2025 Volume 29 Issue 3 Pages 118-125
Introduction: The condition in which sarcopenia and oropharyngeal swallowing dysfunction coexist is referred to as sarcopenic dysphagia (SD). In the diagnostic flowchart for SD, in addition to the skeletal muscle mass index (SMI) obtained via bioelectrical impedance analysis (BIA), calf circumference (CC) may also be used. However, no studies have compared SD detection rates using SMI versus CC. Furthermore, in Japan, the Food Intake LEVEL Scale (FILS) is often employed for SD diagnosis, but the impact of using CC together with FILS on SD detection remains unknown. Therefore, the purposes of this study were twofold: (1) to evaluate whether there is a difference in SD diagnosis rates when using SMI versus CC, and (2) to examine the influence of CC and FILS on the diagnosis of SD.
Methods: Participants were 78 older adults requiring support or long-term care who attended three day-care facilities in Sapporo City, Hokkaido. Data were collected from December 2023 to February 2025. Sarcopenia was diagnosed according to (1) SMI criteria measured by BIA and (2) CC cutoff values from the Asian Working Group for Sarcopenia (AWGS), and SD was defined as a FILS score ≤ 8. Among those classified as sarcopenic by SMI criteria and by AWGS criteria, sensitivity, specificity, and Cohen’s κ coefficient for SD diagnosis were calculated from cross-tabulation, and the results of univariate analyses for SDrelated factors were compared.
Results: Of the 78 participants, 51 (65.3%) were diagnosed with sarcopenia according to the SMI criteria, and 52 (66.7%) according to the AWGS criteria; SD was diagnosed in 13 participants (16.7%) under both criteria. For sarcopenia diagnosis, the sensitivity between SMI and AWGS criteria was 0.90, specificity was 0.78, and Cohen’s κ coefficient was 0.69; for SD diagnosis, Cohen’s κ coefficient was 1.00.
Conclusions: The use of the Food Intake LEVEL Scale (FILS) enables the detection of sarcopenic dysphagia (SD) with comparable validity when applying either the AWGS or SMI criteria. However, FILS identifies dysphagia based on the need for modification of food texture. While FILS is unlikely to overlook cases of SD, it may fail to detect early-stage SD unless sarcopenia of the swallowing-related muscles has progressed to the point of dietary adjustment. These findings suggest that FILS alone may not be sufficient for comprehensive screening, and comparative evaluation with other dysphagia screening tools is warranted to improve the identification of SD.
