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
Various reliable screening methods exist to assess the risk of malnutrition and muscle loss.2 These tools can be used individually or in combination, depending on their practicality and efficiency within your clinical practice.
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
How it works:
SARC-F consists of five questions, each of which is rated on a scale of 0 to 2. Once all questions have been answered, the total is calculated. A score of ≥4 highlights those who are at risk of potential sarcopenia.7 Where a patient is identified as at risk of sarcopenia, clinical strategies may include exercise and nutritional interventions that increase protein intake. A high SARCF score may also indicate the requirement for referral of the patient for further evaluation.7
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.
How it works:
With four simple steps to follow, HCPs can assess the patient’s malnutrition and muscle loss risk. A PDF report is then generated that indicates if the patient is at risk of malnutrition and/or muscle loss, providing recommendations for ongoing observation and treatment. This PDF can be saved to the patient records for use during future appointments and follow-ups.
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
How it works:
During the test, the participant folds their arms across their chest and attempts to stand up from a chair. HCPs then time how long it takes to perform five rises from the chair to an upright position without the use of the arms. A time of over 15 seconds for five rises indicates lower muscle strength.2
Find out more about how to perform STST in this short video.
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
How it works:
The gait speed test measures the time required to walk 4 metres at a normal walking pace. A speed of ≤0.8 m/s or taking more than 5 seconds to walk 4 meters is an indicator of frailty.10
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
How it works:
To measure HGS, a hand dynamometer is used. The patient is asked to squeeze the dynamometer as tightly as possible for a few seconds. The test is usually performed with the patient standing, using their non-dominant hand. It can also be done whilst sitting or lying with the elbow at a 90 degree angle, or using the dominant arm.12
A measurement of less than 27 kg for men, and less than 16 kg for women is considered a predictor of poor outcomes including longer hospital stays, increased functional limitations, poor quality of life and mortality.2
ORDER A FREE HAND GRIP DYNAMOMETER FOR YOUR TRUST
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
How it works:
CC measurements can be taken on either the left or right leg, but the right is preferred. It can be taken in a seating position with the leg at a 90 degree angle. 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.12 A circumference of <34 cm for males and <33 cm for females denotes the probable presence of sarcopenia.13
This infographic displays the 4 steps of the EWDSOP2 clinical algorithm used to help find and diagnose cases of sarcopenia.
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.
UK-N/A-2300358 | October 2023
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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