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In 2013, SARC‐F was developed by the group at Saint Louis University to provide a rapid screening test to allow the recognition of the possible diagnosis of sarcopenia [5] (Table 6.1). This screener was developed with the recognition that functional deterioration of activities requiring muscle activity is the hallmark of sarcopenia. The screener can either be self‐administered or administered by the person responsible for rooming the patient. It takes less than 30 seconds to complete.

Table 6.1 SARC‐F screen for sarcopenia.

Component	Question	Scoring
Strength	How much difficulty do you have in lifting and carrying 10 pounds?	None = 0 Some = 1 A lot or unable = 2
Assistance in walking	How much difficulty do you have walking across a room?	None = 0 Some = 1 A lot, use aids, or unable = 2
Rise from a chair	How much difficulty do you have transferring from a chair or bed?	None = 0 Some = 1 A lot or unable without help = 2
Climb stairs	How much difficulty do you have climbing a flight of 10 stairs?	None = 0 Some = 1 A lot or unable = 2
Falls	How many times have you fallen in the past year?	None = 0 1–3 falls = 1 ≥4 falls = 2

The original validation of SARC‐F was completed in 230 persons in China [6]. SARC‐F was correlated with impaired physical performance and grip strength as well as hospitalizations. Woo et al. [7, 8] compared SARC‐F to working definitions for sarcopenia (Asian, European, and International) in 4000 community dwellers in Hong Kong. SARC‐F had good specificity and poor sensitivity. Equivalent predictive ability of functional measures at four years was compared to working definitions. It also predicted mortality.

Malmstrom et al. [9] evaluated SARC‐F in the St. Louis African American Health Study (AAH), the Baltimore Longitudinal Study of Aging (BLSA) and in the National Health and Nutrition Examination Survey. They found that SARC‐F had internal consistency and good criterion and construct validity. In all three groups it had a good correlation with functional performance and mortality at six years. In the BLSA it predicted mortality.

Tanaka et al. [10] studied a group of patients with cardiovascular disease. They found that an elevated SARC‐F score was associated with lower handgrip and leg strength, respiratory muscle strength, poorer standing balance, slow gait speed and six‐minute walking distance, and lower short physical performance battery (SPPB) score.

A meta‐analysis of seven studies including 12 800 subjects showed that SARC‐F has a high specificity but poor sensitivity, suggesting it is a reasonable screening test for sarcopenia [11]. SARC‐F has been validated in China [6], Hong Kong [7, 8, 12], United States [9, 13], Japan [10, 14–17], Taiwan [18], Mexico [19], Germany [20], France [21], Singapore [22], Korea [23], Austria [24], Turkey [25, 26], Spain [16, 27], and Belgium [28] (Table 6.2).

Table 6.2 Validations of SARC‐F.

Author	Country	n	Outcomes
Cao et al. [6]	China	230	Predicts poor function, grip strength, and hospitalization
Woo et al. [7, 8]	Hong Kong	4000	Good specificity compared with Asian and European working definitions – predictive of function (gait speed, grip strength, and repeated chair stand) at 4 years and mortality at 10 years
Malmstrom [9]	United States: St. Louis United States: Baltimore United States: NHANES	998 1053 3288	Instrumental activities of daily living (IADL) deficits, slower chair stands, lower grip strength, lower short physical performance battery scores (cross‐sectionally) and predicted poor IADL deficits, poor physical performance and 6‐year hospitalization IADL deficits, lower grip strength at baseline, and mortality at two‐month follow‐up Slower walk speed, knee extensor strength at baseline, and mortality at 27‐month follow‐up
Tanaka [10]	Japan	235	Lower grip, leg and respiratory muscle strength, poorer gait speed and walking distance, and poorer balance and SPPB
Wu [18]	Taiwan	670	Low grip strength and lean mass, poor quality of life, and hospitalization and mortality
Parra‐Rodriguez [19]	Mexico	487	Reliability. ADL deficits, low gait speed, poor grip strength, lower SPPB
Ida [14]	Japan	207	Specificity (85.8% men and 72.4% women); sensitivity (14.8 and 33.3%) to EWGOS
Kemmler [20]	Germany	74	Diagnostic overlap equivalent for SARC‐F to EWGSOP, FNIH, IWGS
Rolland [21]	France	504	Specificity 85% versus FNIH; lower physical performance
Tan [22]	Singapore	115	More than two hospitalization in a year; higher rate of falls
Kotiarczyk [13]	United States	141	Specificity versus EWGSOP 78.7% and versus FNIH 81.1%, low sensitivity
Kim [23]	Korea	1222	High specificity versus Asian sarcopenia. Poor grip strength, slow walking speed, lower quality of life, poor cognitive performance
Ida [15]	Japan	140	High specificity (90.89–95.5%) and predictive value (81.5%) in chronic liver disease
Peball [24]	Austria	434	High prevalence in Parkinson disease compared with the controls
Bahat [25]	Turkey	207	High specificity and low sensitivity versus EWGSOP, FNIH, IWGS, Society of sarcopenia, cachexia and wasting disorders (SCWD). High specificity for muscle mass, handgrip, SPPB, and sit to stand
Su [12]	Hong Kong	4000	SARC‐F with FRAX has an increased ability to predict hip fracture
Ida [16]	Japan	318	SARC‐F associated with sleep disorder
Requena‐Calleja [29]	Spain	596	SARC‐F increases mortality in persons with atrial fibrillation
Nozoe [17]	Japan	183	SARC‐F predicts severe stroke
Sanchez‐Rodriguez [27]	Spain	208	SARC‐F is useful to identify sarcopenic patients in outpatients
Tuna [26]	Turkey	56	Correlates with poor sleep quality
Hajaoui [28]	Belgium	306	Specificity of 87.1% and sensitivity of 36.0% compared with EWGSOP1

ADL, activities of daily living; EWGSOP, European Working Group on Sarcopenia in Older People; FNIH, Foundation for the National Institutes of Health; IWGS, International Working Group on Sarcopenia; SPPB, short physical performance battery.

Woo et al. [30] reported that a three‐item scale (strength, ability to climb stairs, and need for assistance in walking) had a better diagnostic area under the curve and better predictive value of bad outcomes compared with the five‐item SARC‐F. Lim et al. [31] studied 200 participants in Singapore and felt that the shorter version was not superior to the full SARC‐F. They did suggest that the falls item was not an important factor in making the diagnosis. Yang et al. [32] found that the three‐item questionnaire had a worse area under the curve than the SARC‐F.

Barbosa‐Silva et al. [33] found that calf circumference together with SARC‐F had greatly improved sensitivity when compared with SARC‐F alone with the European Working Group on Sarcopenia in Older People (EWGSOP) as a gold standard. Bahat et al. [34] found that SARC‐F plus calf circumference improved specificity but not sensitivity when compared with SARC‐F. In 120 participants in Indonesia, SARC‐F plus calf circumference had good diagnostic performance for sarcopenia [35]. Mo et al. [36] in a meta‐analysis found that SARC‐CalF has excellent accuracy with moderate sensitivity as a diagnostic tool for sarcopenia.

Overall, these studies support the concept that SARC‐F or SARC‐CalF is a good screening tool for sarcopenia. Adding age and body mass index may further enhance its accuracy [37].