The current guide to assessing Sarcopenia among older patients uses guidelines developed in Europe and North America. The SWAG SARCO guideline is the first South Asian guideline to address this issue. I have summarized the SWAG SARCO approach into 7 steps to make it easy to understand and implement.

Step 1: SUSPECT, Sarcopenia should be suspected in older patients visiting Diabetic/ Neurology/ Endocrine/Fracture/Geriatric and other clinics.

Step 2: SCREEN, Easy screening tools like the SARC-F questionnaire or Ishii’s formula should be used to screen suspected patients. The SWAG SARCO group recommends the SARC-F questionnaire for screening.

Step 3: ASSESS MUSCLE STRENGTH. Multiple studies in the last decade have suggested that muscle strength assessments rather than muscle mass assessments are more indicative of adverse outcomes, including falls, fractures and major adverse CV events. The SWAG SARCO recommends the HANDGRIP STRENGTH (HGS) assessment as the choice for assessment of muscle strength using the Southampton protocol.

Step 4: USE ETHNICITY SPECIFIC CUT OFFS for interpretation of HGS data. For South Asians, the SWAG SARCO guideline suggests a cutoff of <27.5 kg (Male) and <18 kg (Female).

Step 5: ASSESS MUSCLE MASS. European guidelines suggest using CT/MRI/DEXA/BIA to assess muscle mass which is not feasible in South Asia. The SWAG SARCO guideline recommends the assessment of calf muscle circumference as an indirect assessment of muscle mass. The cut-off recommended by the guideline is <34 cm (Male) and <33 cm (Female).

Step 6: ASSESS MUSCLE FUNCTION. For muscle function, the SWAG SARCO guideline suggests the use of GAIT SPEED assessment using a 4-meter gait assessment. The cut-off gait speed to imply poor function for Indians is ≤0.8 m/sec (Male and Female).

Step 7: INTERPRET. The final step is interpreting the above data. The presence of two out of three abnormal assessments among strength, mass and function leads to a diagnosis of Sarcopenia. The presence of abnormal assessments in all three domains suggests severe Sarcopenia.