Skip to main content
Log in

Muscle Strength Definitions Matter: Prevalence of Sarcopenia and Predictive Validity for Adverse Outcomes Using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) Criteria

  • Published:
The journal of nutrition, health & aging



EWGSOP2 criteria for sarcopenia recommends the use of either handgrip strength (GS) or 5-times repeated chair stand test (RCS) as a muscle strength measure. We aim to compare the impact of different muscle strength definitions on sarcopenia prevalence and predictive validity for 2-year outcomes, using the EWGSOP2 clinical algorithm.


We studied 200 community-dwelling older adults, comparing sarcopenia prevalence using three muscle strength definitions: 1) maximum GS (Asian Working Group cutoffs); 2) RCS-1 (standard cutoff >15s); and 3) RCS-2 (ROC-derived cutoff >12.5s). Two-year outcomes include: 1) Incident frailty (modified Fried criteria); 2) Physical performance [Short Physical Performance Battery (SPPB) score <10]; and 3) Quality of life [EuroQol-5 dimension (EQ-5D) <25th percentile]. We performed logistic regression on 2-year outcomes adjusted for age, gender, cognition and mood.


Prevalence of confirmed sarcopenia was 14.5%, 4% and 9% for GS, RCS-1 and RCS-2 respectively. For 2-year outcomes (N=183), RCS-2 predicted incident frailty (OR: 5.7, 95% CI 1.4–22.8, p=0.013), low SPPB (OR: 4.4, 95% CI 1.4–13.1, p=0.009), and trended towards predicting low QOL (OR: 2.1, 95% CI 0.9–4.9, p=0.095). In contrast, GS and RCS-1 did not predict frailty nor low QOL, but predicted low SPPB only (GS: OR 3.8, 95% CI 1.3–10.6, p=0.01; RCS-1: OR: 8.8, 95% CI 2.2–35.0, p=0.002).


Sarcopenia prevalence varies with muscle strength definitions, with GS being significantly higher vis-á-vis RCS definitions. Our results also support the use of population-specific over standard cutoffs for RCS to obtain intermediate estimates of sarcopenia prevalence and the best predictive validity for two-year outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Cruz-Jentoft, A.J., G. Bahat, J. Bauer, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1): 16–31.

    Article  Google Scholar 

  2. Janssen, I., R.N. Baumgartner, R. Ross, et al. Skeletal muscle cutpoints associated with elevated physical disability risk in older men and women. Am J Epidemiol. 2004;159(4): 413–21.

    Article  Google Scholar 

  3. Delmonico, M.J., T.B. Harris, M. Visser, et al. Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr. 2009;90(6): 1579–85.

    Article  CAS  Google Scholar 

  4. Chew, J., L. Tay, J.P. Lim, et al. Serum Myostatin and IGF-1 as Gender-Specific Biomarkers of Frailty and Low Muscle Mass in Community-Dwelling Older Adults. J Nutr Health Aging. 2019;23(10): 979–986.

    Article  CAS  Google Scholar 

  5. Chen, L.K., L.K. Liu, J. Woo, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15(2): 95–101.

    Article  Google Scholar 

  6. Guralnik, J.M., E.M. Simonsick, L. Ferrucci, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2): M85–94.

    Article  CAS  Google Scholar 

  7. Vasunilashorn, S., A.K. Coppin, K.V. Patel, et al. Use of the Short Physical Performance Battery Score to predict loss of ability to walk 400 meters: analysis from the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2009;64(2): 223–9.

    Article  Google Scholar 

  8. Fried, L.P., C.M. Tangen, J. Walston, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3): M146–56.

    Article  CAS  Google Scholar 

  9. Wade, D.T., J. Legh-Smith and R. Langton Hewer. Social activities after stroke: measurement and natural history using the Frenchay Activities Index. Int Rehabil Med. 1985;7(4): 176–81.

    Article  CAS  Google Scholar 

  10. Oh, B., B. Cho, H.C. Choi, et al. The influence of lower-extremity function in elderly individuals’ quality of life (QOL): an analysis of the correlation between SPPB and EQ-5D. Arch Gerontol Geriatr. 2014;58(2): 278–82.

    Article  Google Scholar 

  11. Abdin, E., M. Subramaniam, J.A. Vaingankar, et al. Measuring health-related quality of life among adults in Singapore: population norms for the EQ-5D. Qual Life Res. 2013;22(10): 2983–91.

    Article  Google Scholar 

  12. Mahoney, F.I. and D.W. Barthel. Functional Evaluation: The Barthel Index. Md State Med J. 1965;14: 61–5.

    CAS  PubMed  Google Scholar 

  13. Lawton, M.P. and E.M. Brody. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3): 179–86.

    Article  CAS  Google Scholar 

  14. Sahadevan, S., P.P. Lim, N.J. Tan, et al. Diagnostic performance of two mental status tests in the older chinese: influence of education and age on cut-off values. Int J Geriatr Psychiatry. 2000;15(3): 234–41.

    Article  CAS  Google Scholar 

  15. Yesavage, J.A., T.L. Brink, T.L. Rose, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17(1): 37–49.

    Article  Google Scholar 

  16. Kim, M. and C.W. Won. Prevalence of sarcopenia in community-dwelling older adults using the definition of the European Working Group on Sarcopenia in Older People 2: findings from the Korean Frailty and Aging Cohort Study. Age Ageing. 2019;48(6): 910–916.

    Article  Google Scholar 

  17. Bahat, G. and A.J. Cruz-Jentoft. Putting Sarcopenia at the Forefront of Clinical Practice. Eur J Geriatr Gerontol. 2019;1(2): 43–45.

    Article  Google Scholar 

  18. Harris-Love, M.O., K. Benson, E. Leasure, et al. The Influence of Upper and Lower Extremity Strength on Performance-Based Sarcopenia Assessment Tests. J Funct Morphol Kinesiol. 2018;3(4).

  19. Forrest, K.Y., J.M. Zmuda and J.A. Cauley. Correlates of decline in lower extremity performance in older women: A 10-year follow-up study. J Gerontol A Biol Sci Med Sci. 2006;61(11): 1194–200.

    Article  Google Scholar 

  20. W. H. O. Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403): 157–63.

    Article  Google Scholar 

  21. Leung, Y.Y., S. Ma, M. Noviani, et al. Validation of screening questionnaires for evaluation of knee osteoarthritis prevalence in the general population of Singapore. Int J Rheum Dis. 2018;21(3): 629–638.

    Article  Google Scholar 

  22. Buatois, S., D. Miljkovic, P. Manckoundia, et al. Five times sit to stand test is a predictor of recurrent falls in healthy community-living subjects aged 65 and older. J Am Geriatr Soc. 2008;56(8): 1575–7.

    Article  Google Scholar 

  23. Makizako, H., H. Shimada, T. Doi, et al. Predictive Cutoff Values of the Five-Times Sit-to-Stand Test and the Timed “Up & Go” Test for Disability Incidence in Older People Dwelling in the Community. Phys Ther. 2017;97(4): 417–424.

    PubMed  Google Scholar 

  24. Cesari, M., S.B. Kritchevsky, A.B. Newman, et al. Added value of physical performance measures in predicting adverse health-related events: results from the Health, Aging And Body Composition Study. J Am Geriatr Soc. 2009;57(2): 251–9.

    Article  Google Scholar 

  25. Aoyagi, K., P.D. Ross, M.C. Nevitt, et al. Comparison of performance-based measures among native Japanese, Japanese-Americans in Hawaii and Caucasian women in the United States, ages 65 years and over: a cross-sectional study. BMC Geriatr. 2001;1: 3.

    Article  CAS  Google Scholar 

Download references


We would like to thank all participants who contributed to this study. This study was supported by the Lee Foundation Grant 2013.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Justin Chew.

Ethics declarations

Conflict of interest: The authors have no conflicts of interest to disclose.

Ethical standards: Ethics approval for the study was obtained from by the Domain Specific Review Board of the National Healthcare Group and informed written consent was obtained from the participants.

Electronic supplementary material

Appendix 1

. Receiver Operating Characteristic (ROC) analysis of five-times repeated chair stand (RCS) time with Asian Working Group for Sarcopenia (AWGS)-defined impaired maximum grip strength (GS) as the outcome variable.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chew, J., Yeo, A., Yew, S. et al. Muscle Strength Definitions Matter: Prevalence of Sarcopenia and Predictive Validity for Adverse Outcomes Using the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) Criteria. J Nutr Health Aging 24, 614–618 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

Key words