BMC geriatrics · 2026
Role of sarcopenia, obesity and sarcopenic obesity in frailty, frailty transitions and death.
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Álvarez-Bustos Alejandro, Carnicero Jose A, Sepúlveda-Loyola Walter, Garcia-Garcia Francisco J, Rodríguez-Mañas Leocadio
Аннотация
BACKGROUND & AIMS: The role of sarcopenic obesity in the transitions of frailty has been largely neglected. The aim of this study is to assess the role of sarcopenic obesity with prevalent frailty, frailty transitions and mortality.
METHODS: This is a cohort-based retrospective study including 1538 (74.73 years, 45.51% men) community-dwelling ≥ 65 years. Frailty status (baseline and at follow-up) was evaluated with the Frailty Phenotype (FP) and the Frailty Trait Scale-5 (FTS5). Sarcopenic obesity (SO) status was defined by Body Mass Index ≥ 30 and the Foundation for the National Institutes of Health criteria, standardized to our population. Logistic/multilevel/Poisson regression models were used to assess the role of categories according to the presence of sarcopenia and obesity [Non-sarcopenic, non-obese (NS-NO); Non-sarcopenic, obese (NS-O); Sarcopenic, non-obese (S-NO); Sarcopenic obese (SO)] on frailty, frailty transitions (median follow-up 2.99 years). Mortality (median follow-up 6.29 years) was assessed with Cox proportional hazard models.
RESULTS: Cross-sectionally, NS-O, S-NO and SO were significantly associated with frailty across FP and FTS5, compared with the NS-NO category. Longitudinally, S-O was significantly associated with increased rates of frailty progression according to the FP [IRR (95% CI) 1.67 (1.05, 2.68) in robust; 3.35 (1.15, 9.71) in prefrail] and FTS5 [IRR (95% CI): 6.56 (3.68, 11.68)], and reduced the probability of reversing prefrailty status [FP IRR (95% CI): 0.63 (0.41, 0.98)]. S-NO [FP robust, IRR (95% CI) 1.87 (1.17, 2.98); FTS5 non-frail IRR 2.80 (1.46, 5.37)] and NS-O [FTS5 non-frail IRR (95% CI) 2.26 (1.25, 4.09)] also exhibited higher rates of frailty worsening. When sarcopenic obesity was used as the reference category, NS-NO showed a significantly lower incidence of frailty worsening [FP robust IRR 0.60 (0.37, 0.96); FP prefrail IRR 0.30 (0.10, 0.87)], while according to the FTS5, all non-S-O phenotypes were associated with a lower risk of frailty progression, with the strongest associations observed for NS-NO [IRR 0.15 (0.09, 0.27)]. In addition, S-NO and S-O presented a significantly lower likelihood of maintaining robustness or non-frail status across frailty definitions. No category was independently associated with mortality after considering frailty status.
CONCLUSIONS: Sarcopenic obesity is consistently associated with a poor functional evolution in frailty status, but it does not modify the odds of death when frailty status is considered. In addition, it may influence the likelihood of improvement in frailty status among prefrail individuals. Further studies are needed to determine whether obesity provides an additional effect on sarcopenia in shaping frailty transitions.
METHODS: This is a cohort-based retrospective study including 1538 (74.73 years, 45.51% men) community-dwelling ≥ 65 years. Frailty status (baseline and at follow-up) was evaluated with the Frailty Phenotype (FP) and the Frailty Trait Scale-5 (FTS5). Sarcopenic obesity (SO) status was defined by Body Mass Index ≥ 30 and the Foundation for the National Institutes of Health criteria, standardized to our population. Logistic/multilevel/Poisson regression models were used to assess the role of categories according to the presence of sarcopenia and obesity [Non-sarcopenic, non-obese (NS-NO); Non-sarcopenic, obese (NS-O); Sarcopenic, non-obese (S-NO); Sarcopenic obese (SO)] on frailty, frailty transitions (median follow-up 2.99 years). Mortality (median follow-up 6.29 years) was assessed with Cox proportional hazard models.
RESULTS: Cross-sectionally, NS-O, S-NO and SO were significantly associated with frailty across FP and FTS5, compared with the NS-NO category. Longitudinally, S-O was significantly associated with increased rates of frailty progression according to the FP [IRR (95% CI) 1.67 (1.05, 2.68) in robust; 3.35 (1.15, 9.71) in prefrail] and FTS5 [IRR (95% CI): 6.56 (3.68, 11.68)], and reduced the probability of reversing prefrailty status [FP IRR (95% CI): 0.63 (0.41, 0.98)]. S-NO [FP robust, IRR (95% CI) 1.87 (1.17, 2.98); FTS5 non-frail IRR 2.80 (1.46, 5.37)] and NS-O [FTS5 non-frail IRR (95% CI) 2.26 (1.25, 4.09)] also exhibited higher rates of frailty worsening. When sarcopenic obesity was used as the reference category, NS-NO showed a significantly lower incidence of frailty worsening [FP robust IRR 0.60 (0.37, 0.96); FP prefrail IRR 0.30 (0.10, 0.87)], while according to the FTS5, all non-S-O phenotypes were associated with a lower risk of frailty progression, with the strongest associations observed for NS-NO [IRR 0.15 (0.09, 0.27)]. In addition, S-NO and S-O presented a significantly lower likelihood of maintaining robustness or non-frail status across frailty definitions. No category was independently associated with mortality after considering frailty status.
CONCLUSIONS: Sarcopenic obesity is consistently associated with a poor functional evolution in frailty status, but it does not modify the odds of death when frailty status is considered. In addition, it may influence the likelihood of improvement in frailty status among prefrail individuals. Further studies are needed to determine whether obesity provides an additional effect on sarcopenia in shaping frailty transitions.