Original articleCalf circumference, frailty and physical performance among older adults living in the community
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)
Loss of skeletal muscle mass in aging: examining the relationship of starvation, sarcopenia and cachexia
Clin Nutr
(2007)- et al.
Frailty syndrome and skeletal muscle – results from the InCHIANTI study
Am J Clin Nutr
(2006) - et al.
Midarm muscle circumference, physical performance and mortality: results from the aging and longevity study in the Sirente geographic area (ilSIRENTE study)
Clin Nutr
(2010) - et al.
Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study
Clin Nutr
(2012) - et al.
Body composition in the elderly: reference values and bioelectrical impedance spectroscopy to predict total body skeletal muscle mass
Clin Nutr
(2009) - et al.
Sarcopenia: prevalence and prognostic significance in hospitalized patients
Clin Nutr
(2013) - et al.
Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”
Clin Nutr
(2010) - et al.
Sarcopenic obesity: a critical appraisal of the current evidence
Clin Nutr
(2012) - et al.
Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies
Lancet
(2006) - et al.
The bioelectrical impedance phase angle as an indicator of undernutrition and adverse clinical outcome in cardiac surgical patients
Clin Nutr
(2012)
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
Bioimpedance vector analysis as a measure of muscle function
Clin Nutr
Frailty in older adults: evidence for a phenotype
J Gerontol A Biol Sci Med Sci
Understanding sarcopenia as a geriatric syndrome
Curr Opin Clin Nutr Metab Care
Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study
Age Ageing
Cited by (187)
Defining and diagnosing sarcopenia: Is the glass now half full?
2023, Metabolism: Clinical and ExperimentalA Nomogram for Optimizing Sarcopenia Screening in Community-dwelling Older Adults: AB3C Model
2023, Journal of the American Medical Directors AssociationCalf circumference as a surrogate indicator for detecting low muscle mass in hospitalized geriatric patients
2024, Aging Clinical and Experimental Research