Comparison between EWGSOP1 and EWGSOP2 criteria and modelling of diagnostic algorithm for sarcopenic obesity in over 70 years old patients

Key summary pointsAim This study proposed to compare performance of sarcopenia EWGSOP2 (Cruz-Jentoft et al. in Age Ageing 48:16-31, 2019) and EWGSOP1 (Cruz-Jentoft et al. in Age Ageing 39:412-423, 2010) diagnostic criteria in identifying sarcopenia and their applicability for detecting SO; further to describe prevalence of sarcopenia and SO in Czech patient cohort screened for SPRINTT study (Sarcopenia and Physical fRailty IN older people: multicomponenT Treatment strategies) and develop a more precise algorithm for detecting SO. Findings Our study results suggest that EWGSOP1 (2010) criteria have higher sensitivity to identify patients with sarcopenia and SO than EWGSOP2 (2019). Using the newer criteria (EWGSOP2) may leave significant proportion of sarcopenic and sarcopenic obese patients undetected despite their physical and functional deficit. Message Our proposed diagnostic algorithm model can increase the sensitivity of SO diagnosis, is simple and easy to implement in clinical practice. Early detection of sarcopenia and SO using simple and readily available methods can help initiate optimal therapy and improve the quality of life for at-risk older adults. Purpose Sarcopenic obesity (SO) as a new diagnostic entity defined by presence of obesity in combination with sarcopenia represents serious health condition negatively affecting quality of life in old age. Despite the rapidly increasing incidence of SO associated with demographic aging, clear diagnostic criteria for SO have not yet been established. We describe here the applicability of the EWGSOP2 and EWGSOP1 diagnostic criteria in identifying sarcopenia and SO and the development of a refinement algorithm for SO detection. Methods In total 156 subjects were pre-screened, 126 had a complete dataset and were included, 20.6% (n = 26) were men and 79.4% (n = 100) women, mean age 81 +/- 6.3 years in tertiary hospital, Prague, Czech Republic. Testing of physical performance (hand-grip test, 400 m walk test, chair stand test, gait speed), anthropometric measures and SARC-F, SPPB and MNA-SF were used to determine physical, functional, and nutritional status, while muscle mass and fat mass were measured by DXA scans to confirm sarcopenia and SO diagnosis. Results The prevalence of sarcopenia (BMI adjusted ALM < 0.789 for men, < 0.512 for women) was 26.2% (n = 33), SO in 20.6% (n = 26). 78.8% of all sarcopenic subjects fulfilled the criteria of SO (FM > 27% for men and > 38% for women; waist circumference > 90 cm for men and > 85 cm for women). EWGSOP1 criteria for diagnosing sarcopenia showed better sensitivity of 97.0% than the EWGSOP2 66.7%, while specificity reached 100% for both criteria. According to DXA measurement, EWGSOP1 identified 3.0% cases (1 out of 33) as false negative meanwhile EWGSOP2 identified 33.3% cases as false negative and this difference was statistically significant (McNemar's test, p < 0.001). An algorithm for SO was developed (which uses sex, BMI, height, waist circumference and SPPB) with sensitivity and specificity of 88.5 and 91.0%, respectively. Conclusion High prevalence of obesity among elderly people and rather low sensitivity of current diagnostic criteria for SO call for ongoing research. Broader international consensus for SO diagnostic criteria, screening and diagnosis algorithm are crucial for early detection of SO in older people in clinical practice so that optimal multi-component therapy can be initiated.

Automated summary

This study compares the performance of diagnostic criteria for sarcopenia (EWGSOP1 and EWGSOP2) and develops a more precise algorithm for detecting sarcopenic obesity (SO). The results suggest that EWGSOP1 criteria have higher sensitivity than EWGSOP2 in identifying patients with sarcopenia and SO. The proposed diagnostic algorithm model can increase the sensitivity of SO diagnosis and is simple to implement in clinical practice. Early detection of sarcopenia and SO using simple methods can improve therapy and quality of life for older adults.