Sarcopenia plus obesity a greater risk factor for frailty, functional decline

The presence of both sarcopenia and obesity compounds the risks of frailty, functional decline, cognitive impairment, and mobility limitations compared with either condition alone, according to a study from Singapore.

In a cohort of community-dwelling older adults who were seen at three local community frailty clinic sites, those with sarcopenic obesity had a disproportionate burden of frailty compared with those who had sarcopenia only or obesity only. This was true regardless of whether frailty was measured on the Clinical Frailty Scale (CFS) (85 percent vs 76.9 percent and 36.6 percent, respectively; p<0.001) or the 5-item FRAIL* scale (55 percent vs 40 percent and 9.8 percent, respectively; p<0.001). [J Frailty Sarcopenia Falls 2025;10:150-156]

Participants with sarcopenic obesity also had worse functional status (modified Barthel Index score: 81.9 vs 86.9 among participants with sarcopenia and 98.4 among those with obesity; p=0.004), had a greater reliance on mobility aids (85 percent vs 73.8 percent and 45 percent, respectively; p=0.002), and were more likely to have cognitive impairment based on the Singapore-modified Mini-mental state examination (52.9 percent vs 39.3 percent and 13.2 percent, respectively; p=0.004).

On multivariate regression analysis, sarcopenic obesity was significantly associated with frailty (odds ratio [OR], 4.71, 95 percent confidence interval [CI], 1.35–22.23), impaired function (ß, –16.53, 95 percent CI, –24.55 to –8.52), mobility limitations (OR, 5.73, 95 percent CI, 1.65–27.02), and cognitive impairment (OR, 3.56, 95 percent CI, 1.18–10.98).

“Our findings underscore that sarcopenic obesity is not merely an additive condition but represents a distinct phenotype with compounded adverse health outcomes,” the authors noted.

They pointed out that a synergistic pathophysiology may explain why sarcopenic obesity is so much more damaging than sarcopenia or obesity alone.

“Sarcopenia contributes to reduced strength, balance, and mobility, while obesity imposes additional biomechanical load and promotes systemic inflammation through adipokines and pro-inflammatory cytokines,” they said. [Ageing Res Rev 2017;35:200-221; J Gerontol A Biol Sci Med Sci 2016;71:259-264; Aging Clin Exp Res 2023;35:2069-2079; Front Endocrinol (Lausanne) 2021;12:765415]

In the presence of both sarcopenia and obesity, fat infiltrates into skeletal muscle and impairs muscle quality and mitochondrial function, further accelerating physical decline, the authors explained. They Individuals with sarcopenic obesity are trapped in a self-perpetuating cycle of reduced mobility, muscle atrophy, and fat accumulation—culminating in frailty and functional dependence, they added.

The authors highlighted the study’s potential clinical implications, noting an increased prevalence of age-related conditions, such as frailty and sarcopenia, with an ageing population.

“Older adults with sarcopenia experience disability, reduced quality of life, increased mortality, and healthcare utilization,” they said. “Concurrently, rates of obesity are increasing and have become a major public health concern… with older adults having higher rates of obesity, estimated at 35 percent globally.” [J Am Med Dir Assoc 2015;16:247-252; Lancet Diabetes Endocrinol 2019;7:231-240]

There is a need to screen older patients for sarcopenic obesity, but there is currently no agreement on its definition, according to the authors. Despite the lack of a universal definition, the 2022 Sarcopenic Obesity Global Leadership Initiative recommends screening using BMI or waist circumference using ethnicity-specific cutoffs, followed by muscle strength and body composition assessment to establish a diagnosis of sarcopenic obesity. [Clin Nutr 2022;41:990-1000; Obes Facts 2022;15:321-335]

“The consensus statement recognizes the limitations of BMI but states that BMI is acceptable in the screening phase of sarcopenic obesity due to ease and accessibility. Further work on different assessments of sarcopenic obesity and their associations is warranted,” they said.

The study included 202 older adults (mean age 80.4 years, 62.9 percent female, 75.7 percent Chinese). Of these, 20.3 percent had obesity, 32.2 percent had sarcopenia only, and 9.9 percent had sarcopenic obesity.

*Fatigue, Resistance, Ambulation, Illness, and Loss of Weight