{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T12:52:02Z","timestamp":1780491122612,"version":"3.54.1"},"reference-count":51,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T00:00:00Z","timestamp":1721952000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: For the study of quantitative and qualitative muscle parameters, ultrasound and bioelectric impedance analysis are reliable, non-invasive, and reproducible. The aim of this study was to test the combined role of those techniques for the diagnosis of sarcopenia in a population of hospitalized older males and females. Methods: A total of 70 subjects were recruited, including 10 healthy adults and 60 hospitalized elderly patients with a good level of independence and cooperation, with and without sarcopenia. The rectus femoris cross-sectional area (CSA), thickness, echogenicity, and compressibility were measured with ultrasound echography. The phase angles (PhAs) and skeletal muscle mass were calculated by bioimpedence analysis. The muscle quality index (MQI) was calculated as the product of CSA and PhA. Results: Muscle compressibility was greater and PhA was lower in sarcopenic when compared with non-sarcopenic subjects. The threshold values for sarcopenia diagnosis in both sexes of CSA, of PhA, and of the MQI were identified. The obtained CSA values showed an AUC of 0.852 for women and 0.867 for men, PhA of 0.792 in women and 0.898 in men, while MQI was 0.900 for women and 0.969 for men. Conclusions: The newly calculated cut-off values of CSA, PhA, and MQI predicted the presence of sarcopenia with good sensitivity and specificity values. The use of the MQI proved to be more promising than the separate use of CSA and PhA in both male and female subjects.<\/jats:p>","DOI":"10.3390\/nu16152429","type":"journal-article","created":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T09:22:42Z","timestamp":1721985762000},"page":"2429","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Role of Combined Muscle Ultrasound and Bioimpedentiometry Parameters for Sarcopenia Diagnosis in a Population of Hospitalized Older Adults"],"prefix":"10.3390","volume":"16","author":[{"given":"Alfredo","family":"Zanotelli","sequence":"first","affiliation":[{"name":"Section of Geriatric Medicine, Ospedale Santa Maria del Carmine, 38068 Rovereto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5472-1175","authenticated-orcid":false,"given":"Andrea P.","family":"Rossi","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, Ospedale C\u00e0 Foncello, 31100 Treviso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Letizia","family":"Del Monte","sequence":"additional","affiliation":[{"name":"Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Vantini","sequence":"additional","affiliation":[{"name":"Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0858-2477","authenticated-orcid":false,"given":"Giovanni","family":"Stabile","sequence":"additional","affiliation":[{"name":"Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Urbani","sequence":"additional","affiliation":[{"name":"Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Giani","sequence":"additional","affiliation":[{"name":"Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5235-1545","authenticated-orcid":false,"given":"Elena","family":"Zoico","sequence":"additional","affiliation":[{"name":"Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Babbanini","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, Dentistry, Pediatric and Gynecology, Healthy Aging Center, University of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1763-6024","authenticated-orcid":false,"given":"Francesco","family":"Fantin","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, University of Trento, 38100 Trento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Zamboni","sequence":"additional","affiliation":[{"name":"Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria","family":"Mazzali","sequence":"additional","affiliation":[{"name":"Department of Medicine, Geriatrics Division, University of Verona, 37100 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1093\/gerona\/glx245","article-title":"Associations of Sarcopenia Definitions, and Their Components, with the Incidence of Recurrent Falling and Fractures: The Longitudinal Aging Study Amsterdam","volume":"73","author":"Schaap","year":"2018","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_2","first-page":"16","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis","volume":"48","author":"Bahat","year":"2018","journal-title":"Age Ageing"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1093\/epirev\/mxs006","article-title":"Adiposity, muscle mass, and muscle strength in relation to functional decline in older persons","volume":"35","author":"Schaap","year":"2013","journal-title":"Epidemiol. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s40814-016-0067-x","article-title":"A feasibility study of implementing grip strength measurement into routine hospital practice (GRImP): Study protocol","volume":"2","author":"Ibrahim","year":"2016","journal-title":"Pilot. Feasibility Stud."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/S0140-6736(14)62000-6","article-title":"Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study","volume":"386","author":"Leong","year":"2015","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.jamda.2023.05.012","article-title":"The Role of Ultrasound Muscle Parameters for Myosteatosis and Myofibrosis Measurement in Young, Older, and Obese Subjects","volume":"25","author":"Rossi","year":"2024","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s41999-020-00433-9","article-title":"Application of ultrasound for muscle assessment in sarcopenia: 2020 SARCUS update","volume":"12","author":"Perkisas","year":"2021","journal-title":"Eur. Geriatr. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3245","DOI":"10.2174\/13816128113196660694","article-title":"The multidomain mobility lab in older persons: From bench to bedside. The assessment of body composition in older persons at risk of mobility limitations","volume":"20","author":"Rossi","year":"2014","journal-title":"Curr. Pharm. Des."},{"key":"ref_9","first-page":"2767232","article-title":"Bedside Ultrasound Measurement of Rectus Femoris: A Tutorial for the Nutrition Support Clinician","volume":"2017","year":"2017","journal-title":"J. Nutr. Metab."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1111\/j.1475-097X.2011.01057.x","article-title":"Component characteristics of thigh muscle volume in young and older healthy men","volume":"32","author":"Ogawa","year":"2012","journal-title":"Clin. Physiol. Funct. Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1152\/japplphysiol.90332.2008","article-title":"Muscle fiber size and function in elderly humans: A longitudinal study","volume":"105","author":"Frontera","year":"2008","journal-title":"J. Appl. Physiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1007\/s11357-013-9600-5","article-title":"Age-related site-specific muscle wasting of upper and lower extremities and trunk in Japanese men and women","volume":"36","author":"Abe","year":"2014","journal-title":"Age"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/2046-2395-3-9","article-title":"It is not just muscle mass: A review of muscle quality, composition and metabolism during ageing as determinants of muscle function and mobility in later life","volume":"3","author":"McGregor","year":"2014","journal-title":"Longev. Healthspan"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.ultrasmedbio.2008.09.016","article-title":"Skeletal muscle ultrasound: Correlation between fibrous tissue and echo intensity","volume":"35","author":"Pillen","year":"2009","journal-title":"Ultrasound Med. Biol."},{"key":"ref_15","first-page":"73","article-title":"Skeletal muscle sonography: A correlative study of echogenicity and morphology","volume":"12","author":"Reimers","year":"1993","journal-title":"J. Ultrasound Med. Off. J. Am. Inst. Ultrasound Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/j.clnu.2014.07.010","article-title":"Assessing appendicular skeletal muscle mass with bioelectrical impedance analysis in free-living Caucasian older adults","volume":"34","author":"Sergi","year":"2015","journal-title":"Clin. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.archger.2013.11.002","article-title":"Assessment of appendicular skeletal muscle mass by bioimpedance in older community-dwelling Korean adults","volume":"58","author":"Kim","year":"2014","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.archger.2015.03.007","article-title":"Accuracy of a predictive bioelectrical impedance analysis equation for estimating appendicular skeletal muscle mass in a non-Caucasian sample of older people","volume":"61","year":"2015","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/S0261-5614(03)00048-7","article-title":"Validation of a bioelectrical impedance analysis equation to predict appendicular skeletal muscle mass (ASMM)","volume":"22","author":"Kyle","year":"2003","journal-title":"Clin. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Yu, S.C.Y., Powell, A., Khow, K.S.F., and Visvanathan, R. (2016). The Performance of Five Bioelectrical Impedance Analysis Prediction Equations against Dual X-ray Absorptiometry in Estimating Appendicular Skeletal Muscle Mass in an Adult Australian Population. Nutrients, 8.","DOI":"10.3390\/nu8040189"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1152\/jappl.1986.60.4.1327","article-title":"Validation of tetrapolar bioelectrical impedance method to assess human body composition","volume":"60","author":"Lukaski","year":"1986","journal-title":"J. Appl. Physiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"612","DOI":"10.3945\/ajcn.2010.29215","article-title":"Cutoff percentiles of bioelectrical phase angle predict functionality, quality of life, and mortality in patients with cancer","volume":"92","author":"Norman","year":"2010","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1016\/j.clnu.2012.05.008","article-title":"Bioelectrical phase angle and impedance vector analysis--clinical relevance and applicability of impedance parameters","volume":"31","author":"Norman","year":"2012","journal-title":"Clin. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1177\/0884533617728487","article-title":"Bioelectrical Impedance Analysis-Derived Measurements in Chronic Hepatitis C: Clinical Relevance of Fat-Free Mass and Phase Angle Evaluation","volume":"33","author":"Bering","year":"2018","journal-title":"Nutr. Clin. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.rmed.2017.11.006","article-title":"Malnutrition and sarcopenia assessment in patients with chronic obstructive pulmonary disease according to international diagnostic criteria, and evaluation of raw BIA variables","volume":"134","author":"Bianco","year":"2018","journal-title":"Respir. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1002\/ncp.10110","article-title":"Association Between Standardized Phase Angle, Nutrition Status, and Clinical Outcomes in Surgical Cancer Patients","volume":"34","author":"Pena","year":"2019","journal-title":"Nutr. Clin. Pract."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/ageing\/afr051","article-title":"A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach","volume":"40","author":"Roberts","year":"2011","journal-title":"Age Ageing"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1038\/ejcn.2016.159","article-title":"Inflammation and nutritional status as predictors of physical performance and strength loss during hospitalization","volume":"70","author":"Rossi","year":"2016","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the Areas under Two or More Correlated Receiver Operating Characteristic Curves: A Nonparametric Approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2377","DOI":"10.1007\/s11357-013-9517-z","article-title":"Association between ultrasound measurements of muscle thickness, pennation angle, echogenicity and skeletal muscle strength in the elderly","volume":"35","author":"Strasser","year":"2013","journal-title":"Age"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.1152\/japplphysiol.00433.2003","article-title":"Effect of aging on human muscle architecture","volume":"95","author":"Narici","year":"2003","journal-title":"J. Appl. Physiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1093\/ajcn\/81.4.903","article-title":"Adipose tissue in muscle: A novel depot similar in size to visceral adipose tissue","volume":"81","author":"Gallagher","year":"2005","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"D\u2019Souza, K., Mercer, A., Mawhinney, H., Pulinilkunnil, T., Udenigwe, C.C., and Kienesberger, P.C. (2020). Whey peptides stimulate differentiation and lipid metabolism in adipocytes and ameliorate lipotoxicity-induced insulin resistance in muscle cells. Nutrients, 12.","DOI":"10.3390\/nu12020425"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Nishioka, S. (2023). Current Understanding of Sarcopenia and Malnutrition in Geriatric Rehabilitation. Nutrients, 15.","DOI":"10.3390\/nu15061426"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Curtis, M., Swan, L., Fox, R., Warters, A., and O\u2019Sullivan, M. (2023). Associations between Body Mass Index and Probable Sarcopenia in Community-Dwelling Older Adults. Nutrients, 15.","DOI":"10.3390\/nu15061505"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.pmrj.2015.09.014","article-title":"Ultrasound-Based Detection of Low Muscle Mass for Diagnosis of Sarcopenia in Older Adults","volume":"8","author":"Minetto","year":"2016","journal-title":"PM R"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.1007\/s00421-011-2099-5","article-title":"Skeletal muscle quality assessed from echo intensity is associated with muscle strength of middle-aged and elderly persons","volume":"112","author":"Fukumoto","year":"2012","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1212\/WNL.25.9.879","article-title":"Distinct subtypes of type I fibers of human skeletal muscle","volume":"25","author":"Askanas","year":"1975","journal-title":"Neurology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"C638","DOI":"10.1152\/ajpcell.1997.272.2.C638","article-title":"Effects of aging on shortening velocity and myosin isoform composition in single human skeletal muscle cells","volume":"272","author":"Larsson","year":"1997","journal-title":"Am. J. Physiol.-Cell Physiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1111\/j.1748-1716.1983.tb00024.x","article-title":"Histochemical characteristics of human skeletal muscle during aging","volume":"117","author":"Larsson","year":"1983","journal-title":"Acta Physiol. Scand."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.archger.2013.06.001","article-title":"Myosteatosis and myofibrosis: Relationship with aging, inflammation and insulin resistance","volume":"57","author":"Zoico","year":"2013","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Ismail, C., Zabal, J., Hernandez, H.J., Woletz, P., Manning, H., Teixeira, C., DiPietro, L., Blackman, M.R., and Harris-Love, M.O. (2015). Diagnostic ultrasound estimates of muscle mass and muscle quality discriminate between women with and without sarcopenia. Front. Physiol., 6.","DOI":"10.3389\/fphys.2015.00302"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/S0022-510X(96)00037-8","article-title":"Calf enlargement in neuromuscular diseases: A quantitative ultrasound study in 350 patients and review of the literature","volume":"143","author":"Reimers","year":"1996","journal-title":"J. Neurol. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1002\/mus.22254","article-title":"Intramuscular fibrous tissue determines muscle echo intensity in amyotrophic lateral sclerosis","volume":"45","author":"Arts","year":"2012","journal-title":"Muscle Nerve"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1007\/s40520-019-01413-1","article-title":"Changes in the bioelectrical impedance parameters estimating appendicular skeletal muscle mass in healthy older persons","volume":"32","author":"Ignasiak","year":"2020","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"585","DOI":"10.2147\/CIA.S38488","article-title":"The potential of classic and specific bioelectrical impedance vector analysis for the assessment of sarcopenia and sarcopenic obesity","volume":"7","author":"Marini","year":"2012","journal-title":"Clin. Interv. Aging"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.clnesp.2019.05.003","article-title":"Phase angle as a marker for sarcopenia in cirrhosis","volume":"32","author":"Waitzberg","year":"2019","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1002\/jpen.1830","article-title":"Role of ultrasonography in estimating muscle mass in sarcopenic obesity","volume":"44","author":"Deniz","year":"2020","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"111692","DOI":"10.1016\/j.nut.2022.111692","article-title":"The role of muscle ultrasound to predict sarcopenia","volume":"101","author":"Ozturk","year":"2022","journal-title":"Nutrition"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s12603-018-1151-0","article-title":"Phase Angle is a Useful indicator for Muscle Function in Older Adults","volume":"23","author":"Yamada","year":"2019","journal-title":"J. Nutr. Health Aging"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1038\/s41598-019-57195-z","article-title":"Association of sarcopenia with phase angle and body mass index in kidney transplant recipients","volume":"10","author":"Kosoku","year":"2020","journal-title":"Sci. Rep."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/15\/2429\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:24:03Z","timestamp":1760109843000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/15\/2429"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,26]]},"references-count":51,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["nu16152429"],"URL":"https:\/\/doi.org\/10.3390\/nu16152429","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,26]]}}}