The Optimal Cut-off Value of Upper Arm Circumference and Calf Circumference for Assessing Sarcopenia Among Chinese Community-Dwelling Older Adults

Abstract

Objective

To explore the cut-off values and health evaluations of upper arm circumference (AC) and calf circumference (CC) on sarcopenia in Chinese community-dwelling older people.

Methods

In this cross-sectional study, AC, CC, handgrip strength, muscle mass and gait speed were measured in 1537 Chinese community-dwelling older people in Sub-study 1. Correlation analysis, receiver operator characteristic curve (ROC curve) analysis, and consistency analysis were used for determination of AC and CC cut-off values for sarcopenia diagnosis (sarcopenia-AC and CC). Thereafter, 269 participants accepted additional assessments on physical function, body composition and muscle strength in Sub-study 2. T-test or Mann-Whitney U-test was used to explore the differential effects of sarcopenia-AC and CC on health indicators between sarcopenic and non-sarcopenic participants.

Results

In Sub-study 1, the Area Under ROC (AUC) of AC and CC for sarcopenia screening were greater than 0.700 (P<0.05). The cut-off values, sensitivity and specificity of AC and CC on sarcopenia in males were 25.9 cm (86.0%, 83.6%) and 33.7 cm (90.7%, 81.4%) whereas in females were 26.5 cm (70.8%, 69.7%) and 33.0 cm (86.5%, 69.4%), respectively. In Sub-study 2, the participants with sarcopenia-AC or sarcopenia-CC showed lower muscle strength and lower fat and muscle mass than the ones without (P<0.05). Additionally, males instead of females with sarcopenia-AC or sarcopenia-CC showed worse performance in time-up and go test and 6-Minute Walk Test (P<0.05). However, the 30-second chair stand test was not different between participants with and without sarcopenia-AC or sarcopenia-CC in both sexes.

Conclusion

We found accurate and Chinese population targeted cut-off values of AC and CC on sarcopenia diagnosis (25.9 cm and 33.7 cm in males; 26.5 cm and 33.0 cm in females) and a good evaluation effect of AC and CC on fat and muscle mass, muscle strength and physical functions in males, not females.

Keywords:

• sarcopenia
• upper arm circumference
• calf circumference
• health assessment

Abbreviations

AC, arm circumference; ADS, Ankle dorsiflexion strength; ASM, appendix skeletal muscle mass; AUC, area under curve; AWGS, Asian Working Group for Sarcopenia; BCT, the Biceps Curl Test; BMI, body mass index; BFP, body fat percentage; BST, the Back Scratch Test; CC, calf circumference; CI, confidence interval; CSRT, the Chair Sit and Reach Test; EES, Elbow extension strength; EFS, Elbow flexion strength; FFM, fat-free mass; HFS, Hip flexion strength; KES, Knee extension strength; KFS, Knee flexion strength; LLEMM, left lower extremity muscle mass; LUEMM, left upper extremity muscle mass; LR+, positive likelihood ratio; LR-, negative likelihood ratio; LUEMM, left upper extremity muscle mass; MNA, mini nutritional assessment; NPV, negative predictive value; PPV, positive predictive value; RLEMM, right lower extremity muscle mass; ROC, receiver-operating characteristic; RUEMM, right upper extremity muscle mass; SD, standard deviation; SMI, skeletal muscle mass index; TUGT, Time-Up and Go Test; YI, Youden index; 30CST, 30-second Chair Stand Test; 6MWT, 6-Minute Walk Test.

Data Sharing Statement

In an attempt to preserve the privacy of individuals, clinical data will not be shared; the data can be available from the corresponding author on reasonable request authors upon request.

Ethics Approval and Consent to Participate

All participants were fully informed about the research purpose and characteristics before they provided signed consent. Ethical approval was granted from the Ethics Committee of Soochow University (ECSU-2019000161). This study conformed to the standards of the Declaration of Helsinki and was registered with Chinese Clinical Trial Registry (ChiCTR1900027960).

Acknowledgments

We would like to thank all the participants and others who supported this study. This paper has been uploaded to ResearchSquare as a preprint: https://www.researchsquare.com/article/rs-3198459/v1

Author Contributions

All authors 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; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by the Humanities and Social Sciences Research Project of Soochow University (Grant 21XM2012) and the Major Project of Suzhou Vocational Health College (Grant szwzy202303).