Simple and effective screening methods for identifying malnutrition and muscle loss in adults.
Muscle strength and function measurements are an effective part of routine screening and are typically non-invasive, inexpensive and convenient for the patient.1,2 Muscle screening and assessments are recommended by the European Working Group on Sarcopenia in Older People (EWGSOP), The European Society for Clinical Nutrition and Metabolism (ESPEN)* and The European Respiratory Society.^3-5 Screening and assessment can identify limited strength and performance, which can predict adverse health outcomes such as care dependence, falls, fractures, hospitalisation and death.1
Muscle screening tools are easy to use in clinical settings as they are quick and easy to implement and do not require specialist nutritional training or complex equipment.1
Screening and assessment in a clinical environment can be easily used for increasing physical activity, identifying appropriate nutritional interventions and supporting patients’ self-management.6
SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs, Falls) is a quick and reliable tool that measures health status changes that can help determine the likelihood of sarcopenia. It predicts clinically significant outcomes associated with poor muscle function.7 Studies demonstrate that SARC-F is an effective screening tool due to its high specificity for sarcopenia.8
R-MAPP (Remote Malnutrition Application for Primary Care) is a digital screening tool developed by nutrition experts to support healthcare professionals (HCPs) to identify nutritional risk and muscle loss in adults. It incorporates two validated tools for the identification of malnutrition and sarcopenia: ‘MUST’ and SARC-F.9
R-MAPP is available on any web-enabled device and can be used during either remote or face-to-face consultations.
The sit-to-stand test (also called chair stand test) measures the amount of time needed for a patient to rise five times from a seated position. It is an assessment measure for strength of leg muscles.2
Hand grip strength (HGS) is a reliable indicator of overall strength and upper limb function. It can be used as a predictor of bone density, fractures, falls, multimorbidity and quality of life.11
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The World Health Organisation suggest that calf circumference (CC) is a sensitive indicator of muscle loss. A low CC is associated with disability and self-reported function.12
The gait speed test is a quick and reliable predictor and outcome measurement of multiple aspects of physical function. It has been shown to predict adverse outcomes related to sarcopenia, including disability, cognitive impairment, falls and mortality.2
In this video series, Adrian Slee, PhD, and Sanjay Suman, MD, FRCP, explain the importance of preventing muscle loss in older adults, and how specialised nutrition can impact clinical outcomes.
This infographic displays the 4 steps of the EWDSOP2 clinical algorithm used to help find and diagnose cases of sarcopenia.
Footnotes:
*Muscle screening recommended by ESPEN for Oncology patients.
^Muscle screening recommended for COPD patients.
References:
1. Beaudart C. et al. Calcif Tissue Int 2019;105,1-14.
2. Cruz Jentoft A. et al. Age Ageing. 2019;48(1):16-31.
3. Cruz-Jentoft AJ. et al. Age Ageing 2010;39,412-23.
4. Muscaritoli M et al. Clin Nutr 2021;40:2898-2913.
5. Marklund S. et al. Int J Chron Obstruct Pulmon Dis 2019;14:1825-1838.
6. Strasser B. Front Genet 2020;11:5838.
7. Malmstrom T.K. et al. J Cachexia Sarcopenia Muscle 2016;7:28-36.
8. Nishikawa H. et al. In Vivo 2021: 35(6):3001-3009.
9. Krznarić Ž. et al Clin Nutr 2020;39(7):1983-1987.
10. BGS, 2014: Recognising frailty. Available online: https://www.bgs.org.uk/resources/recognising-frailty Last accessed October 2023.
11. Bohannon RW. Clin Interv Aging 2019:14:1681-1691.
12. Todorovic VE. Mafrici B. A Pocket Guide to Clinical Nutrition 2018. 5th edition 2.35-2.36.
13. Piodena-Aportadera M. et al. Ann Geriatr Med Res 2022;26(3):215-224.
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