Original Study| Volume 22, ISSUE 4, P746-750.e1, April 2021

Comparison of Three Screening Methods for Sarcopenia in Community-Dwelling Older Persons



      The 2019 Asian Working Group on Sarcopenia in Older People (AWGS 2019) recommends using either calf circumference or the strength, assistance in walking, rising from a chair, climbing stairs, and falls (SARC-F) or SARC-F combined with calf circumference (SARC-CalF) questionnaires for sarcopenia screening. The aim of this study was to compare the ability and applicability of calf circumference, SARC-F, and SARC-CalF for screening sarcopenia among community-dwelling older adults.


      Cross-sectional study.

      Setting and Participants

      A total of 1050 community-dwelling older people were enrolled.


      Sarcopenia was diagnosed according to the AWGS 2019 criteria: bioimpedance analysis for appendicular skeletal muscle index, hand grip, and 6-m gait speed test. Participants also completed the SARC-F questionnaire and calf circumference measurement. The screening tools’ performances were evaluated through receiver operating characteristic (ROC) curves, area under the ROC curves (AUC), and sensitivity/specificity analyses.


      Sarcopenia was identified in 263 (25.0%) participants by the AWGS 2019 criteria. Calf circumference had a sensitivity of 81.4% and a specificity of 77.0%. Sensitivity and specificity of SARC-F for screening sarcopenia were 17.9% and 93.7%, respectively. SARC-CalF improved the sensitivity of SARC-F (47.5%) while keeping similar specificity (92.0%). The AUCs of calf circumference, SARC-F, and SARC-CalF were 0.79 [95% confidence interval (CI), 0.77–0.82], 0.56 (95% CI, 0.52–0.59), and 0.70 (95% CI, 0.67–0.73), respectively. The differences across ROC curves were statistically significant among 3 screening tools (P < .001).

      Conclusions and Implications

      The overall screening ability of calf circumference was better than that of SARC-F and SARC-CalF for sarcopenia in community-dwelling older persons despite gender, age, and cognitive function. SARC-F and SARC-CalF have high specificity but are susceptible to the preceding factors.


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        • Cruz-Jentoft A.J.
        • Landi F.
        • Schneider S.M.
        • et al.
        Prevalence of and interventions for sarcopenia in ageing adults: A systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS).
        Age Ageing. 2014; 43: 748-759
        • Cederholm T.
        • Morley J.E.
        Sarcopenia: The new definitions.
        Curr Opin Clin Nutr Metab Care. 2015; 18: 1-4
        • Chen L.K.
        • Woo J.
        • Assantachai P.
        • et al.
        Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment.
        J Am Med Dir Assoc. 2020; 21: 300-307.e2
        • Visvanathan R.
        • Chapman I.
        Preventing sarcopaenia in older people.
        Maturitas. 2010; 66: 383-388
        • Rosenberg I.H.
        Sarcopenia: Origins and clinical relevance.
        J Nutr. 1997; 127: 990s-991s
        • Ishii S.
        • Tanaka T.
        • Shibasaki K.
        • et al.
        Development of a simple screening test for sarcopenia in older adults.
        Geriatr Gerontol Int. 2014; 14: 93-101
        • Cruz-Jentoft A.J.
        • Baeyens J.P.
        • Bauer J.M.
        • et al.
        Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People.
        Age Ageing. 2010; 39: 412-423
        • Kawakami R.
        • Murakami H.
        • Sanada K.
        • et al.
        Calf circumference as a surrogate marker of muscle mass for diagnosing sarcopenia in Japanese men and women.
        Geriatr Gerontol Int. 2015; 15: 969-976
        • Kusaka S.
        • Takahashi T.
        • Hiyama Y.
        • et al.
        Large calf circumference indicates nonsarcopenia despite body mass.
        J Phys Ther Sci. 2017; 29: 1925-1928
        • McIntosh E.I.
        • Smale K.B.
        • Vallis L.A.
        Predicting fat-free mass index and sarcopenia: A pilot study in community-dwelling older adults.
        Age (Dordr). 2013; 35: 2423-2434
        • Hwang A.C.
        • Liu L.K.
        • Lee W.J.
        • et al.
        Calf circumference as a screening instrument for appendicular muscle mass measurement.
        J Am Med Dir Assoc. 2018; 19: 182-184
        • Malmstrom T.K.
        • Morley J.E.
        • SARC-F
        A simple questionnaire to rapidly diagnose sarcopenia.
        J Am Med Dir Assoc. 2013; 14: 531-532
        • Bahat G.
        • Oren M.M.
        • Yilmaz O.
        • et al.
        Comparing SARC-F with SARC-CalF to screen sarcopenia in community living older adults.
        J Nutr Health Aging. 2018; 22: 1034-1038
        • 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
        • Parra-Rodriguez L.
        • Szlejf C.
        • Garcia-Gonzalez A.I.
        • et al.
        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
        • Ida S.
        • Murata K.
        • Nakadachi D.
        • et al.
        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
        • Barbosa-Silva T.G.
        • Menezes A.M.
        • Bielemann R.M.
        • et al.
        Enhancing SARC-F: Improving sarcopenia screening in the clinical practice.
        J Am Med Dir Assoc. 2016; 17: 1136-1141
        • Rolland Y.
        • Dupuy C.
        • Abellan Van Kan G.
        • et al.
        Sarcopenia screened by the SARC-F questionnaire and physical performances of elderly women: A cross-sectional study.
        J Am Med Dir Assoc. 2017; 18: 848-852
        • Kim S.
        • Kim M.
        • Won C.W.
        Validation of the Korean version of the SARC-F questionnaire to assess sarcopenia: Korean Frailty and Aging Cohort Study.
        J Am Med Dir Assoc. 2018; 19: 40-51
        • Ida S.
        • Kaneko R.
        • Murata K.
        SARC-F for screening of sarcopenia among older adults: A meta-analysis of screening test accuracy.
        J Am Med Dir Assoc. 2018; 19: 685-689
        • Mo Y.
        • Dong X.
        • Wang X.H.
        Screening accuracy of SARC-F combined with calf circumference for sarcopenia in older adults: A diagnostic meta-analysis.
        J Am Med Dir Assoc. 2020; 21: 288-289
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        “Mini-mental state”.
        J Psychiatr Res. 1975; 12: 189-198
        • Katzman R.
        • Zhang M.Y.
        • Ouang Ya Q.
        • et al.
        A Chinese version of the Mini-Mental State Examination; impact of illiteracy in a Shanghai dementia survey.
        J Clin Epidemiol. 1988; 41: 971-978
        • Moraes-Gorecki V.
        Cultural variations on gender: Latin American marianismo/machismo in Australia.
        Aust J Anthropol. 1988; 18: 26-35
        • DeLong E.R.
        • DeLong D.M.
        • Clarke-Pearson D.L.
        Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach.
        Biometrics. 1988; 44: 837-845
        • Kim M.
        • Yabushita N.
        • Tanaka K.
        Exploring effective items of physical function in slow walking speed and self-reported mobility limitation in community-dwelling older adults.
        Geriatr Gerontol Int. 2012; 12: 50-58