Calf Circumference as a Simple Screening Marker for Diagnosing Sarcopenia in Older Korean Adults: the Korean Frailty and Aging Cohort Study (KFACS)

Abstract

BackgroundThe purpose of this study was to explore the optimal cut-off point of calf circumference (CC) as a simple proxy marker of appendicular skeletal muscle mass (ASM) and sarcopenia in the Korean elderly and to test the criterion-related validity of CC by analyzing its relationships with the physical function.MethodsThe participants were 657 adults aged 70 to 84 years who had completed both dual energy X-ray absorptiometry (DXA) and physical function test in the first baseline year of the Korean Frailty and Aging Cohort Study.ResultsASM and skeletal muscle mass index (SMI) were correlated positively with CC (male, ASM, r = 0.55 and SMI, r = 0.54; female, ASM, r = 0.55 and SMI, r = 0.42; all P < 0.001). Testing the validity of CC as a proxy marker for low muscle mass, an area under the curve (AUC) of 0.81 for males and 0.72 for females were found and their optimal cut-off values of CC were 35 cm for males and 33 cm for females. In addition, CC-based low muscle groups were correlated with physical functions even after adjusting for age and body mass index. Also, the cut-off value of CC for sarcopenia was 32 cm (AUC; male, 0.82 and female, 0.72).ConclusionThe optimal cut-off values of CC for low MM are 35 cm for males and 33 cm for females. Lower CC based on these cut-off values is related with poor physical function. CC may be also a good indicator of sarcopenia in Korean elderly.

Gait speed as a mediator of the effect of sarcopenia on dependency in activities of daily living

“…Our results clearly show the differences between older adults with sarcopenia and non-sarcopenia in the performance in gait speed and the level of dependence. As shown in previous studies, our findings confirm that sarcopenia results in lower gait speed 18,34 and independence in daily living. 6,35 Consequently, the promotion of physical activity in older adults is key to maintain the muscle mass to prevent the deterioration of gait speed.…”

“…CC is an anthropometric parameter that is closely related to whole body muscle mass and is known to be associated with the nutrition status of the elderly population. 22 Our findings indicate that lower CC, a valid predictor of sarcopenia, 18,19 might increase the risk of dependency in older adults. This result is similar to previous cross-sectional studies in which lower CC was associated with poor functioning in basic ADL, indicating the high dependency of these patients and a high necessity of care.…”

“…First, the cross‐sectional design of the study limits the causality of the findings and only associations can be drawn, providing hypotheses that can be verified in future studies. A second limitation is the criteria used to establish sarcopenia and non‐sarcopenia groups, since the European Working Group on Sarcopenia in Older People proposes an algorithm for sarcopenia case‐finding and not only CC; however, it seems that CC is a valid and reliable method to diagnose sarcopenia . Another limitation that could affect the results of this study is the level of functional dependence, because this was assessed through a self‐reported questionnaire …”

“…A second limitation is the criteria used to establish sarcopenia and non-sarcopenia groups, since the European Working Group on Sarcopenia in Older People proposes an algorithm for sarcopenia case-finding and not only CC; however, it seems that CC is a valid and reliable method to diagnose sarcopenia. 18,19 Another limitation that could affect the results of this study is the level of functional dependence, because this was assessed through a self-reported questionnaire. 41 To the best of our knowledge, this is the first study aimed at investigating the possible role of gait speed performance in the relationship between sarcopenia and functional dependence.…”

“…14 On the other hand, sarcopenia, resulting from reduced skeletal muscle mass, is associated with aging. 15 Based on the need for a simpler method of assessing muscle mass in community-based, and large-scale epidemiological contexts, several regions (Europe, USA, and Asia) and organizations incorporated the use of calf circumference (CC), as a marker of muscle mass in elderly people in primary care setting 11,[16][17][18] . In a Japanese study including 526 participants, CC was positively correlated with appendicular skeletal muscle and as a surrogate marker of muscle mass for diagnosing sarcopenia.…”