Which pathway of the possible sarcopenia algorithm of the AWGS 2019 guideline is the best in Korean community-dwelling older men and women?

Objective: To compare the diagnostic accuracy of possible sarcopenia identification pathways, as suggested by Asian Working Group for Sarcopenia (AWGS) in 2019, by gender among Korean community-dwelling older adults. Design: Cross-sectional analysis of data from 2,129 community-dwelling adults (70–84 years, 50.4% men) enrolled in Korean Frailty and Aging Cohort Study. Methods: Based on AWGS 2019 guideline, possible sarcopenia was defined by low handgrip strength (HGS) or slow five-times chair stand test (5CST) time, referred to as “assessments.” “Case-findings” (low calf circumference [CC], SARC-F ≥4, or SARC-CalF ≥11) were recommended for screening ‘possible sarcopenia’ before assessment. For the six ‘possible sarcopenia’ pathways (combining three case-finding and two assessment tools), area under the curve (AUC) and F₁ score are compared. Results: For case-finding in men, CC demonstrated the highest AUC (0.657) and F₁ score (0.504) for predicting sarcopenia compared with SARC-F and SARC-CalF (p <0.001, =0.001). Among men with low CC, ΔAUC between HGS and 5CST was not significant as assessment (p=0.079) (AUCs: 0.763 vs. 0.707; F₁ scores: 0.713 vs. 0.650). For case-finding in women, SARC-CalF demonstrated the highest AUC (0.631) and F₁ score (0.389) compared with CC and SARC-F (p=0.012, <0.001). Subsequently, ΔAUC between HGS and 5CST was not significant in women (p=0.069) (AUCs: 0.566 vs. 0.636; F₁ scores: 0.387 vs. 0.514). Conclusions: Based on AWGS 2019 guideline, CC in men and SARC-CalF in women was the best case-finding tool for community-dwelling older adults. After the best case-finding in each gender, two assessment pathways demonstrated insignificant difference in both genders. Brief summary: For case-finding of possible sarcopenia, using calf circumference in older men and using SARC-CalF in older women demonstrated the highest diagnostic accuracy for predicting sarcopenia. After the best case-finding in each gender, two assessment pathways (handgrip strength and five-times chair stand test) of possible sarcopenia demonstrated insignificant difference in both genders.