Determination of Skeletal Muscle Mass Index Values in the Turkish Population Using Dual Energy X-Ray Absorptiometry

Sarcopenia is defined by the European Working Group on Sarcopenia in Older People (EWGSOP) as "a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, carrying a risk of adverse outcomes such as physical disability, fractures, falls, impaired quality of life, and death." However, despite the severity of the disease, a single diagnostic criterion has not yet been established, and various guidelines have been proposed to standardize the diagnostic criteria and cut-off values. Current European Working Group on Sarcopenia in Older People (EWGSOP) recommendations focus on European populations and, where possible, the use of normative references from healthy young adults. Since measurements such as gait and muscle strength are height-dependent, the use of regional normative populations is recommended whenever possible. Currently, some cut-off points for the diagnosis of sarcopenia are arbitrary. The development of validated cut-off points will depend on normative data and their predictive value for endpoints. Further studies are needed to determine whether gender-specific and region-specific threshold values for the diagnosis of sarcopenia improve the prediction of sarcopenia outcomes.

There are no studies in the literature on dual-energy x-ray absorptiometry cutoff values specific to the Turkish population. In our study, we aimed to define reference cutoff values for muscle mass, muscle strength, and calf circumference in Türkiye in order to improve the general applicability of EWGSOP criteria.

Study Overview

• Status: Completed
• Conditions: Sarcopenia; Sarcopenia in Elderly

Detailed Description

When low muscle strength is detected, the patient is evaluated for possible sarcopenia; the diagnosis is confirmed by the presence of low muscle mass or quality. Severe sarcopenia is considered when low muscle strength, low muscle mass or quality are accompanied by low physical performance. Muscle strength can be assessed by measuring hand grip strength and isometric or isokinetic measurements of lower extremity strength. A wide variety of techniques are used to measure muscle mass, including magnetic resonance imaging (MRI), computed tomography (CT), dual-energy x-ray absorptiometry (DEXA), bioelectrical impedance analysis (BIA), and anthropometric measurements; the most suitable method should be determined based on cost, accessibility, and ease of use. Muscle mass is related to body size; that is, individuals with larger body sizes typically have greater muscle mass. Therefore, to adjust for body size, the skeletal muscle index (SMI) is calculated as appendicular skeletal muscle mass (ALM) / height² (m²). The SMI cut-off value for sarcopenia, as defined by EWGSOP2, is <5.5 kg/m² for women and <7.0 kg/m² for men. There is ongoing debate regarding the preferred adjustment and whether the same method can be used for all populations. Physical performance assessment can be measured in various ways, including walking speed, the Short Physical Performance Battery (SPPB), and the Timed Up and Go Test (TUG).

• Study Type: Observational
• Enrollment (Actual): 145

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Ankara, Turkey (Türkiye), 06800
    • Ankara Bilkent City Hospital

Participation Criteria

Eligibility Criteria

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

• Sampling Method: Probability Sample

Study Population

city hospital

Description

Inclusion Criteria:

• Having mental and physical capacity
• Being between 18-39 and 65-99 years of age
• Being able to ambulate independently or with support

Exclusion Criteria:

• Pregnancy
• Infection
• Pacemaker or metallic implant
• Peripheral circulatory disorder
• Known concomitant malignancy, end-stage organ failure
• Known concomitant central nervous system and/or peripheral nervous system disease
• History of genetic disease
• Coagulopathy
• Amputation
• Patients with a history of genetic disease
• Patients weighing >120 kg

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
young population; Ages 18-39
elderly population; Ages 65-99

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
skeletal muscle mass index	Skeletal muscle mass index: calculated by dividing the sum of the non-bone lean mass of the four extremities by height² (meters).	At the start of the work

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
muscle strength	Muscle strength will be assessed by measuring hand grip strength using the Baseline hydraulic hand dynamometer (INC. White Plains NY 10602 U.S.A), which has proven validity and reliability.	at the start of the work
walking speed test	For the walking speed test, participants will be asked to walk 4 meters at their normal pace. Walking speed will be measured in m/s.	at the start of the work
Calf circumference	Calf circumference will be measured at the widest part of the calf.	at the start of the work
Mid-arm circumference	Mid-arm circumference will be measured standing with the shoulder abducted at 90 degrees, at the midsection of the humerus.	at the start of the work

Collaborators and Investigators

• Sponsor: Ankara City Hospital Bilkent
• Investigators: Principal Investigator: Ayşe U Baykut, Ankara City Hospital Bilkent; Study Chair: Güldal F Yüzer Nakipoğlu, Ankara City Hospital Bilkent; Study Chair: Zeynep S Güneş, Ankara City Hospital Bilkent

Publications and helpful links

General Publications

• Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M; Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019 Jan 1;48(1):16-31. doi: 10.1093/ageing/afy169.

Study record dates

Study Major Dates

• Study Start (Actual): June 30, 2024
• Primary Completion (Actual): May 30, 2026
• Study Completion (Actual): May 30, 2026

Study Registration Dates

• First Submitted: March 28, 2026
• First Submitted That Met QC Criteria: March 28, 2026
• First Posted (Actual): April 3, 2026

Study Record Updates

• Last Update Posted (Actual): June 17, 2026
• Last Update Submitted That Met QC Criteria: June 16, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: sarcopenia; sarcopenia in elderly
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neuromuscular Manifestations; Pathological Conditions, Anatomical; Muscular Atrophy; Atrophy; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Sarcopenia
• Other Study ID Numbers: ACHBİLKENTAUBAYKUT003

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: I haven't decided yet.

Drug and device information, study documents

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