Dynamic trajectories of possible sarcopenia under the AWGS 2025 criteria and long-term prognosis: A national landmark cohort study.

BACKGROUND

Possible sarcopenia is defined by low handgrip strength in the Asian Working Group for Sarcopenia (AWGS) 2025 consensus. Whether functional recovery under these criteria improves long-term prognosis remains unclear.

METHODS

The study included 2761 community-dwelling participants aged ≥60 years from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018) who were free of baseline activities of daily living (ADL) disability. Participants were categorized into four trajectory subgroups based on their possible sarcopenia status in 2011 and 2013: Persistently Normal (72.0%), Reversed Possible Sarcopenia (10.8%), Progressive Possible Sarcopenia (10.8%), and Persistent Possible Sarcopenia (6.5%). Survey-weighted Cox and Fine-Gray competing risk models estimated hazard ratios (HRs) for all-cause mortality and severe ADL disability prevalent at the 2018 follow-up.

RESULTS

During a median follow-up of 5.0 years, 258 all-cause deaths and 109 cases of prevalent severe ADL disability were documented. Persistent Possible Sarcopenia was independently associated with higher risks of all-cause mortality (HR 1.75, 95% CI 1.16-2.62) and the composite adverse outcome (HR 1.76, 95% CI 1.22-2.53), with significant ordinal trends. For the Reversed trajectory, severe ADL disability risk did not differ significantly from reference (subdistribution hazard ratio (sHR) 1.40, 95% CI 0.79-2.46).

CONCLUSIONS

Persistently Normal handgrip strength predicts the most favorable prognosis, whereas Persistent Possible Sarcopenia carries higher risks of mortality and adverse outcomes. Whether sarcopenia reversal attenuates these risks awaits further study.