. The nomogram's effectiveness was assessed through various metrics, including the receiver operating characteristic (ROC) curve, area under the curve (AUC), concordance index (C-index), Hosmer-Lemeshow (HL) test, and calibration curve. Its clinical utility was demonstrated using decision curve analysis (DCA).

Results

Several key independent risk factors for sarcopenia in PAD patients were identified, namely age, body mass index (BMI), history of coronary heart disease (CHD), and white blood cell (WBC) count, as well as the severity of luminal stenosis (P < 0.05). The discriminative ability of the nomogram was supported by the C-index and an AUC of 0.810 (95% confidence interval: 0.757-0.862). A robust concordance between predicted and observed outcomes was reflected by the calibration curve. The HL test further affirmed the model's calibration with a P-value of 0.40. The DCA curve validated the nomogram's favorable clinical utility. Lastly, the model underwent internal validation.

Conclusions

A simple nomogram based on five independent factors, namely age, BMI, history of CHD, WBC count, and the severity of luminal stenosis, was developed to assist clinicians in estimating sarcopenia risk among PAD patients. This tool boasts impressive predictive capabilities and broad utility, significantly aiding clinicians in identifying high-risk individuals and enhancing the prognosis of PAD patients.

Sarcopenia assessed using a questionnaire can predict in-hospital mortality in older patients with pulmonary tuberculosis

BACKGROUND & AIMS

Pulmonary tuberculosis is a severe disease with a high mortality rate. However, whether sarcopenia is a risk factor for in-hospital mortality remains unclear. The SARC-F (five items: strength, assistance in walking, rising from a chair, climbing stairs, and falls) is a questionnaire developed to screen for sarcopenia. This study aimed to determine whether the high risk of sarcopenia, assessed using the SARC-F questionnaire, affects in-hospital mortality in older patients with pulmonary tuberculosis.

METHODS

This was a retrospective, observational study. We included patients with active pulmonary tuberculosis aged ≥65 years who required inpatient treatment between 30 April 2021 and 30 November 2022. We assessed sarcopenia using SARC-F, and SARC-F ≥ 4 points at admission was defined as a high risk of sarcopenia. The primary outcome was all-cause mortality during hospitalisation. We extracted information on age, sex, body mass index, comorbidities, blood and biochemical tests, modified Glasgow Prognostic Score, calf circumference, geriatric nutritional risk index, physiotherapy, and length of hospital stay from medical records.

RESULTS

We included 147 patients (mean age: 83.0 ± 7.8 years; males: 61.9%). Ninety-three (63.3%) patients had a high risk of developing sarcopenia. Patients with a high risk of sarcopenia were significantly older (mean: 85.0 ± 7.1 years), had a lower body mass index (median: 18.1 kg/m2, range: 16.1-20.5 kg/m2), had a higher modified Glasgow Prognostic Score (median: 2, range: 2-2), and had a lower calf circumference (mean: 26.8 ± 3.6 cm), had a lower geriatric nutritional risk index (mean: 72.2 ± 12.9) than those without high-risk sarcopenia. More patients with a high risk of sarcopenia underwent physiotherapy (93.5%) than those without high-risk sarcopenia (P < 0.01, all). Kaplan-Meier survival curves showed that patients with a high risk of sarcopenia had significantly lower overall survival than those without high-risk sarcopenia (log-rank test, P = 0.001). Logistic regression analysis for in-hospital mortality showed that a high risk of sarcopenia significantly affected in-hospital mortality (odds ratio [OR]: 6.425, 95% confidence interval [CI]: 1.399-47.299). In addition, logistic regression analysis for each item of SARC-F showed that assistance in walking (OR: 3.931, 95% CI: 1.816-9.617) and rising from a chair (OR: 2.458, 95% CI: 1.235-5.330) significantly affected in-hospital mortality.

CONCLUSION

A high risk of sarcopenia, as assessed using SARC-F at admission, was a risk factor for in-hospital mortality in older patients with pulmonary tuberculosis. Among the SARC-F items, assistance in walking and rising from a chair were the risk factors for in-hospital mortality.

Stroke related sarcopenia in individuals with different physical activity levels: A cross-sectional study

BACKGROUND AND OBJECTIVE

Individuals after stroke are likely to deal with the possible development of sarcopenia and reduced physical activity levels. The purpose of this study was to compare sarcopenia of individuals with chronic stroke who were stratified according to their physical activity levels, and to evaluate the relationship between sarcopenia and physical activity levels.

MATERIALS AND METHODS

This cross-sectional study was conducted with individuals after chronic stroke recruited from the general community. Individuals were submitted to sarcopenia screening (SARC-F questionnaire) and assessment of physical activity levels (Human Activity Profile questionnaire) to classify the individuals as impaired, moderately active, and active according to their Adjusted Activity Status (AAS). ANOVA was used to investigate the sarcopenia between groups and Pearson's coefficient to investigate the association among variables.

RESULTS

Fifty-four individuals with a mean age of 56 ± 17.4 years were included. Twenty-one percent of the individuals were screened for sarcopenia. Inactive individuals had higher mean scores in the SARC-F (3.6 ± 2.1 points), whereas moderately active and active individuals presented lower mean scores in the same questionnaire, being 1.2 ± 1.1 points and 0.5 ± 0.7 points, respectively. A statistically significant inverse and high association was found between sarcopenia and physical activity levels (r = -0.716; p < 0.01).

CONCLUSION

Sarcopenia was found to be higher in individuals after chronic stroke with lower physical activity levels considered inactive when compared to individuals with higher physical activity levels. Furthermore, there was an inverse relationship between sarcopenia and physical activity level in stroke survivors.

Risk of sarcopenia and mobility of older adults during the COVID-19 pandemic: the longitudinal data from the REMOBILIZE study

BACKGROUND

We assessed whether clinical, functional and behavioral factors were associated with the decrease in mobility trajectories reported in older people at risk of sarcopenia (RS) and without risk of sarcopenia (NRS) during COVID-19 pandemic.

METHODS

We prospectively analyzed mobility trajectories reported in older adults with RS and NRS over 16-month follow-up (Remobilize study). The self-perceived risk of sarcopenia and mobility were assessed using the SARC-F and the Life-Space Assessment (LSA) tools, respectively. Gender, age, comorbidities, pain, functional limitation, physical activity (time spent in walking; min/week), and sitting time (ST; hours/day) were assessed. We used a multilevel model to determine changes in mobility between groups and over time.

RESULTS

Mobility was lower in RS than in NRS. Older people at RS, who were women, aged 70-79 years and 80 years or older, inactive, and with moderate to severe functional limitation experienced reduced mobility trajectories reported over the pandemic. For older people at NRS, trajectories with reduce mobility reported were experienced by women with comorbidities, for those with insufficient walking time and aged 70-79 years; aged 70-79 years and with ST between 5 and 7 hours/day; for those with insufficient walking time and increased ST; and for those with pain and increased ST.

CONCLUSION

Mobility trajectories reported in older people at risk of sarcopenia were negatively influenced by insufficient level of physical inactivity and pre-existing moderate to severe functional limitation. Health and social interventions should be target to avoid mobility limitation during and after the COVID-19 pandemic.

Comparison of six screening methods for sarcopenia among rural community-dwelling older adults: a diagnostic accuracy study

OBJECTIVE

The objective of this analysis was to determine the diagnostic efficacy of the Ishii test, SarSA-Mod, SARC-F, SARC-Calf, SARC-F+AC, and SARC-Calf+AC for screening for sarcopenia among rural community-dwelling older adults.

METHODS

The AWGS 2019 diagnostic criteria was a diagnostic reference for sarcopenia. There were six screening tools whose accuracy was determined through the use of metrics, including specificity, sensitivity, negative and positive predictive values, and the receiver operating characteristic (ROC) curve.

RESULTS

The study included 551 participants (304 women, age 70.9 ± 4.9 years). The prevalence of sarcopenia was 44.5% in men and 39.1% in women. In males, the sensitivity/specificity of the Ishii test, SarSA-Mod, SARC-F, SARC-Calf, SARC-F+AC, and SARC-Calf+AC screening sarcopenia were 87.3%/65.7%, 98.2%/21.9%, 6.4%/98.5%, 28.2%/91.2%, 33.6%/83.9%, and 84.6%/43.8%, and in females, they were 68.1%/82.2, 100%/23.2%, 16.0%/90.3%, 35.3%/84.3%, 58.8%/61.1%, and 89.9%/42.2%, respectively. In males, the area under the curves of the Ishii test, SarSA-Mod, SARC-F, SARC-Calf, SARC-F+AC, and SARC-Calf+AC were 0.846 (95% CI 0.795-0.889), 0.800 (95% CI 0.745-0.848), 0.581 (95% CI 0.516-0.643), 0.706 (95% CI 0.645-0.762), 0.612 (95% CI 0.548-0.673), and 0.707 (95% CI 0.646-0.763), respectively, and in females, they were 0.824 (95% CI 0.776-0.865), 0.845 (95% CI 0.799-0.883), 0.581 (95% CI 0.524-0.637), 0.720 (95% CI 0.666-0.770), 0.632 (95% CI 0.575-0.686), and 0.715 (95% CI 0.661-0.765), respectively.

CONCLUSION

Our findings demonstrate that the overall accuracy of the Ishii test was best among the six screening tools for sarcopenia screening in rural community-dwelling older adults.

Case-Finding for Sarcopenia in Community-Dwelling Older Adults: Comparison of Mini Sarcopenia Risk Assessment with SARC-F and SARC-CalF

BACKGROUND

We compared the diagnostic performance of the short five-item and full seven-item Mini Sarcopenia Risk Assessment Questionnaire (MSRA-5 and MSRA-7) against the Strength, Assistance walking, Rise from a chair, Climb stairs, and Falls (SARC-F) and SARC-F with calf circumference (SARC-CalF) scales for sarcopenia in healthy community-dwelling older adults.

METHODS

We conducted a post-hoc cross-sectional secondary data analysis of a prospective cohort study, using data from 230 older adults (mean age 67.2±7.4 years, 92% Chinese, and 73% female) from the "Longitudinal Assessment of Biomarkers for characterization of early Sarcopenia and Osteosarcopenic Obesity in predicting frailty and functional decline in community-dwelling Asian older adults Study" (GeriLABS-2) conducted between December 2017 and March 2019 in Singapore. We performed receiver operating characteristic curve analysis to ascertain the area under the curve (AUC) for sarcopenia diagnosis using the Asian Working Group for Sarcopenia 2019 consensus criteria. We applied the Delong method to compare the AUCs of the four instruments.

RESULTS

The MSRA-5 and MSRA-7 demonstrated poor diagnostic performance (AUC of 0.511, 95% confidence interval [CI] 0.433-0.589 and AUC of 0.526, 95% CI 0.445-0.606, respectively), compared to that in SARC-CalF (AUC of 0.739, 95% CI 0.671-0.808) and SARC-F (AUC of 0.564, 95% CI 0.591-0.636). The SARC-CalF demonstrated significantly superior discriminatory ability compared to that in the SARC-F, MSRA-5, and MSRA-7 (all p<0.01). The MSRA-5 demonstrated lower sensitivity (0.464) and specificity (0.597) than in the SARC-CalF (0.661 and 0.738, respectively), whereas the MSRA-7 had higher specificity (0.887) and lower sensitivity (0.145).

CONCLUSION

Conclusions: The poor diagnostic performances of the MSRA-5 and MSRA-7 in our study suggest limitations of self-reported questionnaires for assessing general and dietary risk factors for sarcopenia in healthy and culturally diverse community-dwelling older adults. Studies in different populations are needed to ascertain the utility of the MSRA for the community detection of sarcopenia.

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

AIM

SARC-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.

METHODS

We 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.

RESULTS

The 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).

CONCLUSIONS

The 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 2024; 24: 182-188.

Life After Traumatic Brain Injury: Effects on the Lifestyle and Quality of Life of Community-Dwelling Patients

Persons who have experienced traumatic brain injury (TBI) may encounter a range of changes in their physical, mental, and cognitive functions as well as high fatigue levels. To gain a comprehensive understanding of the challenges faced by persons after TBI, we conducted multi-domain assessments among community-dwelling persons with a history of TBI and compared them with age- and sex-matched controls from the Northeastern Taiwan Community Medicine Research Cohort between 2019 and 2021. A total of 168 persons with TBI and 672 non-TBI controls were not different in terms of demographics, comorbidities, and physiological features. However, compared with the non-TBI group, the TBI group had a distinct lifestyle that involved increased reliance on analgesics (6.9% vs. 15.0%, respectively; p = 0.001) and sleep aids (p = 0.008), which negatively affected their quality of life. Moreover, they consumed more coffee (p < 0.001), tea (p < 0.001), cigarettes (p = 0.002), and betel nuts (p = 0.032) than did the non-TBI group. Notably, the use of coffee had a positive effect on the quality of life of the TBI group (F = 4.034; p = 0.045). Further, compared with the non-TBI group, the TBI group had increased risks of sarcopenia (p = 0.003), malnutrition (p = 0.003), and anxiety (p = 0.029) and reduced blood levels of vitamin D (29.83 ± 10.39 vs. 24.20 ± 6.59 ng/mL, respectively; p < 0.001). Overall, the TBI group had a reduced health-related quality of life, with significant challenges related to physical health, mental well-being, social interactions, pain management, and fatigue levels. Moreover, the TBI group experienced poorer sleep quality and efficiency than did the non-TBI group. In conclusion, persons who have sustained brain injuries that require comprehensive and holistic care that includes lifestyle modification, mental and physical healthcare plans, and increased long-term support from their communities. ClinicalTrials.gov (identifier: NCT04839796).

The accuracy of screening tools for sarcopenia in older Chinese adults: a systematic review and meta-analysis

Objective

This review aimed to analyze and compare the accuracy of eight screening tools for sarcopenia in older Chinese adults according to different diagnostic criteria.

Methods

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang databases were searched between the publication of the first expert consensus on sarcopenia in 2010 and April 2023 using relevant MeSH terms. We evaluated the risk bias of the included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The pooled result of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and plot the summary receiver operating characteristic curve (SROC) were calculated by using a bivariate random-effects model. The accuracies of sensitivity and specificity of the screening tools were compared using the Z-test.

Results

A total of 30 studies (23,193 participants) were included, except for calf circumference (CC), Ishii, and Finger-ring Test; Screening tools for sarcopenia in older Chinese adults have consistently shown low to moderate sensitivity and moderate to high specificity. Regional and sex differences affect the accuracy of the screening tools. In terms of sensitivity and specificity, the CC, Ishii, and Finger-ring Test were superior to the other screening tools.

Conclusion

The Asian Working Group on Sarcopenia (AWGS) 2019 criteria are more appropriate for the diagnosis of sarcopenia in older Chinese adults. According to the AWGS 2019, CC and Ishii are recommended for sarcopenia screening in older Chinese adults.

The prevalence and impact of sarcopenia in older cardiac patients undergoing inpatient cardiac rehabilitation - results from a prospective, observational cohort pre-study

BACKGROUND

The prevalence of sarcopenia and its impact in older patients undergoing inpatient cardiac rehabilitation (iCR) after cardiac procedure has been insufficiently studied. The main aim of this study was to evaluate the prevalence of sarcopenia and quantify the functional capacity of older sarcopenic and non-sarcopenic patients participating in iCR.

METHODS

Prospective, observational cohort study within the framework of the ongoing multicenter prehabilitation study "PRECOVERY". A sample of 122 patients ≥75 years undergoing iCR after cardiac procedure were recruited in four German iCR facilities and followed up 3 months later by telephone. At iCR (baseline), the Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls (SARC-F) questionnaire was used to identify sarcopenic patients. In addition, Katz-Index, Clinical Frailty Scale (CFS), handgrip strength (HGS), Short Physical Performance Battery (SPPB) and 6-minute walk distance (6MWD) measured functional capacity and frailty at baseline. Outcomes were prevalence of sarcopenia and the correlation of sarcopenia to functional capacity and frailty at baseline as well as the SARC-F score at follow-up. The Wilcoxon test was applied for pre-post-test analysis. Correlation between sarcopenia and 6MWD, SPPB score and HGS was tested with the eta coefficient with one-way ANOVA.

RESULTS

Complete assessments were collected from 101 patients (79.9 ± 4.0 years; 63% male). At baseline, the mean SARC-F score was 2.7 ± 2.1; 35% with sarcopenia. Other baseline results were Katz-Index 5.7 ± 0.9, CFS 3.2 ± 1.4, HGS 24.9 ± 9.9 kg, SPPB score 7.5 ± 3.3 and 6MWD 288.8 ± 136.5 m. Compared to baseline, fewer patients were sarcopenic (23% versus 35%) at follow-up. In the subgroup of sarcopenic patients at baseline (n = 35), pre-post comparison resulted in a significant SARC-F improvement (p = 0.017). There was a significant correlation between sarcopenia measured by SARC-F and poor results in the assessments of functional capacity (p < 0.001; r > 0.546).

CONCLUSIONS

The prevalence of sarcopenia in older patients at iCR after cardiac procedure is high (35%) and remains high at follow-up (23%). Sarcopenia screening is important since the diagnosis of sarcopenia in these patients correlates significantly with poor functional capacity. The results indicate that these patients may benefit from prehabilitation aimed at improving perioperative outcomes, increasing functional capacity and mitigating adverse effects.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS; http://www.drks.de ; DRKS00032256). Retrospectively registered on 13 July 2023.

Pathogenesis and comprehensive treatment strategies of sarcopenia in elderly patients with type 2 diabetes mellitus

Sarcopenia and diabetes are two age-related diseases that are common in the elderly population, and have a serious effect on their general health and quality of life. Sarcopenia refers to the progressive loss of muscle mass, strength and function, whereas diabetes is a chronic disease characterized by elevated blood sugar levels. The comorbidity of sarcopenia and diabetes is particularly concerning, as people with diabetes have a higher risk of developing sarcopenia due to the combination of insulin resistance, chronic inflammation and reduced physical activity. In contrast, sarcopenia destroyed blood sugar control and exacerbated the development of people with diabetes, leading to the occurrence of a variety of complications. Fortunately, there are a number of effective treatment strategies for sarcopenia in people with diabetes. Physical exercise and a balanced diet with enough protein and nutrients have been proved to enhance the muscular quality and strength of this population. Additionally, pharmacological therapies and lifestyle changes can optimize blood sugar control, which can prevent further muscle loss and improve overall health outcomes. This review aims to summarize the pathogenesis and comprehensive treatment strategies of sarcopenia in elderly patients with type 2 diabetes, which help healthcare professionals recognize their intimate connection and provide a new vision for the treatment of diabetes and its complications in this population. Through early identification and comprehensive treatment, it is possible to improve the muscle function and general quality of life of elderly with diabetes and sarcopenia.

Dietary patterns from mid-through later-life in relation to sarcopenia risk over 20 years among Chinese community-dwelling oldest old individuals

BACKGROUND

Evidence regarding how dietary patterns (DPs) from mid- (60 years old) to later-life (over 80 years old) affect sarcopenia risk in old age is scarce.

METHODS

We included 7267 participants aged ≥80 years from the Chinese Longitudinal Healthy Longevity Survey in 2018. The Simplified Healthy Eating Index (SHE index) based on nine dietary variables was used to measured DPs and changes in DPs, with a higher score indicating better diet quality. The term "Mid-life" DPs denoted dietary habits at the age of 60 whereas "Later-life" DPs referred to dietary habits acquired over 80 years old. Sarcopenia risk was evaluated using the SARC-CalF questionnaire. We applied multivariable adjusted logistic regression models to investigate the cross-sectional association between DPs in a life course and sarcopenia risk in 2018 after adjusting for potential confounders including sociodemographic characteristics, lifestyle risk factors, and unfavorable health conditions. Several sensitivity analyses were conducted to verify the robustness of the results.

RESULTS

We found that healthier DPs during both mid- and later-life were associated with a decreased odds of sarcopenia risk, with adjusted odds ratios (ORs) of 0.69 (95 % confidence interval [CI]: 0.54-0.88) and 0.84 (95 % CI: 0.71-0.99), respectively. The odds of sarcopenia risk were also decreased among those with healthier DPs over a period of 20 years (OR = 0.80, 95 % CI: 0.69-0.93). For each nutrient consumption, participants who had high-quality fish consumption both in mid- and later-life had a 23 % decreased odds of sarcopenia risk (OR = 0.77, 95 % CI: 0.67-0.88) compared with those who had low-quality fish consumption all the time. The results were largely unchanged in sensitivity analyses.

CONCLUSIONS

Our findings highlight the importance of maintaining healthy dietary habits throughout life to reduce the risk of sarcopenia in old age.

Development and validation of a rapid sarcopenia screening questionnaire: The Otassha study

AIM

To develop a rapid and easy screening tool to detect sarcopenia.

METHODS

In total, 683 community-dwelling older adults who participated in our cohort study, the "Otassha Study," in 2019, completely responded to a questionnaire, and were diagnosed with sarcopenia were included. Participants responded to a nine-item questionnaire, including candidate items for a new sarcopenia screening tool named rapid sarcopenia screening, based on items of the Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) questionnaire. To select appropriate items for the new screeening tool, multiple logistic regression analyses were performed, with sarcopenia as the dependent variable and questionnaire responses as independent variables. The area under the curve using 10 000 bootstraps was used to assess the rapid sarcopenia screening diagnostic ability for detecting sarcopenia.

RESULTS

Responses to question nos 2 (how much can you squeeze a wet towel?), 5 (how much muscle strength do you think you have compared with that of people of your age and sex?), 7 (how fast do you usually walk?), and 9 (age-related item) were related to sarcopenia in multiple logistic regression analysis. The area under the curve of the total score of rapid sarcopenia screening was 0.82, 0.80, and 0.81 for men, women, and overall, respectively. At a cut-off value of 14/15, the sensitivity and specificity for sarcopenia detection were 0.73 and 0.73, respectively.

CONCLUSIONS

The newly developed sarcopenia screening tool has a better diagnostic ability for sarcopenia than the SARC-F. Rapid sarcopenia screening does not require physical function measurements, making it a useful and accessible tool among older adults to detect sarcopenia. Geriatr Gerontol Int 2023; 23: 945-950.

Frailty and prefrailty phenotypes increase the odds of abnormal cognitive impairment screens in people with HIV

OBJECTIVE

Evaluate whether prefrail and frail people with HIV (PWH) have a higher risk of cognitive impairment on screens.

METHODS

Analysis of PWH aged 70 or older included in the ANRS EP66 SEPTAVIH cohort, on antiretroviral therapy for at least 12 months and with a MoCA test at enrolment. Adjusted risk of a Montreal Cognitive Assessment (MoCA) less than 26 was compared in frail/prefrail versus robust PWH.

RESULTS

A total of 503 PWH were enrolled with a median age of 73 years, IQR [71-77], 81.5% were male, 73.8% were French natives, 32.9% had low socio-economic status (EPICES score >30.2), and 41.3% were college graduates; 27.3% had a history of clinical AIDS. A total of 294 (58.5%) PWH had a MoCA score less than 26; 182 (36%) a MoCA score 23 or less. Frailty, prefrailty and robustness were found in 13.1, 63.6 and 23.3% participants, respectively. PWH with a MoCA less than 26 had a significantly higher risk of being frail/prefrail, this before [odds ratio (OR) = 2.31; 95% confidence interval (CI) 1.50-3.57], and after adjustment for confounders (OR = 1.80; 95% CI 1.07-3.01). The risk of being frail/prefrail in patients with a MoCA 23 or less was higher (adjusted OR = 2.75; 95% CI 1.46-5.16). Other factors independently associated with a MoCA less than 26 were older age, birth outside of France and a lower education level and being diabetic.

CONCLUSION

Abnormal MoCA screens were frequent in our cohort of PWH aged 70 or older with controlled HIV disease. Cognitive impairment should be systematically screened in frail/prefrail PWH. Frailty/prefrailty, diabetes and social factors, but not HIV-related factors, are important determinants of cognitive function in PWH with controlled disease.

Clinical validation of SARC-F by proxy as a practical tool to evaluate sarcopenia in dependent older adults

INTRODUCTION

Sarcopenia is a prevalent disorder in older adults with significant adverse outcomes and regular screening is recommended for those at risk. The SARC-F questionnaire is the most commonly recommended screening tool for sarcopenia. However, as a self-reported tool, it cannot be applied to dependent individuals with communication problems. We hypothesized that implementation of the proxy-reported SARC-F (SARC-F by proxy) would be non-inferior in screening sarcopenia when compared with the standard SARC-F. Thus, we aimed to investigate the clinical validity of the SARC-F by proxy in identifying sarcopenia in older adults and to compare its performance with the standard SARC-F. Additionally, we aimed to determine the ideal cut-off of SARC-F by proxy in screening sarcopenia.

MATERIALS AND METHODS

This is a validation study including older adults aged ≥60 years without communication problems and their close proxies. The participants were recruited from a geriatric outpatient clinic of a tertiary health center and a nursing home. Standard SARC-F was transformed to SARC-F by proxy and administered to the proxies of older adults, and standard SARC-F was administered to the patients simultaneously in different rooms. We defined sarcopenia as probable and confirmed by the EWGSOP2 consensus report. We performed receiver operating characteristics (ROC) and sensitivity/specificity analyses of SARC-F by proxy for diagnosing sarcopenia and compared its performance with standard SARC-F by the DeLong test.

RESULTS

We included 172 older adults (median age: 72; 44.8% female) and 107 proxies in close contact (median age: 55, 63.2% female). The prevalence of probable and confirmed sarcopenia was 18.9% and 12.9%, respectively. For both definitions, area under the curve (AUC) values of SARC-F by proxy and standard SARC-F were moderate and similar [probable sarcopenia: 0.619 and 0.624 (p = 0.9); confirmed sarcopenia 0.613 and 0.645 (p = 0.7), respectively]. The best balance between sensitivity and specificity was achieved with a SARC-F by proxy score of ≥2 for both sarcopenia definitions (sensitivity levels were 74.7% and 77.8%, and specificity levels were 50.0% and 49.6%, for probable and confirmed sarcopenia, respectively).

DISCUSSION

SARC-F by proxy showed a similar, non-inferior performance compared to the standard SARC-F in the evaluation of sarcopenia. Our results suggest that it can be used instead of standard SARC-F to screen sarcopenia in older patients with communication problems. Further validation studies in different populations are warranted to support our findings.

SARC-F as a screening tool to detect computed tomography-based sarcopenia and myosteatosis among older adults with cancer

BACKGROUND

The European Working Group on Sarcopenia in Older People (EWGSOP) recommends SARC-F as a tool for identifying sarcopenia among older adults. However, the role of SARC-F among older adults with cancer remains unexplored. We aimed to evaluate the diagnostic utility of SARC-F to identify those with sarcopenia, or low muscle mass (using skeletal muscle index [SMI]), and myosteatosis (using skeletal muscle density [SMD]) from computed tomography (CT) imaging and the association of SARC-F with all-cause mortality.

METHODS

Older adults (≥60 years) presenting for initial consultation at UAB medical oncology clinic who underwent geriatric assessment were enrolled in a prospective cohort study. We identified study participants who completed SARC-F screening and had available CT imaging within 60 days of study enrollment. Using single-slice CT images at the L3 vertebral level, we computed SMI and SMD using published methods. Sarcopenia and myosteatosis were defined using published cutpoints. We calculated the sensitivity and specificity of SARC-F for detecting low muscle mass and low muscle density using published thresholds. Finally, we computed the impact of SARC-F and CT measures on overall survival using Kaplan-Meier curves and Cox regression models, after adjusting for age, sex, cancer type, and cancer stage.

RESULTS

We identified 212 older adults with a median age of 68.8 years; with 60.8% males, 76.6% whites, and pancreatic cancer (21.2%) being the most common malignancy. In the overall cohort, 30.7% had abnormal SARC-F using published cutpoints. SARC-F ≥ 4 had a sensitivity of 35% and a specificity of 76% to identify low muscle mass. SARC-F ≥ 4 had a sensitivity of 38% and a specificity of 74% to identify low muscle density. Those with SARC-F ≥ 4 and low SMI/SMD had worse survival compared to those with low SMI/SMD alone. Incorporating SARC-F improved survival prognostication beyond SMI and SMD (HR = 3.1; p < 0.001; Harrel's C from 0.73 to 0.76).

CONCLUSIONS

SARC-F as a screening tool has limited diagnostic utility for identifying older adults with low muscle mass and/or density. However, SARC-F retains prognostic value independent of CT-based muscle measures in predicting mortality among older adults with cancer.

Validated Tools for Screening Sarcopenia: A Scoping Review

OBJECTIVE

Choosing the optimal sarcopenia screening tool for a specific clinical scenario is challenging. We aimed to summarize all validated sarcopenia screening tools with diagnostic accuracy tested in one or more study populations.

DESIGN

Scoping review.

SETTING AND PARTICIPANTS

Hospitals, nursing homes, communities, or health checkups.

METHODS

We systematically searched 3 databases in April 2022: MEDLINE, EMBASE, and CENTRAL. Two review authors independently performed the study selection and data extraction. The included tools' contents, characteristics, and number of citations were summarized and visualized.

RESULTS

We summarized 102 diagnostic accuracy studies involving 53 screening tools, classified into 7 groups: questionnaires (n = 13); serum biomarkers (n = 10); formulas, algorithms, and models (n = 9); physical ability tests (n = 9); integration tools (n = 7); anthropometric indices (n = 3); and ultrasound or bioimpedance analysis (n = 2). The most commonly used questionnaire was SARC-F (770 citations), followed by SARC-CalF (254 citations) and MSRA-7 (61 citations). Handgrip strength and Ishii score were the most widely used physical performance tests (331 citations) and formulas (294 citations), respectively. Sarcopenia index (based on serum cystatin C and creatinine) and calf circumference were the most commonly used serum biomarkers (123 citations) and anthropometric indexes (127 citations), respectively. Ultrasound was the most commonly used imaging tool for screening sarcopenia (57 citations). The included tools varied significantly in content. Various tools assessed some or all components of sarcopenia with different methods, and others assessed different domains, such as age, body mass index, falls, diet, and even mental health. We also summarized the screening tools that were validated in different clinical settings (hospitals, communities, nursing homes, and health checkups).

CONCLUSIONS AND IMPLICATIONS

More than 50 validated tools are currently available for screening sarcopenia in different clinical settings. The results of this review may help clinicians and researchers in selecting optimal tools for sarcopenia in different clinical scenarios and in developing future tools.

Performance Evaluation of Machine Learning Algorithms for Sarcopenia Diagnosis in Older Adults

BACKGROUND

Sarcopenia is a progressive and generalized skeletal muscle disorder. Early diagnosis is necessary to reduce the adverse effects and consequences of sarcopenia, which can help prevent and manage it in a timely manner. The aim of this study was to identify the important risk factors for sarcopenia diagnosis and compare the performance of machine learning (ML) algorithms in the early detection of potential sarcopenia.

METHODS

A cross-sectional design was employed for this study, involving 160 participants aged 65 years and over who resided in a community. ML algorithms were applied by selecting 11 features-sex, age, BMI, presence of hypertension, presence of diabetes mellitus, SARC-F score, MNA score, calf circumference (CC), gait speed, handgrip strength (HS), and mid-upper arm circumference (MUAC)-from a pool of 107 clinical variables. The results of the three best-performing algorithms were presented.

RESULTS

The highest accuracy values were achieved by the ALL (male + female) model using LightGBM (0.931), random forest (RF; 0.927), and XGBoost (0.922) algorithms. In the female model, the support vector machine (SVM; 0.939), RF (0.923), and k-nearest neighbors (KNN; 0.917) algorithms performed the best. Regarding variable importance in the ALL model, the last HS, sex, BMI, and MUAC variables had the highest values. In the female model, these variables were HS, age, MUAC, and BMI, respectively.

CONCLUSIONS

Machine learning algorithms have the ability to extract valuable insights from data structures, enabling accurate predictions for the early detection of sarcopenia. These predictions can assist clinicians in the context of predictive, preventive, and personalized medicine (PPPM).

Assessing Stroke-Related Sarcopenia in Chronic Stroke: Identification of Clinical Assessment Tools-A Pilot Study

Stroke-related sarcopenia has recently been defined as the muscle atrophy consequent to stroke and assessing it following the guidelines with simple clinical tools is crucial in chronic stroke survivors. The aim of this study was to determine the characteristics of patient-friendly instruments sarcopenia in a chronic stroke sample (SG) compared to non-stroke counterparts (CG). Each participant underwent a single assessment which consisted of: SARC-F questionnaire, assessment of muscle strength (hand grip and five-times sit-to-stand test, 5STS), the calf circumference (CC) of both legs, the short physical performance battery (SPPB), and the 10 m walk test. A total of 68 participants were included (SG, n = 34 and CG, n = 34). All variables showed statistical differences (p < 0.05) between the SG and the CG, except handgrip although it showed lower values for SG. The values of the 5STS (16.26 s) and the SPPB (7 points) were below to the cutoff values for the SG. The five-times sit-to-stand test, SPPB, and gait speed can lead clinicians to detect stroke-related sarcopenia. Maximum handgrip shows a trend of low values for men and women in the SG, however, CC did not detect sarcopenia in our sample.

Diabetes mellitus, malnutrition, and sarcopenia: The bond is not explained by bioelectrical impedance analysis in older adults

As people age, their risk of diabetes mellitus (DM) and sarcopenia increases due to the decline in muscle mass and strength. Bioelectrical impedance analysis (BIA) is a method used to detect changes in body composition. The primary aim of the study was to determine the distribution of BIA variables among a group of non-DM people and two groups of patients with controlled and uncontrolled DM. The secondary aim was to establish the independent association between BIA-derived data, lipidic assets, and the prevalence of metabolic syndromes with DM. This study included a total of 235 participants who were categorized into three groups based on the presence of diabetes mellitus (DM) and their glycated hemoglobin (HbA1c) levels: non-DM, controlled DM (HbA1c≤7.0%), and uncontrolled DM (HbA1c>7.0%). Waist circumference (p=0.005), bone (p<0.001), muscular (p<0.001), and appendicular skeletal mass (p<0.001) were lower in the non-DM group, while sarcopenic risk (p<0.001), total cholesterol (p<0.001), and LDL (p<0.001), were higher. Grip strength (p<0.001), visceral fat (p=0.01), and phase angle (p=0.04) were significantly lower in non-DM than uncontrolled DM patients, as well as the number of drugs taken (p=0.014). A multivariate analysis highlighted that LDL (coefficient -0.006, p=0.01) was negatively associated, while bone mass (coefficient 0.498, p=0.0042) was positively associated with DM uncontrol. Our study shows that BIA may not be the ideal tool for distinguishing between elderly individuals with and without DM, as it can be affected by numerous covariates, including potential differences in glucometabolic and cardiovascular control.

The accuracy of screening instruments for sarcopenia: a diagnostic systematic review and meta-analysis

OBJECTIVE

This review aimed to summarise the diagnostic accuracy of screening tools for sarcopenia.

METHODS

We conducted a systematic review along with a critical appraisal of published studies on screening tools for sarcopenia. We assessed the measurement properties of screening instruments using the consensus-based standards for selecting health measurement instruments (COSMIN) checklist. We evaluated the risk bias of the included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The diagnostic test accuracy of instruments for sarcopenia was reported using sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR).

RESULTS

We screened 7,120 titles and abstracts; 42 studies including five screening tools for sarcopenia were included. The overall study quality assessed by the QUADAS-2 tool was moderate to good. Of the five screening tools, three instruments had specificities ≥85%: 92% [95% confidence interval (CI): 63-99%] for the SARC-F modified version, 87% (95% CI: 82-90%) for the SARC-F and 85% (95% CI: 77-90%) for the Ishii score. Three tools had sensitivity ≥75%, namely, MSRA 82% (95% CI: 69-90%), Ishii score 79% (95% CI: 62-89%) and U-TEST 76%. PLR higher than 5.0 were present for the Ishii score and SARC-F modified versions; the Ishii score also had the best NLR of 0.25 of all scales.

CONCLUSION

The MSRA and Ishii score had excellent sensitivity for sarcopenia screening at an early stage; SARC-F modified versions and Ishii score had superior specificity for sarcopenia diagnosis.

Sarcopenia and Related Functional Outcomes Following Hip Surgery Among Egyptian Geriatric Patients With Hip Fracture

Background Sarcopenia is highly prevalent among elderly patients with hip fracture. Studies reported a significant association between sarcopenia and clinical outcomes in patients with hip fractures. The current study aimed to determine the prevalence of sarcopenia among elderly patients with hip fracture and its effect on short-term functional outcomes, highlighting predictors of postoperative functional decline.  Methods This is a cross-sectional study followed by a prospective cohort. Elderly patients (60 years and above) with hip fractures were recruited from the orthopedic department. Patients were followed by the ortho-geriatric team in the perioperative period and for three postoperative months. Patients were subjected to comprehensive geriatric assessment including a full history and physical examination. In the preoperative state and after three months of follow-up the following were assessed: functional independence using the Barthel index (BI); nutritional state using a checklist named DETERMINE Your Nutritional Health; sarcopenia using the SARC-F questionnaire assessing strength, ambulation, rising from a chair, climbing stairs, and fall history. Perioperative risk assessment and post-discharge care were obtained through medical records and by questioning patients or families. Preoperative sarcopenia was confirmed using the Ishii equation which is an equation that includes (age, calf circumference, and hand grip strength). Results Preoperative sarcopenia screening showed that 29.3% of patients suffered sarcopenia by SARC-F questionnaire and 28.6% by Ishii equation score. At the end of the follow-up, 57.9% of patients suffered sarcopenia by SARC-F questionnaire. There was a marked post-fracture decline in independence level; 52.1% had slight dependence in function, 27.1% had moderate dependence in function, and 20.7% had total dependence in function. Conclusion This study gives us the chance for a greater understanding of the negative effects of sarcopenia on the outcomes following hip fracture surgery in the geriatric population. It shows a prevalence of sarcopenia among the elderly with hip fractures at 29.3%. The elderly experience a marked post-fracture decline in their level of independence concerning basic activities of daily living. Those with older age, higher comorbidities, cognitive impairment, and functional dependence with poor nutritional state are more vulnerable to functional decline. Other perioperative risks include delayed surgery, surgery type, postoperative complications, longer hospital stays, lack of planned rehabilitative and nutritional plans, and postoperative depression. Early detection of sarcopenia helps establish early interventional plans to reverse such poor outcomes.

Use, satisfaction, and preference of online health services among older adults with multimorbidity in Hong Kong primary care during COVID-19

BACKGROUND

The use of online and mobile internet and social media has been increasing in healthcare service delivery. However, there is limited literature on the acceptance and use of online health services for older adults with multimorbidity who require more medical care and assistance. This study aims to explore the use of social media in older adults with multimorbidity in Hong Kong primary care and to assess the feasibility and usage of online health services in this population, including satisfaction, preference, and problems encountered.

METHODS

This is a cross-sectional study among older adults with multimorbidity conducted between November 2020 and March 2021 in a Hong Kong primary care programme. Online and face-to-face services were offered based on the needs of the participants. Demographic characteristics and health conditions were assessed at baseline. Participants using online services were invited to complete a feedback questionnaire.

RESULTS

The study included 752 participants, of which 66.1% use social media every day. Participants who declined to use online services were found to be significantly older, live alone, have lower income, have social security assistance, have greater cognitive decline, and be less depressed (p < 0.05). Non-responders to the online questionnaire had fewer years of education and greater cognitive decline (p < 0.05). The median satisfaction with the online services was 8 (interquartile range: 7, 9), and 14.6% of the participants preferred online more than face-to-face services. Lower education levels, fewer internet connection issues, and more self-efficacy on mobile apps were associated with a higher level of online satisfaction after adjustment (p < 0.05). Fewer internet connection issues and more self-efficacy on mobile apps were associated with participants' preference for online services (p < 0.05).

CONCLUSIONS

More than half of Hong Kong older adults with multimorbidity in primary care use social media daily. Internet connection issues can be a significant barrier to the usage of online services in this population. Prior use and training can be beneficial to enhance use and satisfaction in older adults.

Sarcopenic obesity research perspectives outlined by the sarcopenic obesity global leadership initiative (SOGLI) - Proceedings from the SOGLI consortium meeting in rome November 2022

The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched the Sarcopenic Obesity Global Leadership Initiative (SOGLI) to reach expert consensus on a definition and diagnostic criteria for Sarcopenic Obesity (SO). The present paper describes the proceeding of the Sarcopenic Obesity Global Leadership Initiative (SOGLI) meeting that was held on November 25th and 26th, 2022 in Rome, Italy. This consortium involved the participation of 50 researchers from different geographic regions and countries. The document outlines an agenda advocated by the SOGLI expert panel regarding the pathophysiology, screening, diagnosis, staging and treatment of SO that needs to be prioritized for future research in the field.

The Geriatric Nutritional Risk Index predicts sarcopenia in patients with cirrhosis

Patients with cirrhosis are at high risk for sarcopenia and malnutrition, which are associated with reduced quality of life and increased mortality. We investigated the relationship between the Geriatric Nutritional Risk Index (GNRI) and sarcopenia/gait speed and assessed the usefulness of the GNRI for predicting sarcopenia in patients with cirrhosis. We evaluated 202 patients with cirrhosis and divided them into three groups based on baseline GNRI values: low (L)-GNRI (< 94.0, n = 49), intermediate (I)-GNRI (between 94.0 and 109.5, n = 103), and high (H)-GNRI groups (> 109.5, n = 50). Sarcopenia was diagnosed according to the criteria of the Japan Society of Hepatology. The prevalence of sarcopenia and slow gait speed was the lowest in the H-GNRI group (8.0% and 26.0%, respectively) and the highest in the L-GNRI group (49.0% and 44.9%, respectively). They increased stepwise with a decline in the GNRI group (p < 0.001 and p = 0.05, respectively). The GNRI values were significantly and positively correlated with handgrip strength, skeletal muscle mass index, and gait speed. Multivariate analysis identified lower GNRI as an independent risk factor for sarcopenia. The optimal cutoff value of the GNRI for predicting sarcopenia was 102.1 (sensitivity/specificity, 0.768/0.630). The GNRI was significantly associated with sarcopenia and physical performance and could be a helpful screening tool for predicting sarcopenia in patients with cirrhosis.

Greek Translation, Cultural Adaptation and Validation of the Mini Sarcopenia Risk Assessment Questionnaire, to Evaluate Sarcopenia in Greek Elderly at a Hospital Setting

Sarcopenia is a progressive aging syndrome with severe socioeconomic costs. Therefore, the early diagnosis of sarcopenia is required to secure early treatment and to enhance quality of life. The Mini Sarcopenia Risk Assessment (MSRA) questionnaire, which is available in seven-item (MSRA-7) and five-item (MSRA-5) versions, is a sarcopenia screening tool that was translated into Greek, adapted, and validated in this study. The present study was developed in an outpatient hospital setting, from April 2021 to June 2022. The MSRA-7 and MSRA-5 questionnaires were translated backwards and forwards and adapted to the Greek language. To validate the MSRA questionnaire as a pre-screening tool to identify the risk of sarcopenia in the older Greek population, both the MSRA-7 and MSRA-5 versions were correlated with the Greek version of the SARC-F questionnaire, which is a widely accepted and well-known tool used in sarcopenia screening. Ninety elderly subjects aged 65–89 years-old with no mobility impairments participated in this study. The questionnaires’ content validity was assessed using the Content Validity Ratio, and the Content Validity Index was calculated for the instrument. The intra-rater reliability was assessed by calculating the Intra-class Correlation Coefficient between the initial assessment and the reassessment of the MSRA questionnaire, which was 0.986, with a 95% Confidence Interval of 0.961–0.995. Concurrent validity was assessed between the Greek MSRA questionnaires and the SARC-F questionnaire using the Spearman’s rank correlation coefficient (p). The Greek MSRA-7 questionnaire had a very high correlation with the SARC-F questionnaire (rho = −0.741, p < 0.001), as did the Greek MSRA-5 questionnaire (rho = −0.724, p < 0.001). The proofs of content validity, concurrent validity, and intra-rater reliability provided for the Greek versions of the MSRA, designated them as reliable pre-screening tools for the detection of sarcopenia in the older population and in clinical practice.

Symptoms of Sarcopenia and Physical Fitness through the Senior Fitness Test

INTRODUCTION

Physical fitness concerns a set of attributes related to the ability to perform physical activity that may justify the symptoms reported by the elderly in the context of sarcopenia.

OBJECTIVE

This study aimed to investigate the relationship between the perception (symptomatology) of physical functioning (what the person thinks they are capable of) and the capacity itself for physical functioning in elderly people in northern Brazil.

METHODS

Cross-sectional study that analyzed 312 elderly people (72.6 ± 7.8 years) from the city of Novo Aripuanã, Amazonas, Brazil. Sarcopenia symptomatology was assessed using the SARC-F, a 5-item questionnaire designed for screening sarcopenia in older individuals in five domains: strength, walking aids, difficulty getting up from a chair, difficulty climbing stairs, and falls. Physical fitness was assessed by the Senior Fitness Test (SFT) battery including balance evaluated with the short version of the Fullerton Advanced Balance scale (FAB).

RESULTS

ROC curve analysis revealed that the tests with the greatest ability to discriminate participants with significant symptoms for sarcopenia (≥4 points on SARC-F) were arm curl and 6 min walk: the probability of suspected sarcopenia increased exponentially with an arm curl < 11.5 reps for men (se = 71%; sp = 69%; AUC = 0.706, 95% CI: 0.612-0.788; p = 0.013) and women (se = 81%; sp = 51%; AUC = 0.671, 95% CI: 0.601-0.735; p ≤ 0.001) or with a 6-min walk <408.5 m for men (se = 71%; sp = 63%; AUC = 0.720, 95% CI: 0.628-0.690; p = 0.001) and <366.0 m for women (se = 69%; sp = 58%; AUC = 0.692, 95% CI: 0.623-0.755; p = 0.0001).

CONCLUSIONS

Physical fitness assessed through the senior fitness test, particularly the 30-s-arm curl test and the 6-min walk test, can discriminate for suspected symptoms of sarcopenia.

Preoperative dysphagia risk in community-dwelling adults aged ≥50 years: Prevalence and risk factors

BACKGROUND

Preoperative dysphagia screening is rare. The purpose of this study was to assess the prevalence and potential risk factors of preoperative dysphagia risk in adults preparing for surgery.

METHODS

The Eating Assessment Tool (EAT-10), Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), and Sarcopenia Screening Tool (SARC-F) were self-administered in adults preparing for surgery to identify dysphagia, malnutrition, and sarcopenia risk, respectively. Other variables collected include clinical demographics, fall risk, and surgical history associated with increased dysphagia risk. Descriptive summary statistics, univariate analysis, and logistic regression were performed as appropriate.

RESULTS

The median age was 69 years and preoperative dysphagia risk was 9.6%. Among 357 patients completing both EAT-10 and PG-SGA SF or SARC-F, 7.3% had preoperative dysphagia and malnutrition risk and 7.2% had preoperative dysphagia and sarcopenia risk. Preoperative dysphagia risk was 2.7 times greater in those with prior surgical history associated with increased risk of dysphagia, 2.2 times higher in women, and almost twice as high in Black patients and patients with fall risk. Logistic regression revealed significant odds ratios (ORs) for prior surgical history associated with increased risk of dysphagia (OR, 2.95; 95% CI, 1.62-5.40) and male sex (OR, 0.52; 95% CI, 0.29-0.94), and a significant relationship between preoperative dysphagia and malnutrition risk (OR, 4.56; 95% CI, 2.02-10.28) when controlling for clinical variables.

CONCLUSION

The high prevalence of dysphagia risk alone and in combination with malnutrition and sarcopenia risk in community-dwelling adults underscores the need for standardized preoperative screening and optimization prior to surgery.

Applicability of the SARC-F questionnaire by remote interview

OBJECTIVE

The aim of this study was to assess the applicability of the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire by telephone to identify sarcopenia risk (SR; SARC-F ≥6) and low muscle function risk (LMFR; SARC-F ≥ 4) and their associated risk factors in a cohort of community-dwelling older adults in southern Brazil.

METHODS

A longitudinal study was carried out with community-dwelling older individuals from COMO VAI?

STUDY

Sociodemographic, behavioral, and health-related information were collected at baseline, and, in the second assessment, the SARC-F questionnaire was applied by phone or in-person interviews. Older adults identified with sarcopenia at the baseline assessment were excluded. Adjusted analysis by Poisson regression according to hierarchical levels was performed.

RESULTS

Of the 1451 participants interviewed at baseline, only 951 participated in the second assessment. During the second assessment, 732 adults (77%) were interviewed by phone and 219 (23%) in person. There was no statistically significant difference for the SR (9.1 versus 9.7%, P = 0.802) and LMFR (22.4 versus 20.0%, P = 0.435) prevalence when the SARC-F questionnaire was administered in person or by phone, respectively. Age ≥80 y, presence of depressive symptoms, multimorbidity, dependence to perform one or more daily activities, and polypharmacy were factors associated with a higher risk for poor outcomes in older adults interviewed by phone.

CONCLUSIONS

The similar prevalence between in-person and remote assessments suggests the feasibility of using the SARC-F questionnaire by phone interview as a reliable alternative for sarcopenia and low muscle function risk assessment without the requirement of face-to-face evaluations.

Untangling the Complex Interplay between Social Isolation, Anorexia, Sarcopenia, and Mortality: Insights from a Longitudinal Study

BACKGROUND

Social isolation is a pervasive and debilitating condition that has adverse prognostic impacts. This condition often co-occurs with other geriatric syndromes, further exacerbating negative health outcomes. Given these considerations, the present study aims to elucidate the roles of social isolation in older adults with anorexia of aging and/or sarcopenia with respect to long-term mortality using a nationally representative cohort study.

METHODS

Data were obtained from the Taiwan Longitudinal Study on Aging (TLSA), with a sample size of 3,762 study participants aged 50 years and older. Data from 1999 (wave 4) to 2015 (wave 9) were analyzed. The TLSA questionnaire was used to define social isolation, anorexia, and sarcopenia. Logistic regressions were employed to explore the associations between social isolation, anorexia, and sarcopenia. The Cox proportional hazard model was utilized to examine the synergistic effects of social isolation and anorexia or sarcopenia on 16-year all-cause mortality.

RESULTS

After controlling for demographic information and comorbidities, older adults with social isolation were significantly associated with anorexia (adjusted odds ratio [aOR] 1.46 [95% confidence interval: 1.00-2.12, p=0.0475]) and sarcopenia (aOR 1.35 [95% CI: 1.12-1.64, p=0.0021]). Furthermore, the synergistic effects of social isolation with anorexia (aOR 1.65 [95% CI: 1.25-2.18, p=0.0004]) or sarcopenia (aOR 1.65 [95% CI: 1.42-1.92, p<0.0001]) were both significantly associated with higher risks of all-cause mortality, while social isolation alone revealed borderline statistical significance.

CONCLUSIONS

Our findings indicate that social isolation is closely linked to anorexia and sarcopenia among middle-aged and older adults. Additionally, social isolation significantly exacerbates the long-term mortality risk associated with anorexia of aging and sarcopenia. However, social isolation alone appears to have borderline long-term mortality risk in this cohort. These findings underscore the importance of addressing social isolation in older adults with anorexia and/or sarcopenia to optimize their health outcomes and mitigate long-term mortality risk.

Determinants of post-COVID-19 symptoms among adults aged 55 or above with chronic conditions in primary care: data from a prospective cohort in Hong Kong

Background

Primary care patients, especially those with an older age, are one of the most vulnerable populations for post-COVID-19 symptoms. Identifying predictors of post-COVID symptoms can help identify high-risk individuals for preventive care.

Methods

Out of 977 primary care patients aged 55 years or above with comorbid physical and psychosocial conditions in a prospective cohort in Hong Kong, 207 patients infected in the previous 5-24 weeks were included. The three most common post-COVID-19 symptoms (breathlessness, fatigue, cognitive difficulty), which lasted beyond the 4-week acute infection period, were assessed using items from the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), together with other self-reported symptoms. Multivariable analyses were conducted to identify predictors of post-acute and long COVID-19 symptoms (5-24 weeks after infection).

Results

The 207 participants had a mean age of 70.8 ± 5.7 years, 76.3% were female, and 78.7% had ≥2 chronic conditions. In total, 81.2% reported at least one post-COVID symptom (mean: 1.9 ± 1.3); 60.9, 56.5 and 30.0% reported fatigue, cognitive difficulty, and breathlessness respectively; 46.1% reported at least one other new symptom (such as other respiratory-related symptoms (14.0%), insomnia or poor sleep quality (14.0%), and ear/nose/throat symptoms (e.g., sore throat) (10.1%), etc.). Depression predicted post-COVID-19 fatigue. The female sex predicted cognitive difficulty. Receiving fewer vaccine doses (2 doses vs. 3 doses) was associated with breathlessness. Anxiety predicted a higher overall symptom severity level of the three common symptoms.

Conclusion

Depression, the female sex, and fewer vaccine doses predicted post-COVID symptoms. Promoting vaccination and providing intervention to those at high-risk for post-COVID symptoms are warranted.

Falls across Health Care Settings: Findings from a Geriatric Screening Program

Falls are a major public health problem for older adults, resulting in injuries and mortality. Screening is recommended to identify the multifactorial fall risks that can be addressed with interventions to prevent future falls. This study examined the utility of using the Rapid Geriatric Assessment (RGA) tool to identify fall risks across multiple settings. RGA data was collected at primary care sites, hospitals, long-term care settings, and community events (n = 8686, 65% female, mean age 77.6). Multinomial logistic regression was used to determine predictors of falls using the RGA. The FRAIL, SARC-F, Rapid Cognitive Screen and SNAQ measures all significantly predicted history of falls. The RGA provides a brief screening that can be used in any setting by multiple providers to identify fall risk.

Sarcopenia Screened with SARC-F and Subjective Memory Complaints Are Independently Associated with Increased Risk of Incident Dementia among Cognitively Unimpaired Older Adults

OBJECTIVES

The main aim of this study was to examine the association of sarcopenia and subjective memory complaints with the incidence of dementia in a population-based cohort of cognitively unimpaired older adults.

DESIGN

Three-year longitudinal study.

SETTINGS AND PARTICIPANTS

A total of 2163 community-dwelling persons aged 65 years or older who participated in the National Health Interview Survey in Taiwan, 2017.

MEASUREMENTS

Sarcopenia was determined based on SARC-F, a self-reported symptom-based questionnaire that includes five components: strength, assistance walking, rise from a chair, climb stairs, and falls. Two questions ("Do you have difficulties with your memory or attention?" and "Do you have difficulties with your memory only or attention only or both?") were used to screen for subjective memory complaints (SMCs). The incidence of dementia was determined by data linkage to the Taiwan National Health Insurance claims database from 2018 to 2020.

RESULTS

Among the 2163 participants without dementia at baseline, 135 had incident dementia during the 3-year follow-up, giving a crude incidence rate of 6.2% (135/2163). Compared to participants free from sarcopenia and SMCs, the adjusted hazard ratio for incident dementia was 1.83 (95% confidence interval [CI]: 1.23-2.72) for SMCs alone, 2.40 (95% CI: 1.17-4.93) for sarcopenia alone, and 2.49 (95% CI: 1.21-5.11) for coexisting SMCs and sarcopenia.

CONCLUSIONS

Our results indicate that sarcopenia screened with SARC-F and SMCs independently predict the cognitively unimpaired older adults at risk of incident dementia. Our findings highlight the importance of screening not only for cognitive but also muscle deficits to identify those at increased risk of incident dementia.

[Geriatric aspects for the management of diabetes mellitus (Update 2023)]

There is a high prevalence of diabetes mellitus in the elderly population of industrial countries. The present article provides recommendations for the screening, prevention and treatment of elderly diabetic patients according to current scientific evidence.

Comparison of four screening methods for sarcopenia among community-dwelling older adults: A diagnostic accuracy study

This study aimed to compare the diagnostic values of SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls), SARC-Calf (SARC-F combined with calf circumference), CC (calf circumference), and the Yubi-wakka (finger-ring) test for screening for sarcopenia in community-dwelling older adults. The Asian Working Group for Sarcopenia (AWGS) 2019 criteria were used as a standard reference. A total of 209 participants were enrolled, and 40.7% were identified as sarcopenia. The sensitivity, specificity, and AUC were respectively 54.1%, 70.2%, and 0.687 for SARC-F; 76.5%, 73.4% and 0.832 for SARC-calf, 86.7%, 82.4%, and 0.906 for CC in men, and 85.5%, 63.3%, and 0.877 for CC in women. Relative to the "bigger," a significant association between sarcopenia and the Yubi-wakka test ("just fits" OR: 4.1, 95% CI: 1.57-10.98; "small" OR: 27.5, 95% CI: 10.14-74.55) was observed. The overall accuracy of CC was better than SARC-Calf for sarcopenia screening.

SARC-F predicts poor motor function, quality of life, and prognosis in older patients with cardiovascular disease and cognitive impairment

OBJECTIVES

We investigated whether SARC-F scores were associated with motor function, quality of life (QOL) related to physical function, and prognosis in older patients with cardiovascular disease (CVD) and cognitive impairment.

METHODS

This was a retrospective cross-sectional cohort study. The study population consisted of 408 patients with CVD (≥60 years old) who completed the SARC-F questionnaire and Mini-Cog, a cognitive function test, at discharge. Sarcopenia was defined as a total SARC-F score ≥ 4 points. Patients who were cognitively-preserved (Mini-Cog score ≥ 3 points) were excluded. Patients completed the handgrip strength, leg strength, usual gait speed, 6-minute walking distance, short physical performance battery score, and 36-item Short-Form Health Survey Physical Functioning (SF-36PF) tests before discharge. Associations of SARC-F with physical function, QOL, and prognoses (i.e., composite of all-cause death and emergency CVD rehospitalization and the number of CVD rehospitalizations) were investigated.

RESULTS

Sarcopenia (SARC-F score ≥ 4 points) was associated with poorer motor function test outcomes and SF-36PF scores (all P < 0.001). The correlations remained significant after adjusting for comorbidities (e.g., anemia, prior heart failure, and renal dysfunction). Sarcopenia was also associated with a poorer prognosis (hazard ratio: 1.574; 95 % confidence interval [CI], 1.011-2.445) and an increased risk of CVD rehospitalization (incidence rate ratio: 1.911; 95 % CI, 1.312-2.782) after adjusting for comorbidities.

CONCLUSIONS AND IMPLICATIONS

In older patients with CVD and cognitive impairment, the SARC-F questionnaire may be a simple and inexpensive tool for identifying patients with decreased motor function and a poor prognosis.

Association between pre-stroke sarcopenia risk and stroke-associated infection in older people with acute ischemic stroke

Background

Stroke-associated infection (SAI) is a common complication after a stroke. The incidence of infection was higher in people with sarcopenia than in the general population. However, the relationship between pre-stroke sarcopenia risk and SAI in older patients has not been confirmed. This study aimed to investigate the association between pre-stroke sarcopenia risk and SAI in older patients with acute ischemic stroke (AIS).

Methods

This retrospective study was conducted by the Peking University People's Hospital. We evaluated the pre-stroke sarcopenia risk by applying the SARC-F questionnaire. Multivariate logistic regression was applied to explore the association between pre-stroke sarcopenia risk and SAI.

Results

A total of 1,002 elder patients with AIS (592 men; 72.9 ± 8.6 years) were enrolled in our study. Pre-stroke sarcopenia risk was found in 29.1% of the cohort. The proportion of patients with pre-stroke sarcopenia risk was larger in the SAI group than in the non-SAI group (43.2 vs. 25.3%, p   < 0.001). In multivariate logistic analysis, pre-stroke sarcopenia risk was shown to be independently associated with SAI (OR = 1.454, 95% CI: 1.008-2.097, p = 0.045) after adjusting for potential factors. This association remained consistent across the subgroups based on age, sex, body mass index, smoking status, drinking status, diabetes, hypertension, and dyslipidemia.

Conclusion

Pre-stroke sarcopenia risk was independently associated with SAI in older patients with AIS. Our findings highlight the significance of pre-stroke sarcopenia identification in the prevention and management of SAI in this population.

Diagnostic and prognostic utility of phase angle in patients with cancer

Patients with cancer experience dynamic and longitudinal changes in nutritional status and body composition along the disease trajectory. They often want to know about their outlook with regard to treatment outcomes and overall survival. One of the commonly used measures for body composition is bioelectrical impedance analysis (BIA). BIA is an easy-to-use, quick, inexpensive, noninvasive, and reproducible technique that is often incorporated in daily clinical practice. Phase angle (PA), which is derived from BIA, is an indicator of cell membrane health and integrity. Higher PA values reflect better cell function, higher muscle mass, and lower fat mass. PA is also thought to be a proxy of water distribution (ratio between extracellular water [ECW] and intracellular water [ICW]) and body cell mass. In this narrative review, we discuss studies examining the diagnostic and prognostic value of PA regarding nutritional status, body composition and physical function, complications of cancer treatments, overall survival, symptoms, and quality of life (QOL) in patients with cancer. The literature suggests that PA is moderately to strongly correlated with body composition and physical function but only weakly correlated with nutritional status, complications, survival, symptoms, and QOL. Furthermore, the PA cutoff values vary significantly according to study and patient population with the diversity of bioelectrical impedance technology and electrode composition and placement. Thus, PA has yet to be routinely incorporated into clinical practice for patients with cancer. Future research is needed to determine how to translate scientific understanding of PA to clinical practice.

Different assessment tools to detect sarcopenia in patients with Parkinson's disease

Introduction

Sarcopenia and Parkinson's disease are closely related diseases of the elderly population leading to progressive disability and nursing-dependent care.

Objective

The aim of this study was to estimate the prevalence of sarcopenia in PD patients with three different approaches: (1) the screening tool SARC-F, (2) EWGSOP-1 criteria, and (3) EWGSOP-2 criteria. Moreover, we aimed to evaluate the diagnostic accuracy of the screening tool SARC-F to detect sarcopenia according to the updated EWGSOP-2 criteria.

Methods

Eighty-one patients with Parkinson's disease aged 65 years and above were interviewed in a cross-sectional study at a tertiary referral center. All patients were screened with the SARC-F questionnaire and were evaluated for motor and non-motor symptoms, exercise, quality of life, and frailty. Muscle mass was assessed with bioelectrical impedance analysis, handgrip strength with a dynamometer, and gait speed was assessed with the 8-m walk test. EWGSOP-2 criteria were considered the gold standard to diagnose sarcopenia in our study.

Results

Eighty-one patients were evaluated (mean age: 73.82; SD 5.30). The prevalence of sarcopenia was 28.4% according to the EWGSOP-2 criteria. The concordance between EWGSOP-2 and EWGSOP-1 was poor (weighted kappa of 0.361[95% 0.164–0.557]). The sensitivity of the SARC-F screening test for detecting sarcopenia was 60.9%. The corresponding AUC in the ROC curve analysis showed 0.598 (0.462, 0.734 CI). The item assessing strength was found to have the highest sensitivity (69.6%).

Conclusion

Sarcopenia prevalence in patients with PD in Tirol, Austria is higher with EWGSOP-1 criteria compared to EWGSOP-2 criteria. The sensitivity and specificity of the SARC-F scale to detect sarcopenia in this population are poor.

Role of sarcopenia risk in predicting COVID-19 severity and length of hospital stay in older adults: a prospective cohort study

Sarcopenia is more common in the elderly and causes adverse outcomes with increased morbidity and mortality. This prospective cohort study assessed the association of sarcopenia risk with the severity of COVID-19 at the time of admission and during hospitalisation and the length of hospital stay. Two hundred patients (aged ≥ 60 years) who were hospitalised for COVID-19 were enrolled using consecutive sampling between 29 December 2020 and 20 May 2021. The sarcopenia score of the patients was assessed using the Strength, Assistance in walking, Rising from a chair, Climbing stairs, and Falls questionnaire. The severity of COVID-19 was determined using the modified National Early Warning Score (m-NEWS) system for 2019 n-CoV-infected patients at admission (T1), day three (T2) and at discharge (T3). Data were analysed using SPSS, version 22 and STATA, version 14. Of the 165 patients included, thirty four (20·6 %) were at risk of sarcopenia. The length of hospital stay was slightly longer in patients with sarcopenia risk, but the difference was not significant (P = 0·600). The adjusted OR of respiratory rate (RR) > 20 /min at T1 for the sarcopenia risk group was 6·7-times higher than that for the non-sarcopenic group (P = 0·002). According to generalised estimating equations, after adjusting for confounding factors, the m-NEWS score was 5·6 units higher in patients at risk of sarcopenia (P < 0·001). Sarcopenia risk could exacerbate COVID-19 severity and increase RR at admission, as well as the need for oxygen therapy at discharge.

O uso do escore SARC-F como auxiliar na prevenção de fraturas por fragilidade

Objetivo O presente estudo teve como objetivo relacionar o escore strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) com a presença ou não de fratura por fragilidade na população acima de 60 anos.

Métodos O risco de sarcopenia foi determinado por meio da aplicação do questionário SARC-F, sendo os pacientes divididos em 2 grupos, de acordo com a ocorrência ou não de fratura por fragilidade (n = 100).

Resultados Foram levantados 32 casos de fratura de rádio distal e 18 casos de fratura de fêmur proximal. Uma maior pontuação no SARC-F determina bem entre ter ou não ter fratura por fragilidade, estimando que a cada ponto a mais no escore há um acréscimo de 70% na chance de o paciente ter fratura, independentemente da idade, sexo e índice de massa corporal (IMC).

Conclusão Houve correlação direta entre uma maior pontuação no SARC-F e aumento na chance de fratura por fragilidade.

Development of a risk prediction nomogram for sarcopenia in hemodialysis patients

Background

Sarcopenia is associated with various adverse outcomes in hemodialysis patients. However, current tools for assessing and diagnosing sarcopenia have limited applicability. In this study, we aimed to develop a simple and reliable nomogram to predict the risk of sarcopenia in hemodialysis patients that could assist physicians identify high-risk patients early.

Methods

A total of 615 patients undergoing hemodialysis at the First Affiliated Hospital College of Medicine Zhejiang University between March to June 2021 were included. They were randomly divided into either the development cohort (n = 369) or the validation cohort (n = 246). Multivariable logistic regression analysis was used to screen statistically significant variables for constructing the risk prediction nomogram for Sarcopenia. The line plots were drawn to evaluate the effectiveness of the nomogram in three aspects, namely differentiation, calibration, and clinical net benefit, and were further validated by the Bootstrap method.

Results

The study finally included five clinical factors to construct the nomogram, including age, C-reactive protein, serum phosphorus, body mass index, and mid-upper arm muscle circumference, and constructed a nomogram. The area under the ROC curve of the line chart model was 0.869, with a sensitivity and specificity of 77% sensitivity and 83%, the Youden index was 0.60, and the internal verification C-statistic was 0.783.

Conclusions

This study developed and validated a nomogram model to predict the risk of sarcopenia in hemodialysis patients, which can be used for early identification and timely intervention in high-risk groups.