Diagnostic Performance of Calf Circumference, Thigh Circumference, and SARC-F Questionnaire to Identify Sarcopenia in Elderly Compared to Asian Working Group for Sarcopenia’s Diagnostic Standard

Mienche Mienche, Siti Setiati, Bambang Setyohadi, Juferdy Kurniawan, Purwita Wijaya Laksmi, A Ariane, Gunawan Tirtarahardja


Background: sarcopenia is one of many geriatric problems that may lead to major clinical outcomes. Calf and thigh circumference have good correlation with muscle mass, whereas SARC-F questionnaire is very predictive of muscle function. There has not been a study that evaluates the diagnostic performance of calf and thigh circumference in combination with SARC-F questionnaire in detecting sarcopenia. The aim of this study was to investigate the diagnostic performance of calf and thigh circumference in combination with SARC-F questionnaire compared to standard diagnostic methods of sarcopenia according to the Asian Working Group for Sarcopenia (AWGS) to predict sarcopenia in patient aged 60 years or older. Methods: this cross-sectional study was conducted in Geriatric Clinic Cipto Mangunkusumo Hospital, Jakarta, Indonesia during April–June 2018. Analysis was performed using receiver operating characteristic (ROC) curve to determine the cut-off point as well as sensitivity (Sn), specificity (Sp), positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (LR+ and LR-) of calf and thigh circumference as an indicator of low muscle mass, and SARC-F questionnaire score to detect decreased muscle function. Results: from 120 participants, there were 46 men (38.3%) and 74 women (61.7%). The combination of calf circumference with cut-off point below 34 cm in men and below 29 cm in women, thigh circumference below 49 cm in men and below 44 cm in women with SARC-F questionnaire score of ≥4 have Sn, Sp, PPV, NPV, LR+, and LR- of 15.79%; 99.01%; 75.00%; 86.21%; 15.95; and 0.85 respectively. Conclusion: combination of calf and thigh circumference with SARC-F questionnaire showed good diagnostic accuracy in predicting sarcopenia in elderly outpatients.


calf circumference; elderly; thigh circumference; SARC-F questionnaire; sarcopenia


Pusat Data dan Informasi. Analisis lansia di Indonesia. Jakarta: Kementerian Kesehatan Republik Indonesia; 2017. 1–6 p.

Chen LK, Liu LK, Woo J, et al. Sarcopenia in Asia: Consensus report of the Asian working group for sarcopenia. J Am Med Dir Assoc. 2014;15(2):95–101.

Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis. Age Ageing. 2010;39(4):412–23.

Fielding RA, Vellas B, Evans WJ, et al. Sarcopenia: an undiagnosed condition in older adults. current consensus definition: prevalence, etiology, and consequences. International Working Group on Sarcopenia. J Am Med Dir Assoc. 2012;12(4):249–56.

Rantanen T, Avlund K, Suominen H, Schroll M, Frändin K, Pertti E. Muscle strength as a predictor of onset of ADL dependence in people aged 75 years. Aging Clin Exp Res. 2002;14(3):10–5.

Taekema DG, Gussekloo J, Maier AB, Westendorp RGJ, de Craen AJM. Handgrip strength as a predictor of functional, psychological and social health. A prospective population-based study among the oldest old. Age Ageing. 2010;39(3):331–7.

Taekema DG, Ling CHY, Kurrle SE, et al. Temporal relationship between handgrip strength and cognitive performance in oldest old people. Age Ageing. 2012;41(4):506–12.

Burns JM, Johnson DK, Watts A, Swerdlow RH, Brooks WM. Reduced lean mass in early Alzheimer disease and its association with brain atrophy. Arch Neurol. 2010;67(4):428–33.

Alfaro-Acha A, Al Snih S, Raji MA, Kuo YF, Markides KS, Ottenbacher KJ. Handgrip strength and cognitive decline in older Mexican Americans. J Gerontol A Biol Sci Med Sci. 2006;61(8):859–65.

Lim S, Kwon S, Yoon JW, et al. Association between body composition and pulmonary function in elderly people : the Korean longitudinal study on health and aging. Obesity. 2009;19(3):631–8.

Yamada M, Nishiguchi S, Fukutani N, et al. Prevalence of Sarcopenia in Community-Dwelling Japanese Older Adults. J Am Med Dir Assoc. 2013;1–5.

Ling CHY, Taekema D, De Craen AJM, Gussekloo J, Westendorp RGJ, Maier AB. Handgrip strength and mortality in the oldest old population: The Leiden 85-plus study. CMAJ. 2010;182(5):429–35.

Cooper R, Kuh D, Hardy R, Mortality Review Group. Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ. 2010;341:4467.

Cesari M, Pahor M, Lauretani F, et al. Skeletal muscle and mortality results from the InCHIANTI study. J Gerontol. 2009;64(3):377–84.

Newman A, Kupelian V, Visser M, et al. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol. 2006;61(1):72–7.

Kamiya K, Hamazaki N, Matsuzawa R, Nozaki K, Tanaka S, Ichinosawa Y. Sarcopenia: prevalence and prognostic implications in elderly patients with cardiovascular disease. 2017;2(2):1–13.

Janssen I, Shepard DS, Katzmarzyk PT, Roubenoff R. The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc. 2004;52(1):80–5.

Woo J, Leung J, Morley JE. Validating the SARC-F: A suitable community screening tool for sarcopenia? J Am Med Dir Assoc. 2014;15(9):630–4.

Malmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC-F: A symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle. 2016;7(1):28–36.

Cao L, Chen S, Zou C, et al. A pilot study of the SARC-F scale on screening sarcopenia and physical disability in the Chinese older people. J Nutr Heal Aging. 2014;18(3):277–83.

Liccini A, Malmstrom TK. Frailty and sarcopenia as predictors of adverse health outcomes in persons with diabetes mellitus. J Am Med Dir Assoc. 2016;17(9):846–51.

Beaudart C, McCloskey E, Bruyère O, et al. Sarcopenia in daily practice: assessment and management. BMC Geriatr. 2016;16(1):1–10.

Barbosa-Silva TG, Menezes AMB, Bielemann RM, Malmstrom TK, Gonzalez MC. Enhancing SARC-F: Improving Sarcopenia Screening in the Clinical Practice. J Am Med Dir Assoc. 2016;17(12):1136–41.

Urzi F, Šimunič B, Buzan E. Basis for sarcopenia screening with the SARC-CalF in nursing homes. J Am Med Dir Assoc. 2017;18(11):991.e5-991.e10.

Jonathan T, Aldo S, Pieter CJAN, Erik C. Reliability of standard circumferences in domain-related constitutional applications. Am J Hum Biol. 2013;642:637–42.

Visser M, Kritchevsky SB, Goodpaster BH, et al. Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: the health, aging and body composition study. JAGS. 2002;50:897–904.

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