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Body composition, energy expenditure and physical activity

Ethnic-specific cut-points for sarcopenia: evidence from black South African women



Age-related muscle and fat mass (FM) changes are ethnicity specific. We aimed to develop a cut-point for the muscle mass component of sarcopenia for black South African (SA) women, and to assess its predictive value, in comparison to established cut-points, to identify functional ability among older black SA women.


In a cross-sectional study, a sarcopenia cut-point was calculated from dual energy X-ray absorptiometry (DXA)-derived appendicular skeletal muscle mass (ASM) indexes (ASMI) from two young black SA reference groups. The new cut-point was compared with the most recent Foundation for the National Institutes of Health (FNIH) criteria (ASM <15.02 kg; and ASMBMI <0.512), an internationally accepted cut-point (ASMI <5.5 kg/m2) and a residual method adjusting for FM. All cut-points were then applied to 221 older black women to predict gait speed and handgrip strength.


A cut-point of ASMI <4.94 kg/m2 was derived from the young SA reference groups. Using this cut-point, 9.1% of older women were classified as sarcopenic, compared with 16.7–38.7% using other cut-points. The only cut-points that significantly predicted low functional ability (low gait speed and low handgrip strength) in older black women were the new SA cut-point and the FNIH ASM criterion. Multivariate logistic regression models for both these cut-points significantly predicted low handgrip strength (odds ratio (OR)=3.71, P=0.007 and OR=3.42, P=0.001, respectively) and low gait speed (OR=9.82, P=0.004 and OR=8.71, P=0.008, respectively).


The new SA cut-point had similar or greater odds of predicting reduced functional ability in older SA women when compared with other internationally accepted cut-points.

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The work was funded by the South African National Research Foundation, the South African Medical Research Council, the International Atomic Energy Agency and the University of Cape Town. LKM acknowledges funding from the MRC/DFID African Research Leader Scheme. The funders had no role in study design, in the collection, analysis or interpretation of data, in the writing of the report or in the decision to submit the paper for publication. Any opinion, findings and conclusions or recommendations expressed in this material are those of the authors, and therefore the National Research Foundation does not accept any liability in regard thereto. Data analyses were conducted with assistance from Professor HS Steyn and S Ellis of the Statistical Consultation Service of the North-West University. We acknowledge the contribution to data analysis made by Treasure A Munonoka during his NRF internship at the UCT/MRC Research Unit for Exercise Science and Sports Medicine.

Author Contributions

The study was conceptualised and designed by HSK, JHG and LKM; HSK, JHG, LKM, HHW and LHN contributed to data collection; data analyses were performed by HSK, JHG and LKM, with assistance from Professor HS Steyn and S Ellis of the Statistical Consultation Service of the North-West University; and discussion of the data and writing of the manuscript was carried out by HSK, JHG, LKM, HHW and LHN.

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Correspondence to H S Kruger.

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Kruger, H., Micklesfield, L., Wright, H. et al. Ethnic-specific cut-points for sarcopenia: evidence from black South African women. Eur J Clin Nutr 69, 843–849 (2015).

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