Simplifying Sarcopenia Screening: A Community-Based Evaluation of Screening and Assessment Combinations

Abstract

Objectives: Sarcopenia is a serious condition in older individuals, characterized by muscle loss and physical decline. Early detection is crucial but challenging due to subtle symptoms. The Asian Working Group for Sarcopenia (AWGS) 2019 consensus recommends detection for possible sarcopenia, but the effectiveness of the suggested tools varies, and the ideal screening combination remains unclear. This study aims to identify the most suitable screening pathway for early sarcopenia detection in community settings.

Design: Prospective cross-sectional study.

Setting and participants: Participants were recruited from locations offering congregated meal services between October 2018 and November 2019. Eligible participants were community-dwelling residents aged 50 years or older who were capable of completing the full sarcopenia survey.

Methods: All assessments recommended in the AWGS 2019 algorithm were conducted. We organized these tests into 12 distinct pathways, each combining a case-finding method with an assessment, either a muscle strength test or a physical performance test. Skeletal muscle mass was measured using bioelectrical impedance analysis. The validity of different combinations was then compared.

Results: A total of 567 participants were enrolled in this study. Among the 3 case-finding tools, calf circumference had the highest sensitivity and the SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls) had the lowest (80% vs 8%). Across the 12 different screening combinations tested, pathways involving calf circumference outperformed those involving the SARC-F or the SARC-F combined with calf circumference (SARC-CalF). Notably, the combination of calf circumference and handgrip strength emerged as the optimal pathway, offering the best sensitivity and satisfactory specificity, along with superior discrimination ability (indicated by receiver operating characteristic analysis) and prediction accuracy (indicated by Brier score).

Conclusions and implications: The combination of calf circumference and handgrip strength is the most effective screening pathway for detecting sarcopenia in community settings. Its performance is even close to conducting all the tests outlined in the AWGS 2019 consensus. This simplified pathway may serve as a practical screening option in community settings.

Keywords: Sarcopenia; assessment; calf circumference; handgrip strength; screening.