Diagnostic accuracy of sarcopenia by “possible sarcopenia” premiered by the Asian Working Group for Sarcopenia 2019 definition

PurposeThe Asian Working Group for Sarcopenia 2019 (AWGS 2019) proposed a simple assessment of sarcopenia called ”possible sarcopenia“ for the purpose of early detection and intervention of sarcopenia. The purpose of this study was to report the accuracy of possible sarcopenia against definitive sarcopenia and the characteristics of false-negative cases.Materials and MethodsThis was a cross-sectional study using a research registry with outpatients aged ≥65 years who visited a frailty clinic at a geriatric hospital. The diagnosis of possible sarcopenia and sarcopenia was performed according to the AWGS 2019 criteria, using calf circumference (CC) for case-finding. The accuracy of the diagnosis of sarcopenia in participants with possible sarcopenia was evaluated by calculating sensitivity, specificity, and F-value.ResultsOf the 349 patients (mean age, 78.0±6.0 years; 63% women) analyzed, 86 (24.6%) revealed possible sarcopenia. Possible sarcopenia predicted sarcopenia with a sensitivity of 0.893 and 0.921, specificity of 0.990 and 0.870, and F-values of 0.926 and 0.714 for men and women, respectively. When either the grip strength test or 5-time chair stand test result was examined, the sensitivity of possible sarcopenia to predict sarcopenia decreased, whereas the specificity remained at 0.990–1.000 in men and 0.890–0.940 in women. An extremely decreased CC was identified as a significant characteristic of patients with sarcopenia not detected in the simplified assessment.ConclusionsThe diagnostic accuracy of possible sarcopenia for definitive sarcopenia is excellent. Sarcopenia should be actively examined in patients with extremely decreased CC.     

Diagnostic accuracy of quadriceps strength-based criteria compared to handgrip-based criteria for diagnosing sarcopenia and severe sarcopenia in older adults

Aim. Handgrip strength (HS) is an established parameter for sarcopenia diagnosis; however, a considerable proportion of older adults have some kind of hand abnormality or limitation that can prevent reliable hand muscle power testing. This study set forth to investigate the diagnostic accuracy of quadriceps strength (QS)-based criteria compared to handgrip strength (HS)-based criteria for diagnosing sarcopenia and severe sarcopenia in older adults.Setting and participants. A total of 381 subjects aged ≥60 years who attended the outpatient geriatric clinic at Siriraj Hospital (Bangkok, Thailand) during 2015-2017 were recruited via convenience sampling. Patients who were ambulatory, able to communicate, and without metallic prosthesis or pacemaker were eligible for inclusion.Methods. All consenting subjects underwent HS and QS testing, muscle mass measurement by bioelectrical impedance analysis, and gait speed analysis. The Asian Working Group for Sarcopenia (AWGS) 2019 consensus criteria were used as reference standard.Results. The prevalence of sarcopenia and severe sarcopenia by HS-based criteria was 13.9% and 6.8%, respectively. In comparison, the prevalence of sarcopenia and severe sarcopenia by QS-based criteria was 14.7% and 10.2%, respectively. The sensitivity and specificity of QS-based criteria for diagnosing sarcopenia was 100% (95% confidence interval [CI]: 93.3-100%) and 99.1% (95%CI: 97.4-99.8%), respectively. The sensitivity and specificity of QS-based criteria for diagnosing severe sarcopenia was 88.5% (95%CI: 69.9-97.6%) and 95.5% (95%CI: 92.8-97.4%), respectively.Conclusions. With very high sensitivity and specificity, QS-based diagnostic criteria could be used to diagnose sarcopenia and severe sarcopenia in older adults whose HS measurements could not be reliably obtained.Thai Clinical Trials Registry registration number. TCTR 20200717004     

Ultrasound measurement of rectus femoris muscle thickness as a quick screening test for sarcopenia assessment

IntroductionSarcopenia is a geriatric syndrome related to loss of muscle mass and function, leading to disability, frailty and higher mortality. According to European Working Group on Sarcopenia in Older People (EWGSOP) the diagnosis of sarcopenia requires the assessment of muscle mass, muscle force and function, that is time-consuming and not easily at hand in everyday clinical practice.We propose the B-mode ultrasound measurement of muscle thickness as a quick screening test to assess the presence of sarcopenia.MethodsA cross-sectional study was realized, 119 patients (average age 82 years, 50.4% females) from the Department of Internal Medicine of the University Hospital of Siena (Italy) were enrolled. The diagnosis of sarcopenia was assessed according to EWGSOP criteria. Rectus femoris muscle (RFM) thickness (in cm) was measured by ultrasound B-mode scanning. Sensibility and specificity of the test was evaluated and Receiver Operating Analysis (ROC) was performed to assess the accuracy of the test.ResultsAverage RFM thickness was 0.78 ± 0.26, significantly lower in sarcopenic patients (0.55 ± 0.2 vs. 0.9 ± 0.3; Mann-Whitney; p < 0.001) and females (0.7 ± 0.3 vs 0.86 ± 0.3; Mann-Whitney; p < 0.001). The cut-off point of 0.7 cm for females and 0.9 cm for males was established as a threshold to assess the presence of sarcopenia by ultrasound. Sensibility of ultrasound measurement of RFM thickness was 100%, specificity 64%, positive predictive value (PPV) 64.3% and negative predictive value (NPV) 100%. ROC analysis was performed in order to quantify how accurately RFM thickness can discriminate between sarcopenia and non-sarcopenia state. AUC for all patients was 0.9 and after a comparative analysis for gender higher values for males (0.94 vs. 0.92) were observed.ConclusionWe suggest a screening test for sarcopenia based on the ultrasound measurement of RFM thickness, as a not invasive and easy to perform method even in elderly patients with functional or cognitive impairment.     

Sarcopenia and its associated factors in Iranian older individuals: Results of SARIR study

BackgroundSarcopenia, an age- related loss of muscle mass, is a significant associating factor for functional impairment among older adults. The aim of this study was to investigate the prevalence of and associated factors for sarcopenia and severe sarcopenia among older adults in Iran.MethodsA total of 300 individuals aged over 55 years were randomly selected from the 6th district of Tehran, Iran, in 2011. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm. The skeletal muscle mass was assessed using DXA. Muscle strength and muscle performance were assessed according to hand grip strength and 4-m usual walking gait speed test. A logistic regression analysis was performed.ResultsThe prevalence values of presarcopenia, sarcopenia, and severe sarcopenia were 52.7%, 20.7%, and 6%, in men and 25.3%, 15.3%, and 5.3% in women, respectively. The prevalence of sarcopenia was higher in men older than 75 years than women in the same age range (36.7% versus 20%, respectively). Using multiple logistic regression models, age, sex, smoking, and body mass index (BMI) were independently associated with different stages of sarcopenia.ConclusionsThe prevalence of sarcopenia is high in Iranian older adults. The older age, male sex, smoking and lower BMI were independently associated with presarcopenia, sarcopenia and severe sarcopenia.     

The association between systemic inflammatory markers and sarcopenia: Results from the West China Health and Aging Trend Study (WCHAT)

BackgroundIncreased evidence suggests chronic inflammation is significant in the progression of sarcopenia in older adults. In this study, we aimed to compare the level of systemic inflammation markers (White blood cells, neutrophils, lymphocytes, platelets and their derived ratios) between sarcopenic and non-sarcopenic individuals and investigate the association of these inflammatory markers with sarcopenia.MethodsThis cross-sectional study included 4224 adults (1514 men and 2710 women) from the West China Health and Aging Trend (WCHAT) study. Sarcopenia was defined according to the recommended diagnostic algorithm of the Asia Working Group for Sarcopenia (AWGS). The value of systemic inflammatory markers was based on laboratory data. Multiple logistic regression analysis was used to explore the association between inflammatory markers and sarcopenia after adjusting for covariates.ResultsAmong 4224 participants (mean age 62.3 ± 8.2 years, 64.2 % women), 814 (19.3 %) were diagnosed as sarcopenia. After adjusting for potential confounders, logistic regression analysis indicated that neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) were significantly associated with sarcopenia. Participants in the highest NLR, PLR and SII value group had higher odds for sarcopenia than those in the lowest value group (OR [95 %CI]: 1.233 [1.002,1.517], 1.455 [1.177,1.799] and 1.268 [1.029,1.561], respectively).ConclusionsHigher NLR, PLR, and SII level are associated with an increased prevalence of sarcopenia in middle-aged and older adults. Since these systemic inflammatory markers are inexpensive and can be obtained easily from routine blood tests, regular follow-up of NLR, PLR and SII may be an effective strategy in sarcopenia screening and management.     

Sarcopenia,calf circumference,and physical function of elderly women: a cross-sectional study

OBJECTIVES: To determine whether calf circumference (CC), related to appendicular skeletal muscle mass, can be used as a measure of sarcopenia and is related to physical function. DESIGN: Retrospective analysis of data from 1992 to 1994 of the European Patient Information and Documentation Systems Study. SETTING: Community setting in France. PARTICIPANTS: One thousand four hundred fifty-eight French women aged 70 and older without previous history of hip fracture were recruited from the electoral lists. MEASUREMENTS: Muscular mass was assessed using dual-energy x-ray absorptiometry (DEXA). CC was measured using a tape measure. Anthropometric measurements (height; weight; and waist, hip, and calf circumference), strength markers (grip strength), and self-reported physical function were also determined. Sarcopenia was defined (using DEXA) as appendicular skeletal muscle mass (weight (kg)/height (m2)) less than two standard deviations below the mean of a young female reference group. RESULTS: The prevalence of sarcopenia was 9.5%. CC was correlated with appendicular skeletal muscle mass (r = 0.63). CC under 31 cm was the best clinical indicator of sarcopenia (sensitivity = 44.3%, specificity = 91.4%). CC under 31 cm was associated with disability and self-reported physical function but not sarcopenia (defined using DEXA), independent of age, comorbidity, obesity, income, health behavior, and visual impairment. CONCLUSION: CC cannot be used to predict sarcopenia defined using DEXA but provides valuable information on muscle-related disability and physical function.     

Cut-off points of knee extension strength allometrically adjusted to identify sarcopenia risk in older adults: A cross-sectional study

PurposeHandgrip strength used to identify sarcopenia is not representative of overall strength, especially as greater muscle volume and consequent autonomy-mobility are concentrated in the lower limbs. While absolute strength or relative to body mass is used to define sarcopenia, this relationship is not always linear. The aim of this study was to establish allometrically adjusted cut-off points of lower limb (quadriceps) muscle strength to identify sarcopenia risk in older adults.Methodsninety-four physically independent individuals over the age of 60 were measured by DXA and sarcopenia was identified. The one-repetition maximum (1RM) test of knee extension strength was estimated using the extensor chair by the submaximal repetition protocol. The six-minute walk test performance was recorded. 1RM values were scaled by body mass (1RM/body mass) and allometrically adjusted (1RM/body mass^b). Cut-off points for sarcopenia from 1RM were defined with ROC curve and Youden index with functional limitation (walking distance<400 m). Analyzes considered sex (α = 5%).ResultsSarcopenia was present in 10.6 % of participants. The exponents ^b obtained were 0.70 for women and 0.96 for men. Except for absolute 1RM in women, all areas under the curve were acceptable (>0.70). The cut-off points for women and men were respectively, 38.1 and 56.1 kg for 1RM, 0.53 and 0.85 for 1RM/body mass, 1.48 and 1.00 for 1RM/body mass^b.Conclusions1RM of knee extension scaled by body mass or allometrically adjusted is an effective parameter to identify sarcopenia in older adults. The proposed cut-off points could be used to monitor sarcopenia risk in geriatrics.     

Prevalence of sarcopenia in heart failure: A systematic review

ObjectiveHeart Failure (HF) is emerging as a crucial factor promoting muscle wasting and dysfunction contributing to sarcopenia. This modulates disease severity and reduces exercise capacity and leading to poorer outcomes. Therefore, we aimed to systematically investigate the overall prevalence of sarcopenia in HF.MethodsAn electronic search was carried out in selected databases until 21st January, 2021. Data was pooled from the included articles and represented as pooled prevalence of sarcopenia. Subgroup analysis was undertaken between methods of diagnosis of sarcopenia, gender, ejection fraction, median time point and geographical region.ResultsAmongst 32,643 citations imported from selected databases, 12 articles were included in final analysis. Analysis for prevalence of sarcopenia was 34%, with prevalence rates ranging from 10.1% to 68%. Subgroup analysis revealed strong associations between Dual-energy X-ray Absorptiometry (DXA) and Asian Working Group for Sarcopenia (AWGS) (chi square = 3.24; p < 0.001), with a good level of agreement (kappa = 0.76 [95% CI: 0.70–0.82]; p < 0.001). Gender wise analysis revealed higher prevalence of sarcopenia among males (66%) than females (34%).ConclusionSarcopenia is highly prevalent among those with HF (irrespective of type of HF) and is more commonly seen in males compared to females.     

Impact of using the updated EWGSOP2 definition in diagnosing sarcopenia: A clinical perspective

Background and PurposeThe revised European Working Group on Sarcopenia in Older People (EWGSOP2, version 2019) definition of sarcopenia differs with respect to the EWGSOP (version 2010) definition in applied criteria and their cut-off values. We aimed to investigate the impact of the new definition on sarcopenia prevalence in various populations of older adults.MethodsEight cohorts, including community-dwelling older adults, geriatric outpatients and patients admitted to acute and subacute inpatient wards were assessed on sarcopenia prevalence.ResultsA total of 2256 participants (56.4 % female) were included with a median age of the cohorts of 71.7–83.3 years. In males, sarcopenia prevalence was 31.9 % according to EWGSOP compared to 12.0 % according to EWGSOP2. In females, sarcopenia prevalence was 4.9 % and 6.1 % according to EWGSOP and EWGSOP2 respectively. Lower cut-off points for handgrip strength (27 kg versus 30 kg (males) and 16 kg versus 20 kg (females) for EWGSOP and EWGSOP2 respectively) resulted in the lower sarcopenia prevalence in males.ConclusionsAccording to the EWGSOP2 definition, the prevalence of sarcopenia in males is significantly lower compared to the EWGSOP definition, whereas the prevalence among women is slightly higher. The lower cut-off points for handgrip strength result in fewer adults being diagnosed with sarcopenia.     

Sarcopenia: An important prognostic factor for males treated for a locally advanced esophageal carcinoma

IntroductionSarcopenia is a prognostic factor of esophageal carcinoma (EC) before surgery, with less convincing data reported before chemoradiotherapy (CRT).Material and methodsAll patients with a locally advanced EC who had been treated with upfront CRT, between 2010 and 2015, were included. The decision of surgery was made after CRT (40–50 Gy). Muscle mass was measured on a single third lumbar vertebra CT-scan slice. Sarcopenia was internationally defined as skeletal muscle index of ≤39cm2/m2 for women and ≤55cm2/m2 for men. Results were additionally analyzed according to clinical parameters, with a cut-off based on the mean skeletal muscle lumbar index (SMI) of the population studied.ResultsOverall, 104 patients were included (male: 69%). Mean SMI was 35cm2/m2 for women and 46cm2/m2 for men, with 81% of patients being sarcopenic (n = 84). The 3-year overall survival (OS) rate, of 34.6%, was not significantly associated with sarcopenia in the whole population. In men, there was, however, a highly significant correlation between SMI and OS (p = 0.003), which remained significant upon multivariate analysis (p = 0.02). When using the mean SMI as cut-off, sarcopenia was significantly associated with 3-year OS (43.3% vs. 26.2%, p = 0.02).ConclusionA high sarcopenia level appears negatively associated with OS in male EC patients treated with upfront CRT.     

Severity of sarcopenia is associated with postural balance and risk of falls in community-dwelling older women

Background/Study context: Falls represent the leading cause of accidental deaths in the elderly. Sarcopenia is a geriatric syndrome defined as the loss of muscle mass and strength. However, the association between falls and sarcopenia is still unclear. Thus, the aim of the present study was to investigate the association between different stages of sarcopenia and postural balance, risk of falls, and fear of falling in community-dwelling older women. Methods: A total of 196 women (68.6 ± 6.5 years) underwent body composition (Dual-energy X-ray Absorptiometry), muscle strength (isokinetic), and functional (Timed Up-and-Go) assessments. Sarcopenia was classified according to European Working Group on Sarcopenia in Older People. Center of pressure (CoP) sway, risk, and fear of falling were assessed through force platform, QuickScreen, and Falls Efficacy Scale, respectively. ANOVA models and chi-squared were used to compare groups. Results: Severe sarcopenic subjects presented higher risk of falling when compared to the other stages (p < 0.01). Regarding CoP sway, both mean speed and mediolateral range were significantly higher in severe sarcopenia when compared to both nonsarcopenia and presarcopenia (p < 0.05). Fear of falling was higher in all sarcopenia stages when compared to nonsarcopenic individuals (p < 0.05). Conclusion: Sarcopenia negatively affects balance, and both risk and fear of falling in community-dwelling older women. Moreover, this study provides evidence that sarcopenia severity is further associated to reduced balance and imposes an even greater risk of falls in the elderly.     

Comparison of diagnostic significance of the initial versus revised diagnostic algorithm for sarcopenia from the Asian Working Group for Sarcopenia

BackgroundsSarcopenia in older adults is a risk factor for age-related morbidity and mortality. This study aimed to clarify the diagnostic significance of the revised diagnostic algorithm for sarcopenia from Asian Working Group for Sarcopenia by comparing physical and clinical characteristics of individuals diagnosed with sarcopenia by the initial and revised algorithms.MethodsStudy participants were 2061 older community residents. Skeletal muscle mass was measured by bioimpedance analysis. Handgrip strength and physical function required for the diagnosis of sarcopenia were measured by conventional methods. Carotid intima-media thickness was used as a marker of atherosclerosis in a large artery.ResultsUsing the initial algorithm, 60 of the participants were diagnosed with sarcopenia, but based on the revised algorithm, 89 had sarcopenia and 21 severe sarcopenia. The higher frequency of sarcopenia was attributed to changes in the cut-off values for slow gait speed and the addition of the 5-time chair-stand test as part of the assessment of physical performance. Physical characteristics of individuals diagnosed with sarcopenia by either algorithm did not differ markedly, but those with severe sarcopenia had significantly poorer physical performance even with a muscle mass similar to those with sarcopenia. There was a linear correlation between the severity of sarcopenia and carotid intima-media thickness (no sarcopenia: 0.94 ± 0.31, sarcopenia: 1.04 ± 0.41, and severe sarcopenia: 1.07 ± 0.55 mm, P = 0.003).ConclusionThe revised diagnostic algorithm was superior to the initial version at identifying individuals with sarcopenia and severe sarcopenia with a worse cardiovascular profile.     

Limitations of SARC-F in the diagnosis of sarcopenia in community-dwelling older adults

PurposeThe SARC-F is a recommended screening tool for sarcopenia; however, its sensitivity is reported to be very low. This study aimed to confirm the diagnostic efficacy of the SARC-F and whether it is affected by population characteristics.MethodsIn this study, 2 cohorts of 1060 community-dwelling older adults, who were monitored by the Tokyo Metropolitan Institute of Gerontology, were included. In addition to the overall dataset, receiver operating characteristic curve analysis was performed to obtain the SARC-F results for sarcopenia among the datasets for only those older in age (over 75 years), those with higher frailty points (above the median total score for the Kihon Checklist points), those with lower grip strength (below the median), lower gait speed (below the median), and those with comorbidities (hypertension, cerebral vascular disease, heart disease, and diabetes mellitus).ResultsIn the overall dataset, sensitivity and specificity were 3.9% and 97.3%, respectively. In analyzing the area under the curve, sensitivity and specificity for older age and low physical function datasets were significant, but had low values. The diabetes dataset had higher values but did not effectively diagnose sarcopenia at a cutoff value of 4.ConclusionThe SARC-F had high specificity for the diagnosis of sarcopenia in community-dwelling older adults with low physical function. However, its sensitivity was low. Despite these limitations, it may be used as a screening tool for sarcopenia in selected populations, such as adults in hospitals or nursing homes.     

Interaction of central obesity and sarcopenia on nutritional status in the community-dwelling older people

ObjectivesTo investigate the interrelationships between central obesity, sarcopenia and nutritional status in the elderly.MethodsWe enrolled 501 elderly (women: 47.5 %) with complete datasets. Biochemical and anthropometric data were measured after an overnight fast. Basic characteristics, psychosocial and behavioral factors, nutritional status, and history of chronic disease came from structured questionnaires. Central obesity was defined as waist circumference ≥ 90 cm for men, ≥ 80 cm for women. Sarcopenia was defined by the Asian consensus. Nutritional status was assessed using Mini Nutritional Assessment scores: abnormal nutritional status ≤ 23.5. Multiple logistic regression analysis was done to determine the independent factors of an abnormal nutritional status.ResultsNinety (18.0 %) participants had an abnormal nutritional status, 300 (59.9 %) had central obesity, 52 (10.4 %) sarcopenia and 3 (0.6 %) sarcopenic obesity. Central obesity (OR = 0.455, 95 % CI: 0.244-0.847) and total lymphocyte count (OR = 0.526, 95 % CI: 0.315-0.880) were negatively and sarcopenia (OR = 3.170, 95 % CI: 1.485–6.767), current smoking (OR = 4.071, 95 % CI: 1.357–12.211), and total number of chronic diseases (OR = 1.484, 95 % CI: 1.234–1.785) were positively associated with abnormal nutritional status. An analysis of the combine effects of central obesity and sarcopenia on nutritional status showed that significantly fewer participants with central obesity but not sarcopenia had abnormal nutrition than participants with sarcopenia with or without central obesity (12.8 % vs 38.5 or 65.4 %, p < 0.001).ConclusionsCentral obesity and sarcopenia were interactively associated with the nutritional status of older people living in a rural community.     

The prevalence and risk factors for sarcopenia in older adults and long-living older adults

PurposeSarcopenia is a muscular syndrome that is related to several adverse risks. The present study aimed to evaluate the prevalence of risk of sarcopenia and associated factors in older adults and long-living older adults.MethodsA crosssectional epidemiological study of older adults patients at a geriatric outpatient clinic. The older adults were evaluated for sarcopenia risk using the SARC-F questionnaire supplemented with the measurement of the calf circumference. In addition, nutritional status was characterized using the Mini Nutritional Assessment, and the relationship of sarcopenia with associated factors (comorbidities, polypharmacy, smoking).ResultsA total of 100 eligible older adults with a mean age of 77.2 ± 1.8 years in the older adults and 86.3 ± 4.2 years in the long-living older adults (p < 0.001) were evaluated. The long-living older adults (OR = 6.1; 95 % CI: 1.44–16.09; p = 0.01) and older adults at risk of malnutrition (OR = 13.6; 95 % CI: 1.55–11.38; p < 0.05) had a higher risk of sarcopenia, whereas BMI ≥ 27 kg/m 2 (OR = 0; 95 % CI: 0–0.06; p < 0.001) was a protective factor. The risk of sarcopenia was six times higher in the over-80 s (95 % CI = 1.44, 16.09), while the older adults with malnutrition or at nutritional risk ran a 13 times higher risk of sarcopenia (95 % CI = 1.55, 11.38).ConclusionThe prevalence of risk of sarcopenia was higher in the long-living older adults and the older adults at nutritional risk, making its early evaluation in clinical practice important.     

A nomogram as an indirect method to identify sarcopenia in patients with liver cirrhosis

Introduction and ObjectivesSarcopenia is one of the most common complications of cirrhosis, associated with an increased risk of morbidity and mortality. It is therefore necessary to perform a proper nutritional evaluation in these patients. Although CT scans are the gold standard for diagnosing sarcopenia, they are not widely used in clinical practice. There is thus a need to find indirect methods for identifying sarcopenia in patients with cirrhosis.Material and methodsThis is a cross-sectional study consecutively including all cirrhotic outpatients who underwent CT scans.ResultsA total of 174 patients met all the inclusion criteria and none of exclusion criteria. Fifty-five patients (31.6%) showed sarcopenia on CT scans. Multivariate analysis revealed that the factors that were independently associated with the presence of sarcopenia on CT scans were: male sex (OR 11.27, 95% CI 3.53–35.95; p<0.001), lower body mass index (BMI) (OR 1.22, 95% CI 1.11–1.34; p<0.001) and lower phase angle by bioelectrical impedance analysis (OR 2.83, 95% CI 1.74–4.6; p<0.001). With the variables identified from the multivariate study we developed a nomogram that allows ruling out the presence of sarcopenia. Our model rules out sarcopenia with an area under the receiver operating characteristic curve value of 0.8. The cutoff point of the probability to rule out sarcopenia was 0.6 (sensitivity 85%, specificity 73%, Youden index 0.58, PPV 82.5% and NPV 91.3%).ConclusionSince CT scans involve exposure to radiation and their availability is limited, we propose using this nomogram as an indirect method to rule out sarcopenia in cirrhotic patients.     

Optimal waist circumference cutoff values for predicting metabolic syndrome among older adults in Ecuador

AimsTo determine optimal waist circumference cutoff values for predicting metabolic syndrome (MetS) among adults aged 60 years and older in Ecuador.Material and methodsThe National Survey of Health, Wellbeing, and Aging survey was used to describe the prevalence of MetS according to standard definitions. Receiver operating characteristics (ROC) curve analyses and the Younden index J (YI) were performed to examine optimal waist circumference cutoff values for predicting MetS. Moreover, the prevalence of MetS according to country-specific waist circumference cutoff values was compared with those using standard definitions.ResultsAmong 2306 participants with a mean age of 70.6 years, the optimal waist circumference cutoff value for predicting MetS was 90.7 cm in women with a sensitivity of 66.1%, specificity of 65.6% and YI of 0.31. In men, a waist circumference of 91.2 cm with a sensitivity of 73.2%, specificity of 62.8%, and YI of 0.36 was the optimal cutoff point for predicting MetS. In general, applying country-specific cutoff values decreased the prevalence of MetS among older Ecuadorian women. In men, except with the ATP III definition, similar MetS prevalence rates were seen whether the country-specific or standard waist circumference cutoff values were applied.ConclusionsThe optimal waist circumference cutoff values for predicting metabolic syndrome among older Ecuadorians adults were 90.7 cm for women and 91.2 cm for men. Moreover, current standard definitions of abdominal obesity may overestimate the prevalence of MetS, particularly in Latin American women.     

Comparative analysis of the sarcopenia and HALP score on postoperative outcomes in pancreatic cancer patients after pancreatoduodenectomy

BackgroundSarcopenia and HALP (Hemoglobin, Albumin, Lymphocyte, and Platelet) scores are factors commonly associated with postoperative outcomes used in cancer patients. This study aims to evaluate the effect of these two prognostic factors on postoperative outcomes in operated pancreatic cancer patients and their correlation with each other.MethodsThe study is a single-center, retrospective study conducted with 179 patients diagnosed with pancreatic adenocarcinoma after pancreatoduodenectomy (PD) between January 2012 and January 2022. The Psoas muscular index (PMI) and HALP scores of the patients were calculated. Cut-off values were determined in order to determine the nutritional status of the patients and to group them. The cut-off value of the HALP score was determined according to survival status. In addition, the clinical data and pathological findings of tumors were collected. These two parameters were evaluated in terms of length of hospital stay, postoperative complication rates, fistula development, and overall survival, and their correlations with each other were examined.ResultsOf the patients, 74 (41.3%) were female, and 105 (58.7%) were male. According to PMI cut-off values, 83 (46.4%) patients were in the sarcopenia group. According to the HALP score cut-off values, 77 (43.1%) patients were in the low HALP group. Sarcopenia and Low HALP group had a higher risk of death (respectively Hazard ratio:5.67, CI:3.58–8.98, Hazard ratio:5.95, CI: 3.72–9.52) (p < 0.001). There was a moderate correlation between PMI and HALP score (rs = 0.34, p = 0.01). The correlation in these values was higher in the female gender.ConclusionsIn line with the data obtained from our study, HALP score and sarcopenia are among the important parameters used to evaluate postoperative complications and provide information about survival. Patients with a low HALP score and sarcopenic have an increased likelihood of developing postoperative complications and a lower survival.     

Sarcopenia and post-hospital outcomes in older adults: A longitudinal study

IntroductionSarcopenia poses a significant problem for older adults, yet very little is known about this medical condition in the hospital setting. The aims of this hospital-based study were to determine: (i) the prevalence of sarcopenia; (ii) factors associated with sarcopenia; and (iii) the association of sarcopenia with adverse clinical outcomes post-hospitalisation.MethodsThis is a longitudinal analysis of consecutive patients aged ≥70 years admitted to a Geriatric Management and Evaluation Unit (GEMU) ward. Sarcopenia was classified using the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm, which included: handgrip strength, gait speed, and muscle mass using Bioelectrical Impedance Analysis (BIA). Outcomes were assessed at 12-months post-hospital discharge, and included both mortality and admission to a hospital Emergency Department (ED). Kaplan-Meier methods were used to estimate survival, with Cox proportion hazard models then applied. All regression analyses controlled for age, sex, and co-morbidity.Results172 patients (72% female) with a mean (SD) age of 85.2 (6.4) years were included. Sarcopenia was present in 69 (40.1%) of patients. Patients with sarcopenia were twice as likely to die in the 12-months post-hospitalisation (HR, 95% CI = 2.23, 1.15–4.34), but did not have an increased likelihood of ED admission.ConclusionsSarcopenia showed an independent association with 12-month post-hospital mortality in older adults. With the new recognition of sarcopenia as a medical condition with its own unique ICD-10-CM code, awareness and diagnosis of sarcopenia in clinical settings is paramount.