Abstract
BackgroundSarcopenic obesity (SO) is a prevalent geriatric syndrome with significant implications for cardiovascular health and survival. However, the absence of a standardised diagnostic consensus hinders risk stratification and targeted management in older adults. We evaluated SO prevalence using the ESPEN-EASO, FNIH, and EWGSOP2 criteria and assessed associations with cardiovascular disease (CVD) and all-cause mortality.MethodsWe analysed data from 121,111 UK Biobank participants aged ≥ 60 years. SO was operationally defined by ESPEN-EASO, FNIH, and EWGSOP2 criteria. We compared the prevalence and agreement among the three definitions. Cox-proportional hazard models were used to investigate the association between the combined categories of sarcopenia and obesity and the incidence of CVD and all-cause mortality.ResultsSO prevalence varied significantly: 2.28% (ESPEN-EASO), 0.28% (FNIH), and 0.01% (EWGSOP2), with poor inter-criteria agreement (kappa < 0.20). Among men, ESPEN-EASO-defined SO showed the strongest associations with incident CVD and all-cause mortality (HR 1.61, 95% CI 1.43-1.81; and HR 1.66, 95% CI 1.45-1.91, respectively). Among women, ESPEN-EASO-defined SO showed the strongest association with all-cause mortality (HR 1.59, 95% CI 1.37-1.83), whereas FNIH-defined SO showed the highest point estimate for incident CVD (HR 1.99, 95% CI 1.40-2.82). The EWGSOP2 criteria identified too few SO cases for robust prognostic assessment.ConclusionSO prevalence and prognostic performance differed substantially across consensus definitions. ESPEN-EASO identified more SO cases and showed more consistent associations with incident CVD and all-cause mortality in older adults. Regardless of definition, SO was associated with increased risks of incident CVD and all-cause mortality.