Which pathway of the possible sarcopenia algorithm of the AWGS 2019 guideline is the best in Korean community-dwelling older men and women?

Abstract

Objective

To compare the diagnostic accuracy of possible sarcopenia identification pathways, as suggested by Asian Working Group for Sarcopenia (AWGS) in 2019, by gender among Korean community-dwelling older adults.

Design

Cross-sectional analysis of data from 2,129 community-dwelling adults (70–84 years, 50.4% men) enrolled in Korean Frailty and Aging Cohort Study.

Methods

Based on AWGS 2019 guideline, possible sarcopenia was defined by low handgrip strength (HGS) or slow five-times chair stand test (5CST) time, referred to as “assessments.” “Case-findings” (low calf circumference [CC], SARC-F ≥4, or SARC-CalF ≥11) were recommended for screening ‘possible sarcopenia’ before assessment. For the six ‘possible sarcopenia’ pathways (combining three case-finding and two assessment tools), area under the curve (AUC) and F₁ score are compared.

Results

For case-finding in men, CC demonstrated the highest AUC (0.657) and F₁ score (0.504) for predicting sarcopenia compared with SARC-F and SARC-CalF (p <0.001, =0.001). Among men with low CC, ΔAUC between HGS and 5CST was not significant as assessment (p=0.079) (AUCs: 0.763 vs. 0.707; F₁ scores: 0.713 vs. 0.650). For case-finding in women, SARC-CalF demonstrated the highest AUC (0.631) and F₁ score (0.389) compared with CC and SARC-F (p=0.012, <0.001). Subsequently, ΔAUC between HGS and 5CST was not significant in women (p=0.069) (AUCs: 0.566 vs. 0.636; F₁ scores: 0.387 vs. 0.514).

Conclusions

Based on AWGS 2019 guideline, CC in men and SARC-CalF in women was the best case-finding tool for community-dwelling older adults. After the best case-finding in each gender, two assessment pathways demonstrated insignificant difference in both genders.

Brief summary

For case-finding of possible sarcopenia, using calf circumference in older men and using SARC-CalF in older women demonstrated the highest diagnostic accuracy for predicting sarcopenia. After the best case-finding in each gender, two assessment pathways (handgrip strength and five-times chair stand test) of possible sarcopenia demonstrated insignificant difference in both genders.