Sarcopenia and Sarcopenic Obesity and Mortality Among Older People
Open accessAbstract
Importance: Sarcopenia and obesity are 2 global concerns associated with adverse health outcomes in older people. Evidence on the population-based prevalence of the combination of sarcopenia with obesity (sarcopenic obesity [SO]) and its association with mortality are still limited. Objective: To investigate the prevalence of sarcopenia and SO and their association with all-cause mortality. Design, Setting, and Participants: This large-scale, population-based cohort study assessed participants from the Rotterdam Study from March 1, 2009, to June 1, 2014. Associations of sarcopenia and SO with all-cause mortality were studied using Kaplan-Meier curves, Cox proportional hazards regression, and accelerated failure time models fitted for sex, age, and body mass index (BMI). Data analysis was performed from January 1 to April 1, 2023. Exposures: The prevalence of sarcopenia and SO, measured based on handgrip strength and body composition (BC) (dual-energy x-ray absorptiometry) as recommended by current consensus criteria, with probable sarcopenia defined as having low handgrip strength and confirmed sarcopenia and SO defined as altered BC (high fat percentage and/or low appendicular skeletal muscle index) in addition to low handgrip strength. Main Outcome and Measure: The primary outcome was all-cause mortality, collected using linked mortality data from general practitioners and the central municipal records, until October 2022. Results: In the total population of 5888 participants (mean [SD] age, 69.5 [9.1] years; mean [SD] BMI, 27.5 [4.3]; 3343 [56.8%] female), 653 (11.1%; 95% CI, 10.3%-11.9%) had probable sarcopenia and 127 (2.2%; 95% CI, 1.8%-2.6%) had confirmed sarcopenia. Sarcopenic obesity with 1 altered component of BC was present in 295 participants (5.0%; 95% CI, 4.4%-5.6%) and with 2 altered components in 44 participants (0.8%; 95% CI, 0.6%-1.0%). An increased risk of all-cause mortality was observed in participants with probable sarcopenia (hazard ratio [HR], 1.29; 95% CI, 1.14-1.47) and confirmed sarcopenia (HR, 1.93; 95% CI, 1.53-2.43). Participants with SO plus 1 altered component of BC (HR, 1.94; 95% CI, 1.60-2.33]) or 2 altered components of BC (HR, 2.84; 95% CI, 1.97-4.11) had a higher risk of mortality than those without SO. Similar results for SO were obtained for participants with a BMI of 27 or greater. Conclusions and Relevance: In this study, sarcopenia and SO were found to be prevalent phenotypes in older people and were associated with all-cause mortality. Additional alterations of BC amplified this risk independently of age, sex, and BMI. The use of low muscle strength as a first step of both diagnoses may allow for early identification of individuals at risk for premature mortality.
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Differential changes in the phenotypic criteria of SO have been generally gone undetected in terms of their impact on adverse health outcomes.
“Differential changes in the phenotypic criteria of SO have been generally gone undetected in terms of their impact on adverse health outcomes [1, 2, 3].”
From Sarcopenic Obesity Phenotype Index (SOP <i>i</i> ): A Population‐Based Study (2025) · cites this paper as [3]
The Introduction (page unavailable) says that SO’s association with mortality in the general population remained unknown. The Discussion (page unavailable) says this study expanded prior findings by examining combinations of altered body-composition components and low muscle function. That supports a gap in evidence about these criteria and mortality, but not the broader assertion that their effects on adverse health outcomes had generally gone undetected. (LLM, conf=0.78)
Experimental — accuracy not yet measuredSarcopenic obesity (SO) is a clinical condition defined by the coexistence of high body fat mass and low muscle function and mass, and it increases the risk of adverse health outcomes, including disability and mortality.
“Sarcopenic obesity (SO) is a clinical condition defined by the coexistence of high body fat mass and low muscle function and mass, which increases the risk of adverse health outcomes, including disability and mortality.”
From Sarcopenic Obesity Phenotype Index (SOP <i>i</i> ): A Population‐Based Study (2025) · cites this paper as [3]
The Introduction describes sarcopenic obesity as obesity occurring alongside low muscle function and mass, and the Conclusions report an association with increased all-cause mortality in older people. The paper mentions risk of functional deficiencies but does not establish an increased risk of disability. Its diagnostic criteria also allow high body fat and/or low muscle mass, rather than requiring both. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThere is a group of persons who are at risk of adverse health outcomes without clinically present SO.
“Nevertheless, it seems that there is a group of persons who are at risk of adverse health outcomes without clinically present SO [3].”
From Sarcopenic Obesity Phenotype Index (SOP <i>i</i> ): A Population‐Based Study (2025) · cites this paper as [3]
Sarcopenic obesity is associated with increased all-cause mortality.
“Sarcopenic obesity poses increased risk of a range of adverse outcomes, including a potential increase in fractures among those using GLP-1 therapy (particularly among women) [5] and all-cause mortality [7], yet may not be as readily apparent in those with obesity compared to normal-weight individuals.”
From Reply to GM Tinsley et al.; DB Ibsen et al.; and EJ Dhurandhar et al. (2025) · cites this paper as [7]
Sarcopenic obesity is linked to a higher risk of several adverse outcomes.
“Sarcopenic obesity poses increased risk of a range of adverse outcomes, including a potential increase in fractures among those using GLP-1 therapy (particularly among women) [5] and all-cause mortality [7], yet may not be as readily apparent in those with obesity compared to normal-weight individuals.”
From Reply to GM Tinsley et al.; DB Ibsen et al.; and EJ Dhurandhar et al. (2025) · cites this paper as [7]
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References 55 · Cited by 261
Research works printed but not linked: 3
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- Authors
- Benz, E., Pinel, A., Guillet, C., Capel, F., Pereira, B., De Antonio, M., Pouget, M., Cruz-Jentoft, A. J., Eglseer, D., Topinkova, E., Barazzoni, R., Rivadeneira, F., Ikram, M. A., Steur, M., Voortman, T., Schoufour, J. D., Weijs, P. J. M., & Boirie, Y.
- Affiliations
- Université Clermont Auvergne (FR)
- Human Nutrition Unit, Clermont Auvergne University, Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, Centre de Recherche en Nutrition Humaine, Clermont-Ferrand, France
- Centre Hospitalier Universitaire de Clermont-Ferrand (FR)
- Unit of Biostatistics, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Department of Clinical Nutrition, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
- Instituto Ramón y Cajal de Investigación Sanitaria (ES)
- Medical University of Graz (AT)
- Department of Geriatrics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- University of Trieste (IT)
- Erasmus MC (NL)
- Amsterdam University of Applied Sciences (NL)
- Amsterdam Public Health (NL)
- ORCID
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2024-03-25
- Volume
- 7
- Issue
- 3
- Pages
- e243604
- ISSN
- 2574-3805 (ISSN-L)
- OpenAlex
- W4393144213
- Cited by
- 261
- References
- 55
- Citations by year
- 2026: 105 · 2025: 121 · 2024: 35
- FWCI
- 74.28
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by)
- Pure Amsterdam UMC (acceptedVersion, cc-by)
- HAL (submittedVersion, cc-by)
- ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, cc-by)
- Funders
- Univerzita Karlova v Praze
- Joint Programming Initiative A healthy diet for a healthy life (727565)
- Amsterdam University Medical Centers
- European Commission (727565, HORIZON2020)
- Agence Nationale de la Recherche (ANR-20-HDH2-0001, 727565)
- ZonMw (727565)
- Erasmus Medisch Centrum
- Österreichische Forschungsförderungsgesellschaft
- lékařská fakulta Univerzity Karlovy
- Agencia Estatal de Investigación
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Keywords
- sarcopenia, sarcopenic obesity, all-cause mortality, older adults, grip strength, body composition, appendicular skeletal muscle mass index, body fat percentage, prevalence, mortality risk, Rotterdam Study, body mass index, sex differences, accelerated failure time model, dual-energy X-ray absorptiometry, mortality prediction model, frailty, multimorbidity
- MeSH terms
- Aged, Female, Humans, Male, Obesity, Cohort Studies, Hand Strength, Muscle Strength, Sarcopenia
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