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Background: Sarcopenia, the loss of muscle mass and strength, is associated with adverse health outcomes. Calf circumference (CC) has been proposed as a surrogate measure of muscle mass in the elderly; however, ethnic/sex specific cut-off values remain to be established. Objective: A study was undertaken to investigate the relationship between CC and appendicular skeletal muscle mass (ASM), and the ASM index (ASMI), as well as to determine whether CC could be used to diagnose sarcopenia. Methods: This was a cross-sectional study of 247 older black women living from Tlokwe, South Africa. ASM was measured using dual-energy X-ray absorptiometry, and the ASMI was calculated. Receiver operator characteristics curves and maximum Youden index were applied to identify a CC cut-off point for sarcopenia according to low gait speed (< 0.8 m/s), low hand-grip strength (< 16 kg) and low ASMI using a South African cut-off point for sarcopenia (ASMI < 4.94 kg/m 2 ). Results: A strong positive correlation between CC and ASMI (r = 0.84, p < 0.001) was observed. The CC to predict low hand-grip strength was 34.3 cm and 37.8 cm for low gait speed. A CC of 29.9 cm was indicative of sarcopenia. The area under the curve for all outcomes was > 0.60. Conclusion: A CC of 30 cm is proposed as a simple and inexpensive way to predict, screen or diagnose sarcopenia in black women in low-resource health settings. An accessible, inexpensive screening or diagnostic tool could facilitate timely interventions and prevention.

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In addition, once an institution chooses a specific technological approach, such as using e-guides, there should be resources in place to support the forerunners of these initiatives.