Calf circumference (CC) is a validated, low-cost, quick and easy indirect measure of skeletal muscle mass.1 It is widely used in clinical settings to not only aid in the diagnosis of malnutrition and sarcopenia but also as a predictor for falls, frailty, length of hospital stay and mortality.2
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Calf circumference measurements can be taken on either the left or right leg, but the right is preferred.3 It should be taken using an inextensible and flexible plastic tape.1 The measurement should be taken on the widest part of the calf, and the tape should fit snugly to the skin, taking care not to suppress the calf.3
Calf circumference measurements can be taken in a standing position, or in a seated or supine position - with the leg at a 90 degree angle:3-5
STANDING POSITION
For patients who are capable of standing
SEATED POSITION
For patients unable to stand
SUPINE POSITION
For patients in bed who are unable to sit or stand
Read and accurately record the measurement. Probable sarcopenia can be identified using the below cut-offs:6
| Calf Circumference cut-off | Males | Females |
|---|---|---|
| Moderately low CC | 34 cm | 33 cm |
| Severely low CC | 32 cm | 31 cm |
Taking calf circumference measurements in some patients can be challenging in certain circumstances. Measurements therefore need to be adjusted for some patients, such as:
Excess adipose tissue (body fat) may lead to falsely normal values.2
Build-up of fluid in the body can lead to swelling, which may artificially increase the measurement.7,8
For individuals with a BMI ≥ 25 kg/m2, take the measurement as normal, then make the following adjustments, and compare to the cut-off table above.2
BMI 25-29.9 kg/m2:
Subtract 3 cm from measured CC
BMI 30-39.9 kg/m2:
Subtract 7 cm from measured CC
BMI ≥40 kg/m2:
Subtract 12 cm from measured CC
Take the measurement as normal, then make the following adjustments, and compare to the cut-off table above.8
For men:
Subtract 2 cm from the measured CC
For women:
Subtract 1.6 cm from the measured CC
The tables outlined below show calf circumference percentiles adjusted for age/gender.
NORMATIVE VALUES OF CALF CIRCUMFERENCE IN MEN, STRATIFIED BY AGE*
| Age (Years) | Observations | Centiles | Mean (SD) | ||||
|---|---|---|---|---|---|---|---|
| 5th | 25th | 50th | 75th | 95th | |||
| 45-49 | 595 | 33.0 | 35.5 | 37.0 | 39.0 | 42.6 | 37.1 (3.4) |
| 50-54 | 771 | 32.8 | 35.5 | 37.0 | 39.0 | 42.5 | 37.4 (3.4) |
| 55-59 | 881 | 32.0 | 35.0 | 37.0 | 39.0 | 42.5 | 37.1 (3.4) |
| 60-64 | 753 | 31.5 | 35.0 | 36.7 | 39.0 | 42.0 | 36.8 (3.6) |
| 65-69 | 704 | 31.2 | 34.4 | 36.3 | 38.6 | 42.0 | 36.5 (3.2) |
| 70-74 | 675 | 31.0 | 34.0 | 36.0 | 38.0 | 41.0 | 35.9 (3.0) |
| 75-79 | 436 | 30.0 | 33.0 | 35.4 | 38.0 | 41.0 | 35.3 (3.2) |
| 80+ | 304 | 30.0 | 32.5 | 35.0 | 37.0 | 41.0 | 35.0 (3.4) |
NORMATIVE VALUES OF CALF CIRCUMFERENCE IN WOMEN, STRATIFIED BY AGE*
| Age (Years) | Observations | Centiles | Mean (SD) | ||||
|---|---|---|---|---|---|---|---|
| 5th | 25th | 50th | 75th | 95th | |||
| 45-49 | 833 | 30.0 | 33.5 | 35.5 | 38.0 | 42.0 | 35.6 (3.5) |
| 50-54 | 1201 | 30.0 | 33.0 | 35.0 | 37.0 | 41.0 | 35.1 (3.5) |
| 55-59 | 1126 | 30.0 | 33.0 | 35.0 | 37.0 | 41.0 | 35.0 (3.6) |
| 60-64 | 1010 | 29.5 | 32.6 | 35.0 | 37.0 | 40.2 | 34.8 (3.5) |
| 65-69 | 956 | 29.2 | 32.2 | 34.2 | 36.5 | 40.0 | 34.5 (3.3) |
| 70-74 | 759 | 29.0 | 32.0 | 34.0 | 36.5 | 40.0 | 34.3 (3.3) |
| 75-79 | 514 | 28.5 | 31.6 | 34.0 | 36.0 | 39.0 | 33.7 (3.3) |
| 80+ | 296 | 28.0 | 31.0 | 33.1 | 35.8 | 39.0 | 33.4 (3.3) |
*Table taken from Martone AM et al.1
Abbott is committed to supporting you and your patients achieve the best possible outcomes, and as part of this commitment, Abbott is providing your Trust with a handgrip dynamometer to be used in patient assessments and to help monitor intervention strategies and patient progress.
Frail and sarcopenic patients are at increased risk of malnutrition and muscle loss, which in turn, can escalate the progression of frailty. However, frailty can be treated and promoting healthy ageing from middle age onwards could delay its onset as people grow older.
Vitamin D and protein for muscle health
This article by Richie Kirwan, discusses the casual effect that vitamin D potentially has in increasing muscle mass. There is emerging evidence for the importance of vitamin D in musculoskeletal health. Therefore, ensuring adequate serum vitamin D levels is a realistic and easy strategy to improve muscle health. Vitamin D, combined with resistance exercise and adequate protein intake could help improve quality of life and reduce the risk of common, chronic diseases of ageing.
References:
1. Martone AM et al. Journal of Cachexia, Sarcopenia and Muscle 2023:10.1002/jcsm.13286.
2. da Costa Pereira JP et al. Nutrition 2024;112505.
3. Todorovic VE. Mafrici B. A Pocket Guide to Clinical Nutrition 2018. 5th edition 2.35-2.36.
4. Piodena-Aportadera M. et al. Ann Geriatr Med Res 2022;26(3):215-224
5. Selvaraj K et al. J Family Med Prim Care. 2017;6(2):356-359.
6. Gonzalez, MC et al. Am J Clin Nutr 2021 Jun 1;113(6):1679-1687
7. Lent-Schochet D & Jialal I. StatPearls Publishing 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537065/.
8. Ishida Y et al. Geriatrics and Gerontology International 2019;19(10).
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