Sarcopenia among mid-to-older adults in Southeast Asia: A multi-national systematic review and meta-analysis of prevalence and risk factors

Sarcopenia, a progressive skeletal muscle disorder associated with falls, fractures, and mortality, poses significant challenges for Southeast Asia’s aging population. This systematic review and meta-analysis determined sarcopenia prevalence among Southeast Asian older adults and identified associated risk factors. We searched PubMed/MEDLINE, Embase, Scopus, and Web of Science through December 2024 for studies reporting sarcopenia prevalence in adults aged ≥ 45 years using validated criteria (AWGS, EWGSOP). Two reviewers independently conducted selection, extraction, and quality assessment using the JBI Critical Appraisal Checklist. Random-effects meta-analysis calculated the pooled prevalence with 95% confidence intervals. Meta-regression and meta-moderator analysis explored heterogeneity sources. Publication bias was assessed using Begg’s and Egger’s tests, and funnel plots. Sensitivity analysis, GRADE assessment, and Baujat plots evaluated robustness and evidence quality. Thirty-six studies (99,008 participants) from Thailand ( n = 18), India ( n = 16), and Indonesia ( n = 2) were included. Pooled sarcopenia prevalence was 26% (95% CI: 20–33%), though this estimate should be interpreted as a broad summary rather than a precise regional figure given very high heterogeneity (I² = 98.7%) and overall LOW GRADE certainty. Country-specific prevalence varied widely: Indonesia 56% (95% CI: 42–69%; based on only two studies), India 32% (95% CI: 21–45%), and Thailand 19% (95% CI: 14–25%). Hospital-based studies reported higher prevalence (31%) than community-based studies (21%). Countries with official sarcopenia policies showed lower prevalence (19%) than those without (35%); this cross-sectional, hypothesis-generating association does not establish causality. Significant risk factors included advanced age, underweight status, suboptimal calf circumference, and female sex (full odds ratios reported in Table 3). Meta-moderator analysis identified sample size (29.7%), country (16.5%), and national guideline adoption (13.9%) as the primary sources of between-study variance, though most heterogeneity remained unexplained. Publication bias was detected by Egger’s test ( p = 0.0014), but trim-and-fill analysis indicated minimal impact on the pooled estimate. Sarcopenia appears common among older adults in the included evidence base from Thailand, India, and Indonesia (pooled estimate 26%, 95% CI: 20–33%), although this figure should be interpreted cautiously given very high heterogeneity, geographic imbalance across included countries, mixed hospital/community settings, and overall LOW certainty of evidence. The association between national guideline adoption and lower prevalence is hypothesis-generating rather than causal. These findings nonetheless support further evaluation of systematic screening programmes and evidence-based interventions targeting modifiable risk factors. CRD42024629074