Mid-Upper Arm Circumference as an Alternative Screening Instrument to Appendicular Skeletal Muscle Mass Index for Diagnosing Sarcopenia

Abstract

Purpose

Mid-upper arm circumference (MUAC) is a simple, noninvasive anthropometric indicator. This study evaluated the applicability of MUAC as an alternative screening instrument to appendicular skeletal muscle mass index (ASMI) for detecting sarcopenia, and determined the optimal MUAC cutoff values.

Patients and Methods

A total of 4509 subjects ≥50 years of age from the West China Health and Aging Trend study were included in the present study. ASM was measured by bioelectrical impedance analysis. MUAC, calf circumference (CC), and grip strength were evaluated and the Short Physical Performance Battery and 3-m timed up-and-go test were administered. Low muscle mass was diagnosed based on Asian Working Group for Sarcopenia 2019 (AWGS2019) and updated European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria.

Results

ASMI was positively correlated with MUAC in both men (r=0.726, P<0.001) and women (r=0.698, P<0.001). The area under the receiver operating characteristic curve (AUC) for MUAC as an indicator of low muscle mass in men and women was 0.86 (95% confidence interval [CI]: 0.85–0.88) and 0.85 (95% CI: 0.84–0.86), respectively, according to AWGS2019 criteria; and 0.86 (95% CI: 0.85–0.88) and 0.86 (95% CI: 0.85–0.88), respectively, according to EWGSOP2 criteria. Optimal MUAC cutoff values for predicting low muscle mass were ≤28.6 cm for men and ≤27.5 cm for women. There was no significant difference between the AUCs of MUAC and CC in men according to the 2 reference standards (P=0.809), whereas the AUC of CC was superior to that of MUAC in women according to AWGS2019 (P<0.001) and EWGSOP2 (P=0.008) criteria.

Conclusion

MUAC is strongly correlated with ASMI among community-dwelling middle-aged and older adults in China. MUAC can be used as a simple screening instrument to ASMI for diagnosing sarcopenia, especially in men.

Keywords:

• anthropometry
• low muscle mass
• diagnosis
• older adults

Acknowledgments

The authors thank the participants in this study and the members of the survey teams. We also thank The Charlesworth Group (www.cwauthors.com) for its linguistic assistance during the preparation of this manuscript.

Abbreviations

ASM, appendicular skeletal muscle mass; ASMI, appendicular skeletal muscle mass index; AUC, area under the receiver operating characteristic curve; AWGS2019, Asian Working Group for Sarcopenia 2019; BIA, bioelectrical impedance analysis; BMI, body mass index; CC, calf circumference; CI, confidence interval; CT, computed tomography; DXA, dual-energy X-ray absorptiometry; EWGSOP2, European Working Group on Sarcopenia in Older People 2; MAMC, mid-arm muscle circumference; MRI, magnetic resonance imaging; MUAC, mid-upper arm circumference; ROC, receiver operating characteristic; SARC-F, Strength, Assistance Walking, Rise from a Chair, Climb Stairs, and Falls; SARC-CalF, Strength, Assistance Walking, Rise from a Chair, Climb Stairs, and Falls Combined with Calf Circumference; SPPB, Short Physical Performance Battery; TUG, timed up-and-go; WCHAT, West China Health and Aging Trend.

Data Sharing Statement

Data in this article are confidential and not publicly available. But those data are available from the corresponding author upon a reasonable request.

Ethics Approval and Informed Consent

The WCHAT study was registered in the Chinese Clinical Trial Registry (registration no. ChiCTR1800018895) and was approved by the Ethics Committee of West China Hospital, Sichuan University (approval no. 2017-445). This study was conducted in accordance with the Declaration of Helsinki and written informed consent was obtained from all participants and/or their proxy respondents.

Author Contributions

All authors met the following conditions 1, 2, 3, 4 and 5.

1. Made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas.

2. Have drafted or written, or substantially revised or critically reviewed the article.

3. Have agreed on the journal to which the article will be submitted.

4. Reviewed and agreed on all versions of the article before submission, during revision, the final version accepted for publication, and any significant changes introduced at the proofing stage.

5. Agree to take responsibility and be accountable for the contents of the article.

Disclosure

The authors have no conflicts of interest to declare.