{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:40:33Z","timestamp":1791614433423,"version":"4.3.4"},"reference-count":41,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Sarcopenia is a progressive and multifactorial condition linked to aging, malnutrition, and chronic diseases, presenting significant clinical and public health challenges. Current screening tools vary in complexity and diagnostic accuracy, emphasizing the need for simple, evidence-based predictive models suitable for settings with limited resources. Methods: A cross-sectional study was conducted among community-dwelling older adults to develop and internally validate hierarchical predictive models for sarcopenia using readily available primary care variables. Three models were built: (1) a basic clinical model (age, sex, BMI, calf circumference, and SARC-F), (2) a model including nutritional status (Mini Nutritional Assessment, MNA), and (3) an extended model adding bioelectrical impedance parameters (phase angle, PhA). Model performance was assessed using AUC, Brier score, Hosmer\u2013Lemeshow test, and decision curve analysis. Results: The parsimonious model demonstrated excellent discrimination (AUC = 0.91) and good calibration (Hosmer\u2013Lemeshow p = 0.36), while the extended model with MNA and PhA achieved the highest overall performance (AUC = 0.95; Brier = 0.064; p = 0.97). Incorporating MNA and PhA enhanced calibration and clinical utility, especially for risk probabilities between 0.10 and 0.40. Internal validation showed minimal optimism and stable coefficients, with BMI, sex, and PhA as consistent predictors. Conclusions: A model combining anthropometric, nutritional, and bioelectrical variables provides high diagnostic accuracy for sarcopenia while remaining practical for clinical use. Its stepwise design facilitates application at various healthcare levels, supporting early detection and targeted interventions in aging populations.<\/jats:p>","DOI":"10.3390\/jcm14248707","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T13:51:46Z","timestamp":1765288306000},"page":"8707","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hierarchical Evaluation of Predictive Models for Confirmed Sarcopenia: Discrimination, Calibration, and Clinical Applicability in a Cross-Sectional Study of Older Adults"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6116-6122","authenticated-orcid":false,"given":"Ludwig","family":"\u00c1lvarez-C\u00f3rdova","sequence":"first","affiliation":[{"name":"Maestr\u00eda de Nutrici\u00f3n y Diet\u00e9tica, Facultad de Ciencias de la Salud, Universidad de las Am\u00e9ricas (UDLA), Quito 170124, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3641-1501","authenticated-orcid":false,"given":"Daniel","family":"Simancas-Racines","sequence":"additional","affiliation":[{"name":"Facultad de Salud y Bienestar, Pontificia Universidad Cat\u00f3lica del Ecuador, Quito 170143, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4234-5524","authenticated-orcid":false,"given":"Claudia","family":"Reytor-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Escuela de Medicina, Pontificia Universidad Cat\u00f3lica del Ecuador, Santo Domingo 230203, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6437-2730","authenticated-orcid":false,"given":"Diana","family":"Fonseca-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Carrera de Nutrici\u00f3n y Diet\u00e9tica, Facultad de Ciencias de la Salud, Universidad Cat\u00f3lica De Santiago de Guayaquil, Guayaquil 090614, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0052-9209","authenticated-orcid":false,"given":"V\u00edctor","family":"Sierra-Nieto","sequence":"additional","affiliation":[{"name":"Carrera de Fisioterapia, Facultad de Ciencias de la Salud, Universidad Cat\u00f3lica De Santiago de Guayaquil, Guayaquil 090614, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2472-3820","authenticated-orcid":false,"given":"Cecilia","family":"Arteaga-Pazmi\u00f1o","sequence":"additional","affiliation":[{"name":"Carrera de Nutrici\u00f3n y Diet\u00e9tica, Facultad de Ciencias M\u00e9dicas, Universidad de Guayaquil, Guayaquil 090510, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6956-668X","authenticated-orcid":false,"given":"Natasha","family":"Giler-P\u00e1rraga","sequence":"additional","affiliation":[{"name":"Maestr\u00eda de Nutrici\u00f3n y Diet\u00e9tica, Facultad de Ciencias de la Salud, Universidad de las Am\u00e9ricas (UDLA), Quito 170124, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1684-5206","authenticated-orcid":false,"given":"Jaen","family":"Cagua-Ordo\u00f1ez","sequence":"additional","affiliation":[{"name":"Escuela de Medicina, Pontificia Universidad Cat\u00f3lica del Ecuador, Santo Domingo 230203, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Montalvan","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad Esp\u00edritu Santo, Samborond\u00f3n 0901952, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1093\/ageing\/afz046","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1002\/jcsm.12783","article-title":"Global prevalence of sarcopenia and severe sarcopenia: A systematic review and meta-analysis","volume":"13","author":"Balntzi","year":"2022","journal-title":"J. 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