Evaluating SARC-F, SARC-CalF, and Calf Circumference as Diagnostic Tools for Sarcopenia in Thai Older Adults: Results From a Nationwide Study

As the elderly population grows, musculoskeletal disorders, including sarcopenia, have become a critical area of study due to their association with falls and fractures. Sarcopenia, characterized by decreased muscle mass, is prevalent among older adults and poses a significant risk for falls. This study aimed to assess the effectiveness of the SARC-F and SARC-CalF questionnaires, along with calf circumference measurements, in screening for sarcopenia among Thai community-dwelling older adults, following the Asian Working Group on Sarcopenia (AWGS) 2019 criteria.

Study Overview

• Status: Completed
• Conditions: Sarcopenia; Diagnosis
• Intervention / Treatment: Diagnostic test: SARC-F Questionnaire; Diagnostic test: Calf Circumference Measurement; Diagnostic test: SARC-CalF Questionnaire

Detailed Description

The data utilized in this analysis were derived from the Thai Musculoskeletal Diseases Nationwide Study. This cross-sectional study targeted Thai adults aged 60 years and older, conducted between March 2021 and August 2022. Participants were sampled using a multi-level sampling technique to ensure representativeness from community-dwelling older adults across 12 provinces, encompassing Thailand's six primary geographical regions.

Participants were evaluated for possible sarcopenia or sarcopenia, according to AWGS 2019 criteria, by using SARC-F questionnaire, calf circumference measurement, SARC-CalF questionnaire, and appendicular skeletal muscle mass (ASM).

• Study Type: Observational
• Enrollment (Actual): 2543

Contacts and Locations

Study Locations

• Thailand
  • Bangkok
    • Bangkoknoi, Bangkok, Thailand, 10700
      • Faculty of Medicine Siriraj Hospital, Mahidol University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

Community-dwelling older Thai adults living at that area for at least 1 year

Description

Inclusion Criteria:

• Thai adults aged 60 years and older

Exclusion Criteria:

• missing data on SARC-F, SARC-CalF, and calf circumference
• unable to walk independently
• bedridden individuals
• neuromuscular disorders or severe comorbidities that could impair their ability to perform performance-based tests

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Thai community-dwelling older adults

Diagnostic test: SARC-F Questionnaire; The SARC-F scale consists of five components: strength, walking assistance, rising from a chair, stair climbing, and falls. These elements were selected to reflect changes in health status related to the effects of sarcopenia. Scores on the SARC-F scale range from 0 to 10, composed of five domains, assesses strength, walking assistance, raising from a chair, stair climbing and falls. Each domain score ranges from 0-2. A SARC-F score of ≥4 was considered abnormal. The Thai-version SARC-F questionnaire has been validated in Thai older adults.; Diagnostic test: Calf Circumference Measurement; Calf circumference was measured using a nonelastic tape measure while the participant was standing with relaxed legs. The tape was placed snugly and flat around the widest part of the calf, parallel to the floor. According to the AWGS 2019 criteria, calf circumferences were considered abnormal if they were less than 34 cm for males and less than 33 cm for females.; Diagnostic test: SARC-CalF Questionnaire; This questionnaire integrates the SARC-F and calf circumference as a trigger for case finding. If the calf circumference is below the cut-off value, 10 points are added to the SARC-F score for evaluation. The SARC-CalF score ranges from 0 to 20, with a score of ≥11 considered abnormal for sarcopenia screening.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Appendicular skeletal muscle mass (ASM)	To assess appendicular skeletal muscle mass (ASM), we used the Tanita RD-545, a dual-frequency bioelectrical impedance analysis (BIA) device (Tanita Corporation, Tokyo, Japan). Previous studies have demonstrated that this BIA method is reliable and comparable to dual-energy X-ray absorptiometry (DXA) for diagnosing sarcopenia in Thai elderly adults. The appendicular skeletal muscle mass index (ASMI) was calculated by dividing the ASM by the square of the height. According to the 2019 criteria of the AWGS, low muscle mass is defined as <7.0 kg/m² for men and <5.7 kg/m² for women.	up to 4 weeks
Handgrip strength	Participants were asked to squeeze a digital Smedley spring hand dynamometer (Takei 5401 Digital Dynamometer; Takei, Tokyo, Japan) with maximum effort while standing with fully extended arms at their sides. The grip size was adjusted for each participant's hand size, and 2 or 3 trials were performed, with the highest output value recorded. Handgrip strengths < 28 kg in males and < 18 kg in females were classified as low muscle strength, per the AWGS 2019 criteria.	up to 4 weeks
5-time sit-to-stand test (5TSTS)	Participants were directed to sit upright on armless chairs with their backs supported firmly by the backrest. They were then instructed to stand up as quickly as possible for 5 repetitions with their arms crossed, trunk upright, and hips and knees fully extended. The time taken by each participant to complete the test from the initial sitting to the fifth sitting was recorded. The test is considered abnormal if it takes equal or more than 12 seconds to complete the task.	up to 4 weeks

Collaborators and Investigators

• Sponsor: Siriraj Hospital
• Collaborators: National Research Council of Thailand
• Investigators: Principal Investigator: Apichat Asavamongkolkul, MD, Siriraj Hospital

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2021
• Primary Completion (Actual): August 31, 2022
• Study Completion (Actual): August 31, 2022

Study Registration Dates

• First Submitted: August 10, 2024
• First Submitted That Met QC Criteria: August 14, 2024
• First Posted (Actual): August 16, 2024

Study Record Updates

• Last Update Posted (Actual): August 20, 2024
• Last Update Submitted That Met QC Criteria: August 17, 2024
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Keywords: diagnostic accuracy; elderly; sarcopenia; calf circumference; SARC-F questionnaire
• Additional Relevant MeSH Terms: Nervous System Diseases; Neurologic Manifestations; Neuromuscular Manifestations; Pathological Conditions, Anatomical; Muscular Atrophy; Atrophy; Sarcopenia
• Other Study ID Numbers: COA-023/2024

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No