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Optimising SARC-F cut-off for sarcopenia screening: A comparative analysis with muscle strength and physical
Deniz Cengiz1, Arzu Okyar Baş2, Yelda Öztürk3
1Hacettepe University Department of Internal Medicine, Division of Geriatric Medicine, Ankara, Turkey; St. George's University Hospitals NHS Trust, Department of Senior Health, London, United Kingdom.
Objectives:
Sarcopenia, a prevalent geriatric syndrome with multifactorial origins, is strongly influenced by malnutrition alongside immobility and chronic illness and contributes substantially to falls, disability, and mortality. The (Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire is widely used to screen for probable sarcopenia; however, the conventional cut-off of ≥4 has yielded insufficient sensitivity across studies. The aim of the study was to evaluate how SARC-F scores correspond to muscle strength and physical performance tests endorsed by the EWGSOP2 algorithm and to determine the most suitable cut-off for screening probable sarcopenia in older adults.
Methods:
This retrospective cross-sectional study included community-dwelling adults aged ≥65 years who attended a tertiary geriatric outpatient clinic (January 2022-May 2024). Patients with active malignancy, non-ambulatory status, or missing performance data were excluded. Diagnostic accuracy of SARC-F thresholds was assessed against handgrip strength (HGS), the sit-to-stand test (STST), 4-meter gait speed, and the Timed Up and Go (TUG) test using receiver operating characteristic analysis.
Results:
A total of 1,355 participants (mean age 74.0 ± 6.0 years; 64.9% female) were analyzed. Prevalence of SARC-F ≥4 was 22.2%. For HGS and STST, a cut-off of ≥2 yielded the most favorable discrimination (AUC = 0.705 and 0.735, respectively). Gait speed showed the best accuracy at ≥3 (AUC = 0.788), while TUG demonstrated the highest performance at ≥4 (AUC = 0.881).
Conclusions:
SARC-F performance varies across muscle strength and functional domains. A threshold of ≥2 may enhance early detection of sarcopenia in community-dwelling older adults, while higher cut-offs better reflect advanced functional impairment.
