Evaluation of sarcopenia diagnosis strategies in Chinese community-dwelling older adults based on the 2019 Asian Working Group guidelines: a cross-sectional study.

BACKGROUND

Most diagnostic studies on sarcopenia in Asia follow the 2019 Asian Working Group for Sarcopenia (AWGS) guidelines, which recommend distinct diagnostic strategies for community and hospital settings due to challenges in measuring muscle mass in community environments. This study evaluates the screening-to-diagnosis process in community-based preventive services.

METHODS

This cross-sectional study utilized a questionnaire survey to evaluate SARC-F and SARC-CalF. Measurements included calf circumference (CC), handgrip strength, gait speed and bioelectrical impedance analysis (BIA). Participants were diagnosed according to the AWGS 2019 criteria. Four scenarios simulating the screening-to-diagnosis process in a community setting were evaluated. Sensitivity, specificity, and the area under the ROC curve (AUC) were calculated to assess diagnostic performance.

RESULTS

A total of 2453 community-dwelling older adults aged ≥60 years were included. The prevalence of sarcopenia was 14.1% (345/2453), with rates of 15.4%(160/1038) in males and 13.1% (185/1415) in females. In the simulated diagnostic scenarios, the number of confirmed cases was 218 (combination,Scenario1), 211 (CC,Scenario2), 60 (SARC-CalF,Scenario3) and 21 (SARC-F,Scenario4), respectively. In the case-finding step, the sensitivity for Scenarios1 to 4 was 0.86,0.84,0.23 and 0.07, respectively; specificity was 0.57,0.58,0.93 and 0.99, respectively; and the AUCs were 0.717,0.710,0.581 and 0.530, respectively. In the assessment step, the sensitivity for Scenarios 1 to 4 was 0.73,0.73,0.74 and 0.88, respectively; specificity was 0.81,0.82,0.68 and 0.24, respectively; and the AUCs were 0.774,0.774,0.712 and 0.557,respectively. The integrated sensitivity of the case-finding and assessment steps for Scenarios 1 to 4 was 0.63,0.61,0.17 and 0.06, respectively; integrated specificity was 0.92,0.92,0.98 and 0.99, respectively; and integrated AUCs were 0.776,0.768,0.575 and 0.523, respectively. The diagnostic performance of the entire procedure was better in females than in males.

CONCLUSIONS

In the case-finding step, the CC tool demonstrated superior performance compared to the combination tool, SARC-CalF, and SARC-F. In the assessment step, the muscle strength test was consistently performed with stability. The integrated performances of the case-finding and assessment steps exhibited moderate accuracy in Scenarios 1 and 2, but low accuracy in Scenarios 3 and 4. There is a pressing need to develop more accurate and user-friendly tools to improve sarcopenia detection among community-dwelling older adults in China.