Using the Updated EWGSOP2 Definition in Diagnosing Sarcopenia in Spanish Older Adults: Clinical Approach

Anna Arnal-Gómez, Maria A Cebrià I Iranzo, Jose M Tomas, Maria A Tortosa-Chuliá, Mercè Balasch-Bernat, Trinidad Sentandreu-Mañó, Silvia Forcano, Natalia Cezón-Serrano, Anna Arnal-Gómez, Maria A Cebrià I Iranzo, Jose M Tomas, Maria A Tortosa-Chuliá, Mercè Balasch-Bernat, Trinidad Sentandreu-Mañó, Silvia Forcano, Natalia Cezón-Serrano

Abstract

Recently the European Working Group on Sarcopenia in Older People (EWGSOP2) has updated diagnostic criteria for sarcopenia, which consist of one or more measures of muscle strength, muscle mass, and physical performance, plus an initial screening test called SARC-F. The main objective was to compare the number of cases of sarcopenia, using the different measurements and screening options. A cross-sectional study was conducted on Spanish older adults (n = 272, 72% women). Combining the different measures proposed by the steps described in the EWGSOP2 algorithm, 12 options were obtained (A-L). These options were studied in each of the three models: (1) using SARC-F as initial screening; (2) not using SARC-F; and (3) using SARC-CalF instead of SARC-F. A χ2 independence test was statistically significant (χ2(6) = 88.41, p < 0.001), and the association between the algorithm used and the classification of sarcopenia was moderate (Cramer's V = 0.226). We conclude that the different EWGSOP2 measurement options imply case-finding differences in the studied population. Moreover, when applying the SARC-F, the number of people classified as sarcopenic decreases. Finally, when SARC-CalF is used as screening, case finding of sarcopenic people decreases. Thus, clinical settings should consider these outcomes, since these steps can make preventive and therapeutic interventions on sarcopenia vary widely.

Keywords: clinical; diagnostic criteria; older adults; sarcopenia.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Multinomial 95% confidence intervals for the proportion of each category in the 12 options of Model 1.
Figure 2
Figure 2
Multinomial 95% confidence intervals for the proportion of each category in the 12 options of Model 2.
Figure 3
Figure 3
Multinomial 95% confidence intervals for the proportion of each category in the 12 options of Model 3.
Figure 4
Figure 4
Association between the three models and the severity levels of sarcopenia (no sarcopenia (NS), probable sarcopenia (PS), confirmed sarcopenia (CS), and severe sarcopenia (SS)). Note: blue indicates positive association of row and column and red negative association.

References

    1. Tan L.F., Lim Z.Y., Choe R., Seetharaman S., Merchant R. Screening for frailty and sarcopenia among older persons in medical outpatient clinics and its associations with healthcare burden. J. Am. Med. Dir. Assoc. 2017;18:583–587. doi: 10.1016/j.jamda.2017.01.004.
    1. Dennison E.M., Sayer A.A., Cooper C. Epidemiology of sarcopenia and insight into possible therapeutic targets. Nat. Rev. Rheumatol. 2017;13:340–347. doi: 10.1038/nrrheum.2017.60.
    1. Marzetti E., Calvani R., Tosato M., Cesari M., di Bari M., Cherubini A., Collamati A., d’Angelo E., Pahor M., Bernabei R., et al. Sarcopenia: An overview. Aging Clin. Exp. Res. 2017;29:11–17. doi: 10.1007/s40520-016-0704-5.
    1. Norman K., Otten L. Financial impact of sarcopenia or low muscle mass—A short review. Clin. Nutr. 2019;38:1489–1495. doi: 10.1016/j.clnu.2018.09.026.
    1. Dupuy C., Lauwers-Cances V., Guyonnet S., Gentil C., Abellan Van Kan G., Beauchet O., Schott A.M., Vellas B., Rolland Y. Searching for a relevant definition of sarcopenia: Results from the cross-sectional EPIDOS study. J. Cachexia Sarcopenia Muscle. 2015:144–154. doi: 10.1002/jcsm.12021.
    1. Witham M.D., Stott D.J. A new dawn for sarcopenia. Age Ageing. 2019;48:2–3. doi: 10.1093/ageing/afy171.
    1. Cruz-Jentoft A.J., Bahat G., Bauer J., Boirie Y., Bruyère O., Cederholm T., Cooper C., Landi F., Rolland Y., Sayer A.A., et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31. doi: 10.1093/ageing/afy169.
    1. Cruz-Jentoft A.J., Bahat G., Bauer J., Boirie Y., Bruyère O., Cederholm T., Cooper C., Landi F., Rolland Y., Sayer A.A., et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48:601. doi: 10.1093/ageing/afz046.
    1. Chew J., Yeo A., Yew S., Lim J.P., Tay L., Ding Y.Y., Lim W.S. Muscle strength definitions matter: Prevalence of sarcopenia and predictive validity for adverse outcomes using the European working group on sarcopenia in older people 2 (EWGSOP2) criteria. J. Nutr. Health Aging. 2020;24:614–618. doi: 10.1007/s12603-020-1371-y.
    1. Kim H., Hirano H., Edahiro A., Ohara Y., Watanabe Y., Kojima N., Kim M., Hosoi E., Yoshida Y., Yoshida H., et al. Sarcopenia: Prevalence and associated factors based on different suggested definitions in community-dwelling older adults. Geriatr. Gerotol. Int. 2016;16:110–122. doi: 10.1111/ggi.12723.
    1. Reijnierse E.M., Trappenburg M.C., Leter M.J., Blauw G.J., Sipilä S., Sillanpää E., Narici M.V., Hogrel J.Y., Butler-Browne G., McPhee J.S., et al. The impact of different diagnostic criteria on the prevalence of sarcopenia in healthy elderly participants and geriatric outpatients. Gerontology. 2015;61:491–496. doi: 10.1159/000377699.
    1. Reijnierse E.M., de van der Schueren M.A.E., Trappenburg M.C., Doves M., Meskers C.G.M., Maier A.B. Lack of knowledge and availability of diagnostic equipment could hinder the diagnosis of sarcopenia and its management. PLoS ONE. 2017;12:e0185837. doi: 10.1371/journal.pone.0185837.
    1. Beaudart C., McCloskey E., Bruyère O., Cesari M., Rolland Y., Rizzoli R., Araujo de Carvalho I., Thiyagarajan J.A., Bautmans I., Bertière M.C., et al. Sarcopenia in daily practice: Assessment and management. BMC Geriatr. 2016;16:170. doi: 10.1186/s12877-016-0349-4.
    1. Van Ancum J.M., Alcazar J., Meskers C.G.M., Rubaek Nielsen B., Suetta C., Maier A.B. Impact of using the updated EWGSOP2 definition in diagnosing sarcopenia: A clinical perspective. Arch. Gerontol. Geriatr. 2020;90:104125. doi: 10.1016/j.archger.2020.104125.
    1. Malmstrom T.K., Miller D.K., Simonsick E.M., Ferrucci L., Morley J.E. SARC-F: A symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J. Cachexia Sarcopenia Muscle. 2016;7:28–36. doi: 10.1002/jcsm.12048.
    1. Bahat G., Cruz-Jentoft A. Putting sarcopenia at the forefront of clinical practice. Eur. J. Geriatr. Gerontol. 2019;1:43–45. doi: 10.4274/ejgg.galenos.2019.82.
    1. Woo J., Leung J., Morley J.E. Validating the SARC-F: A suitable community screening tool for sarcopenia? J. Am. Med. Dir. Assoc. 2014;15:630–634. doi: 10.1016/j.jamda.2014.04.021.
    1. Parra-Rodríguez L., Szlejf C., García-González A.I., Malmstrom T.K., Cruz-Arenas E., Rosas-Carrasco O. Cross-cultural adaptation and validation of the Spanish-language version of the SARC-F to assess sarcopenia in Mexican community-dwelling older adults. J. Am. Med. Dir. Assoc. 2016;17:1142–1146. doi: 10.1016/j.jamda.2016.09.008.
    1. Beaudart C., Locquet M., Bornheim S., Reginster J.Y., Bruyère O. French translation and validation of the sarcopenia screening tool SARC-F. Eur. Geriatr. Med. 2018;9:29–37. doi: 10.1007/s41999-017-0007-1.
    1. Yang M., Hu X., Xie L., Zhang L., Zhou J., Lin J., Wang Y., Li Y., Han Z., Zhang D., et al. SARC-F for sarcopenia screening in community-dwelling older adults. Are 3 items enough? Medicine. 2018;97:e11726. doi: 10.1097/MD.0000000000011726.
    1. Yang M., Hu X., Xie L., Zhang L., Zhou J., Lin J., Wang Y., Li Y., Han Z., Zhang D., et al. Screening sarcopenia in community-dwelling older adults: SARC-F vs SARC-F combined with calf circumference (SARC-CalF) J. Am. Med. Dir. Assoc. 2018;19:277.e1–277e8. doi: 10.1016/j.jamda.2017.12.016.
    1. Lobo A., Saz P., Marcos G., Día J.L., de la Cámara C., Ventura T., Morales Asín F., Pascual L.F., Montañés J.A., Aznar S., et al. Revalidación y normalización del Mini-Examen Cognoscitivo (primera versión en castellano del Mini-Mental Status Examination) en la población general geriátrica. Med. Clin. 1999;112:767–774.
    1. Roberts H.C., Denison H.J., Martin H.J., Patel H.P., Syddall H., Cooper C., Sayer A.A. A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach. Age Ageing. 2011;40:423–429. doi: 10.1093/ageing/afr051.
    1. Dodds R.M., Syddall H.E., Cooper R., Benzeval M., Deary I.J., Dennison E.M., Der G., Gale C.R., Inskip H.M., Jagger C., et al. Grip strength across the life course: Normative data from twelve British studies. PLoS ONE. 2014;9:e113637. doi: 10.1371/journal.pone.0113637.
    1. Cesari M., Kritchevsky S.B., Newman A.B., Simonsick E.M., Harris T.B., Penninx B.W., Brach J.S., Tylavsky F.A., Satterfield S., Bauer D.C., et al. Added value of physical performance measures in predicting adverse health-related events: Results from the health, aging and body composition study. J. Am. Geriatr. Soc. 2009;57:251–259. doi: 10.1111/j.1532-5415.2008.02126.x.
    1. Bravo-José P., Moreno E., Espert M., Romeu M., Martínez P., Navarro C. Prevalence of sarcopenia and associated factors in institutionalised older adult patients. Clin. Nutr. ESPEN. 2018;27:113–119. doi: 10.1016/j.clnesp.2018.05.008.
    1. Landi F., Liperoti R., Fusco D., Mastropaolo S., Quattrociocchi D., Proia A., Russo A., Bernabei R., Onder G. Prevalence and Risk Factors of Sarcopenia Among Nursing Home Older Residents. J. Gerontol. A Biol. Sci. Med. Sci. 2012;67:48–55. doi: 10.1093/gerona/glr035.
    1. Sergi G., de Rui M., Veronese N., Bolzetta F., Berton L., Carraro G., Bano G., Coin A., Manzato E., Perissinotto E. Assessing appendicular skeletal muscle mass with bioelectrical impedance analysis in free-living Caucasian older adults. Clin. Nutr. 2015;34:667–673. doi: 10.1016/j.clnu.2014.07.010.
    1. Studenski S.A., Peters K.W., Alley D.E., Cawthon P.M., McLean R.R., Harris T.B., Ferrucci L., Guralnik J.M., Fragala M.S., Kenny A.M., et al. The FNIH sarcopenia project: Rationale, study description, conference recommendations, and final estimates. J. Gerontol. A Biol. Sci. Med. Sci. 2014;69:547–558. doi: 10.1093/gerona/glu010.
    1. Working Group on Functional Outcome Measures for Clinical Trials Functional outcomes for clinical trials in frail older persons: Time to be moving. J. Gerontol. A Biol. Sci. Med. Sci. 2008;63:160–164. doi: 10.1093/gerona/63.2.160.
    1. Cruz-Jentoft A.J., Baeyens J.P., Bauer J.M., Boirie Y., Cederholm T., Landi F., Martin F.C., Michel J.P., Rolland Y., Schneider S.M., et al. European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412–414. doi: 10.1093/ageing/afq034.
    1. Studenski S., Perera S., Patel K. Gait speed and survival in older adults. J. Am. Med. Assoc. 2011;305:50–58. doi: 10.1001/jama.2010.1923.
    1. Guralnik J.M., Simonsick E.M., Ferrucci L., Glynn R.J., Berkman L.F., Blazer D.G., Scherr P.A., Wallace R.B. A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. J. Gerontol. 1994;49:M85–M94. doi: 10.1093/geronj/49.2.M85.
    1. Pavasini R., Guralnik J., Brown J.C., di Bari M., Cesari M., Landi F., Vaes B., Legrand D., Verghese J., Wang C., et al. Short physical performance battery and all-cause mortality: Systematic review and meta-analysis. BMC Med. 2016;14:215. doi: 10.1186/s12916-016-0763-7.
    1. Podsiadlo D., Richardson S. The timed “Up & Go”: A test of basic functional mobility for frail elderly persons. J. Am. Geriatr. Soc. 1991;39:142–148. doi: 10.1111/j.1532-5415.1991.tb01616.x.
    1. Fu X., Tian Z., Thapa S., Sun H., Wen S., Xiong H., Yu S. Comparing SARC-F with SARC-CalF for screening sarcopenia in advanced cancer patients. Clin. Nutr. 2020;39:3337–3345. doi: 10.1016/j.clnu.2020.02.020.
    1. Bahat G., Oren M.M., Yilmaz O., Kiliç C., Aydin K., Karan M.A. Comparing SARC-F with SARC-CalF to screen sarcopenia in community living older adults. J. Nutr. Health Aging. 2018;22:1034–1038. doi: 10.1007/s12603-018-1072-y.
    1. Kaiser M.J., Bauer J.M., Ramsch C., Uter W., Guigoz Y., Cederholm T., Thomas D.R., Anthony P., Charlton K.E., Maggio M., et al. MNA-International Group. Validation of the Mini Nutritional assessment short-form (MNA-SF): A practical tool for identification of nutritional status. J. Nutr. Health Aging. 2009;13:782–788. doi: 10.1007/s12603-009-0214-7.
    1. Gonzalez Barbosa-Silva T., Baptista Menezes A.M., Moraes Bielemann R., Malmstrom T.K., Gonzalez M.C. Enhancing SARC-F: Improving sarcopenia screening in the clinical practice. J. Am. Med. Dir. Assoc. 2016;17:1136–1141. doi: 10.1016/j.jamda.2016.08.004.
    1. Koo T.K., Li M.Y. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J. Chiropr. Med. 2016;15:155–163. doi: 10.1016/j.jcm.2016.02.012.
    1. R Core Team 2017 R: A Language and Environment for Statistical Computing. [(accessed on 21 November 2020)]; Available online:
    1. Meyer D., Zeileis A., Hornik K. VCD: Visualizing Categorical Data. R Package Version 1.4-8. [(accessed on 21 November 2020)];2020 Available online: .
    1. Signorell A., Aho K., Alfons A., Anderegg N., Aragon T., Arachchige C., Arppe A., Baddeley A., Barton K., Bolker B., et al. DescTools: Tools for Descriptive Statistics. R Package Version 0.99.38. [(accessed on 21 November 2020)];2020 Available online: .
    1. Agresti A. Introduction to Categorical Data Analysis. John Wiley and Sons; New York, NY, USA: 1996.
    1. Glaz J., Sison C.P. Simultaneous confidence intervals for multinomial proportions. J. Stat. Plan. Inference. 1999;82:251–262. doi: 10.1016/S0378-3758(99)00047-6.
    1. Sison C.P., Glaz J. Simultaneous confidence intervals and sample size determination for multinomial proportions. J. Am. Stat. Assoc. 1995;90:366–369. doi: 10.1080/01621459.1995.10476521.
    1. Bergsma W., Bergsma W. A bias-correction for Cramer’s V and Tschuprow’s T. J. Korean Stat. Soc. 2013;42:323–328. doi: 10.1016/j.jkss.2012.10.002.
    1. Visvanathan R., Chapman I. Preventing sarcopenia in older people. Maturitas. 2010;66:383–388. doi: 10.1016/j.maturitas.2010.03.020.
    1. Jones C.J., Rikli R.E., Beam W.C. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res. Q. Exerc. Sport. 1999;70:113–119. doi: 10.1080/02701367.1999.10608028.
    1. Yu S.C.Y., Khow K.S.F., Jadczak A.D., Visvanathan R. Clinical screening tools for sarcopenia and its management. Cur. Gerotol. Geriatr. Res. 2016;2016:5978523. doi: 10.1155/2016/5978523.
    1. Gould H., Brennan S.L., Kotowicz M.A., Nicholson G.C., Pasco J.A. Total and appendicular lean mass reference ranges for Australian men and women: The geelong osteoporosis study. Calcif. Tissue Int. 2014;94:363–372. doi: 10.1007/s00223-013-9830-7.
    1. Cawthon P.M., Peters K.W., Shardell M.D., McLean R.R., Dam T.-T.L., Kenny A.M., Fragala M.S., Harris T.B., Kiel D.P., Guralnik J.M., et al. Cutpoints for low appendicular lean mass that identify older adults with clinically significant weakness. J. Gerontol. A Biol. Sci. Med. Sci. 2014;69:567–575. doi: 10.1093/gerona/glu023.
    1. Guillamón-Escudero C., Diago-Galmés A., Tenías-Burillo J.M., Soriano J.M., Fernández-Garrido J.J. Prevalence of sarcopenia in community-dwelling older adults in Valencia, Spain. Int. J. Environ. Res. Public Health. 2020;17:9130. doi: 10.3390/ijerph17239130.
    1. Kim K.M., Jang H.C., Lim S. Differences among skeletal muscle mass indices derived from height-, weight-, and body mass index-adjusted models in assessing sarcopenia. Korean J. Intern. Med. 2016;31:643–650. doi: 10.3904/kjim.2016.015.
    1. Coker R.H., Hays N.P., Williams R.H., Wolfe R.R., Evans W.J. Bed rest promotes reductions in walking speed, functional parameters, and aerobic fitness in older, healthy adults. J. Gerontol. A. 2014;70:91–96. doi: 10.1093/gerona/glu123.
    1. Janssen I., Heymsfield S.B., Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J. Am. Geriatr. Soc. 2002;50:889–896. doi: 10.1046/j.1532-5415.2002.50216.x.
    1. Kortebein P., Symons T.B., Ferrando A., Paddon-Jones D., Ronsen O., Protas E., Conger S., Lombeida J., Wolfe R., Evans W.J. Functional impact of 10 days of bed rest in healthy older adults. J. Gerontol. A Biol. Sci. Med. Sci. 2008;63:1076–1081. doi: 10.1093/gerona/63.10.1076.
    1. Bruyère O., Beaudart C., Reginster J.Y., Buckinx F., Schoene D., Hirani V., Cooper C., Kanis J.A., Rizzoli R., McCloskey E., et al. Assessment of muscle mass, muscle strength and physical performance in clinical practice: An international survey. Eur. Geriatr. Med. 2016;7:243–246. doi: 10.1016/j.eurger.2015.12.009.
    1. Ida S., Murata K., Nakadachi D., Ishihara Y., Imataka K., Uchida A., Monguchi K., Kaneko R., Fujiwara R., Takahashi H. Development of a Japanese version of the SARC-F for diabetic patients: An examination of reliability and validity. Aging Clin. Exp. Res. 2017;29:935–942. doi: 10.1007/s40520-016-0668-5.
    1. Wu T.Y., Liaw C.K., Chen F.C., Kuo K.L., Chie W.C., Yang R.S. Sarcopenia screened with SARC-F questionnaire is associated with quality of life and 4-year mortality. J. Am. Med. Dir. Assoc. 2016;17:1129–1135. doi: 10.1016/j.jamda.2016.07.029.
    1. Yang M., Lu J., Jiang J., Zeng Y., Tang H. Comparison of four sarcopenia screening tools in nursing home residents. Aging Clin. Exp. Res. 2019;31:1481–1489. doi: 10.1007/s40520-018-1083-x.
    1. Dawson-Hughes B., Bischoff-Ferrari H. Considerations concerning the definition of sarcopenia. Osteoporos. Int. 2016;27:3139–3144. doi: 10.1007/s00198-016-3674-8.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit