Rose Berlin Piodena-Aportadera Melissa, Lau Sabrina, Chew Justin, Lim Jun Pei, Ismail Noor Hafizah, Ding Yew Yoong, Lim Wee Shiong
Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore.
Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore.
Ann Geriatr Med Res. 2022 Sep;26(3):215-224. doi: 10.4235/agmr.22.0057. Epub 2022 Aug 29.
Although recommended by the Asian Working Group for Sarcopenia 2019 consensus (AWGS'19) as a screening tool for sarcopenia, there remains no consensus regarding the position (sitting, standing) or laterality (right, left) for the measurement of calf circumference (CC). This study aimed to determine the agreement between CC measurements, correlations with muscle mass and function, and diagnostic performance for sarcopenia screening.
We studied 176 healthy community-dwelling older adults (mean age, 66.8±7.1 years) from the GERILABS-2 study. CC was measured using non-elastic tape in four ways: left and right sides in the sitting and standing positions. Sarcopenia was diagnosed using the AWGS'19 criteria. We produced Bland-Altman plots to assess the agreement, partial correlations for muscle mass and function to compare convergent validity, and area under the receiver operating characteristic curve (AUC) to compare diagnostic performance.
The prevalence rate of sarcopenia was 17.4%. Sitting CC was larger than standing regardless of laterality (right 35.31±2.95 cm vs. 34.61±2.74 cm; left 35.37±2.96 cm vs. 34.70±2.83 cm; both p<0.001), consistent with the systematic bias on Bland-Altman plots showing the overestimation of sitting over standing measurements (right bias=0.70 cm; 95% confidence interval [CI], -0.48-1.88; left bias=0.67 cm, 95% CI, -0.35-1.68). After adjusting for age and sex, CC was significantly correlated with appendicular skeletal mass, hand grip strength, knee extension, gait speed, chair stand, and short physical performance battery. Although right-sided CC measurements had better diagnostic performance (AUC=0.817), the difference was not statistically significant compared to the other positions (p>0.05). The optimal cutoff was <34 cm for all measurements, except for the left standing position (cutoff <35 cm).
Standing CC measurements are recommended for sarcopenia screening in community-dwelling older adults because of their good agreement without systematic bias, convergent validity, and diagnostic performance.
尽管亚洲肌少症工作组2019年共识（AWGS'19）推荐将小腿围（CC）作为肌少症的筛查工具，但对于CC测量的体位（坐姿、站姿）或测量部位（右侧、左侧）仍未达成共识。本研究旨在确定CC测量值之间的一致性、与肌肉质量和功能的相关性以及肌少症筛查的诊断性能。
我们研究了GERILABS-2研究中的176名健康社区老年人（平均年龄66.8±7.1岁）。采用无弹性卷尺以四种方式测量CC：坐姿和站姿下的左侧和右侧。根据AWGS'19标准诊断肌少症。我们绘制了布兰德-奥特曼图以评估一致性，计算肌肉质量和功能的偏相关系数以比较收敛效度，并计算受试者工作特征曲线下面积（AUC）以比较诊断性能。
肌少症患病率为17.4%。无论测量部位如何，坐姿CC均大于站姿（右侧35.31±2.95 cm对34.61±2.74 cm；左侧35.37±2.96 cm对34.70±2.83 cm；p均<0.001），这与布兰德-奥特曼图上显示的系统偏差一致，表明坐姿测量值高估了站姿测量值（右侧偏差=0.70 cm；95%置信区间[CI]，-0.48-1.88；左侧偏差=0.67 cm，95% CI，-0.35-1.68）。在调整年龄和性别后，CC与四肢骨骼肌质量、握力、膝关节伸展、步速、椅子起立试验和简短体能测试显著相关。尽管右侧CC测量具有更好的诊断性能（AUC=0.817），但与其他体位相比差异无统计学意义（p>0.05）。除左侧站姿测量（临界值<35 cm）外，所有测量的最佳临界值均<34 cm。
由于站姿CC测量具有良好的一致性、无系统偏差、收敛效度和诊断性能，因此推荐用于社区老年人肌少症的筛查。
