APLICABILIDADE DO QUESTIONÁRIO SARC-F POR ENTREVISTA TELEFÔNICA

Introdução: A sarcopenia é uma doença muscular, associada ao envelhecimento. Para o rastreamento deste deste quadro, o European Working Group on Sarcopenia in Older People (EWGSOP) recomenda a utilização do questionário SARC-F. Objetivo: Avaliar a aplicabilidade do questionário SARC-F, por entrevista telefônica, em idosos não institucionalizados pertencentes a uma coorte no sul do Brasil. Metodologia: Trata-se de um estudo de base populacional realizado com a polução idosa da cidade de Pelotas-RS. Foram utilizados dados sociodemográficos, comportamentais e de saúde dos idosos, coletados em 2014, e dados referentes ao questionário SARC-F, aplicado por contato telefônico, coletados em 2016. Foram excluídos indivíduos com diagnóstico confirmado de sarcopenia, conforme os critérios da EWGSOP de 2019. A análise dos dados foi realizada pelo programa estatístico Stata 16. Foram testadas associações entre a variável desfecho e variáveis de exposição através de teste Qui-quadrado de Pearson para heterogeneidade e/ou tendência linear. Para todos os testes foi considerado um nível de significância de 5%, bicaudal. Resultados: Foram avaliados 951 idosos, sendo a maioria do sexo feminino (62,67%), entre 60 e 69 anos (59,06%), não praticante de atividade física no lazer (79,10%), com excesso de peso (64,52%) e independente quanto a capacidade funcional (69,19%). A prevalência de risco de sarcopenia foi de 20,50% e esteve associada significativamente com as variáveis: sexo (12,11%:homens; 25,50%:mulheres), idade (14,44%:60-69; 25,59%:70-79; 41,30%:≥80 anos/tendência linear), escolaridade (41,90%:nenhum ano de estudo; 24,11%:<8; 8,66%:≥8 anos/tendência linear), nível socioeconômico (10,48%:classe A/B; 25,57%:C; 37,65%:D/E/tendência linear), situação conjugal (16,55%:casado/com companheiro; 20,26%:solteiro/separado/divorciado; 30,08%:viúvo), atividade física no lazer (9,18%:ativos; 23,72%:inativos), depressão (40,54%:presente; 17,82%:ausente), multimorbidade (5,54%:0-4; 29,47%: 5 ou mais comorbidades), capacidade funcional (11,85%:independentes; 36,67%:dependentes para 1; 78,26%:dependentes para 2 ou mais atividades/tendência linear) e polifarmácia (15,04%:<5; 32,03%:≥5 medicamentos) (p<0,001 para todas associações). Conclusão: O questionário SARC-F, aplicado por contato telefônico, esteve associado à importantes variáveis sociodemográficas, comportamentais e de saúde da população idosa. Estes dados fortalecem a importância da construção de políticas públicas voltadas à prevenção da sarcopenia, que possam ser implementadas em situações de isolamento social.

Comparison between Original and Reviewed Consensus of European Working Group on Sarcopenia in Older People: A Probabilistic Cross-Sectional Survey among Community-Dwelling Older People

<b><i>Introduction:</i></b> The European Working Group on Sarcopenia in Older People (EWGSOP) published a consensus on sarcopenia in 2010 and updated it in 2019 (EWGSOP2) which included the use of specific cut-off points. The aim was to assess how much prevalence of sarcopenia differed between EWGSOP2 and EWGSOP, as well as the use of specific cut-off points to assess differences in presarcopenia versus probable sarcopenia. <b><i>Methods:</i></b> Observational, transversal, and comparative study (<i>n</i> = 1,283 older adults; 57% women). Anthropometrics and handgrip strength were measured, and appendicular skeletal muscle mass equation was defined. Conceptual and methodological definitions of EWGSOP and EWGSOP2 consensus were applied to calculate prevalence of presarcopenia, probable sarcopenia, and sarcopenia. <b><i>Results:</i></b> Using cut-off points recommended for European population, prevalence of sarcopenia with EWGSOP2 was lower (−6.6%; <i>p</i> &#x3c; 0.001) than EWGSOP. The prevalence of probable sarcopenia (EWGSOP2) was higher (+7.8%; <i>p</i> &#x3c; 0.001) than EWGSOP presarcopenia. The agreement between EGWGSOP and EWGSOP2 was moderated (<i>K</i> = 0.45; IC = 0.40–0.51). Using specific-population cut-off points for muscle strength and appendicular muscle mass, the prevalence of probable sarcopenia with EWGSOP2 was higher (46.5%; <i>p</i> &#x3c; 0.001) than EWGSOP (1.8%). The agreement between EGWGSOP and EWGSOP2 was moderated (<i>K</i> = 0.48; IC = 0.42–0.52). <b><i>Conclusion:</i></b> The new EWGSOP2 consensus underestimates the prevalence of sarcopenia, compared with EWGSOP using conventional cut-off points. The prevalence of presarcopenia with EWGSOP (low muscle mass) was lower than probable sarcopenia (low muscle strength) with the new EWGSOP2. In both cases, agreements between EWGSOP2 and EWGSOP were moderated. Discrepancies between the original and new consensus have implications on the primary health setting for identifying old and new cases for prevention and treatment.

AB0154 USAGE OF THE SARC-F QUESTIONNAIRE FOR SARCOPENIA SCREENING IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:Sarcopenia, characterized by low muscle strength and low muscle quantity or quality and associated with increased risks of falling and mortality. The prevalence of sarcopenia is 37% among patients with RA [1]. However, in clinical practice settings, sarcopenia among RA patients remains underdiagnosed. The SARC-F questionnaire [2] was recommended by the European Working Group on Sarcopenia in Older People (EWGSOP) before performing muscle strength tests and assessment muscle mass.Objectives:To evaluate the diagnostic value of the SARC-F questionnaire for the screening of sarcopenia (SP) in women with rheumatoid arthritis (RA).Methods:83 women (average age 59±8 years) with RA without aseptic bone necrosis, joint replacement and severe comorbidities were recruited. All patients were interviewed with the SARC-F questionnaire. The summation score ≥ 4 corresponded to cut-off for suspected sarcopenia. Sarcopenia was evaluated using the European Working Group on Sarcopenia in Older People (EWGSOP2), which included dual-energy X-ray absorptiometry (DXA), handgrip strength or chair stand test, and gait speed. The sensitivity, specificity, positive and negative prognostic values of the SARC-F questionnaire were estimated.Results:Confirmed SP was diagnosed in 20 (24%) RA patients, who had low muscle strength and mass. When conventional cut-off point (≥4) for SARC-F questionnaire was applied, only 30% of the patients with SP met this condition (sensitivity 30%, 95% confidence interval [95% CI] 13% to 54%), and 41% of the patients without SP did not meet this condition (specificity 41%, 95% CI 29% to 54%). Positive and negative prognostic values were 14% (95% CI 6% to 29%) and 65% (95% CI 48% to 79%), respectively.Conclusion:The SARC-F questionnaire alone is not adequate for screening of SP in RA patient. It is necessary to develop other simple screening methods that can easily be carried out in real clinical practice to identify individuals with possible SP for further diagnostic tests.References:[1]Torii M, Hashimoto M, Hanai A, et al. Prevalence and factors associated with sarcopenia in patients with rheumatoid arthritis. Modern Rheumatology, 2018;29(4):589-595. doi:10.1080/14397595.2018.1510565.[2]Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. doi:10.1093/ageing/afy169.Disclosure of Interests:None declared

MO906DIAGNOSIS OF SARCOPENIA ACCORDING TO THE EWGSOP2 STEPS IN VERY ELDERLY HEMODIALYSIS PATIENTS

Background and Aims Sarcopenia, defined as the loss of muscle mass and strength, is common in patients with chronic kidney disease. The variability of the prevalence of sarcopenia depends in part on the diagnostic criteria applied. In 2019, the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) proposed four steps to diagnose and assess sarcopenia. The concept of sarcopenia is encompassed within the broader concept of frailty. The aim of this study was to analyse the incidence of sarcopenia in very elderly patients on haemodialysis following the criteria recently established by the European Working Group on Sarcopenia in Older People EWGSOP2. Additionally, to assess the usefulness of the diagnostic algorithm in the very elderly haemodialysis population, and its association with functionally scales related to sarcopenia, such as dependency, frailty, and nutrition. Method In a prospective study of 60 patients on chronic hemodialysis aged 75- to 95-years, sarcopenia was assessed according to the 4 EWGSOP2 steps: Find-Assess-Confirm-Severity, using Strength, Assistance walking, Rise from a chair, Climb stairs, and Falls (SARC-F) to find, grip strength by dynamometry (GFD) and sit to stand to sit 5 (STS5) test to assess, appendicular skeletal muscle mass by bioimpedance to confirm and gait speed, the Timed-Up and Go (TUG) test, and the Short Physical Performance Battery (SPPB) for severity. Functionality scales of malnutrition inflammation (MIS), comorbility of Charlson, dependence of Barthel, fragility by FRAIL index2 and Physical Activity Scale for the Elderly (PASE) were conducted. Results Sixty patients were involved in the study. Sixty-eight percent (41) were men, with a mean age of 81.85±5.58 years and length of stay in HD 49.88±40.29 months. The sequential four steps resulted in a prevalence of confirmed sarcopenia of 20% and of severe sarcopenia of 20%. Correlation of the different variables defined by the EWGSOP2 with the scales of MIS, Barthel, Frail, Charlson and PASE was analyzed. It is observed that the SARC-F but not BIA correlates with the functionality tests. The GFD is the test that correlates with more variables, both functional and anthropometric. Of the severity measurement scales, the SPPB is the one that correlates with the greatest number of variables. Conclusion These findings question the four-step EWGSOP2 assessment for very elderly hemodialysis patients and suggest that 20% had confirmed severe sarcopenia. Functionality scales correlated better with GFD and SPPB.

SARCOPENIA E ESTADO NUTRICIONAL DE IDOSOS RESIDENTES EM UMA COMUNIDADE NO SUL DO BRASIL

Introdução: Atualmente, a sarcopenia tem sido considerada como importante fator de risco para a redução da mobilidade, aumento no número de quedas e fraturas; e, é comumente associada com um alto risco de hospitalização, institucionalização, dependência, piora da qualidade de vida e mortalidade. Objetivo: verificar a prevalência de sarcopenia e o estado nutricional em idosos de um município do Sul do Brasil. Métodos: trata-se de um estudo transversal de base populacional, realizado com idosos do Sul do Brasil. A sarcopenia foi determinada de acordo com o critério European Working Group on Sarcopenia in Older People (EWGSOP2). O estado nutricional foi avaliado pelo Questionário Mini Avaliação Nutricional (MAN). Aspectos socioeconômicos, demográficos e de desempenho físico foram descritos. Resultados: o estudo contou com uma amostra de 327 idosos; destes, 52,6% apresentaram provável sarcopenia, 23,7% obtiveram confirmação do diagnóstico de sarcopenia e 20,7% apresentavam sarcopenia severa de acordo com os critérios de EWGSOP2. Na avaliação do estado nutricional pela MAN, todos os idosos foram considerados com estado nutricional normais, porém 34,3% dos prováveis sarcopênicos apresentavam excesso de peso, enquanto 17,6% idosos apresentaram risco de desnutrição e 2% desnutridos. Conclusão: os dados apontam uma alta prevalência de idosos com provável sarcopenia (baixa força muscular) e excesso de peso (aumento da circunferência da cintura e índice de massa corporal), sugerindo um desequilíbrio energético nutricional desses idosos.

Rastreamento do risco de sarcopenia em adultos com 50 anos ou mais hospitalizados

Resumo Objetivo Rastrear o risco de sarcopenia em indivíduos hospitalizados por meio dos instrumentos SARC-F e SARC-Calf e verificar a associação entre o risco de sarcopenia com as variáveis sociodemográficas, clínicas e as variáveis que compõem o fenótipo de sarcopenia. Métodos Trata-se de um estudo transversal. Características sociodemográficas, clínicas e todas as variáveis que compõem o fenótipo de sarcopenia (força de prensão palmar, massa muscular e velocidade de marcha) foram investigadas. Para o rastreamento e diagnóstico da sarcopenia adotou-se o algoritmo e critérios propostos pelo European Working Group on Sarcopenia in Older People (EWGSOP2). Resultados Participaram 90 indivíduos. A maioria encontrava-se sem sinais sugestivos de sarcopenia, tanto pelo SARC-F (58,9%) quanto pelo SARC-Calf (68,9%), com força de preensão palmar (FPP) (28,59±9,21;26,74±10,60) e índice de massa muscular esquelética apendicular (IMMEA) (9,31±1,78;9,58±1,62) normais e com baixa velocidade de marcha (VM) (0,69±0,26; 0,68±0,44), respectivamente. O SARC-F apresentou associação significativa com as variáveis sexo (p=0,032), FPP (p<0,001), VM (p=0,001) e sarcopenia (p<0,001). Quando da adição da circunferência da panturrilha (CP), foi encontrado associação com as variáveis grupo etário (p=0,029), atividade laboral (p=0,008), FPP (p<0,001), IMMEA (p=0,033), VM (p=0,019) e sarcopenia (p<0,001). Conclusão O risco de sarcopenia foi observado em aproximadamente um terço dos pacientes avaliados. Sugere-se o uso rotineiro nos hospitais da ferramenta de rastreamento de sarcopenia SARC-Calf, uma vez que apresentou associação com os três fatores preditivos da sarcopenia, além de ser um instrumento de aplicação ágil, baixo custo e não invasivo. A investigação do diagnóstico da sarcopenia deve ser encorajada na prática clínica.

Polish version of SARC-F to assess sarcopenia in older adults: An examination of reliability and validity

Introduction SARC-F is a quick questionnaire recommended as a screening tool for sarcopenia. The aim of the study was to translate, adapt, and validate the Polish version of the SARC-F for community-dwelling older adults in Poland. Materials and methods We included 160 Polish volunteers aged ≥ 60 years (44% of men). The Polish version of SARC-F was adapted following standardized forward-backward translation procedure. SARC-F was validated against the six sets of diagnostic criteria as the reference standards [developed independently by European Working Group on Sarcopenia in Older People1 (EWGSOP1), European Working Group on Sarcopenia in Older People2 (EWGSOP2), Foundation for the National Institutes of Health (FNIH) Sarcopenia Project, Asia Working Group for Sarcopenia (AWGS), the International Working Group for Sarcopenia (IWGS), and Society on Sarcopenia, Cachexia and Wasting Disorders (SCWD)]. Results SARC-F score ≥ 4 points was observed in 18.8% of the study population. Cronbach’s alpha was 0.70. The sensitivity of SARC-F varied from 33.3% to 50.0% depending on the diagnostics criteria used, while the specificity was about 85%. Positive predictive value (PPV) was low (about 30%) for five out of six sets of the diagnostic criteria used (EWGSOP2, IWGS, AWGS, FNIH, and SCWD), while the negative predictive value (NPV) was generally high (>88%). The area under the ROC curves (AUC) was 0.652–0.728. SARC-F had the largest AUC against FNIH criteria (0.728), indicating a moderate diagnostic accuracy. Similar results were found for EWGSOP2 and IWGS criteria. The AUC values were below 0.7 for AWGS, SCWD, and EWGSOP1 criteria. Conclusion Based on the results, the Polish version of SARC-F shows excellent reliability and good internal consistency. High specificity and high NPV make SARC-F a useful tool to rule-out sarcopenia with high accuracy in community-dwelling older adults, independently of the diagnostic criteria used.

Screening of sarcopenia of haemodialysis patients

The informativity of the screening method of sarcopenia «Strength, Assistance, Rise, Climb, Fall» in haemodialysis patients was evaluated. When diagnosing sarcopenia according to the recommendations of the European Working Group on Sarcopenia in Older People, the screening method studied showed a sarcopenia diagnosis accuracy index of 53%, that is, using this method eliminated rather than confirming the diagnosis of sarcopenia. Due to the low level of the sarcopenia diagnosis accuracy index for the screening method under investigation, at the second stage of the study, an attempt was made to develop a highly sensitive and specific screening method for sarcopenia in haemodialysis patients. In the course of the study, a screening method for «Screening of sarcopenia haemodialysis patients» sarcopenia was formed. This method includes two questions asked to the patient, anamnestic data (hemodialysis therapy experience), as well as two laboratory indicators (level of prealbumin and serum C-reactive protein), where each indicator has a score from 0 to 2. As a result of screening, the patient can score a maximum of 10 points. A total score of more than 5 indicates a high risk of sarcopenia in this patient. When diagnosing sarcopenia according to the recommendations of the European Working Group on Sarcopenia in Older People, the developed method demonstrated a sensitivity of 89% with a specificity of 73,5%, the overall accuracy index was 77%.