Table 5.

Diagnostic cutoffs of various tests for sarcopenia in Asian, international and South Asian guidelines.

Parameter	International					Asian			South Asian
	EWGSOP [41]	EWGSOP2 [46]	IWGS [42]	FNIH [44]	ICFSR [47]	AWGS 2014 consensus [43]	AWGS 2019 Consensus Update on Sarcopenia Diagnosis and Treatment [48]	JSH [45] (cut-off for sarcopenia in liver disease)	SWAG-SARCO 2021
Diagnostic tools/Screening	Muscle mass using DXA, BIA Muscle strength by grip strength Muscle function/performance by gait speed, SPPB	Muscle mass using DXA, BIA, Muscle strength by grip strength Muscle function/performance by gait speed, SPPB, or TUG	DXA, gait speed	DXA, gait speed and grip strength	Screen using gait speed, or with the SARC-F Diagnosis using DXA, walking speed, grip strength	Screening with hand grip and gait speed; history taking; height-adjusted skeletal muscle mass by DXA	Screening with calf circumference or SARC-F or SARC-CalF questionnaires	Grip strength, gait speed, DXA, BIA	Screening with clinical suspicion + calf circumference or SARC-F or SARC-CalF questionnaires
Hand grip strength	Male: <30 kg	Male: <27 kg		Male: <26 kg	Cutoff to match population characteristics	Male: <26 kg	Male: <28 kg	Male: <26 kg	Male:
	Female: <20 kg	Female: <16 kg		Female: <16 kg		Female: <16 kg	Female<18 kg	Female: <16 kg	<27.5 kg Female: < 18 kg52
LEMS: one-repetition-maximum (1-RM) knee extension	Not covered				Not covered	Male: <18 kg		Not covered	Median values Indian study:2.29 (0.5–10.0)35
	Knee flexion/extension cited as literature					Female:<16 kg (not recommended but cited as literature)			Can use AWGS 2014 [43] values until further research from South Asia
Gait speed (6-m walk test)	<1 m/s SPPB 0–6 Low performance SPPB 7–9 Intermediate performance SPPB 10–12 High Performance	≤0.8 m/s 400 m walk test Non-completion or ≥6 min for completion	<1.0 m/s (4- minute test)	≤0.8 m/s	Cut off to match population characteristics	<0.8 m/s	<1.0 m/s	≤0.8 m/s	India: ≤0.8 m/s52 Sri Lanka: ≤0.96 m/s10 ≤0.8 m/s is validated in other guidelines as well
Short Physical Performance Battery score (including chair stand test)/TUGT	≤8	>15 s for 5 rises (chair stand test) TUG: ≥20 s			Not covered	Considered sarcopenic if unable to rise from chair unassisted DXA not required for diagnosis	≤9, or 5-time chair stand test ≥12 s	Not covered	TUGT: <10.2 s [89] Can use AWGS 2014 [43] values until further research from South Asia
Calf circumference	Not recommended as vulnerable to errors	Recommended only if no other method available. No cutoffs			Cut off to match population characteristics	Not covered	Men:<34 cm Women: <33 cm	No covered	Men:<34 cm Women: <33 cm Validated for South East Asians
SARC-F	Not covered	Use SARC-F (≥4) or clinical suspicion for screening.			Cutoff to match population characteristics	Not covered	≥4	Not covered	≥4 Internationally validated score
SARC-CalF	Not covered	Not covered			No covered	Not covered	≥11	No covered	≥11 Validated in South East Asians
ALM/height [2]	Male: ≤7.23 kg/m2	Male: ≤7 kg/m2	Male: ≤7.23 kg/m2		Not covered	Male: ≤7.0 kg/m2		Not covered	India: ASMI (Lee's equation for Asians) Male: <7.0 kg/m2 Female: <5.7 kg/m26 Validated in South East Asians
	Female: ≤5.67 kg/m2	Female: ≤5.5 kg/m2	Female: ≤5.67 kg/m2			Female: ≤5.7 kg/m2
Height-adjusted muscle mass: DXA	Male: ≤7.23 kg/m2	Male: ≤7.23 kg/m2	Male: ≤7.23 kg/m2		Cut off to match population characteristics	Male: <7.0 kg/m2	Male: <7.0 kg/m2	Male:<7.0 kg/m2	Sri Lanka: 5.03 kg/m210
	Female: ≤5.67 kg/m2	Female: ≤5.67 kg/m2	Female: ≤5.67 kg/m2			Female: <5.4 kg/m2	Female: <5.4 kg/m2	Female:<5.4 kg/m2	Can use AWGS values until further research from South Asia
Bio-electrical impedance analysis	SM/height [2] Male: 8.87 kg/m2 Female: 6.42 kg/m2 absolute muscle mass/height [2] Male: Severe sarcopenia ≤8.50 kg/m2 Moderate sarcopenia 8.51–10.75 kg/m2 Normal muscle ≥10.76 kg/m2 Female: Severe sarcopenia ≤5.75 kg/m2 Moderate sarcopenia 5.76–6.75 kg/m2 Normal muscle ≥6.76 kg/m2				Cutoff to match population characteristics	Male: <7.0 kg/m2 Female: <5.7 kg/m2	Male: <7.0 kg/m2 Female: <5.7 kg/m2	Male:<7.0 kg/m2 Female:<5.7 kg/m2	India: FFM = 32.637 + (−0.222 X age) + (−32.51 X waist-to-hip ratio) + (0.33 X body mass index) + (1.58 × 1 or 2 (1 = normal birth weight, 2 = low birth weight) + (0.510 X waist circumference) [114] Can use AWGS values until further research from South Asia
Ultrasound	No values have been validated or reported in any guidelines as cut-offs for screening sarcopenia.

ALMBMI, ratio of appendicular lean mass over body mass index; ALM/ht [2], ratio of appendicular lean mass over height squared; AWGS, Asian Working Group for Sarcopenia; EWGSOP, European Working Group on Sarcopenia in Older People; EWGSOP2, Revised European Working Group on Sarcopenia in Older People; FFM, fat free mass; FNIH, Foundation for the National Institutes of Health; ICFSR. International Clinical Practice Guidelines for Sarcopenia; IWGS, International Working Group on Sarcopenia; LEMS, lower extremity muscle strength; SWAG-SARCO, South Asian Working Action Group on Sarcopenia; SM, skeletal muscle mass; TUG, Timed -up-and-go test.

Note: No diagnostic cut-offs were provided by the Clinical Practice Guideline for Sarcopenia from Japan [39].