Validation of the Korean Version of the SARC-F Questionnaire to Assess Sarcopenia: Korean Frailty and Aging Cohort Study

doi:10.1016/j.jamda.2017.07.006

Journal of the American Medical Directors Association

Volume 19, Issue 1, January 2018, Pages 40-45.e1

https://doi.org/10.1016/j.jamda.2017.07.006 Get rights and content

Abstract

Objectives

The SARC-F is a simple sarcopenia screening tool comprising 5 assessment items: strength, assistance walking, rising from a chair, climbing stairs, and falls. The present study aimed to examine the validation of the Korean version of SARC-F for elderly individuals residing in communities.

Setting and Participants

From the first year baseline data of Korean Frailty and Aging Cohort Study, a total of 1222 elderly individuals (70 years and older) who met the study's selection criteria were included in the analysis.

Measurements

The SARC-F was translated into the Korean language in a culturally responsive way. The total score was calculated by adding the scores on the 5 items. The participants were divided into 2 groups according to the total score (SARC-F <4 vs SARC-F ≥4), and its correlations with various factors including walking speed, hand grip, ability to perform everyday activities, and health-related quality of life, were examined by sex. In addition, the tool's validity was analyzed by comparing it with the European, international, and Asian sarcopenia working group diagnostic criteria for sarcopenia.

Results

The prevalence of sarcopenia according to the SARC-F was 4.2% in among men and 15.3% in women. The sensitivity of the SARC-F was low compared with the European, international, and Asian criteria of sarcopenia [male (M): 11%–60%, female (F): 28%–34%]. However, SARC-F showed a high specificity (M: 96.6%–98%, F: 85%–87.7%) and a high negative predictive value (M: 89.2%–99.3%, F: 88.5%–98.4%). The participants in the SARC-F ≥4 group had poorer grip strength, slower walking speed, poorer physical performance, poorer cognitive function, and a lower quality of life (a high EuroQol-5 dimension score) than the participants in the SARC-F <4 group.

Conclusions

The Korean language version of SARC-F showed a high specificity and high negative predictive value. As such, the tool is useful for briefly ruling out sarcopenia in a clinical setting. In addition, diagnosis of sarcopenia using the SARC-F was found to be associated with physical performance, cognitive function, and the quality of life.

Section snippets

Study Population and Protocol

The present study's participant pool consisted of elderly individuals aged 70 years and older who participated in the KFACS. The KFACS is a nationwide cohort study that began in 2016 for the purpose of identifying and preventing the factors contributing to aging in community-dwelling older adults. The KFACS is a multi-institute, cross-sectional study conducted from 2016 to 2017 studying a total of 3000 participants recruited from cities, agricultural communities, and urban/agricultural mixed

Results

Table 1 displays the average characteristics of the participants who were grouped according to their SARC-F scores. Across sexes, the participants in the SARC-F ≥4 group had a higher mean age. As for ASM, men in the SARC-F ≥4 group had a low muscle mass. However, women showed no differences even after adjusting for BMI or height. In terms of individual SARC-F items, a notable sex difference was found for strength. The comparison of the HGS, GS, SPPB scores, TUG, Korean Instrumental Activities

Discussion

The present study verified the validity of the Korean version of the SARC-F, which is a simple screening tool for sarcopenia. The results of the analysis indicated that the SARC-F has a low sensitivity (M: 11%–60%, F: 28%–34%), but has a high specificity (M: 96.6%–98%, F: 85%–87.7%) and high negative predictive value (M: 89.2%–99.3%, F: 88.5%–98.4%). Therefore, the tool is appropriate for use for ruling out elderly individuals without sarcopenia. The screening tool will be useful for

Conclusions

The Korean version of the SARC-F is a screening tool with high specificity and high negative predictive value, which makes it a useful tool for efficiently ruling out sarcopenia in a clinical setting. Furthermore, the diagnosis of sarcopenia based on the SARC-F was found to be associated with physical and cognitive performances, as well as the quality of life. When using this screening tool, a cut-off score of 4 for men and a cut-off score of 6 for women may be appropriate.

References (21)

R.A. Fielding et al.
Sarcopenia: An undiagnosed condition in older adults. Current consensus definition: Prevalence, etiology, and consequences. International working group on sarcopenia
J Am Med Dir Assoc
(2011)
L. Chen et al.
Sarcopenia in Asia: Consensus report of the Asian Working Group for Sarcopenia
J Am Med Dir Assoc
(2014)
L. Cao et al.
Sarcopenia is recognized as an independent condition by an International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) Code
J Am Med Dir Assoc
(2016)
T.K. Malmstrom et al.
SARC-F: A simple questionnaire to rapidly diagnose sarcopenia
J Am Med Dir Assoc
(2013)
J. Woo et al.
Validating the SARC-F: A suitable community screening tool for sarcopenia?
J Am Med Dir Assoc
(2014)
He W, Goodkind D, Kowal P. International Population Reports: An Aging World: 2015, US Census Bureau, 2016,...
Statistics Korea. Korea Statistical Information System (KOSIS)....
R.N. Baumgartner et al.
Epidemiology of sarcopenia among the elderly in New Mexico
Am J Epidemiol
(1998)
A.J. Cruz-Jentoft et al.
Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People
Age Ageing
(2010)
J.E. Morley et al.
Rapid screening for sarcopenia
J Cachexia Sarcopenia Muscle
(2015)

There are more references available in the full text version of this article.

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These findings underscore the importance of the SARC-F questionnaire in the evaluation of motor function and prognosis in patients with CVD and cognitive dysfunction. Many studies have reported the usefulness of SARC-F in older and chronic patients (Kim et al., 2018; Malmstrom et al., 2016; Parra-Rodríguez et al., 2016; Tanaka et al., 2018; Tanaka et al., 2017; Woo et al., 2014). While the population is aging and more people are living with an increased incidence of mild cognitive impairment or dementia (Jia et al., 2020), no studies have assessed whether SARC-F predicts physical function or prognosis in CVD patients with cognitive impairment.
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: This research was supported by a grant of the Korea Health Technology R&D Project through the Korean Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (grant number: HI15C3153).

: The authors declare no conflicts of interest.

View full text

Original StudyValidation of the Korean Version of the SARC-F Questionnaire to Assess Sarcopenia: Korean Frailty and Aging Cohort Study

Abstract

Objectives

Setting and Participants

Measurements

Results

Conclusions

Section snippets

Study Population and Protocol

Results

Discussion

Conclusions

J Am Med Dir Assoc

J Am Med Dir Assoc

J Am Med Dir Assoc

J Am Med Dir Assoc

J Am Med Dir Assoc

Epidemiology of sarcopenia among the elderly in New Mexico

Am J Epidemiol

Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People

Age Ageing

Rapid screening for sarcopenia

J Cachexia Sarcopenia Muscle

Original Study
Validation of the Korean Version of the SARC-F Questionnaire to Assess Sarcopenia: Korean Frailty and Aging Cohort Study