Sarc-frailty: towards an integrated view of ageing

  • Shou-En Wu
    Department of Dermatology, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei City, Taiwan, ROC
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  • Wei-Liang Chen
    Corresponding author at: Division of Geriatric Medicine, Department of Family Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Number 325, Section 2, Chang-gong Rd, Nei-Hu District, 114, Taipei, Taiwan, ROC.
    Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei City, Taiwan, ROC

    Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei City, Taiwan, ROC

    Department of Biochemistry, National Defense Medical Center, Taipei City, Taiwan, ROC
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      • “Sarc-frailty” combines the six diagnostic elements of sarcopenia and frailty.
      • “Sarc-frailty” demonstrated greater power than sarcopenia or frailty singly to predict mortality.
      • A scoring classification which counts the sum of diagnostic elements fulfilled provides a comprehensive evaluation of sarc-frailty.



      Sarcopenia and frailty have both been related to adverse events in ageing, but have long been studied in parallel. The purpose of this study was to provide a better depiction of ageing by taking the advantages of both entities.

      Study design

      2532 participants were enrolled from the National Health and Nutrition Examination Survey 1999–2002. A new diagnostic entity, sarc-frailty, was established by merging the diagnostic elements of both sarcopenia and frailty.

      Main outcome measures

      Cox proportional hazard models, Kaplan-Meier curve, and receiver operating characteristic (ROC) curve analysis were utilized to compare the hazard ratios and predictive power in relation to mortality of sarcopenia, frailty, and sarc-frailty. Two different classification strategies, categorical and scoring, were used as alternative assessment methods.


      The median follow-up duration was 67.49 months, and no participants were lost to follow-up. ROC analysis revealed the highest area under curves (AUC) in sarc-frailty by both categorical and scoring classification (AUC = 0.660, p value <0.001 and AUC = 0.697, p value <0.001, respectively), indicating the best predictive ability in relation to mortality. Kaplan-Meier analysis also demonstrated the shortest overall survival for sarc-frailty with both classifications (p value both <0.001). In addition, hazard ratios (HRs) of sarc-frailty with both classifications were higher than their counterparts for sarcopenia and frailty (HR = 12.599, 95 % CI = 7.780 to 20.403, p < 0.001 by categorical method, and HR = 20.121, 95 % CI = 8.101 to 49.973, p < 0.001 by scoring classification). Moreover, the scoring classification revealed a more delicate hierarchical structure of mortality levels than the categorical classification.


      Sarc-frailty had a better predictive ability in relation to mortality. Considering that ageing well is a holistic health-care issue, our new entity, along with the scoring method, provides clinicians with more effective tools in geriatric assessment.


      AUC (area under curves), AWGS (Asian Working Group for Sarcopenia), CDC (Disease Control and Prevention), CV (cardiovascular), EWGSOP2 (European working Group on Sarcopenia in Older People in 2019), HR (hazard ratio), MEC (mobile examination center), NCHS (National Center for Health Statistics), NHANES (National Health and Nutrition Examination Survey), ROC (receiver operating characteristic)


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