Endocrinol Metab.  2021 Jun;36(3):672-677. 10.3803/EnM.2021.1041.

Reference Values for Skeletal Muscle Mass at the Third Lumbar Vertebral Level Measured by Computed Tomography in a Healthy Korean Population

• Yoon JK
• Lee S
• Kim KW
• Lee JE
• Hwang JA
• Park T
• Lee J

• KMID: 2517657
• DOI: http://doi.org/10.3803/EnM.2021.1041

Abstract

Background
Sarcopenia is defined as the loss of skeletal muscle mass and is associated with negative clinical outcomes. This study aimed to establish sex-specific cutoff values for the skeletal muscle area (SMA) and skeletal muscle index (SMI) at the third lumbar vertebral (L3) level using computed tomography (CT) imaging to identify sarcopenia in healthy Korean liver donors.
Methods
This retrospective study included 659 healthy liver donors (408 men and 251 women) aged 20 to 60 years who had undergone abdominal CT examinations between January 2017 and December 2018. Assessment of body composition was performed with an automated segmentation technique using a deep-learning system. Sex-specific SMA and SMI distributions were assessed, and cutoff values for determining sarcopenia were defined as values at either two standard deviations (SDs) below the mean reference value or below the fifth percentile.
Results
Using the SD definition, cutoff values for SMA and SMI were 117.04 cm² and 39.33 cm²/m², respectively, in men and 71.39 cm² and 27.77 cm²/m², respectively, in women. Using the fifth percentile definition, cutoff values for SMA and SMI were 126.88 cm² and 40.96 cm²/m², respectively, in men and 78.85 cm² and 30.60 cm²/m², respectively, in women.
Conclusion
Our data provide sex-specific cutoff values for the SMA and SMI at the L3 level measured by CT imaging in a healthy Korean population, which may be applicable for identifying sarcopenia in this population.

Keyword

Reference values; Muscle, skeletal; Multidetector computed tomography, Sarcopenia

Figure

• 

  Fig. 1 Cross-sectional computed tomographic images at the third lumbar vertebral level. Skeletal muscle area was quantified using the threshold values of −29 to 150 Hounsfield units.

Reference

1. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010; 39:412–23.

2. Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014; 15:95–101.

3. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019; 48:16–31.

4. Walowski CO, Braun W, Maisch MJ, Jensen B, Peine S, Norman K, et al. Reference values for skeletal muscle mass: current concepts and methodological considerations. Nutrients. 2020; 12:755.

5. Mourtzakis M, Prado CM, Lieffers JR, Reiman T, McCargar LJ, Baracos VE. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008; 33:997–1006.

6. Schweitzer L, Geisler C, Pourhassan M, Braun W, Gluer CC, Bosy-Westphal A, et al. What is the best reference site for a single MRI slice to assess whole-body skeletal muscle and adipose tissue volumes in healthy adults? Am J Clin Nutr. 2015; 102:58–65.

7. van der Werf A, Langius JAE, de van der Schueren MAE, Nurmohamed SA, van der Pant KAMI, Blauwhoff-Buskermolen S, et al. Percentiles for skeletal muscle index, area and radiation attenuation based on computed tomography imaging in a healthy Caucasian population. Eur J Clin Nutr. 2018; 72:288–96.

8. Derstine BA, Holcombe SA, Ross BE, Wang NC, Su GL, Wang SC. Skeletal muscle cutoff values for sarcopenia diagnosis using T10 to L5 measurements in a healthy US population. Sci Rep. 2018; 8:11369.

9. Hamaguchi Y, Kaido T, Okumura S, Kobayashi A, Hammad A, Tamai Y, et al. Proposal for new diagnostic criteria for low skeletal muscle mass based on computed tomography imaging in Asian adults. Nutrition. 2016; 32:1200–5.

10. Kim JS, Kim WY, Park HK, Kim MC, Jung W, Ko BS. Simple age specific cutoff value for sarcopenia evaluated by computed tomography. Ann Nutr Metab. 2017; 71:157–63.

11. Park HJ, Shin Y, Park J, Kim H, Lee IS, Seo DW, et al. Development and validation of a deep learning system for segmentation of abdominal muscle and fat on computed tomography. Korean J Radiol. 2020; 21:88–100.

12. Benjamin J, Shasthry V, Kaal CR, Anand L, Bhardwaj A, Pandit V, et al. Characterization of body composition and definition of sarcopenia in patients with alcoholic cirrhosis: A computed tomography based study. Liver Int. 2017; 37:1668–74.

13. Ufuk F, Herek D. Reference skeletal muscle mass values at L3 vertebrae level based on computed tomography in healthy Turkish adults. Int J Gerontol. 2019; 13:221–5.

14. Mijnarends DM, Koster A, Schols JM, Meijers JM, Halfens RJ, Gudnason V, et al. Physical activity and incidence of sarcopenia: the population-based AGES-Reykjavik Study. Age Ageing. 2016; 45:614–20.

15. Bloom I, Shand C, Cooper C, Robinson S, Baird J. Diet quality and sarcopenia in older adults: a systematic review. Nutrients. 2018; 10:308.