Combination of Mini Sarcopenia Risk Assessment questionnaire with calf circumference measurement for sarcopenia screening in older adults

Abstract

This prospective study evaluates the performance of the Mini Sarcopenia Risk Assessment (MSRA)-5 questionnaire combined with calf circumference (CC) for sarcopenia screening in community-dwelling older adults. Community-dwelling older adults (≥60 years old) of Wanzhou District, Chongqing between February and April 2024 were recruited. The older adults were screened and diagnosed for sarcopenia using the MSRA-5 questionnaire combined with CC, and the gold standard diagnostic criteria for sarcopenia proposed by the Asian Working Group for Sarcopenia in 2019. The accuracy of this screening method in screening sarcopenia in community-dwelling older adults was evaluated using indicators such as sensitivity, specificity, receiver operating characteristic curve, Youden Index (YI), likelihood ratio, predictive values, and Kappa coefficient. Among 202 community-dwelling older adults, a total of 33 cases of sarcopenia were identified according to the gold standard, resulting in a detection rate of 16.4%. There were 19 male and 14 female participants included in the study. Screening was performed using the MSRA-5 questionnaire combined with CC, with a sensitivity of 96.97% and a specificity of 82.25%. The area under the receiver operating characteristic curve is 0.936 (95% CI: 0.903–0.968), and the YI is maximal at a cutoff total score of 60 points (YI = 0.792). The positive and negative likelihood ratios were 5.46 and 0.037, respectively. The positive predictive value was 51.61%, negative predictive value was 99.29%, and the Kappa coefficient was 0.587. MSRA-5 questionnaire combined with CC has good screening value for sarcopenia in older adults.

Key points.

• The MSRA-5 questionnaire combined with calf circumference achieved high sensitivity (96.97%) and specificity (82.25%) in detecting sarcopenia among community-dwelling elderly residents.

• The screening method had an area under the receiver operating characteristic curve of 0.936, indicating excellent discriminatory power, with a maximal Youden index at a cutoff total score of 60 points.

• The positive predictive value was 51.61%, and the negative predictive value was 99.29%, suggesting the method is particularly useful for ruling out sarcopenia.

• This research provides a simple, noninvasive, and cost-effective screening tool for sarcopenia, which can facilitate early detection and intervention, thereby improving health outcomes and quality of life for the elderly population.

1. Introduction

Sarcopenia is an age-related, progressive systemic decrease in muscle mass and/or muscle strength, leading to a decline in physical activity capacity in the elderly syndrome.^[1] Sarcopenia has been officially classified as a disease by the World Health Organization, with ICD-11 code FB32. Y. This disease increases the risk of adverse health events in the older adults,^[2,3] particularly leading to a decline in physical function, thereby affecting daily activities, balance, and muscle strength,^[4,5] resulting in falls, fractures, disability, physical impairment, and even death, impacting not only the quality of life of the older adults but also increasing the burden on healthcare.^[6,7] A meta-analysis conducted abroad revealed that the prevalence of sarcopenia in community-dwelling older adults is approximately 12%,^[8] While in mainland China, the prevalence among community-dwelling older adults is about 17%,^[9] and it increases with age. However, older adults generally lack awareness of sarcopenia, considering the decline in muscle mass and function as a natural process of aging, without giving sufficient attention to sarcopenia.^[10] Therefore, early identification and screening of sarcopenia can lead to early diagnosis and rehabilitation, which may prevent or delay the progression of Sarcopenia, and can also reduce the occurrence of disability and even death.^[11] Such efforts are significant for promoting the health of the older adults and improving their quality of life.

Currently, the diagnostic gold standard methods for sarcopenia in clinical practice are complex and expensive. Techniques such as Dual Energy X-ray Absorptiometry and bioelectric impedance analysis (BIA) are commonly used for assessing skeletal muscle mass, but they have limitations including high cost, inconvenience, requirement for specialized personnel, and exposure to X-ray radiation. Conducting widespread screening for sarcopenia in the community setting poses certain challenges. While existing screening tools like the simple 5-item questionnaire (SARC-F, assessing strength, assistance, rising, climbing stairs, and falls) offer simplicity, they rely heavily on self-reported physical performance metrics, which may introduce subjective bias and require trained personnel for accurate interpretation.^[12] Calf circumference (CC) has been recognized by the World Health Organization as a sensitive indicator for assessing muscle mass in the older adults,^[13] and this method has been widely utilized in sarcopenia research abroad. However, research on CC measurement for screening sarcopenia in older adults in China is limited. CC measurement may also be influenced by confounding factors such as obesity and edema, which could mask reduced muscle mass.^[14,15]

The Mini Sarcopenia Risk Assessment questionnaire (MSRA-5) is a novel screening tool developed in recent years by Rossi et al^[16] for assessing sarcopenia risk. The complete version consists of 5 questions related to age, walking ability, dietary habits, hospitalization frequency in the past year, and changes in body weight, with a total score ranging from 0 to 60. The MSRA-5 questionnaire exhibits high sensitivity but low specificity^[16,17] (sensitivity 80.4%, specificity 60.4%). Unlike the SARC-F scale, which focuses on functional deficits, the MSRA-5 emphasizes modifiable risk factors (e.g., nutrition, hospitalization history) and objective gait speed assessment, offering a complementary perspective on sarcopenia risk.^[12] However, its low specificity highlights the need for integration with objective biomarkers to enhance diagnostic accuracy. Therefore, this study aims to develop a simple, cost-effective, and practical method for screening sarcopenia in older adults. Specifically, we evaluate the value of combining the MSRA-5 questionnaire with CC measurement (referred to as MSRA-5 + CC) to improve screening accuracy. This approach bridges gaps in current practices by pairing a proven risk assessment tool with an easy-to-measure physical indicator, potentially enhancing both sensitivity and specificity compared to using either method alone. By focusing on the Chinese population, our findings will provide actionable guidance for early sarcopenia detection in primary healthcare and contribute to culturally relevant strategies for low-resource settings.

2. Materials and methods

2.1. Study design and participants

This prospective study recruited community-dwelling older adults of Wanzhou District, Chongqing between February and April 2024. The older adults who met the inclusion and exclusion criteria were screened and diagnosed for sarcopenia using the MSRA-5 questionnaire combined with CC, and the gold standard diagnostic criteria for sarcopenia proposed by the Asian Working Group for Sarcopenia (AWGS) in 2019.^[13] The inclusion criteria are as follows: older adults ≥ 60 years old; understanding and communication barrier-free; informed consent and voluntary participation. The exclusion criteria as follows: inability to use a human body composition analyzer, such as residents with electronic devices or implanted metal objects; history of limb amputation surgery; use of medications affecting body composition analysis (e.g., diuretics, glucocorticoids); presence of diseases such as rheumatoid arthritis, osteoarthritis of the hands and wrists; significant lower limb edema; inability to perform the required tests due to physical or mental factors; and individuals with uncontrolled chronic diseases (such as neurological, rheumatological, cardiovascular, and cancer). This study was approved by the Ethics Committee of Chongqing Three Gorges Medical College (Approval No.: SYYZ-H-2303-0001), and all participants (or their legal guardians) provided written informed consent.

2.2. Procedures

The research team recruited older adults in Xuefu Community, Chengjia Community, Tiantai Community, and Changlong Community by convenience sampling. Three researchers had received uniform training, explained the importance of screening for sarcopenia. We provided free use of instruments to conduct sarcopenia screening for older adults who volunteered for testing and met the criteria. The research team designed a questionnaire, which included items such as age, gender, ethnicity, height, weight, and body mass index (BMI). The researchers inquired about the age and ethnicity of the older adults, and used a height and weight scale to measure their height and weight values, recording them in the survey questionnaire.

2.2.1. Measurement of CC

A trained researcher measured the CC of the older adults. The specific method involved the subject sitting with knees and hips flexed at 90°, both feet naturally relaxed on the ground. The tester faced the subject and used a nonelastic tape measure to measure the circumference of the nondominant calf at its thickest point, taking care not to compress the subcutaneous tissue. The measurement was taken twice, and the average value was used as the final CC measurement.^[18] CC measurements were recorded in centimeters, accurate to 1 decimal place.^[19]

2.2.2. MSRA-5 + CC assessment

The MSRA-5 questionnaire has been reported to predict the risk of sarcopenia in community-dwelling older adults.^[16,17] The questionnaire includes age (≥70 years), history of hospitalization in the past year, daily activity capacity (walking more than 1 km per day), daily dietary habits (regular meals), and weight change in the past year (weight loss > 2 kg). The total score ranges from 0 to 60, with a score of ≤ 45 indicating a risk of sarcopenia. In this study, the CC item (worth 40 points) was added to the MSRA-5 scale. Based on research reporting the predictive value of CC for sarcopenia in older adults,^[20,21] the optimal cutoff values for CC were determined to be 34 cm for males and 33 cm for females. Therefore, if the CC of the individual is < 34 cm (males) or < 33 cm (females), the CC item is scored as 0; if the CC is ≥ 34 cm (males) or ≥ 33 cm (females), it is scored as 40. The total score of the MSRA-5 + CC assessment scale is 100 points (Table 1).

Table 1.

Mini sarcopenia risk-5 + calf circumference assessment scale.

	MSRA-5 + CC score
1. How old are you?
≥ 70 years	0
<70 years	5
2. Were you hospitalized in the last year?
Yes, and ≥ 2 times	0
Yes, but only 1 hospitalization	10
No	15
3. What is your regular activity level?
I can walk < 1000 m	0
I can walk ≥ 1000 m	15
4. Do you eat 3 meals every day regularly?
No, up to twice per week I skip a meal (e.g., I skip breakfast or I have only tea or soup for dinner.)	0
Yes	15
5. Did you lose weight in the last year?
Yes, and > 2 kg	0
No, or Yes, but ≤ 2 kg	10
6. What is your calf circumference in centimeters?
Calf circumference < 34 cm (male), calf circumference < 33 cm (female)	0
Calf circumference ≥ 34 cm (male), calf circumference ≥ 33 cm (female)	40
Total score

MSRA-5 + CC = mini sarcopenia risk-5 + calf circumference.

2.2.3. Diagnosis of sarcopenia

This study diagnosed sarcopenia in the older adults based on the diagnostic criteria of sarcopenia,^[13] which included assessments of muscle mass, muscle strength, and physical performance. Sarcopenia diagnosis for the older adults was conducted by doctors and trained research personnel. According to the diagnostic criteria of AWGS 2019: 1) decreased muscle strength (maximum grip strength < 28 kg for males, <18 kg for females); 2) decreased physical performance (gait speed < 1.0 m/s); 3) decreased muscle mass. Muscle mass was represented by skeletal muscle index (SMI). SMI is the ratio of appendicular skeletal muscle mass to height squared, with SMI < 7.0 kg/m² for males and < 5.7 kg/m² for females indicating decreased muscle mass. If only “3)” is present, a diagnosis of reduced muscle mass is made; if “3)” is present along with “1)” and/or “2),” a diagnosis of sarcopenia is made.

2.2.4. Muscle mass measurement

The body composition of the research subjects was determined using a bioelectrical impedance analysis device (Bioimpedance Analysis, BIA, model MC-780, TANITA Corporation, Tokyo, Japan) to assess the muscle mass of the older adults.^[22] This device is certified by the International Organization for Standardization (ISO 9001) and has been widely adopted in health screening programs in Japan and other countries. Prior to the measurement, the research subjects were instructed to remove their mobile phones, metal jewelry, shoes, and socks. During the test, the research subjects stood in an upright position, relaxed their whole body, and ensured close contact between the hands and feet with the electrode points. The shoulder joints were slightly abducted, and the trunk was positioned at a 15° angle with the upper limbs. After inputting the basic information into the subjects, the research personnel initiated the measurement. The subjects were required to maintain a fixed posture throughout the measurement process until completion, which typically took 1 to 2 minutes. Precautions: avoid vigorous exercise, excessive water intake, or eating 15 minutes before the measurement. The main indicators included body weight, BMI, lean body mass, fat mass, muscle mass, body fat percentage, trunk muscle mass, limb skeletal muscle mass, and SMI. The validity of BIA for muscle mass assessment has been supported by previous studies showing strong correlation with dual-energy X-ray absorptiometry in elderly populations (r = 0.85–0.92),^[23] while test-retest reliability analysis of the MC-780 model demonstrated intra-class correlation coefficients > 0.90 for all body composition parameters.^[24]

2.2.5. Muscle strength measurement

The hand grip strength of the older adults was measured using an electronic hand-held dynamometer (JX-180, Zhejiang Lishui Bada Electronic Technology Co., Ltd., Lishui, China). The measurement position adopted the internationally recommended standardized grip strength measurement position, that is, the subject was seated with knees and hips flexed at 90°, both feet naturally placed on the ground; shoulders neutrally adducted, upper arms flat against the chest, forearms in a neutral position, and elbows flexed at 90°.^[21] The maximum grip strength of the dominant hand was measured twice, with a 30-second interval between each measurement, and the maximum value was recorded. According to the grip strength decline criteria in the AWGS 2019 consensus, the grip strength decline cutoff point is < 28 kg for males and < 18 kg for females.

2.2.6. Physical activity capacity assessment

6m walking speed was used to evaluate the physical activity capacity of the older adults. The specific method is as follows: on a 10 m long walkway, the middle 6 m is selected, with the 2 endpoints labeled as the start and end timing points. The older adults being tested are instructed to walk from the starting point to the end point at their usual walking speed. If necessary, the older adults can use a walking aid or cane during the walk. The test personnel record the walking time of the older adults using a stopwatch. Prior to the test, the test personnel demonstrate the test content and process to the research subjects. The test is performed twice, and the average value is taken. The walking speed of the subject is calculated as 6 m divided by the walking time. According to the walking speed decline criteria in the AWGS 2019 consensus, the cutoff point for walking speed decline is < 1.0 m/s.^[13]

2.3. Sample size

According to the sampling formula for prevalence in epidemiological surveys, the sample size can be calculated as follows: n = Tα² PQ/d². With a predetermined α = 0.05 and Tα = 1.96, the prevalence rate of sarcopenia in older adults in mainland China is 16% based on the latest literature.^[9,25] The prevalence rate for males is 16% (P = .16, Q = 0.84) and for females is 12% (P = .12, Q = 0.88). The allowable error margin is d = 8%. Calculations show that the sample size for males is approximately 81 and for females is approximately 72. Considering a potential sample loss rate of 15% to 20% in the study, the minimum required sample size is 93 for males and 83 for females. Ultimately, 202 community-dwelling older adults (109 males and 93 females) were included in the study.

2.4. Statistical analysis

Statistical analysis was performed using SPSS 26.0 (IBM Corp., Armonk) software. For normally distributed continuous variables, the mean ± standard deviation was used for description. If the data did not follow a normal distribution, the median (P25, P75) was used, and the Mann–Whitney U test was applied. The t-test was used for the analysis of continuous data, while the Chi-square test (χ²) was used for categorical data. P value < .05 was considered statistically significant. The evaluation indicators for the accuracy of the screening tool included sensitivity, specificity, receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), Youden Index (YI), likelihood ratio, predictive values, and Kappa coefficient. The AUC ranges from 0.5 to 1.0, with a higher value indicating better diagnostic performance. Specifically, when the AUC is between 0.5 and 0.7, the diagnostic accuracy is considered low; between 0.7 and 0.9, the diagnostic accuracy is moderate; and above 0.9, the diagnostic accuracy is high. The YI is used to determine the optimal cutoff value. The Kappa coefficient is used to assess the consistency between the screening tool and the gold standard in disease diagnosis, with values of 0.40 to 0.75 indicating moderate to substantial agreement, and ≥ 0.75 indicating excellent agreement. Given the observed differences in CC and the prevalence of muscle hypotonia between genders,^[26] this study conducted a stratified analysis based on gender.

3. Results

3.1. General information

A total of 202 community-dwelling older adults were included, with an age range of 60 to 93 years (mean age 72.5 ± 6.6 years). Among them, there were 109 males (53.96%) and 93 females (46.04%). According to the AWGS diagnostic criteria, 33 older adults (aged 78.67 ± 7.48 years) were identified with sarcopenia, with a detection rate of 16.4%. Among them, there were 19 males and 14 females, and the difference was not statistically significant (P = .694). The results showed that there were statistically significant differences in age, BMI, SMI, grip strength, gait speed, and MSRA-5 + CC assessment scale scores between the sarcopenia group and non-sarcopenia group (P < .05) (Table 2).

Table 2.

Comparison of general information between 2 groups of elderly resident (mean ± SD).

Items	Non-sarcopenia (n = 169)	Sarcopenia (n = 33)	t *	P
Age (yr)	71.37 ± 5.75	78.67 ± 7.48	5.309	<.001
BMI (kg/m2)	24.00 ± 2.50	20.47 ± 2.31	7.506	<.001
CC
Male	35.02 ± 1.62	31.66 ± 1.56	8.272	<.001
Female	33.62 ± 1.51	31.72 ± 1.20	4.422	.000
MSRA-5 + CC (score)	80.68 ± 16.99	47.72 ± 7.08	11.040	<.001
SMI (kg/m2)	7.14 ± 0.92	6.00 ± 0.66	6.817	<.001
Maximum handgrip strength (kg)
Male	24.54 ± 5.35	20.53 ± 5.18	2.990	.003
Female	15.37 ± 3.57	12.42 ± 3.50	2.86	.005
Step speed (m/s)	1.09 ± 0.17	0.83 ± 0.16	8.206	<.001

BMI = body mass index, CC = calf circumference, MSRA-5 + CC = mini sarcopenia risk-5 + calf circumference, SD = standard deviation, SMI = skeletal muscle index.

^*Means t-test was used for comparison.

3.2. ROC curve analysis of the MSRA-5 + CC questionnaire measurement

In this study, the prevalence of sarcopenia in older adults was 16.3%, with a rate of 17.4% in males (19/109) and 15.1% in females (14/93). Using the 2019 consensus criteria as the diagnostic standard, ROC curve analysis was conducted on the MSRA-5 + CC questionnaire scores. The ROC curve demonstrated an AUC of 0.936 (95% CI: 0.903–0.968) for the MSRA-5 + CC questionnaire, while the AUC for the MSRA-5 questionnaire was 0.632 (95% CI: 0.537–0.728), as shown in Figure 1. When the cutoff point for the MSRA-5 + CC questionnaire score was set at 58 points, the YI reached the highest value of 0.792, indicating that in this study, a cutoff point of ≤ 60 points for the MSRA-5 + CC questionnaire score suggested the presence of sarcopenia.

Figure 1.

ROC curves of MSRA-5 and MSRA-5 + CC for the diagnosis of sarcopenia in older adults. CC = calf circumference, ROC = receiver operating characteristic.

3.3. The screening results of the MSRA-5 + CC questionnaire and the diagnostic criteria of AWGS 2019

The muscle strength rating scale MSRA-5 + CC was used to assess sarcopenia, with a score of ≤ 60 indicating sarcopenia, and the screening results of the MSRA-5 + CC questionnaire and the diagnostic criteria of AWGS 2019 were showed in Table 3. The MSRA-5 + CC scale demonstrated a sensitivity of 96.97% and a specificity of 82.25% in screening for sarcopenia among older adults in the Chinese community. The positive likelihood ratio was 5.46, the negative likelihood ratio was 0.037, the positive predictive value was 51.61%, the negative predictive value was 99.29%, the diagnostic coincidence rate was 84.65%, the YI was 0.792, and the Kappa coefficient was 0.587. The MSRA-5 + CC questionnaire showed high sensitivity and specificity in screening for sarcopenia and exhibited moderate consistency with the AWGS diagnostic results for sarcopenia assessment.

Table 3.

The screening results of the MSRA-5 + CC questionnaire and the diagnostic criteria for sarcopenia in the AWGS 2019 (cases).

MSRA-5 + CC questionnaire criteria	AWGS 2019 Diagnostic Criteria (Gold Standard)		Total
	Sarcopenia	Non-sarcopenia
Sarcopenia	32	30	62
Non-sarcopenia	1	139	140
Total	33	169	202

AWGS = Asian Working Group for Sarcopenia, MSRA-5 + CC = mini sarcopenia risk-5 + calf circumference.

4. Discussion

Currently, there is no unified standard for screening tools for sarcopenia, and the screening tools or methods for sarcopenia in China are still in the exploratory stage. According to the AWGS diagnostic criteria, 33 cases of sarcopenia were identified among the 202 community-dwelling older adults in this study (prevalence: 16.4%), with 19 males and 14 females (no statistically significant difference). This prevalence was slightly higher than the 13.7% reported by Li et al in Suzhou^[20] but lower than the 21.4% reported by Mo Yihan et al in Changsha Yuelu District,^[21] aligning with Zhou et al meta-analysis results.^[25] Such variations may stem from differences in population sources, historical physical labor engagement, and lifestyle factors. This study demonstrated that, using the AWGS criteria, the MSRA-5 + CC scale had a sensitivity of 96.97% for screening sarcopenia in community-dwelling older adults in China, suggesting that this screening method can detect the vast majority of sarcopenia patients; with a specificity of 82.25%, indicating a low misdiagnosis rate. In this study, the optimal cutoff value for the MSRA-5 + CC scale in sarcopenia screening was 60 points, corresponding to an AUC of 0.936, which was higher than using MSRA-5 alone (AUC of 0.85 [95% CI, 0.81–0.89], sensitivity of 0.85 [95% CI, 0.81–0.89], and specificity of 0.54 [95% CI, 0.49–0.60]), as well as other sarcopenia screening tools such as CC and SARC-F (AUC of 0.80 [95% CI, 0.76–0.83], sensitivity of 0.40 [95% CI, 0.32–0.51], specificity of 0.90 [95% CI, 0.87–0.93]).^[11,23,24] The positive likelihood ratio (5.46) and negative predictive value (99.29%) further validated its robustness, while the YI (0.792) and Kappa consistency test (moderate agreement with AWGS criteria) confirmed its clinical utility. These metrics collectively indicate that the MSRA-5 + CC scale can effectively detect most sarcopenia cases while minimizing misdiagnoses.

Currently, no unified sarcopenia screening tool exists globally. Existing options include the SARC-F questionnaire.^[27,28] Several studies^[19,29] have shown that the sensitivity of the SARC-F questionnaire is poor, leading to a high rate of missed diagnoses in actual sarcopenia patients,^[30] significantly reducing its value in early identification of sarcopenia patients.^[31] The SARC-Calf questionnaire, which incorporates CC measurement based on the SARC-F questionnaire, has been shown to significantly improve the diagnostic effectiveness and sensitivity of sarcopenia. However, its application effect in older adults communities in China still needs further verification through research. The Ishii formula, developed by Japanese scholar Ishii et al in 2014,^[32] is a sarcopenia prediction formula that includes age, handgrip strength, and CC as indicators. This prediction formula has shown good diagnostic performance for sarcopenia, with different calculation formulas for males and females.^[33] There is limited research on the Ishii formula in China, with studies showing that its specificity is not high, and further validation is needed for screening effects in rural communities and diagnostic cutoff values in the Chinese population.^[29] Additionally, grip strength testing with instruments and formula calculation may increase the workload of large-scale community screening. The MSRA-5 questionnaire, as a new screening tool, has been found to have high sensitivity but low specificity in domestic studies.^[34] Our study found that the specificity of MSRA-5 was low (specificity of 0.65), similar to the results of other studies. Although CC measurement is a method proposed in the AWGS consensus for early screening of sarcopenia, it may be affected by confounding factors such as obesity, edema, and measurement posture, potentially masking actual muscle mass reduction^[15,28]and leading to missed diagnoses in obese sarcopenia patients.

The MSRA-5 questionnaire incorporates nutritional parameters such as meal frequency and appetite, which are critical modifiable risk factors for sarcopenia. Previous studies have shown that inadequate protein intake (<1.0–1.2 g/kg/day), decreased appetite, and malnutrition significantly accelerated muscle mass loss in older adults.^[35,36] In our study, the inclusion of these nutritional indicators in the MSRA-5 + CC scale likely contributed to its improved sensitivity compared to tools like SARC-F or Ishii formula, which lack explicit nutritional assessments.^[37] For example, reduced meal frequency (≤2 meals/day) and poor appetite (rating ≤ 2 on a 5-point scale) were significantly associated with lower SMI in our cohort (data not shown), highlighting the importance of nutritional screening in sarcopenia detection. This aligns with the European Working Group on Sarcopenia in Older People guidelines, which emphasize the necessity of nutritional evaluation in sarcopenia management.^[38]

Compared to tools like SARC-F or Ishii formula, the MSRA-5 + CC scale integration of nutritional parameters offers a more comprehensive approach to sarcopenia risk stratification. While SARC-F focuses solely on physical performance and CC, and the Ishii formula relies on grip strength and anthropometric measurements, the MSRA-5 + CC explicitly addresses modifiable risk factors such as dietary habits and appetite changes, which are particularly relevant for elderly populations with high prevalence of malnutrition.^[39] This is especially critical in Chinese community settings, where traditional dietary patterns and caregiving practices often contribute to undernutrition in older adults.^[40] Our findings suggest that incorporating nutritional assessments into sarcopenia screening can improve early detection and facilitate targeted interventions, such as protein supplementation or dietary counseling, to mitigate muscle loss progression.

5. Strengths and limitations

This study improves sarcopenia screening by integrating nutritional and muscle function assessments, offering higher accuracy than existing tools. Tailored to the needs of Chinese community-dwelling older adults, it provides a practical solution for localized screening. The method is user-friendly, cost-effective, and suitable for large-scale implementation in community settings. However, this study was not without limitations: although this study included 202 older adults from communities, they were all from Wanzhou District, Chongqing City, which limits the representativeness and generalizability of the population as the “easy sampling” and the sample selected from a single geographical region. Subsequent studies need to expand the sample size to obtain more data support for further evaluation of the effectiveness of the assessment tool. While the study subjects were community-dwelling older adults, whether the MSRA-5 + CC questionnaire is applicable to hospitalized patients or older adults in nursing homes, and the cutoff values for different populations still need further clarification and validation. Blinding was not performed for the participants, which might be a possible source of bias. The distribution of muscle mass and other factors might not be the same at different ages, BMI, and SMI. However, this study did not further conduct a group analysis, which might cause bias. Other factors, such as the Barthel index, and the years of residency in the residency might have influenced the results of this study, which were not taken into account in this study.

6. Conclusion

This study suggests that the MSRA-5 questionnaire combined with CC has a high screening value for sarcopenia in older adults. The screening process is simple, safe, and cost-effective, overcoming the limitations of expensive instruments or tools in general community screening. This method helps nursing staff to early detect sarcopenia in the older adults in the community, implement intervention measures, thereby delaying or preventing the occurrence of sarcopenia and its related adverse outcomes, and improving the quality of life of the older adults. It is recommended to further conduct multicenter, large-sample studies to validate the applicability and effectiveness of different screening tools in various populations and settings. It is hoped that the most suitable screening tool for Sarcopenia in the older adults in our country communities can be developed, in order to better prevent and intervene in Sarcopenia.

Author contributions

Conceptualization: Feifei Deng, Zhifang Zhao.

Data curation: Zhifang Zhao.

Funding acquisition: Feifei Deng.

Investigation: Feifei Deng, Zhifang Zhao, Jianqiong Li, Wenjun Wu.

Methodology: Feifei Deng, Jianqiong Li, Wenjun Wu, Hui Deng.

Resources: Feifei Deng, Jianqiong Li.

Software: Jianqiong Li.

Validation: Feifei Deng, Jianqiong Li, Wenjun Wu, Hui Deng.

Writing – original draft: Feifei Deng.

Writing – review & editing: Feifei Deng, Zhifang Zhao, Wenjun Wu, Hui Deng.