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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

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The journal of nutrition, health & aging

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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Acknowledgements

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

  1. Department of Geriatric Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Novena, Singapore

    Justin Chew, J. P. Lim, Y. Y. Ding & W. S. Lim

  2. Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Novena, Singapore

    Justin Chew, A. Yeo, S. Yew, J. P. Lim, L. Tay, Y. Y. Ding & W. S. Lim

  3. Department of General Medicine, Sengkang General Hospital, Sengkang, Singapore

    L. Tay

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  1. Justin Chew
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  2. A. Yeo
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  3. S. Yew
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  4. J. P. Lim
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  5. L. Tay
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  7. W. S. Lim
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Corresponding author

Correspondence to Justin Chew.

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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.

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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). https://doi.org/10.1007/s12603-020-1371-y

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  • DOI: https://doi.org/10.1007/s12603-020-1371-y

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