Serum creatinine and cystatin C-based index can be a screening biomarker for sarcopenia in older population

  • Sunny Singhal
  • Sumitabh Singh
  • Ashish Datt Upadhyay
  • Sada Nand Dwivedi
  • Chandan Jyoti Das
  • Srikant Mohta
  • Prasun Chatterjee
  • Aparajit Ballav Dey
  • Avinash ChakrawartyEmail author
Research Paper

Key summary points


To use an index based on blood biomarkers (serum creatinine and cystatin c) to screen sarcopenia in older adults.


Lower value of Biochemical Total Body Muscle mass index (TBMM) (calculated from serum creatinine and cystatin C) was significantly associated with higher risk of sarcopenia.


Biochemical Total Body Muscle Mass index based on serum creatinine and cystatin C can be used to screen sarcopenia in older people.



Considering the clinical impact of sarcopenia, it would be interesting to get a rapid and sensible screening tool. We conducted a cross-sectional study with the motive to use an index based on serum creatinine and cystatin C to screen sarcopenia in older people in outpatient settings.


100 participants above the age of 65 years were recruited from the outpatient department of Geriatric medicine of a tertiary care hospital in India. Muscle mass, muscle strength and physical performance were measured by DXA scan, hand-held dynamometer and 4 m gait speed, respectively. Sarcopenia was identified using Asian working group of sarcopenia (AWGS) criteria. Serum creatinine and cystatin C were measured for all participants. Serum creatinine/cystatin C ratio and biochemical total body muscle mass index (TBMM) were calculated and its association was checked with sarcopenia.


The prevalence of sarcopenia was 53%. Mean serum creatinine/cystatin C ratio was 74.79 ± 24.91. It was not significantly associated with sarcopenia. Mean biochemical TBMM index of participants was 36.40 ± 7.88 (males—38.77 ± 7.72, females—31.22 ± 5.13). The lower value of biochemical TBMM index was significantly associated with an increased risk of sarcopenia (p < 0.01). Cut-off value of 40.9 in males (sensitivity—79.41%; specificity—61.76%) and 32.2 in females (sensitivity—78.95%; specificity—66.67%) was proposed for identification of sarcopenia.


Out of the two indices, only low biochemical total body muscle mass index is significantly associated with sarcopenia and a value of less than 40.9 in males and 32.2 in females can be used to screen sarcopenia in older people.


Sarcopenia Biomarkers Creatinine Cystatin C 



This work was supported by National Programme for Health Care of the Elderly, Government of India.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (IECPG-111/12/2015) and with the 1964 Helsinki Declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Kamel HK (2003) Sarcopenia and aging. Nutr Rev 61(5 Pt 1):157–167CrossRefGoogle Scholar
  2. 2.
    Bruyère O, Beaudart C, Ethgen O, Reginster J-Y, Locquet M (2019) The health economics burden of sarcopenia: a systematic review. Maturitas 119:61–69CrossRefGoogle Scholar
  3. 3.
    Janssen I, Shepard DS, Katzmarzyk PT, Roubenoff R (2004) The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc 52(1):80–85CrossRefGoogle Scholar
  4. 4.
    Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in older people. Age Ageing 39(4):412–423CrossRefGoogle Scholar
  5. 5.
    Chen L-K, Liu L-K, Woo J, Assantachai P, Auyeung T-W, Bahyah KS et al (2014) Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 15(2):95–101CrossRefGoogle Scholar
  6. 6.
    Cesari M, Fielding RA, Pahor M, Goodpaster B, Hellerstein M, Van Kan GA et al (2012) Biomarkers of sarcopenia in clinical trials-recommendations from the International Working Group on Sarcopenia. J Cachexia Sarcopenia Muscle 3(3):181–190CrossRefGoogle Scholar
  7. 7.
    Cavalier E, Beaudart C, Buckinx F, Bruyère O, Reginster J-Y (2016) Critical analytical evaluation of promising markers for sarcopenia. Eur Geriatr Med 7(3):239–242CrossRefGoogle Scholar
  8. 8.
    Fougère B, Vellas B, van Kan G, Cesari M (2015) Identification of biological markers for better characterization of older subjects with physical frailty and sarcopenia. Transl Neurosci 6(1):103–110CrossRefGoogle Scholar
  9. 9.
    Levey AS, Perrone RD, Madias NE (1988) Serum creatinine and renal function. Annu Rev Med 39:465–490CrossRefGoogle Scholar
  10. 10.
    Caregaro L, Menon F, Angeli P, Amodio P, Merkel C, Bortoluzzi A et al (1994) Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis. Arch Intern Med 154(2):201–205CrossRefGoogle Scholar
  11. 11.
    Randers E, Erlandsen EJ (1999) Serum cystatin C as an endogenous marker of the renal function—a review. Clin Chem Lab Med 37(4):389–395CrossRefGoogle Scholar
  12. 12.
    Liu CK, Lyass A, Massaro JM, D’Agostino RB, Fox CS, Murabito JM (2014) Chronic kidney disease defined by cystatin C predicts mobility disability and changes in gait speed: the Framingham Offspring Study. J Gerontol A Biol Sci Med Sci 69(3):301–307CrossRefGoogle Scholar
  13. 13.
    Dalrymple LS, Katz R, Rifkin DE, Siscovick D, Newman AB, Fried LF et al (2013) Kidney function and prevalent and incident frailty. Clin J Am Soc Nephrol CJASN 8(12):2091–2099CrossRefGoogle Scholar
  14. 14.
    Kashani KB, Frazee EN, Kukrálová L, Sarvottam K, Herasevich V, Young PM et al (2017) Evaluating muscle mass by using markers of kidney function: development of the sarcopenia index. Crit Care Med 45(1):e23–e29CrossRefGoogle Scholar
  15. 15.
    Kim S, Jung H-W, Kim C-H, Kim K, Chin HJ, Lee H (2016) A new equation to estimate muscle mass from creatinine and cystatin C. PLOS One 11(2):e0148495CrossRefGoogle Scholar
  16. 16.
    Gunasekaran V, Banerjee J, Dwivedi SN, Upadhyay AD, Chatterjee P, Dey AB (2016) Normal gait speed, grip strength and thirty seconds chair stand test among older Indians. Arch Gerontol Geriatr 67:171–178CrossRefGoogle Scholar
  17. 17.
    Cruz-Jentoft AJ, Landi F, Schneider SM, Zúñiga C, Arai H, Boirie Y et al (2014) Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing 43(6):748–759CrossRefGoogle Scholar
  18. 18.
    Agarwalla R, Saikia AM, Baruah R (2015) Assessment of the nutritional status of the elderly and its correlates. J Fam Community Med 22(1):39–43CrossRefGoogle Scholar
  19. 19.
    Reijnierse EM, Trappenburg MC, Leter MJ, Blauw GJ, Sipilä S, Sillanpää E et al (2015) The impact of different diagnostic criteria on the prevalence of sarcopenia in healthy elderly participants and geriatric outpatients. Gerontology 61(6):491–496CrossRefGoogle Scholar
  20. 20.
    Woo J (2017) Sarcopenia. Clin Geriatr Med 33(3):305–314CrossRefGoogle Scholar
  21. 21.
    Chang C-D, Wu JS, Mhuircheartaigh JN, Hochman MG, Rodriguez EK, Appleton PT et al (2018) Effect of sarcopenia on clinical and surgical outcome in elderly patients with proximal femur fractures. Skeletal Radiol 47(6):771–777CrossRefGoogle Scholar
  22. 22.
    Osaka T, Hamaguchi M, Hashimoto Y, Ushigome E, Tanaka M, Yamazaki M et al (2018) Decreased the creatinine to cystatin C ratio is a surrogate marker of sarcopenia in patients with type 2 diabetes. Diabetes Res Clin Pract 139:52–58CrossRefGoogle Scholar
  23. 23.
    Yu R, Wong M, Leung J, Lee J, Auyeung TW, Woo J (2014) Incidence, reversibility, risk factors and the protective effect of high body mass index against sarcopenia in community-dwelling older Chinese adults. Geriatr Gerontol Int 14(S1):15–28CrossRefGoogle Scholar
  24. 24.
    Landi F, Liperoti R, Fusco D, Mastropaolo S, Quattrociocchi D, Proia A et al (2012) Prevalence and risk factors of sarcopenia among nursing home older residents. J Gerontol A Biol Sci Med Sci 67(1):48–55CrossRefGoogle Scholar
  25. 25.
    Beaudart C, Reginster JY, Petermans J, Gillain S, Quabron A, Locquet M et al (2015) Quality of life and physical components linked to sarcopenia: the SarcoPhAge study. Exp Gerontol 69:103–110CrossRefGoogle Scholar
  26. 26.
    de Souza VA, Oliveira D, Barbosa SR, do Amaral Correa JO, Colugnati FAB, Mansur HN et al (2017) Sarcopenia in patients with chronic kidney disease not yet on dialysis: analysis of the prevalence and associated factors. PLoS One 12(4):e0176230CrossRefGoogle Scholar
  27. 27.
    Foley RN, Wang C, Ishani A, Collins AJ, Murray AM (2007) Kidney function and sarcopenia in the United States general population: NHANES III. Am J Nephrol 27(3):279–286CrossRefGoogle Scholar

Copyright information

© European Geriatric Medicine Society 2019

Authors and Affiliations

  • Sunny Singhal
    • 1
  • Sumitabh Singh
    • 1
  • Ashish Datt Upadhyay
    • 2
  • Sada Nand Dwivedi
    • 2
  • Chandan Jyoti Das
    • 3
  • Srikant Mohta
    • 4
  • Prasun Chatterjee
    • 1
  • Aparajit Ballav Dey
    • 1
  • Avinash Chakrawarty
    • 1
    Email author
  1. 1.Department of Geriatric MedicineAll India Institute of Medical Sciences, AIIMSNew DelhiIndia
  2. 2.Department of BiostatisticsAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Department of RadiodiagnosisAll India Institute of Medical SciencesNew DelhiIndia
  4. 4.Department of Internal MedicineAll India Institute of Medical SciencesNew DelhiIndia

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