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.

Department of Clinical Nutrition Clermont Ferrand University Hospital Clermont Ferrand France

Department of Epidemiology Erasmus University Medical Center Rotterdam the Netherlands

Department of Geriatrics 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Internal Medicine Erasmus University Medical Center Rotterdam the Netherlands

Department of Medical Technological and Translational Sciences University of Trieste Ospedale di Cattinara Trieste Italy

Department of Nutrition and Dietetics Amsterdam University Medical Centers Amsterdam Public Health Institute Vrije Universiteit Amsterdam the Netherlands

Faculty of Sports and Nutrition Centre of Expertise Urban Vitality Amsterdam University of Applied Sciences Amsterdam the Netherlands

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

Institute of Nursing Science Medical University of Graz Graz Austria

Servicio de Geriatria Hospital Universitario Ramon y Cajal Madrid Spain

Unit of Biostatistics Clermont Ferrand University Hospital Clermont Ferrand France

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Cruz-Jentoft AJ, Sayer AA. Sarcopenia. Lancet. 2019;393(10191):2636-2646. doi:10.1016/S0140-6736(19)31138-9 PubMed DOI

Beaudart C, Zaaria M, Pasleau F, Reginster JY, Bruyère O. Health outcomes of sarcopenia: a systematic review and meta-analysis. PLoS One. 2017;12(1):e0169548. doi:10.1371/journal.pone.0169548 PubMed DOI PMC

Donini LM, Busetto L, Bischoff SC, et al. . Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement. Obes Facts. 2022;15(3):321-335. doi:10.1159/000521241 PubMed DOI PMC

Bahat G, Kilic C, Ozkok S, Ozturk S, Karan MA. Associations of sarcopenic obesity versus sarcopenia alone with functionality. Clin Nutr. 2021;40(5):2851-2859. doi:10.1016/j.clnu.2021.04.002 PubMed DOI

Batsis JA, Haudenschild C, Crow RS, Gilliam M, Mackenzie TA. Sarcopenia definition outcome consortium—defined weakness and risk of falls: the National Health and Aging Trends Survey. Geriatr Gerontol Int. 2023;23(3):213-220. doi:10.1111/ggi.14548 PubMed DOI PMC

Barazzoni R, Bischoff SC, Boirie Y, et al. . Sarcopenic obesity: time to meet the challenge. Clin Nutr. 2018;37(6, pt A):1787-1793. doi:10.1016/j.clnu.2018.04.018 PubMed DOI

Bischoff SC, Boirie Y, Cederholm T, et al. . Towards a multidisciplinary approach to understand and manage obesity and related diseases. Clin Nutr. 2017;36(4):917-938. doi:10.1016/j.clnu.2016.11.007 PubMed DOI

World Health Federation. World Obesity Atlas 2022. Updated December 13, 2022. Accessed February 8, 2024. https://www.worldobesity.org/resources/resource-library/world-obesity-atlas-2022

Prado CM, Landi F, Chew STH, et al. . Advances in muscle health and nutrition: a toolkit for healthcare professionals. Clin Nutr. 2022;41(10):2244-2263. doi:10.1016/j.clnu.2022.07.041 PubMed DOI

Bahat G. Sarcopenic obesity: a hot yet under considered evolving concept. Eur Geriatr Med. 2022;13(5):1023-1024. doi:10.1007/s41999-022-00674-w PubMed DOI

Polyzos SA, Mantzoros CS. Sarcopenia: still in relative definition-penia and severe treatment-penia. Metabolism. 2024;150:155717. doi:10.1016/j.metabol.2023.155717 PubMed DOI

Cruz-Jentoft AJ, Bahat G, Bauer J, et al. ; Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2 . Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. doi:10.1093/ageing/afy169 PubMed DOI PMC

Cruz-Jentoft AJ, Montero-Errasquín B, Morley JE. Definitions of sarcopenia. Sarcopenia. John Wiley & Sons Ltd.; 2021:1-9.10.1002/9781119597896 DOI

Fernandes LV, Paiva AEG, Silva ACB, et al. . Prevalence of sarcopenia according to EWGSOP1 and EWGSOP2 in older adults and their associations with unfavorable health outcomes: a systematic review. Aging Clin Exp Res. 2022;34(3):505-514. doi:10.1007/s40520-021-01951-7 PubMed DOI

Gao Q, Mei F, Shang Y, et al. . Global prevalence of sarcopenic obesity in older adults: a systematic review and meta-analysis. Clin Nutr. 2021;40(7):4633-4641. doi:10.1016/j.clnu.2021.06.009 PubMed DOI

Vieira FT, Godziuk K, Lamarca F, et al. . Sarcopenic obesity diagnosis by different criteria mid-to long-term post-bariatric surgery. Clin Nutr. 2022;41(9):1932-1941. doi:10.1016/j.clnu.2022.07.006 PubMed DOI

Murawiak M, Krzymińska-Siemaszko R, Kaluźniak-Szymanowska A, et al. . Sarcopenia, obesity, sarcopenic obesity and risk of poor nutritional status in Polish community-dwelling older people aged 60 years and over. Nutrients. 2022;14(14):2889. doi:10.3390/nu14142889 PubMed DOI PMC

Gortan Cappellari G, Semolic A, Zanetti M, et al. . Sarcopenic obesity in free-living older adults detected by the ESPEN-EASO consensus diagnostic algorithm: validation in an Italian cohort and predictive value of insulin resistance and altered plasma ghrelin profile. Metabolism. 2023;145:155595. doi:10.1016/j.metabol.2023.155595 PubMed DOI

Scott D, Blyth F, Naganathan V, et al. . Sarcopenia prevalence and functional outcomes in older men with obesity: comparing the use of the EWGSOP2 sarcopenia versus ESPEN-EASO sarcopenic obesity consensus definitions. Clin Nutr. 2023;42(9):1610-1618. doi:10.1016/j.clnu.2023.07.014 PubMed DOI

Fumagalli C, Maurizi N, Day SM, et al. ; SHARE Investigators . Association of obesity with adverse long-term outcomes in hypertrophic cardiomyopathy. JAMA Cardiol. 2020;5(1):65-72. doi:10.1001/jamacardio.2019.4268 PubMed DOI PMC

Zhang X, Wang C, Dou Q, Zhang W, Yang Y, Xie X. Sarcopenia as a predictor of all-cause mortality among older nursing home residents: a systematic review and meta-analysis. BMJ Open. 2018;8(11):e021252. doi:10.1136/bmjopen-2017-021252 PubMed DOI PMC

Bouchard DR, Dionne IJ, Brochu M. Sarcopenic/obesity and physical capacity in older men and women: data from the Nutrition as a Determinant of Successful Aging (NuAge)—the Quebec longitudinal Study. Obesity (Silver Spring). 2009;17(11):2082-2088. doi:10.1038/oby.2009.109 PubMed DOI

Lee DC, Shook RP, Drenowatz C, Blair SN. Physical activity and sarcopenic obesity: definition, assessment, prevalence and mechanism. Future Sci OA. 2016;2(3):FSO127. doi:10.4155/fsoa-2016-0028 PubMed DOI PMC

Atkins JL, Wannamathee SG. Sarcopenic obesity in ageing: cardiovascular outcomes and mortality. Br J Nutr. 2020;124(10):1102-1113. doi:10.1017/S0007114520002172 PubMed DOI

Matsushita T, Nishioka S, Taguchi S, Yamanouchi A, Nakashima R, Wakabayashi H. Sarcopenic obesity and activities of daily living in stroke rehabilitation patients: a cross-sectional study. Healthcare (Basel). 2020;8(3):255. doi:10.3390/healthcare8030255 PubMed DOI PMC

Yoshimura Y, Wakabayashi H, Nagano F, et al. . The applicability of the ESPEN and EASO-defined diagnostic criteria for sarcopenic obesity in Japanese patients after stroke: prevalence and association with outcomes. Nutrients. 2022;14(19):4205. doi:10.3390/nu14194205 PubMed DOI PMC

Zhang X, Xie X, Dou Q, et al. . Association of sarcopenic obesity with the risk of all-cause mortality among adults over a broad range of different settings: a updated meta-analysis. BMC Geriatr. 2019;19(1):183. doi:10.1186/s12877-019-1195-y PubMed DOI PMC

Tian S, Xu Y. Association of sarcopenic obesity with the risk of all-cause mortality: a meta-analysis of prospective cohort studies. Geriatr Gerontol Int. 2016;16(2):155-166. doi:10.1111/ggi.12579 PubMed DOI

Wannamethee SG, Atkins JL. Sarcopenic obesity and cardiometabolic health and mortality in older adults: a growing health concern in an ageing population. Curr Diab Rep. 2023;23(11):307-314. doi:10.1007/s11892-023-01522-2 PubMed DOI PMC

Liu C, Wong PY, Chung YL, et al. . Deciphering the “obesity paradox” in the elderly: a systematic review and meta-analysis of sarcopenic obesity. Obes Rev. 2023;24(2):e13534. doi:10.1111/obr.13534 PubMed DOI

Donini LM, Busetto L, Bauer JM, et al. . Critical appraisal of definitions and diagnostic criteria for sarcopenic obesity based on a systematic review. Clin Nutr. 2020;39(8):2368-2388. doi:10.1016/j.clnu.2019.11.024 PubMed DOI

Gortan Cappellari G, Guillet C, Poggiogalle E, et al. ; SOGLI Expert Panel . Sarcopenic obesity research perspectives outlined by the sarcopenic obesity global leadership initiative (SOGLI): proceedings from the SOGLI consortium meeting in Rome November 2022. Clin Nutr. 2023;42(5):687-699. doi:10.1016/j.clnu.2023.02.018 PubMed DOI

Ikram MA, Brusselle G, Ghanbari M, et al. . Objectives, design and main findings until 2020 from the Rotterdam Study. Eur J Epidemiol. 2020;35(5):483-517. doi:10.1007/s10654-020-00640-5 PubMed DOI PMC

World Medical Association . World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-2194. doi:10.1001/jama.2013.281053 PubMed DOI

Meeuwsen S, Horgan GW, Elia M. The relationship between BMI and percent body fat, measured by bioelectrical impedance, in a large adult sample is curvilinear and influenced by age and sex. Clin Nutr. 2010;29(5):560-566. doi:10.1016/j.clnu.2009.12.011 PubMed DOI

Dodds RM, Syddall HE, Cooper R, et al. . Grip strength across the life course: normative data from twelve British studies. PLoS One. 2014;9(12):e113637. doi:10.1371/journal.pone.0113637 PubMed DOI PMC

Batsis JA, Barre LK, Mackenzie TA, Pratt SI, Lopez-Jimenez F, Bartels SJ. Variation in the prevalence of sarcopenia and sarcopenic obesity in older adults associated with different research definitions: dual-energy X-ray absorptiometry data from the National Health and Nutrition Examination Survey 1999-2004. J Am Geriatr Soc. 2013;61(6):974-980. doi:10.1111/jgs.12260 PubMed DOI

Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR, Sakamoto Y. Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr. 2000;72(3):694-701. doi:10.1093/ajcn/72.3.694 PubMed DOI

Voortman T, Kiefte-de Jong JC, Ikram MA, et al. . Adherence to the 2015 Dutch dietary guidelines and risk of non-communicable diseases and mortality in the Rotterdam Study. Eur J Epidemiol. 2017;32(11):993-1005. doi:10.1007/s10654-017-0295-2 PubMed DOI PMC

Koolhaas CM, Dhana K, Schoufour JD, et al. . Physical activity and cause-specific mortality: the Rotterdam Study. Int J Epidemiol. 2018;47(5):1705-1713. doi:10.1093/ije/dyy058 PubMed DOI

Salgado AL, Carvalho Ld, Oliveira AC, Santos VN, Vieira JG, Parise ER. Insulin resistance index (HOMA-IR) in the differentiation of patients with non-alcoholic fatty liver disease and healthy individuals. Arq Gastroenterol. 2010;47(2):165-169. doi:10.1590/S0004-28032010000200009 PubMed DOI

Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, et al. . The product of triglycerides and glucose, a simple measure of insulin sensitivity: comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010;95(7):3347-3351. doi:10.1210/jc.2010-0288 PubMed DOI

Schoufour JD, Tieland M, Barazzoni R, et al. . The relevance of diet, physical activity, exercise, and persuasive technology in the prevention and treatment of sarcopenic obesity in older adults. Front Nutr. 2021;8:661449. doi:10.3389/fnut.2021.661449 PubMed DOI PMC

Eglseer D, Traxler M, Bauer S. Association between the intake of different protein sources and obesity coexisting with low handgrip strength in persons near retirement age. Nutrients. 2022;14(21):4684. doi:10.3390/nu14214684 PubMed DOI PMC

World Health Organization . Obesity and overweight. 2021. Accessed February 10, 2024. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

Trajanoska K, Schoufour JD, Darweesh SKL, et al. . Sarcopenia and its clinical correlates in the general population: the Rotterdam Study. J Bone Miner Res. 2018;33(7):1209-1218. doi:10.1002/jbmr.3416 PubMed DOI

Wagenaar CA, Dekker LH, Navis GJ. Prevalence of sarcopenic obesity and sarcopenic overweight in the general population: the Lifelines cohort study. Clin Nutr. 2021;40(6):4422-4429. doi:10.1016/j.clnu.2021.01.005 PubMed DOI

Batsis JA, Mackenzie TA, Barre LK, Lopez-Jimenez F, Bartels SJ. Sarcopenia, sarcopenic obesity and mortality in older adults: results from the National Health and Nutrition Examination Survey III. Eur J Clin Nutr. 2014;68(9):1001-1007. doi:10.1038/ejcn.2014.117 PubMed DOI

Batsis JA, Mackenzie TA, Emeny RT, Lopez-Jimenez F, Bartels SJ. Low lean mass with and without obesity, and mortality: results from the 1999-2004 National Health and Nutrition Examination Survey. J Gerontol A Biol Sci Med Sci. 2017;72(10):1445-1451. doi:10.1093/gerona/glx002 PubMed DOI PMC

Cruz-Jentoft AJ, Gonzalez MC, Prado CM. Sarcopenia ≠ low muscle mass. Eur Geriatr Med. 2023;14(2):225-228. doi:10.1007/s41999-023-00760-7 PubMed DOI

Heiat A, Vaccarino V, Krumholz HM. An evidence-based assessment of federal guidelines for overweight and obesity as they apply to elderly persons. Arch Intern Med. 2001;161(9):1194-1203. doi:10.1001/archinte.161.9.1194 PubMed DOI

Visaria A, Setoguchi S. Body mass index and all-cause mortality in a 21st century U.S. population: a National Health Interview Survey analysis. PLoS One. 2023;18(7):e0287218. doi:10.1371/journal.pone.0287218 PubMed DOI PMC

Ji T, Li Y, Ma L. Sarcopenic obesity: an emerging public health problem. Aging Dis. 2022;13(2):379-388. doi:10.14336/AD.2021.1006 PubMed DOI PMC