In an era where accurate and cost-effective clinical assessments are paramount, the search for a viable proxy for muscle mass measurement is more critical than ever. The study titled “Concordance between changes in calf circumference and muscle mass exists: A narrative literature review” published in the journal Clinical Nutrition ESPEN (2024) has shed light on the potential of using calf circumference measurements as an alternative to more sophisticated technological methods such as Bioelectrical Impedance Analysis (BIA) or Dual-Energy X-ray Absorptiometry (DXA). The article by Hansen et al., asserts the importance of calf circumference measurements and addresses the gaps in existing literature regarding the concordance between calf circumference and muscle mass changes. This article provides a comprehensive insight into the findings of this illuminating study.
According to the study, the Global Leadership Initiative on Malnutrition (GLIM) endorses the use of calf circumference measurements to evaluate muscle mass in situations where advanced technology is less accessible. However, the consistency of this method in detecting changes in muscle mass, particularly when compared to BIA or DXA, has not been fully established. The authors, Signe Skovgaard Hansen, Tina Munk, Anne Wilkens Knudsen, and Anne Marie Beck from the Unit for Dieticians and Nutrition Research, EATEN, Herlev and Gentofte Hospital, Denmark, undertook an extensive narrative literature review which included ten studies to examine the concordance between calf circumference and muscle mass alterations measured by standard technological methods.
The research comprising several cross-sectional studies found a predominantly positive correlation between the changes in calf circumference and muscle mass as evaluated by BIA or DXA. However, the findings were not universally applicable, particularly for certain groups, including hospitalized patients and older adults. The disparities observed within these groups highlight the complexities of muscle mass assessment amidst varying clinical conditions such as sarcopenia, edema, and malnutrition, which can be present concurrently, particularly in the elderly population.
The study’s lead author, Signe Skovgaard Hansen, remarked on the nuances of this method. Hansen pointed out that while calf circumference can be a straightforward, non-invasive, and inexpensive tool, its reliability may vary across different patient demographics and clinical conditions. The study suggests that further research should focus on these specific groups to determine the extent of the tool’s validity and reliability as a proxy indicator.
The narrative literature review conducted for this study thoroughly evaluates the present academic discourse and clinical applications surrounding muscle mass measurement. It emphasizes the potential for calf circumference measurements to serve as a primary or adjunct method for health professionals, especially in contexts where resources are limited. Interestingly, the authors point out that advancements in technology or analysis protocols could bolster the efficacy of calf circumference as a reliable stand-alone measure in the future.
As for the potential implications of this study, they are manifold. For dieticians, nutritionists, geriatricians, and general clinicians, this research underscores the pressing need to establish accessible, precise, and cost-effective means of assessing muscle mass. The ability to accurately gauge muscle mass is essential due to its association with overall health, recovery from illness, and the quality of life for aging populations.
Moreover, the results have prompted discussions on larger issues such as the need for standardization of calf circumference measurement techniques, the incorporation of other clinical parameters to support the assessment, and the potential applications of this method in both clinical and community settings. For clinics and hospitals in developing countries or those without access to advanced technologies, calf circumference could potentially bridge the gap in muscle mass assessment, thereby allowing healthcare providers to better address issues related to sarcopenia and malnutrition.
To extend the reach and impact of these findings, the study’s DOI is 10.1016/j.clnesp.2023.11.026, and the authors can be contacted for further information through the provided electronic addresses. This research article contributes to a fundamental aspect of clinical nutrition and holds the potential for substantive changes in how muscle mass is evaluated across different sectors of healthcare.
The validation of calf circumference as an indirect muscle mass indicator aligns with a broader trend in healthcare emphasizing personalized medicine and resource optimization. It also reflects a growing awareness of the importance of muscle health in the prognosis and management of various conditions, particularly among aging populations and those with chronic diseases.
Keywords
1. Calf circumference measurement
2. Muscle mass assessment
3. Clinical nutrition
4. Sarcopenia diagnosis
5. BIA vs. DXA
References
1. Hansen, S. S., Munk, T., Knudsen, A. W., & Beck, A. M. (2024). Concordance between changes in calf circumference and muscle mass exists: A narrative literature review. Clinical Nutrition ESPEN, 59, 171-175. DOI: 10.1016/j.clnesp.2023.11.026
2. Cruz-Jentoft, A. J., Bahat, G., Bauer, J., et al. (2019). Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing, 48(4), 601. DOI: 10.1093/ageing/afz046
3. Kyle, U. G., Bosaeus, I., De Lorenzo, A. D., et al. (2004). Bioelectrical impedance analysis-part I: review of principles and methods. Clinical Nutrition, 23(5), 1226-1243. DOI: 10.1016/j.clnu.2004.06.004
4. Lohman, T. G., Harris, M., Teixeira, P. J., & Weiss, L. (2000). Assessing body composition and changes in body composition. Another look at dual-energy X-ray absorptiometry. Annals of the New York Academy of Sciences, 904, 45-54. DOI: 10.1111/j.1749-6632.2000.tb06445.x
5. Rolland, Y., Lauwers-Cances, V., Cournot, M., et al. (2003). Sarcopenia, calf circumference, and physical function of elderly women: a cross-sectional study. Journal of the American Geriatrics Society, 51(8), 1120-1124. DOI: 10.1046/j.1532-5415.2003.51362.x
Declaration of competing interest: The authors of the research do not have any conflict of interest.