Sarcopenia, sarcopenic obesity, and functional impairments in older adults: National Health and Nutrition Examination Surveys 1999-2004
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The Foundation for the National Institutes of Health Sarcopenia Project validated cutpoints for appendicular lean mass (ALM) to identify individuals with functional impairment. We hypothesized that the prevalence of sarcopenia and sarcopenic obesity would be similar based on the different Foundation for the National Institutes of Health criteria, increase with age, and be associated with risk of impairment limitations. We identified 4984 subjects at least 60 years of age from the National Health and Nutrition Examination Surveys 1999-2004. Sarcopenia was defined using ALM (men <19.75 kg, women <15.02 kg) and ALM adjusted for body mass index (BMI; men <0.789 kg/m2, women <0.512 kg/m2). Sarcopenic obesity is defined as subjects fulfilling the criteria for sarcopenia and obesity by body fat (men ≥25%, women ≥35%). Prevalence rates of both sarcopenia and sarcopenic obesity were evaluated with respect to sex, age category (60-69, 70-79, and >80 years) and race. We assessed the association of physical limitations, basic and instrumental activities of daily living and sarcopenia status. The mean age was 70.5 years in men and 71.6 years in women. Half (50.8%; n = 2531) were female, and mean BMI was 28 kg/m2 in both sexes. Appendicular lean mass was higher in men than in women (24.1 vs. 16.3; P < .001), but fat mass was lower (30.9 vs. 42.0; P < .001). In men, sarcopenia prevalence was 16.0% and 27.8% using the ALM and ALM/BMI criteria. In women, prevalence was 40.5% and 19.3% using the ALM and ALM/BMI criteria. Sarcopenia was associated with a 1.10 (0.86-1.41) and 0.93 (0.74-1.16), and 1.46 (1.10-1.94), and 2.13 (1.41-3.20) risk of physical limitations using the ALM and ALM/BMI definitions in men and women, respectively. Prevalence of sarcopenia and sarcopenic obesity varies greatly, and a uniform definition is needed to identify and characterize these high-risk populations.
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Further validation of bioelectrical impedance results is needed in individuals aged 80 years and older because they are at increased risk of sarcopenic obesity.
“Further validation of bioelectrical impedance results is needed in individuals aged ≥80 years, as they are at increased risk of sarcopenic obesity177,178.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [177]
The Results report that sarcopenic obesity prevalence increased with age, supporting the concern about older individuals. The Methods say body composition was measured with DEXA, and the Discussion mentions bioelectrical impedance only as an approach used elsewhere; neither section calls for further validation of its results in people aged ≥80 years. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAltered muscle function is associated with global individual functional impairment, reduced quality of life, and shorter survival.
“Although skeletal muscle mass per se may be relevant for metabolic outcomes, altered muscle function is indeed associated with global individual functional impairment, reduced quality of life, and shorter survival [90,91].”
From Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement (2022) · cites this paper as [90]
The Introduction links impaired function in older adults to mortality and compromised quality of life, and the Discussion identifies muscle function or strength as important to studying sarcopenia. But the paper does not establish the claimed association between altered muscle function and all three outcomes: the Discussion says the dataset lacked strength data, and the mortality and quality-of-life statement concerns impaired function generally. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn a 14-year prospective study of older adults (n = 4,652) more than 60 years of age from NHANES III, the prevalence rates of sarcopenic obesity were 18.1% in women and 42.9% in men.
“In a 14-year prospective study of older adults (n = 4,652) more than 60 years of age by the National Health and Nutrition Examination Survey (NHANES) III, the prevalence rates of sarcopenic obesity were 18.1% in women and 42.9% in men (31).”
From Health Consequences of Sarcopenic Obesity: A Narrative Review (2020) · cites this paper as [31]
Myosteatosis is recognized to negatively correlate with skeletal muscle mass and strength, as well as with systemic metabolic derangements including insulin resistance and type 2 diabetes, and with mobility, thereby being of prognostic relevance.
“Myosteatosis is indeed recognized to negatively correlate with skeletal muscle mass and strength, as well as with systemic metabolic derangements including insulin resistance and type 2 diabetes, and with mobility, thereby being of prognostic relevance [85-87].”
From Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement (2022) · cites this paper as [86]
Skeletal muscle quality may be profoundly altered in people with obesity, particularly in terms of ectopic fat deposition (e.g., myosteatosis) which may be highly prevalent in the presence of excess body fat.
“Skeletal muscle quality: among other specific issues, skeletal muscle quality may be profoundly altered in people with obesity, particularly in terms of ectopic fat deposition (e.g., myosteatosis) which may be highly prevalent in the presence of excess body fat.”
From Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement (2022) · cites this paper as [86]
Discrepancies in muscle mass and function may be due, at least in part, to current methodological limitations in accurate assessment of skeletal muscle mass.
“Discrepancies in muscle mass and function may also be due, at least in part, to current methodological limitations in accurate assessment of skeletal muscle mass [86].”
From Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement (2022) · cites this paper as [86]
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References 36 · Cited by 203
- Authors
- Batsis, J. A., Mackenzie, T. A., Lopez-Jimenez, F., & Bartels, S. J.
- Affiliations
- Dartmouth College (US)
- Dartmouth Institute for Health Policy and Clinical Practice (US)
- Corresponding author
- Batsis, John A.
- Venue
- Nutrition Research
- Publisher
- Elsevier BV
- Published
- 2015-12
- Volume
- 35
- Issue
- 12
- Pages
- 1031-1039
- ISSN
- 0271-5317 (ISSN-L)
- PMC
- PMC4825802
- OpenAlex
- W1444047467
- Cited by
- 203
- References
- 36
- Citations by year
- 2026: 10 · 2025: 19 · 2024: 17 · 2023: 22 · 2022: 20 · 2021: 20 · 2020: 17 · 2019: 25 · 2018: 28 · 2017: 19 · 2016: 5 · 2015: 1
- FWCI
- 13.02
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Nutrition Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Agency for Healthcare Research and Quality (K12 HS0217695)
- National Institute of Mental Health (R24MH102794, R01MH089811, T32MH073553, R01MH078052)
- National Center for Chronic Disease Prevention and Health Promotion (U48DP005018)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- sarcopenia, sarcopenic obesity, older adults, appendicular lean mass, functional disability, activities of daily living, instrumental activities of daily living, sarcopenia prevalence, sex differences, racial differences, body mass index adjustment, physical limitations
- MeSH terms
- Activities of Daily Living, Adipose Tissue, Age Factors, Aged, Aged, 80 and over, Aging, Body Composition, Body Fluid Compartments, Female, Humans, Male, Middle Aged, Nutrition Surveys, Obesity, United States, Absorptiometry, Photon, Body Mass Index, Prevalence, Sarcopenia
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