Calf Circumference as an Optimal Choice of Four Screening Tools for Sarcopenia Among Ethnic Chinese Older Adults in Assisted Living

Figures & data

Table 1 Basic Characteristics, Comorbidity, Sarcopenia Markers, and Scores from Screening Tools

	Men (N=93)			Women (N=84)
	Sarcopenia (N=49)	Non-Sarcopenia (N=44)	P-value	Sarcopenia (N=43)	Non-Sarcopenia (N=41)	P-value
Age (year)	79.6 ± 8.5	77.7 ± 8.7	0.278	82.9 ± 5.4	79.3 ± 7.7	0.015
BMI (kg/m^2)	22.4 (20.4–23.8)	25.6 (23.6–28.7)	<0.001	21.2 ± 3.3	26.2 ± 4.0	<0.001
Grip strength (kg)	19.0 (13.4–22.6)	21.3 (14.7–25.4)	0.117	11.0 (9.0–13.7)	14.6 (11.1–19.4)	0.004
Gait speed (m/s)	0.70 ± 0.30	0.80 ± 0.30	0.526	0.70 ± 0.30	0.70 ± 0.30	0.930
ASMI (kg/m^2)	6.20 (5.85–6.70)	7.40 (7.13–7.78)	<0.001	4.90 (4.60–5.40)	6.4 (5.95–6.70)	<0.001
HTN	32 (65.3%)	33 (75.0%)	0.309	29 (67.4%)	31 (75.6%)	0.407
DM	8 (16.3%)	10 (22.7%)	0.435	10 (23.3%)	14 (34.1%)	0.194
CAD	9 (18.4%)	8 (18.2%)	0.982	8 (18.6%)	6 (14.6%)	0.625
Cancer	1 (2.0%)	1 (2.3%)	1.000	3 (7.0%)	3 (7.3%)	1.000
Stroke	7 (14.3%)	6 (13.6%)	0.928	3 (7.0%)	6 (14.6%)	0.435
CC (cm)	31.5 (30.0–34.0)	34.5 (33.5–37.9)	<0.001	29.5 (26.6–31.2)	34.0 (31.5–35.4)	<0.001
CC below cutoff value*	36 (73.5%)	12 (27.3%)	<0.001	38 (88.4%)	14 (34.1%)	<0.001
SARC-F score	1 (0–3)	1 (0–2)	0.263	1 (1–3)	1 (0–2)	0.142
SARC-F (score ≧ 4)	9 (18.4%)	6 (13.6%)	0.536	6 (14.0%)	5 (12.2%)	0.811
MSRA-5 score	40 (40–55)	50 (40–55)	0.078	40 (32.5–55)	50 (35–55)	0.116
MSRA-5 (score ≦ 45)	28 (57.1%)	19 (43.2%)	0.178	26 (60.5%)	19 (46.3%)	0.150
SARC-CalF score	10 (10–12)	4.5 (0–11)	0.003	11 (10–13)	2 (0–10.5)	<0.001
SARC-CalF (score ≧ 11)	23 (46.9%)	13 (29.5%)	0.086	31 (72.1%)	10 (24.4%)	<0.001

Notes: *Cutoff value: men <34cm; women <33cm. Data are mean ± SD for normal distribution data and Median (Interquartile range) for non-normal distribution data, unless other specified.

Abbreviations: BMI, body mass index; ASMI, appendicular skeletal muscle index; DM, diabetic mellitus; HTN, hypertension; CAD, coronary artery disease; CC, calf circumference; MSRA-5, 5-item Mini Sarcopenia Risk Assessment.

Table 2 Logistic Regression Analysis of Factors Associated with Sarcopenia

Variable	β	SE	Exp(B)	95% CI	P-value
Age	0.041	0.032	1.042	0.978–1.11	0.200
Sex (women = 0, men = 1)	−2.64	4.622	0.071	0–613.778	0.568
BMI	−0.34	0.078	0.712	0.611–0.83	<0.001
SARC-CalF score	0.091	0.044	1.096	1.004–1.195	0.040
CC	−0.17	0.080	0.884	0.772–0.987	0.033
Age by Sex interaction	0.025	0.058	1.025	0.916–1.148	0.668

Notes: Variables were selected for inclusion in the multivariate logistic regression model if they were significantly related to sarcopenia (p < 0.05) in bivariate analyses. Cox & Snell R²=0.403, Nagelkerke R²=0.537.

Abbreviations: BMI, body mass index; CC, calf circumference; SE, standard error; CI, confidence interval.

Table 3 Performance of Four Screening Tools for Sarcopenia Defined by AWGS 2019 Criteria

	Sensitivity (%)	Specificity (%)	+LR	−LR	AUC
SARC-F	10.9 (5.3−19.1)	91.8 (83.8–96.6)	1.32 (0.5–3.3)	0.97 (0.9–1.1)	0.576 (0.500–0.650)
MSRA-5	60.7 (49.7−70.9)	54.2 (42.9–65.2)	1.33 (1.0–1.8)	0.73 (0.5–1.0)	0.600 (0.523–0.674)
SARC-CalF	38.0 (28.1–48.8)	80.0 (69.9–87.9)	1.9 (1.2–3.1)	0.77 (0.6–0.9)	0.734 (0.663–0.798)
CC	80.4 (70.9–88.0)	71.8 (61.0–81.0)	2.85 (2.0–4.1)	0.27 (0.2–0.4)	0.819 (0.754–0.872)

Abbreviations: AWGS, Asian Working Group for Sarcopenia; +LR, positive likelihood ratio; −LR, negative likelihood ratio; AUC, area under the curve; MSRA-5, 5-item Mini Sarcopenia Risk Assessment; CC, calf circumference.

Figure 1 Receiver operating characteristic (ROC) curve of SARC-F, MSRA-5, SARC-CalF and Calf circumstance against the Criteria of Asian Working Group for Sarcopenia 2019 in (A) the total participants; (B) women and (C) men.