Polish Translation and Validation of the Mini Sarcopenia Risk Assessment (MSRA) Questionnaire to Assess Nutritional and Non-Nutritional Risk Factors of Sarcopenia in Older Adults

Comparison of the performance of four screening tools for sarcopenia in patients with chronic liver disease

Objectives

Early identification of sarcopenia in patients with chronic liver disease is crucial for patient management and prevention of severe complications. We aimed to assess the effectiveness of Ishii score, Strength, Assistance with Walking, Rise from a Chair, Climb Stairs and Falls (SARC-F), SARC-F and Calf Circumference (SARC-CalF), and Mini Sarcopenia Risk Assessment-7 (MSRA-7) to screen sarcopenia in patients with chronic liver disease.

Methods

This prospective study included patients with chronic liver disease in the infectious department of a tertiary hospital in Sichuan, China. Ishii score, SARC-F, SARC-CalF, and MSRA-7 were used to screen for sarcopenia risk. Sarcopenia was diagnosed according to the Asian Myometriosis Working Group (AWGS) 2019, which was used as the gold standard to compare the performance of the four screening tools. We completed clinical registration on the Chinese Clinical Trial Registration website (ChiCTR2100043910).

Results

A total of 366 patients with chronic liver disease (22.4% women, mean age 48.96 ± 11.88 years) were evaluated. Based on the AWGS 2019 standard, the prevalence of sarcopenia in patients with chronic liver disease was 17.5%. Among all participants, receiver operating characteristic (ROC) produced an area under the curve (AUC) of 0.82 for Ishii score (sensitivity 85.94%, specificity 78.15%), 0.53 for SARC-F (sensitivity 6.25%, specificity 99.34%), 0.64 for SARC-CalF (sensitivity 45.31%, specificity 83.11%), and 0.55 for MSRA-7 (sensitivity 87.50%, specificity 22.85%). Based on AUC, decision curve analysis, and calibration curves, we concluded that Ishii score was the most accurate screening tool and was superior to the other tools.

Conclusions

Ishii score is more suitable for screening sarcopenia in patients with chronic liver disease than the SARC-F, SARC-CalF, and MSRA-7, based on the AWGS 2019 criteria. Nursing professionals can use Ishii score as a clinical tool to screen for sarcopenia in patients with chronic liver disease, providing an indication cue for the final diagnosis of sarcopenia, improving diagnostic efficiency, and enabling early identification and prevention of complications resulting from sarcopenia.

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.

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.

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.

Markers for the Prediction of Probably Sarcopenia in Middle-Aged Individuals

Sarcopenia is a condition that is characterized by a progressive loss of muscle mass, strength, and function, resulting in reduced quality of life. The aim of the study was to analyze the significance of pro-inflammatory markers in the prognostic diagnosis of sarcopenia. The participants were divided into two groups: the main group of 146 people and the control-75 people. The complex of examinations included neuropsychological testing (Hospital Anxiety and Depression Scale (HADS), quality-of-life questionnaire for patients with sarcopenia (SarQoL), and short health assessment form (MOS SF-36)), a 6 m walking speed test, manual dynamometry, bioimpedancemetry, and metabolic markers (nitrates, fibroblast growth factor 21, and malondialdehyde). When analyzing metabolic markers in the main group, a twofold increase in nitrates in the main group was recorded in a subsequent analysis adjusted for multiple variables, there was a negative association between the nitrate levels for weak grip strength and appendicular muscle mass. An additional analysis revealed that the complaint of pain in the lower extremities was more frequent in patients of the main group, as well as constipation and the pathology of thyroid gland, and they were more frequently diagnosed with arterial hypertension. At the same time, patients from the main group more frequently took vitamin D. When conducting body composition, the main group recorded a higher weight visceral fat content, as well as a decrease in appendicular and skeletal muscle mass; these changes were accompanied by a decrease in protein and minerals. Among the markers that differed significantly were nitrates, and it was this that was associated with decreased muscle strength and appendicular mass, which may indicate both a possible mechanism and a possible predictive marker. The results of this study can be used to develop a screening method for diagnosing sarcopenia at the outpatient stage.

SARC-F and other screening tests for sarcopenia

PURPOSE OF REVIEW

Sarcopenia screening tools can enable clinicians to select individuals for more demanding evaluations, and hence, may facilitate its timely diagnosis and management. The most common recommended screening test is SARC-F, whereas many others are proposed. We aimed to summarize the recent studies and evidence performed on SARC-F and other sarcopenia screening tools.

RECENT FINDINGS

Meta-analysis studies reported that despite having moderate-high specificity, SARC-F has low-moderate sensitivity to detect sarcopenia, which would cause a significant number of individuals having sarcopenia to be unrecognized. Several recent studies aimed to increase sensitivity and utility of SARC-F as a screening tool by i.e., application of lower cut-offs, adding extra-items, and combining with other screening tests. Some of these approaches increased its screening efficacy significantly. In line with its previous studies, SARC-F showed success to predict adverse outcomes in the latest studies as well. Recently, it has also been suggested as a reasonable screening test for frailty. In addition to the long-standing screening tests i.e., anthropometric measures, Ishii Test and Mini Sarcopenia Risk Assessment (MSRA) Questionnaire; new tests, i.e., Taiwan Risk Score for Sarcopenia, Sarcopenia Scoring Assessment Model (SarSA-Mod) and re-purposed tests, i.e., SARQoL questionnaire and fracture risk assessment tool have been investigated as potential screening tests for sarcopenia. Some of these tests performed as well as or superior to standard SARC-F.

SUMMARY

Screening of sarcopenia is critical for public health given its significant prevalence and adverse outcomes. SARC-F is the most recommended tool for screening but has low-moderate sensitivity. Studies performed recently indicate that its sensitivity can be increased by some attempts and it may be used as a reasonable test to screen frailty as well. Some other tests have also been developed/re-purposed for an efficient screening, needing to be tested for their performance and usability with future studies in different populations and settings.

Cross-Cultural Adaptation of the Brazilian Portuguese-Translated Version of the Mini Sarcopenia Risk Assessment (MSRA) Questionnaire in Cancer Patients

Background and Aims: This study sought (i) to adapt cross-culturally the Brazilian Portuguese-translated version of the MSRA questionnaire, (ii) to estimate the prevalence of risk of sarcopenia, and (iii) to correlate the MSRA Portuguese version with CC in hospitalized cancer patients. Methods: This was a cross-sectional study developed at the hospital in the year 2018. After being translated and adapted to the Portuguese language, the questionnaire was applied and associated with the measurement of calf circumference (CC) to verify its validity. Results: Of the 45 patients, 71.1% presented significant or severe body weight loss, and 55.5% indicated muscle mass loss (CC < 31 cm). From the MSRA of seven and five items, 91.1 and 84.5% of the patients, respectively, presented risk for sarcopenia. Among those at risk for sarcopenia, more than 60% were aged <70 years, >80% were hospitalized in the last year, more than 40% could not walk > 1000 m, >40% did not eat regularly, and >80% lost >2 kg in the last year. CC was correlated with MSRA of five items (r = 0.46, p = 0.001) and seven items (r = 0.53, p = 0.0002). Furthermore, both versions of the MSRA (seven and five items) presented strong agreement and high reliability. Conclusions: The MSRA full and short version was adapted for a Brazilian Portuguese-translated version and showed strong agreement and high reliability to identify the risk for sarcopenia in hospitalized cancer patients. Therefore, this questionnaire can be used as part of nutritional assessment protocols in order to enable early screening of the risk for sarcopenia