Reclassification and prevalence of sarcopenia based on the Asian Working Group for Sarcopenia 2025 criteria versus the 2019 version in hospitalized older adults
Soichiro Kondo, Shoya Matsumoto, Hiroko Fujimoto, Kazufumi Takada, Michiko Nanao-Hamai, Kotaro Azuma, Tatsuya Hosoi, Mitsutaka Yakabe, Sumito OgawaAbstract
Background
The Asian Working Group for Sarcopenia (AWGS) 2025 introduced appendicular skeletal muscle mass (ASM) adjusted for body mass index (BMI) as an additional criterion for low muscle mass and removed physical performance from diagnostic components. The impact of these changes on sarcopenia prevalence in hospitalized older adults remains unclear.
Methods
This single-center retrospective study included older adults admitted to a university hospital geriatric ward in Japan. The primary cohort comprised participants aged ≥65 years with available BMI, ASM, grip strength, and gait speed data. The secondary cohort included those with BMI, ASM, and grip strength data regardless of gait speed. Sarcopenia prevalence under AWGS 2025 and AWGS 2019 was compared in the primary cohort. In the secondary cohort, the characteristics of participants with low muscle mass identified by BMI-adjusted criteria were described.
Results
In the primary cohort (n = 289), sarcopenia prevalence increased from 39.1% (95% confidence interval, 33.7%–44.8%) (AWGS 2019) to 48.1% (42.4%–53.8%) (AWGS 2025). Thirty-two participants (11.1%) were reclassified from non-sarcopenia to sarcopenia, while six (2.1%) showed the opposite shift. In the secondary cohort (n = 387), sarcopenia prevalence under AWGS 2025 was 51.9% (47.0%–56.9%). Sixty-one participants (15.8%) had newly identified low muscle mass by the BMI-adjusted criterion and had a higher mean BMI than that of the remaining participants (26.5 ± 2.6 vs. 20.6 ± 3.8 kg/m², mean ± standard deviation, p < 0.001).
Conclusions
Among hospitalized older adults, AWGS 2025 identified more sarcopenia cases, primarily through one-way reclassification, and captured individuals with higher BMI and low muscle mass.