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July 29, 2026Public Health NutritionOpen Access

Impact of demographic and lifestyle factors on the association between body mass index and the presence of sarcopenia at follow-up in community-dwelling people aged 40-74 years: a 9-year follow-up study

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Why the study?

Although body mass index is associated with sarcopenia, factors modifying this association remain unclear.

Does low BMI increase the risk of developing sarcopenia in community-dwelling adults aged 40-74 years?

Population

6,632 individuals aged 40–74 years in Japan

Comparison

Baseline body mass index levels across demographic and lifestyle subgroups

Design

Community-based cohort study

Follow-up

9-year

Key result

A 1 kg/m2 decrease in body mass index was associated with a 26% higher odds of sarcopenia at 9-year follow-up (OR 1.26), with the adverse impact of being underweight being greater among middle-aged individuals and those with high physical activity levels.

Authors

NCNorihito ChinaKKKeiko KabasawaKKKaori Kitamura

Discussion

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Overview

May modify BMI-sarcopenia links via demographics and lifestyle; hypothesis-generating and requires prospective confirmation before guiding care.

Key Points

  • This study investigates how demographic and lifestyle factors influence the relationship between body mass index (BMI) and sarcopenia in older adults.
  • 9-year follow-up study with data collected from 6,632 community-dwelling individuals aged 40–74 years
  • Sarcopenia assessed based on the Asian Working Group for Sarcopenia 2019 criteria during follow-up in 2021-2022
  • Multivariable logistic regression analysis was conducted to calculate odds ratios for sarcopenia presence.
  • Lower BMI significantly associated with higher odds of sarcopenia in both genders (P for trend <0.0001)
  • Significant interactions were found between BMI and age (P for interaction=0.0003) and BMI and physical activity level (P for interaction=0.0264)
  • Underweight individuals (<18.5 kg/m2) had a notably higher odds of sarcopenia, particularly in those under 68 years and those with high physical activity levels (≥40.1 MET-hr/d).

Study Design

Type

Cohort (n=6,632)

Multicenter

Yes

Structured PICO

Does low BMI increase the risk of developing sarcopenia in community-dwelling adults aged 40-74 years?

P
Population
6,632 community-dwelling adults aged 40-74 years from Japan were followed for 9 years to evaluate the association between baseline body mass index and the presence of sarcopenia.
E
Exposure
Low body mass index (BMI), specifically underweight (<18.5 kg/m2)
C
Comparator
Higher BMI categories
O
Outcome
Presence of sarcopenia at 9-year follow-up (assessed based on the diagnostic criteria of the Asian Working Group for Sarcopenia 2019)

Main Result

Odds Ratio: 1.26 (95% CI 1.19–1.33)

p-value: p=<0.0001

Low BMI is strongly associated with the development of sarcopenia over 9 years, with the adverse impact of being underweight being greatest among middle-aged individuals and those with high physical activity levels.

Limitations

  • Sarcopenia was not assessed at baseline, so some participants may have already had sarcopenia at baseline.
  • Lifestyle factors were assessed by self-report, which may have led to misclassification of variables.
  • Estimation of muscle mass by bioelectrical impedance analysis is influenced by individual hydration and electrolyte status.
  • Findings from small- to medium-sized municipalities may not be generalizable to populations in large municipalities or metropolitan areas.

Cite This Study

China et al. (2026) conducted a cohort in Sarcopenia (n=6,632). Lower body mass index (BMI) vs. Higher body mass index was evaluated on Presence of sarcopenia at follow-up (OR 1.26, 95% CI 1.19-1.33, p=<0.0001). A 1 kg/m2 decrease in body mass index was associated with a 26% higher odds of sarcopenia at 9-year follow-up (OR 1.26), with the adverse impact of being underweight being greater among middle-aged individuals and those with high physical activity levels.

synapsesocial.com/papers/6a69a28ac8da07d9defa6158https://doi.org/10.1017/s1368980026103255
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