Indonesian Optimal Sarcopenia Cut-off Values of Calf Circumference, Muscle Strength and Physical Performance: A Multicentre Descriptive and Cross-Sectional Study

Siti Setiati^1*Shahrul Bahyah Kamaruzzaman²Samuel Teong Huang Chew^3,4,5Nina Kemala Sari¹Kuntjoro Harimurti¹Purwita Wijaya Laksmi¹I Gusti Putu Suka Aryana⁶Sri Sunarti⁷Noto Dwimartutie¹Ika Fitriana¹Anastasia Asylia Asylia Dinakrisma¹Muhammad Khifzhon Azwar¹Roza Mulyana⁸Dina Aprillia Ariestine^10,9Wiwit Agung Sri Nur Cahyawati^11,12Lazuardhi Dwipa¹³Fatichati Budiningsih¹⁴Agus Sudarso¹⁵Mala Hayati¹⁶Chacha Marisa Isfandiari¹⁷Muhammad Darma Muda Setia¹⁷Rahmi Istanti¹⁸

• ¹Division of Geriatrics, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital – Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
• ²Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
• ³Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
• ⁴Singhealth Duke-NUS Medicine Academic Clinical Programme, Singapore, Singapore
• ⁵Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
• ⁶Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine Universitas Udayana – Prof. Dr. Ngoerah General Hospital Denpasar, Bali, Indonesia
• ⁷Geriatric and medical gerontology Division, Internal Medicine Departement, Medical Faculty of Brawijaya University, Malang, Indonesia
• ⁸Department of Internal Medicine, Faculty of Medicine Universitas Andalas – Dr. M. Djamil General Hospital, Padang, Indonesia
• ⁹Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
• ¹⁰Prof. Chairuddin P. Lubis Universitas Sumatera Utara Hospital, Medan, Indonesia
• ¹¹Division of Geriatrics, Department of Internal Medicine, Ulin District General Hospital, Banjarmasin, Indonesia
• ¹²Department of Internal Medicine Moch Ansari Saleh District General Hospital, Banjarmasin, Indonesia
• ¹³Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran – Hasan Sadikin General Hospital, Bandung, Indonesia
• ¹⁴Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine Universitas Sebelas Maret – Dr Moewardi Hospital, Surakarta, Indonesia
• ¹⁵Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine Universitas Hasanuddin – Wahidin Sudirohusodo General Hospital, Makassar, Indonesia
• ¹⁶Merauke District General Hospital, Merauke, Indonesia
• ¹⁷Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
• ¹⁸Clinical Epidemiology and Evidence Based Medicine Unit, Cipto Mangunkusumo Hospital – Faculty of Medicine Universitas Indonesia, Central Jakarta, Indonesia

Introduction: Prevalence of possible sarcopenia among Indonesian older adults using the Asian Working Group for Sarcopenia (AWGS) 2019 consensus cut-offs was abnormally high compared with reported prevalence in other East Asian countries. This suggests that the current AWGS cut-off values may not be applicable to the Indonesian population as it did not contain reference statistical values based on the local population normative studies. This lack of local data may result in inaccurate assessments and diagnoses of sarcopenia among Indonesian population. We therefore aimed to conduct a nationwide study in the community to obtain optimal cut-off values for calf circumference, muscle strength and physical performance for the diagnosis of sarcopenia in Indonesia.Methods: In this multicentre descriptive and cross-sectional study, we collected data from healthy adults aged 20-39 years in different islands in Indonesia. We followed the recommendation by the European Working Group for Sarcopenia in Older People (EWGSOP) of using 2 standard deviations [SD] below the mean of a young healthy cohort for the new cut-off points of sex-specific handgrip strength, calf circumference, and gait speed. The mean +2 SD was used for five times sit to stand (FTSTST) test.Results: The mean -2 SD value of male handgrip strength was 21.15 kg, and 14.34 kg for female subjects. The mean -2 SD value of male and female calf circumferences were 29.92 cm, and 26.70 cm, respectively. Two SD below the mean of gait speed results was 0.51 s, whereas 2 SD above mean of FTSTST results was 11.69 s.Discussion: The suggested cut-off values for low calf circumference, muscle strength, and gait speed in Indonesian population are different from those in previous consensuses. Body morphology, culture, and obesity may be the factors related to this phenomenon. This study contributes to the body of literature of normative data used to determine cut-off values used in the diagnosis of sarcopenia in Indonesian and Asian populations.