Elsevier

Clinical Nutrition

Volume 33, Issue 3, June 2014, Pages 539-544
Clinical Nutrition

Original article
Calf circumference, frailty and physical performance among older adults living in the community

https://doi.org/10.1016/j.clnu.2013.07.013Get rights and content

Summary

Background & aims

Lean body mass loss has been indicated as a reliable marker of frailty and poor physical performance among older individuals. We evaluated the relationship between calf circumference and frailty, physical performance, muscle strength, and functional status in persons aged 80 years or older.

Methods

Data are from the baseline evaluation of the Aging and Longevity Study in the Sirente geographic area (ilSIRENTE Study) (n = 357). The calf circumference was measured at the point of greatest circumference. Frailty was categorized according to the present of slow gait speed, weakness, weight loss, energy expenditure and exhaustion. Physical performance was assessed using the physical performance battery score, which is based on three timed tests: 4-m walking speed test, the balance test and the chair stand test. Analyses of covariance were performed to evaluate the relationship between different calf circumference and physical function.

Results

After adjustment for potential confounders, which included age, gender, education, body mass index, sensory impairments, cerebrovascular diseases, albumin, reactive C protein, interleukine-6, and cholesterol, physical performance (SPPB score: 7.27 versus 6.18, p = 0.02) and muscle strength (Hand Grip: 32 kg versus 28 kg, p = 0.03) measures significantly improved as calf circumference increased. The frailty index score was significantly lower among subjects with higher calf circumference (1.66 versus 2.17, p = 0.01).

Conclusions

The present study suggests that among community-dwelling older people, calf circumference may be positively related to lower frailty index and higher functional performance. As such, calf circumference is a valuable tool for guiding public health policy and clinical decisions.

Introduction

Aging process is related with significant changes in body composition, with a decline in lean body mass and an increase in visceral fat mass.1 Loss of muscle mass is associated with poor physical performance, physical inactivity, slow gait speed and decreased mobility. These factors are recognized as common features of the frailty syndrome.2, 3 The age-related muscle mass loss is also associated with an increased risk of incident disability and all-cause mortality in the elderly population.4, 5

According to Fried and colleagues,2 loss of lean body mass has a significant part in the frailty progression of older subjects, being also an important player of its latent stage and explaining some characteristics of the frailty status itself.6 The dual energy X-ray absorptiometry (DEXA) and the bioelectrical impedance analysis (BIA) are common methods to assess the lean body mass and the skeletal muscle mass.7 On the other hand, DEXA and BIA may not be accessible and their utilization among older subjects may be limited. In this respect, anthropometric measurements could be very practical for the clinical assessment of nutritional status and sarcopenia in frail older people.4, 8 Anthropometry offers the single most portable, universally applicable, inexpensive and non-invasive technique for assessing the size, proportions and composition of the human body. For these reasons, anthropometric data are used in many contexts to screen for or monitor disease among child and young subjects. On the contrary, anthropometry is a relatively less used and thus difficult to evaluate among older subjects. Previously, several studies have documented that mid-arm muscle circumference reflects both health and nutritional status and predicts performance, health and survival.4, 8, 9

Despite research growing interest, information on how anthropometric data, physical performance and frailty may be related to each other is still lacking. In the present study, we evaluated the relationship between calf circumference and physical performance (4-m walking test, Short Physical Performance Battery), muscle strength (hand grip strength), functional status (Basic and Instrumental Activities of Daily Living) and frailty (based on Fried criteria) in a population of persons aged 80 years or older enrolled in the “Invecchiamento e Longevità nel Sirente” (Aging and longevity in the Sirente geographic area, ilSIRENTE Study) study.

Section snippets

Methods

We used data from the ilSIRENTE, a prospective cohort study conducted in the mountain community living in the Sirente geographic area (L'Aquila, Italy). The Catholic University of Sacred Heart ethical committee ratified the entire study protocol. All the participants signed an informed consent at the baseline visit. The ilSIRENTE study protocol is described in details elsewhere.10

Results

Mean age of study participants was 86.0 (Standard Deviation 4.9) years, and 170 (64.0%) were women. Characteristics of the study population according to the different levels of calf circumference are summarized in Table 1. Compared with participants with low calf circumference, those with higher calf circumference were younger, more likely to have higher level of education and had higher body mass index, serum albumin, cholesterol C-reactive protein and interleukine-6. Subjects with calf

Discussion

In the present study, we explored the association between calf circumference and frailty, physical performance, muscle strength and functional status in a population of community-dwelling older persons aged 80 years and older. Our findings show that in older persons, frailty increases and physical function declines as calf circumference decreases. Specifically, after adjustment for potential confounders, frailty index and physical performance measures (the muscle strength measure and the Short

Funding sources

None.

Statement of authorship

All authors have made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted.

Conflict of interest

None.

Acknowledgments

The “Invecchiamento e Longevità nel Sirente” (ilSIRENTE) study was supported by the “Comunità Montana Sirentina” (Secinaro, L'Aquila, Italy). We thank all the participants for their enthusiasm in participating to the project and their patience during the assessments. We are grateful to all the persons working as volunteers in the “Protezione Civile” and in the Italian Red Cross of Abruzzo Region for their support. We sincerely thank the “Comunità Montana Sirentina”, and in particular its

References (30)

  • A. Coin et al.

    Limb fat-free mass and fat mass reference values by dual-energy X-ray absorptiometry (DEXA) in a 20–80 year-old Italian population

    Clin Nutr

    (2012)
  • K. Norman et al.

    Bioimpedance vector analysis as a measure of muscle function

    Clin Nutr

    (2009)
  • L.P. Fried et al.

    Frailty in older adults: evidence for a phenotype

    J Gerontol A Biol Sci Med Sci

    (2001)
  • A.J. Cruz-Jentoft et al.

    Understanding sarcopenia as a geriatric syndrome

    Curr Opin Clin Nutr Metab Care

    (2010)
  • F. Landi et al.

    Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study

    Age Ageing

    (2013)
  • Cited by (187)

    • Defining and diagnosing sarcopenia: Is the glass now half full?

      2023, Metabolism: Clinical and Experimental
    View all citing articles on Scopus
    View full text