EWGSOP2 Criteria Research Articles

Diagnosing sarcopenia at the point of imaging care: analysis of clinical, functional, and opportunistic CT metrics.

To determine the relationship between CT-derived muscle metrics and standardized metrics of sarcopenia in patients undergoing routine CT imaging. Data collected in 443 consecutive patients included body CT, grip strength, usual gait speed, and responses to SARC-F and FRAIL scale questionnaires. Functional and clinical metrics of sarcopenia were acquired at the time of CT. Metrics were analyzed using the diagnostic framework of the European Working Group on Sarcopenia in Older People (EWGSOP2). The skeletal muscle index (SMI) and skeletal muscle density (SMD) were measured at the T12 and L3 levels. Statistical methods include linear prediction models and ROC analysis. T12-SMD and L3-SMD in women and T12-SMD and L3-SMI in men show weak but significant (p < 0.05) predictive value for gait speed, after adjusting for subject age and body mass index. The prevalence of abnormal CT SMI at T12 and L3 was 29% and 71%, respectively, corresponding to prevalences of confirmed sarcopenia by EWGSOP2 of 10% and 15%, respectively. The agreement of abnormal SARC-F and FRAIL scale screening and EWGSOP2 confirmed sarcopenia was slight to fair (kappa: 0.20-0.28). CT cutpoints, based on EWGSOP2 criteria for abnormal grip strength or gait speed, are generally lower than cutpoints based on normative population data. Collection of clinical and functional sarcopenia information at the point of imaging care can be accomplished quickly and safely. CT-derived muscle metrics show convergent validity with gait speed. Only a minority of subjects with low CT metrics have confirmed sarcopenia by EWGSOP2 definition.

Sarcopenia prevalence and its correlations with age-related disorders among community-dwelling Palestinian older adults

Background & aims. Sarcopenia is an age-related disorder characterized by gradual loss of muscle mass and strength. It has considerable prevalence and health implications among older adults. This study aims to determine the prevalence of Sarcopenia and its correlation with age-related disorders among community-dwelling older adults in two rural areas in Hebron city, Palestine. Methods. A cross-sectional survey design was utilized to analyze data collected from 145 participants (72 males and 78 females) aged ≥ 60 years old. The EWGSOP criteria were used to define Sarcopenia, and the anthropometric measurements, body composition and Mini-Nutritional Assessment were used to assess participants’ nutrition status. The functional status assessment was done based on daily living activities and instrumental activity of daily living; the cognitive function was assessed using the validated Arabic version of MoCA-B; and screening for depressive symptoms was done using the Arabic version of GDS-15. Results. Sarcopenia prevalence was 26.9%, significantly higher among men 35.7% compared to women 18.7%. Sarcopenia was associated with higher BMI, lower cognitive function, lower functional status, and a higher score of depressive symptoms (p < 0.05). Conclusions. Sarcopenia has a considerable prevalence among the study sample, and it is associated with nutritional status, impaired functional status and cognitive status. The study recommends further research utilizing different study designs (quantitative and qualitative) to determine the prevalence of Sarcopenia, causes and risk factors in other areas of Palestine.

The Role of Imaging Biomarkers in the Assessment of Sarcopenia.

Background: The diagnosis of sarcopenia through clinical assessment has some limitations. The literature advises studies that include objective markers along with clinical assessment in order to improve the sensitivity and specificity of current diagnostic criteria. The decrease of muscle quality precedes the loss of quantity, so we studied the role magnetic resonance imaging biomarkers as indicators of the quantity and quality of muscle in sarcopenia patients. Methods: a cross-sectional analysis was performed to analyze what MR-derived imaging parameters correlate better with sarcopenia diagnostic criteria in women of 70 years of age and over (independent walking and community-dwelling women who were sarcopenic in accordance with EWGSOP criteria with muscle mass adjusted to Spanish population were chosen). Results: The study included 26 women; 81 ± 8 years old. A strong correlation was obtained between cineanthropometric variables (BMI; thigh perimeter and fat mass) and imaging biomarkers (muscle/fat ratio, fatty infiltration, muscle T2*, water diffusion coefficient, and proton density fat fraction) with coefficients around 0.7 (absolute value). Conclusions: Knowing the correlation of clinical parameters and imaging-derived muscle quality indicators can help to identify older women at risk of developing sarcopenia at an early stage. This may allow taking preventive actions to decrease disability, morbidity, and mortality in sarcopenia patients.

Accuracy of SARC-F and SARC-CalF for sarcopenia screening in older women from southern Brazil.

The aim of this study was to verify the accuracy of the SARC-F and the SARC-CalF as screening tools for sarcopenia in community-dwelling older women ≥60 y of age. This was a cross-sectional study evaluating a convenience sample of women ≥60 y of age, living in Southern Brazil. Sarcopenia was defined according to the criteria proposed in the latest European Working Group on Sarcopenia in Older People consensus (EWGSOP2). Appendicular muscle mass was assessed by dual-energy x-ray absorptiometry. Muscle strength was measured by handheld dynamometry, and physical performance through the 4-m gait speed test. The SARC-F questionnaire and SARC-CalF score for sarcopenia screening were also applied. We evaluated 288 participants, with a mean age of 67.6 ± 5.8 y. The frequency of probable and confirmed sarcopenia in the sample was 7.3% and 2.1%, respectively. The frequency of risk for sarcopenia assessed by the SARC-F was 4.5% and SARC-CalF 22.2%. Despite the excellent specificity (95.4%) demonstrated by the SARC-F, its sensitivity in identifying confirmed cases was null, whereas the SARC-CalF showed high sensitivity (83.3%) and good specificity (79%). The present study findings suggested that SARC-CalF may be able to outperform SARC-F as a sarcopenia screening tool in women ≥60 y of age even under the new EWGSOP2 criteria, the main determinant of which is strength as observed in studies based on the previous definition.

The diagnostic value of the Short Physical Performance Battery for sarcopenia

BackgroundSarcopenia is defined as the age-related loss of muscle mass, strength, and physical performance. The original European Working Group on Sarcopenia in Older Persons (EWGSOP1) definition, and its revision (EWGSOP2), provide new cut-points and alternate measures for sarcopenia diagnosis. However, sarcopenia is rarely diagnosed in clinical settings owing to its labor-intensive diagnostic process. Given the Short Physical Performance Battery (SPPB) is a quick, easily administrable, and objective measure of muscle strength and physical performance, both of which are key components of sarcopenia, this study examined the diagnostic value of the SPPB for this muscle disease.MethodsA cross-sectional analysis of 294 community-dwelling older persons (≥65 years) was conducted. Appendicular lean body mass [(ALM) divided by height squared (ALM/h2)], muscle strength (handgrip/sit to stand), and physical performance [gait speed, timed up and go (TUG) and SPPB] were assessed using validated procedures, while participants were diagnosed with sarcopenia following the EWGSOP1 and EWGSOP2 criteria. Diagnostic ability of the SPPB independently and combined with ALM/h2 for sarcopenia was determined using area under the curve (AUC). Potential cut-points were identified, and sensitivity and specificity calculated.ResultsPrevalence of sarcopenia ranged from 4 to 16% depending on the definition. The SPPB demonstrated moderate (AUC = 0.644–0.770) value in diagnosing sarcopenia, and a cut-point of ≤8points in SPPB performance resulted in high sensitivity (82–100%) but low specificity (36–41%) for diagnosing those with severe sarcopenia.ConclusionsThe SPPB displayed acceptable value in diagnosing older adults with severe sarcopenia. Moreover, the high sensitivity of the SPPB when using the cut-point of ≤8 suggests it may be a favorable screening tool for sarcopenia in clinical settings where ALM measurements are not available.

Biomarkers Profile of People With Sarcopenia: A Cross-sectional Analysis From UK Biobank

ObjectiveThis study aimed to characterize the biomarker profile of sarcopenic vs nonsarcopenic men and women, using the current European Working Group on Sarcopenia in Older People (EWGSOP2) definition in the UK Biobank study. DesignCross-sectional study. Setting and ParticipantsA total of 396,707 (68.8% women, age 38 to 73) participants from UK Biobank. MeasuresThirty-three biomarkers, standardized to sex-specific z-scores, were included in the analysis. Associations between these biomarkers and sarcopenia, defined using EWGSOP2 criteria, were examined using multiple linear regression. ResultsHigher concentrations of rheumatoid factor, C-reactive protein, cystatin C, sex hormone-binding globulin, gamma-glutamyltransferase, alkaline phosphatase, and total protein, as well as lower concentrations of insulin-like growth factor-1, albumin, creatinine, sodium, and systolic blood pressure, were associated with sarcopenia in both men and women. However, some of the associations differed by sex. Sarcopenia was associated with higher concentrations of phosphate, lipoprotein A, and lower of diastolic blood pressure, HbA1c, urea, glucose, total bilirubin, and testosterone in women only, and with higher concentrations of high-density lipoprotein, aspartate aminotransferase, and direct bilirubin and lower values of apolipoprotein A, vitamin D, and apolipoprotein B in men only. Conclusions and ImplicationsSeveral biomarkers were associated with sarcopenia in men and women using the new EWGSOP2 statement. However, some of these associations and their magnitude differed between men and women. Considering the EWGSOP2 updated its statement on the definition of sarcopenia in 2019, this study enables us to update the study of the biomarkers profile of people with sarcopenia.

Frequency of sarcopenia and factors associated with lean mass in women with rheumatoid arthritis

To evaluate the frequency of sarcopenia (SP) according to EWGSOP2 criteria and factors associated with low lean mass in women with rheumatoid arthritis (RA). 79 women (aged 4075 years) with RA were enrolled in the study. We analyzed clinical data: age, body mass index (BMI), disease duration, methotrexate use, glucocorticoid use, anthropometric measurements, C-reactive protein level, disease activity score in 28 joints-erythrocyte sedimentation rate, bone mineral density (BMD) of the lumbar spine, femur neck, total hip and body composition by Dual energy X-ray absorptiometry. Also, muscle strength and functional tests were performed. We analyzed the correlation between disease parameters and low lean mass with the Spearman method. 73 (92%) patients had low muscle strength, 20 (25%) patients had low muscle strength and low lean mass, among them 9 (11%) also had functional disability. There was no correlation between the age of patients and the presence of SP, while the duration of RA in women with SP was significantly greater (p=0.006). There were significant correlations between lean mass and body mass index, glucocorticoids used, methotrexate doses, creatinine and urea acid serum concentration, bone mineral density and falls number. According EWGSOP2 confirmed sarcopenia was found in 25% RA patients, among them 11% women had severe sarcopenia. Lean mass correlated with the factors related to the disease itself and some general clinical parameters, which requires further study.

P0944UREMIC SARCOPENIA IN THE ELDER: PRELIMINARY RESULTS OF A PRECISION MEDICINE APPROACH IN A COHORT OF UREMIC PATIENTS

Abstract Background and Aims Sarcopenia is defined as a chronic condition of “muscle failure”, characterized by reduced muscular strength, mass and performance. End-stage renal disease (ESRD) and sarcopenia have several complications in common including inflammation, low sexual hormones, reduced levels of Vitamin D, and low satellite cells proliferation rate. Sarcopenic and uremic patients have higher risk for fracture, cardiovascular events, cognitive impairment, low quality of life, hospitalization and death. The European Working Group on Sarcopenia in Older People (EWGSOP2) 2019 guidelines standardize the diagnostic criteria and recommend a systematic approach for sarcopenia assessment. The aim of our study is to evaluate the prevalence of sarcopenia in ESRD patients not yet on dialysis and to characterize their clinical, laboratory and behavioral features. Method This is a pilot cross-sectional study. ESRD patients expected to initiate replacement therapy (hemodialysis or peritoneal dialysis), age ≥60 years, free mobility and hemoglobin levels ≥9.5 g/dL were enrolled. Exclusion criteria were: use of steroids &amp;gt;3 months during the previous year, previous renal replacement treatments. Enrolled patients were screened for sarcopenia following the three diagnostic criteria: muscle strength (through “handgrip strength” and “chair stand-up test”), muscle mass (with dual X-ray absorptiometry and bio-electrical impedance analysis), and muscle performance (with “4m gait speed test”). Clinical data were collected as well as anthropometric measures. Patients also underwent an abdominal ultrasound and a hematology, chemistry, urinary and inflammation laboratory panel. Finally, they filled questionnaires for sarcopenia identification (SARC-F), quality of life (SF-36), daily activity (ADL and iADL) and nutritional status. GFR was estimated according to CKD-EPI formula. Results We evaluated 9 patients (2 females and 7 males), mean age 72 ± 7 years, mean GFR 10.2±1.5 mL/min/1.73 m2 (range 7.3, 11.8). 7/9 reported hypertension history, 4/9 were diabetic. The prevalence of sarcopenia was 44% (4 patients) according EWGSOP2 criteria. Table 1 reports diagnostic exam results from our cohort. Taking individually EGWSOP2 criteria 4 patients showed low muscle strength, 5 reached the threshold for a low DXA muscle mass while 3 patients had a low gait speed performance, marker for sarcopenia severity. Compared with controls, sarcopenic patients (Table 2) showed a significantly lower handgrip strength (15.0±4.3 vs 23.0±6.7 Kg respectively, p-value 0.03), a lower but not significant appendicular lean mass (ALM) index normalized for squared height (European criteria) or for BMI (American criteria). Moreover, sarcopenic patients were more anemic (p 0.05), with a lower hematocrit (p 0.04). Finally, SF36 questionnaire describes sarcopenic patients as more jaded about physical activity, with impaired social activity and higher bodily pain. Conclusion Sarcopenia has a complex and diversified background, and ESRD represents an important risk factor. Sarcopenic patients with ESRD might need more carefulness on daily activity, anemia management, physical functioning and muscle recovery.

Sarcopenia: Influence of Regional Skeletal Muscle Cutoff Points and Fat-Free Mass in Older Mexican People-A Pilot Study.

Background Variation in the prevalence of sarcopenia is related to the skeletal muscle index cutoff points applied. The objective of this pilot study was to examine the recruitment process for testing different sarcopenia definitions (ASMI cutoffs) in older Mexican adults. It explored whether the prevalence of sarcopenia decreased by applying ethnic- and gender-specific, DXA-derived appendicular skeletal muscle index (ASMI)-cutoff points in the definitions, as well as some associated factors in a sample of community-dwelling older Mexican people. Methods This is a pilot feasibility study that included a convenience sample of 217 community-dwelling older adults. Volunteers underwent DXA measurements and an assessment of functional status based on hand grip strength and physical performance. Six definitions were formed based on the 2010 EWGSOP criteria, but using different cutoff points for each of the three components, including regional cutoff points for ASMI derived from young Mexican adults. Several risk factors for sarcopenia were also assessed. Results The prevalence of sarcopenia varied according to the different definitions applied. The lowest level was found with the definition that applied regional ASMI-cutoff points (p < 0.01). The sarcopenic older adults had significant lower body weight, fat mass, and fat-free mass (FFM) than the nonsarcopenic subjects. The risk of sarcopenia increased with age and low FFM (p < 0.001). Conclusion The present study demonstrates the feasibility of the main study, and our data support the notion that using regional ASMI cutoff points resulted in a low prevalence of sarcopenia. Therefore, it is preferable to estimate the prevalence of this condition using ethnic- and gender-specific cutoff points and to explore associated factors such as low FFM.

Osteoporosis and sarcopenia in women with rheumatoid arthritis

Objective: to assess bone mineral density (BMD) and the incidence of osteoporosis (OP) and sarcopenia (SP) in women suffering from rheumatoid arthritis (RA).Patients and methods. Eighty-one women (mean age, 59.0±8.1 years) with a reliable diagnosis of RA were examined. The women underwent the following studies: a survey using a special questionnaire; tests to measure the functional status of muscles, including those to determine their strength; as well as dual-energy X-ray absorptiometry of the axial skeleton and whole body.Results and discussion. According to the EWGSOP2 criteria, 20 (24.7%) female patients were diagnosed with SP, 24 (29.6%) had OP, and 39 (48.2%) had osteopenia. OP in female patients with and without SP occurred in 35.0 and 27.9% of cases, respectively (p&gt;0.05). BMD in the femoral neck and in the proximal femur as a whole was significantly lower in the presence of SP than in its absence (p=0.0006 and p=0.0061, respectively). The frequency of falls was significantly higher in the female patients with SP than in those without SP (p=0.028). The major osteoporotic and hip fracture probabilities calculated according to the FRAX ® algorithm was higher in the patients with SP than in those without SP (p=0.041 and p=0.033, respectively). There were positive correlations of BMD with body mass index, appendicular muscle mass, appendicular muscle index, hand strength, shoulder circumference, and the serum levels of calcium, creatinine and uric acid, as well as negative correlations with age, postmenopausal length, and RA duration.Conclusion. OP and SP are common RA complications that increase the risk of falls and fractures.

Comparison of EWGSOP-1and EWGSOP-2 diagnostic criteria on prevalence of and risk factors for sarcopenia among Iranian older people: the Bushehr Elderly Health (BEH) program.

This study proposed to compare the prevalence and risk factors for sarcopenia by EGWSOP-1 and EWGSOP-2 diagnostic criteria in Iran. This cross-sectional study was conducted based on the data collected during the Bushehr Elderly Health (BEH) Program, stage II. Sarcopenia was defined as 3 definitions: EWGSOP-1(with Iranian cut off), EWGSOP-2(with Iranian cut off), EWGSOP-2(with European cut off) definition. We evaluated the age-standardized prevalence of sarcopenia in both genders. Regression analysis was used to show the associations in the adjusted models. Among 2426 participants, age-standardized prevalence of sarcopenia, and severe sarcopenia by EWGSOP-1 were 19.7%, and 12.9%, in men and 13.6%, and 16.7% in women, respectively. When we used EWGSOP-2 (with Iranian cut-off) criteria, these values were 10.5%, and 12.7% among men and 7.13% and 16.5% in women, respectively. The prevalence sarcopenia and severe sarcopenia by EWGSOP-2 (with European cut-off) were 12.7%, and 13.4% in men and 5.42%, and 13.7% in women, respectively. In both genders, getting older and high-fat mass were positively associated with sarcopenia, and BMI had a significant inverse association in both genders and all defintions. Results showed that a prevalence of sarcopenia varied largely by using different criteria, in both sexes. EWGSOP2- defined sarcopenia prevalence was lower than that defined using EWGSOP-1 criteria due to different diagnostic factors to detect sarcopenia. Some adverse outcomes should be considered for evaluating sarcopenia to compare the accuracy of EWGSOP-1 and EWGSOP-2.

Intracellular Water Content in Lean Mass as an Indicator of Muscle Quality in an Older Obese Population.

Background: In aged populations, muscle strength depends more on muscle quality than on muscle quantity, while all three are criteria for the diagnosis of sarcopenia. Intracellular water content (ICW) in lean mass (LM) has been proposed as an indicator of muscle quality related to muscle strength in older people. Objectives: To evaluate the relationship between the ICW/LM ratio, muscle strength and indicators of functional performance in obese older adults, and to assess the value of the ICW/LM ratio as an indicator of muscle quality. Methodology: Design: cross-sectional study. Population: persons aged 65–75 years with a body mass index of 30–39 kg/m2. ICW and LM were estimated by bioelectrical impedance. Hand grip, gait speed, unipedal stance test, timed up-and-go (TUG) test, Barthel score and frailty (Fried criteria) were assessed. Sarcopenia was established according to EWGSOP2 criteria. Results: Recruited were 305 subjects (66% women), mean age 68 years. The ICW/LM ratio correlated with the TUG test, gait speed and grip strength, and was also associated with sex, the unipedal stance test and frailty. Independently of age, sex and muscle mass, the ICW/LM ratio was related with gait speed, the TUG test and unipedal stance capacity. One person (0.3%) had sarcopenia defined as low muscle strength and low muscle mass, while 25 people (8.2%) had sarcopenia defined as low muscle strength and poor muscle quality (ICW/LM). With this last definition, sarcopenia was related to frailty, gait speed and the TUG test. Conclusions: ICW content in LM could be a useful muscle quality indicator for defining sarcopenia. However, more studies are required to confirm our findings for other populations.

THE FREQUENCY OF SARCOPENIA IN OLDER AGE GROUPS: EVALUATION OF DIAGNOSTIC CRITERIA

The prevalence of sarcopenia in different countries of the world has been well studied. However, the criteria of different international professional groups are used to diagnose the disease, which leads to large variability in data on the frequency of sarcopenia in the population. The paper presents the results of studying the frequency of sarcopenia, by using the diagnostic criteria of different working groups. The measures characterizing muscle strength and skeletal muscle function were analyzed; the components that are most important for the diagnosis of sarcopenia were identified in the studied patient group. Objective: to determine the detection rates of sarcopenia among people aged over 65 years in accordance with the guidelines of different international professional groups and to identify the most significant component for its diagnosis. Subjects and methods. The investigation enrolled 230 people older than 65 years (mean age, 74.0±6.5 years) who were followed up in an outpatient setting. Sarcopenia was diagnosed according to the 2010 European Working Group on Sarcopenia in Older People (EWGSOP) criteria. To confirm its diagnosis, the appendicular muscle mass index (AMMI) was calculated using dual-energy X-ray absorptiometry (DXA) on a HOLOGIC QDR Explorer; muscle strength was measured with a Jamar-J00105 handheld dynamometer (Sammons Preston Inc., USA). Muscle function was also examined using the short physical performance battery (SPPB). The frequency of sarcopenia diagnosed by the criteria of the International Working Group on Sarcopenia (IWGS), the Foundation for the National Institutes of Health (FNIH), and EWGSOP were comparatively analyzed. Results and discussion. The frequency of sarcopenia in the sample of people aged over 65 years was the same when using the diagnostic EWGSOP and IWGS criteria (30%) and was significantly higher than when applying the FNIN criteria (19.8%). The frequency of sarcopenia increased from 21.4% at the age of 65–74 years to 52.9% at the age of over 85 years according to the EWGSOP and IWGS criteria and from 16.2% to 29.4%, respectively, by the FNIN criteria. Dynamometry showed that the muscle strength was significantly lower in patients with low muscle mass than in those with normal muscle mass (the average mass was 15.1±5.4 and 18.2±5.4 kg, respectively; p<0.001) among both males and females. The average SPPB scores in the entire sample were low in all the studied groups (7.6±3.1). It was significantly lower in patients with low muscle mass than in people with normal muscle mass (6.9 and 7.9 scores, respectively; p=0.016) as shown mainly by the Tandem test (p=0.0002). No substantial differences in the frequency of sarcopenia were found in different age groups according to the EWGSOP and EWGSOP2 criteria. Conclusion. The frequency of sarcopenia among people aged over 65 years according to the criteria adopted by professional communities varied widely from 19.8% (FNIN) to 26.5% (EWGSOP2) and 30% (EWGSOP). With age, the frequency of sarcopenia increased, reaching 52.9% among people over 85 years of age. Muscle strength measurement versus other functional tests is a more sensitive diagnostic method for sarcopenia.

Risk factors for 5-year mortality in a cohort of elderly patients with sarcopenia.

The association between multiple risk factors and the mortality of sarcopenic patients has not been studied. This study's aim is to report the prevalence of sarcopenia among a sample of Italian hospitalized older adults, describe the physical function, body fat composition, cognitive, inflammatory and nutritional status of sarcopenic compared with non-sarcopenic subjects, and determine the risk factors associated with mortality in sarcopenic patients. A total of 462 patients were enrolled and followed up for a period of 5years. Sarcopenia was diagnosed according to the EWGSOP2 criteria. Factors associated with sarcopenia were identified with linear regression analysis. Logistic regression was applied to explore the association between the risk factors and mortality in sarcopenic subjects. Survival analyses and predictors of mortality were identified using Kaplan-Meier and Cox regression. The prevalence of sarcopenia was 33.5%. Linear regression showed that sarcopenia was associated with Barthel index (B -9.63, p0.004), BMI (B -3.19, p<0.001) and android fat (B 1.85, p0.004). Of these factors, only the number of co-morbidities (OR 1.394 C95% 1.023-1.862 p 0.025) and MMSE scores (OR 0.857 C95% 0.79-0.930 p <0.001) were associated with mortality in sarcopenia. Kaplan-Meier and the log-rank tests showed the negative prognostic effect of low BMI (p0.007), albumin (p<0.001) and Barthel index (p 0.018). The Cox regression showed that mortality hazard is reduced with BMI >24.9 (HR 0.287 C95% 0.095-0.866 p 0.027). Sarcopenia is associated with low physical function and BMI but higher android fat. Low Barthel, BMI and albumin can significantly decrease the survival rate in sarcopenic patients. Whereas BMI >24.9 is associated with lower mortality hazard.

Comparison of Diagnostic Performance of SARC-F and Its Two Modified Versions (SARC-CalF and SARC-F+EBM) in Community-Dwelling Older Adults from Poland.

PurposeOlder adults should be routinely screened for sarcopenia, which threatens healthy, independent aging. The most popular screening tool is the SARC-F questionnaire. As its sensitivity is unsatisfactory, two modified versions of the questionnaire have been published: SARC-CalF (including calf circumference as an additional item) and SARC-F+EBM (assessing additionally age and Body Mass Index). The diagnostic performance of the three versions of the questionnaire has not been compared. The analysis aimed to assess the diagnostic value of SARC-F, SARC-CalF, and SARC-F+EBM questionnaires, and to compare their psychometric properties against two reference standards of sarcopenia diagnosis, ie, EWGSOP1 and modified EWGSOP2 criteria.Materials and MethodsWe performed the sensitivity/specificity analysis and compared the overall diagnostic accuracy of SARC-F, SARC-CalF (31cm) (cut-off point 31 cm for both genders), SARC-CalF (33/34cm) (cut-off points: 33 cm for women and 34 cm for men), and SARC-F+EBM in 115 community-dwelling volunteers aged ≥ 65 yrs from Poland.ResultsDepending on the version of the SARC-F questionnaire used, from 10.4% [SARC-CalF (31cm)] to 33.0% (SARC-F+EBM) were identified as having an increased risk of sarcopenia. Sarcopenia was identified in 17.4% by the EWGSOP1 criteria and in 13.9% by the modified EWGSOP2 criteria. With respect to the two reference standards used, the sensitivity of SARC-F, SARC-CalF (31cm), SARC-CalF (33/34cm), and SARC-F+EBM ranged 30.0–37.5%, 35.0–37.5%, 60.0–62.5%, 55.0% (the same value for both reference standards), respectively. The specificity ranged 85.3–85.9%, 93.9–94.7%, 88.4–86.9%, 70.7–71.6%, respectively. The AUC of SARC-F, SARC-CalF (31cm), SARC-CalF (33/34cm) and SARC-F+EBM ranged 0.644–0.693, 0.737–0.783, 0.767–0.804, 0.714–0.715, respectively.ConclusionThe modified versions of SARC-F have better diagnostic performance as compared to the original questionnaire. Since an ideal screening tool should have reasonably high sensitivity and specificity, and an AUC value above 0.7, the SARC-CalF (33/34cm) seems to be the best screening tool for sarcopenia in community-dwelling older adults.

Identification of sarcopenia and dynapenia in CKD predialysis patients with EGWSOP2 criteria: An observational, cross-sectional study.

Using the new European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, we identified sarcopenic and dynapenic patients in a cohort of predialysis patients with chronic kidney disease (CKD), and evaluated their clinical and laboratory characteristics. The study population consisted of 85 (55 men) clinically stable predialysis CKD patients (92.9% in stages 3-5), with a median age of 65.0 (52.5-72.0) y. We classified as sarcopenic the patients with handgrip strength (HGS) and muscle mass both lower than the respective EWGSOP2 cutoff values and as dynapenic those in whom only HGS was less than these reference values. HGS was measured with a hand dynamometer, whereas muscle mass was measured by bioimpedance analysis. Renal function was evaluated as Modification of Diet in Renal Disease estimated glomerular filtration rate. The prevalence of sarcopenia and dynapenia was, respectively, 7.1% and 17.6%. As reported in previous studies, serum albumin and hemoglobin were lower in sarcopenic patients than in patients with preserved muscle mass and strength. However, unlike in these studies, sarcopenia prevalence did not increase with CKD stage, and estimated glomerular filtration rate was similar between groups. Moreover, no difference was identified in any of the aforementioned parameters between dynapenic patients and patients with preserved muscle mass and strength. The EWGSOP2 criteria identified sarcopenia in CKD with a prevalence similar to previous diagnostic criteria. In addition, they found that dynapenia was highly prevalent. Nevertheless, the EWGSOP2 criteria could be better adapted to CKD patients to improve their ability to detect high-risk sarcopenic and dynapenic patients.

Associations between osteoporosis, the severity of sarcopenia and fragility fractures in community-dwelling older adults.

To investigate the association between bone mineral density (BMD) and the severity of sarcopenia using the revised European Working Group on Sarcopenia in Older People (EWGSOP2) definition. BMD [dual energy X-ray absorptiometry (DXA)], appendicular lean mass (DXA), handgrip strength (hydraulic dynamometer) and gait speed (over 4-m) were used to screen for osteoporosis and sarcopenia. Participants were categorized as osteoporotic according to the World Health Organization definition (T score ≤ -2.5), and classified with probable sarcopenia or confirmed sarcopenia according to the EWGSOP2 criteria. Fasting biochemistry profile, fragility fractures, malnutrition index, geriatric depression scale and fear of falling, were also measured using validated procedures. A total of 484 community-dwelling older adults (69.6% women) with a median age of 76years [Interquartile range (IQR) 70-81] were included in this study. Osteoporosis prevalence increased from 47.6% in non-sarcopenia to 65.5% in probable sarcopenia and 78.1% in those with confirmed sarcopenia (p < 0.05). After adjusting for age, sex and vitamin D in multivariate models, osteoporosis was associated with a greater risk of confirmed sarcopenia [odds ratio (OR) 2.885, 95% CI 1.155, 7.204, p = 0.023]. The number of fragility fractures was also higher in those with confirmed sarcopenia versus those without (p = 0.013), but this finding did not remain significant in adjusted models (p = 0.078). Prevalence of osteoporosis increased across the severity of sarcopenia, and osteoporosis was associated with a greater risk of sarcopenia. As such, health care professionals should screen for sarcopenia in those with low BMD.

70 Prevalence of Sarcopenia in A Longitudinal UK Cohort Study Using Ewgsop2 Criteria Varies Widely Depending on Which Measures of Muscle Strength and Performance are Used

Abstract Background The European Working Group on Sarcopenia in Older People 2 (EWGSOP2) guidelines have recently been published to aid diagnosis of sarcopenia in the clinical setting and to allow for better comparison between research studies. The guidelines recommend several different tests for diagnosing sarcopenia. We hypothesised that the prevalence of sarcopenia might vary depending on which tests are used. Methods We used data from Wave 3 of the Lothian Birth Cohort 1936 study, a longitudinal ageing study of healthy, community dwelling older adults (n= 697, 52% men, mean age 76y), to assess the prevalence of sarcopenia using the suggested cut-offs in the EWGSOP2 guidelines. Probable sarcopenia was defined as low muscle strength (measured by handgrip strength and 5x chair stand test), confirmed sarcopenia was defined as low muscle strength + low lean mass (measured by bioimpedance analysis), and severe sarcopenia was defined as confirmed sarcopenia + low muscle performance (measured by gait speed and short physical performance battery score). SPSS version 24.0 was used for statistical analysis. Results The maximum prevalence of probable sarcopenia was 24.2% in men and 24.8% in women, of confirmed sarcopenia was 7.4% in men and 11.0% in women, and of severe sarcopenia was 4.6% in men and 5.9% in women, when either of the cut-offs for muscle strength +/- muscle performance were met. When using only one measure of muscle strength +/- performance, rates of probable sarcopenia ranged from 7.7% to 21.1% in men and 5.9% to 21.3% in women; rates of confirmed sarcopenia ranged from 3.9% to 5.3% in men and 5.1% to 9% in women; and rates of severe sarcopenia ranged from 1.4% to 3.9% in men and from 2.0% to 5.1% in women. Conclusions In a UK-based longitudinal ageing study we found that the prevalence of probable, confirmed and severe sarcopenia varied widely using the EWGSOP2 guidelines depending on which identifying tests were used. We found that the cut-off points suggested for some of the measures in the guidelines are not comparable and may lead to differing groups being identified as sarcopenic between different trials. We suggest modification of the cut-offs to adjust for this.

Correlations between the Quality of Life Domains and Clinical Variables in Sarcopenic Osteoporotic Postmenopausal Women.

(1) Background: both sarcopenia and osteoporosis are major health problems in postmenopausal women. The aim of the study was to evaluate the quality of life (QoL) and the associated factors for sarcopenia in osteoporotic postmenopausal women, diagnosed according to EWGSOP2 criteria. (2) Methods: the study sample comprised 122 osteoporotic postmenopausal women with low hand grip strength and was divided into two groups: group 1 (probable sarcopenia) and group 2 (sarcopenia). QoL was assessed using the validated Romanian version of SarQol questionnaire. (3) Results: the D1, D4, D5, D7 and total SarQoL scores were significantly lower in women from group 2 compared to group 1. In group 2, women older than 70 years had significant lower values for D1, D3, D4, D6 and total SarQoL scores. Age, history of falls and the presence of confirmed and severe sarcopenia were predictors for overall QoL. (4) Conclusions: the frequency of sarcopenia was relatively high in our sample, with body mass index and history of falls as predictors for sarcopenia. Older osteoporotic postmenopausal women, with previous falls and an established sarcopenia diagnosis (low muscle strength and low muscle mass), were more likely to have a decreased quality of life.

Is peak expiratory flow an accurate sarcopenia screening tool in older patients referred to respiratory rehabilitation?

To assess the performance of peak expiratory flow (PEF) for sarcopenia screening in patients with chronic obstructive pulmonary disease (COPD), using the revised European Working Group on Sarcopenia in Older People (EWGSOP-2) criteria as the reference standard in pulmonary rehabilitation patients; and second, to study the factors associated with low PEF in this population. Diagnostic accuracy study conducted in consecutive community-dwelling COPD rehabilitation patients. Sensitivity, specificity, accuracy, likelihood ratios, predictive values, and area under the Receiver-Operating Characteristic curve were retrospectively calculated for PEF (index test) and compared with EWGSOP-2 criteria (reference standard). Of 151 potentially eligible patients, 79 (67.5 ± 7.1years; 78.8% men) fulfilled inclusion criteria and 10 (12.7%) had a diagnosis of sarcopenia. The PEF cut-off with highest accuracy (65.8%) was PEF ≤ 200 L/min (sensitivity 90%, specificity 62.3%, and positive and negative likelihood ratios 2.39 and 0.16, respectively). Airway obstruction and muscle mass were significantly associated with PEF ≤ 200 L/min. Considering the EWGSOP-2 criteria as the reference standard, a cut-off of PEF ≤ 200 L/min showed only fair validity for detecting sarcopenia, so it cannot be recommended as a stand-alone screening tool in older rehabilitation patients with COPD.