Miyahara Shuzo, Maeda Keisuke, Satake Shosuke, Akatsu Hiroyasu, Arai Hidenori
Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan; Department of Community Healthcare and Geriatrics, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan.
Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan; Nutrition Therapy Support Center, Aichi Medical University, Nagakute, Aichi, Japan.
Clin Nutr ESPEN. 2025 Oct;69:216-224. doi: 10.1016/j.clnesp.2025.07.013. Epub 2025 Jul 9.
BACKGROUND&AIMS: Sarcopenia and malnutrition are linked to adverse outcomes in older adults, requiring muscle mass assessment for diagnosis. While specialized equipment is recommended, limited accessibility highlights the need for alternative methods. Various skeletal muscle mass estimation equations exist, but their validity across clinical settings is uncertain. This study evaluated the validity and applicability of previously reported appendicular skeletal mass (ASM) estimation equations in older adults across two hospital settings.
This study utilized registry data from the National Center for Geriatrics and Gerontology, including patients aged ≥65 years from a frailty outpatient clinic and geriatric ward. ASM was assessed using dual-energy X-ray absorptiometry (DXA) as the reference standard. A comprehensive review identified multiple ASM estimation equations based on age, sex, height, weight, and creatinine-to-cystatin C ratio (Cre/CysC). As an exception, one skeletal muscle mass index (SMI) estimation equation was included in the analysis. In both groups, intraclass correlation coefficients (ICCs) were calculated to assess the agreement between ASM estimates and DXA measurements. Estimation errors were standardized as T-scores, plotted, and visualized with 95 % confidence ellipses for each group.
The analysis included 856 patients from the frailty clinic group (mean age: 78.2 ± 6.1 years, 58.3 % women) and 328 from the geriatric ward group (mean age: 86.2 ± 6.4 years, 60.7 % women). ICCs between the ASM estimation equations and DXA were generally higher in the frailty clinic group. Several equations achieved ICC ≥0.9 in the frailty clinic group and ICC ≥0.8 in the geriatric ward group. Equations based on age, sex, height, and weight performed well in both groups, with minimal benefit from adding Cre/CysC. Estimation errors showed no substantial differences between groups.
Several ASM estimation equations showed strong agreement with DXA in older adults across outpatient and inpatient settings. While dedicated equipment is ideal, using common patient data for muscle mass estimation improves accessibility and may support the wider adoption of muscle assessment for sarcopenia and malnutrition diagnosis.
肌肉减少症和营养不良与老年人的不良结局相关，需要评估肌肉量以进行诊断。虽然推荐使用专门设备，但设备可及性有限凸显了替代方法的必要性。存在多种骨骼肌量估算方程，但其在不同临床环境中的有效性尚不确定。本研究评估了先前报道的四肢骨骼肌量（ASM）估算方程在两家医院环境中的老年人中的有效性和适用性。
本研究利用了国立老年医学和老年学中心的登记数据，包括来自衰弱门诊和老年病房的≥65岁患者。以双能X线吸收法（DXA）评估ASM作为参考标准。全面检索确定了多个基于年龄、性别、身高、体重和肌酐与胱抑素C比值（Cre/CysC）的ASM估算方程。作为例外，分析中纳入了一个骨骼肌量指数（SMI）估算方程。在两组中，计算组内相关系数（ICC）以评估ASM估算值与DXA测量值之间的一致性。将估算误差标准化为T分数，进行绘图，并为每组绘制95%置信椭圆以进行可视化。
分析纳入了来自衰弱门诊组的856例患者（平均年龄：78.2±6.1岁，58.3%为女性）和来自老年病房组的328例患者（平均年龄：86.2±6.4岁，60.7%为女性）。在衰弱门诊组中，ASM估算方程与DXA之间的ICC通常更高。几个方程在衰弱门诊组中ICC≥0.9，在老年病房组中ICC≥0.8。基于年龄、性别、身高和体重的方程在两组中表现良好，添加Cre/CysC带来的益处极小。两组之间的估算误差没有实质性差异。
几个ASM估算方程在门诊和住院环境中的老年人中与DXA显示出高度一致性。虽然专用设备是理想选择，但使用常见的患者数据进行肌肉量估算可提高可及性，并可能支持更广泛地采用肌肉评估以诊断肌肉减少症和营养不良。
