Discriminating sarcopenia in community-dwelling older women with high frequency of overweight/obesity: the São Paulo Ageing & Health Study (SPAH)



The criteria most used for the definition of sarcopenia, those based on the ratio between the appendicular skeletal muscle mass (ASM) and the square of the height (h2) underestimate prevalence in overweight/obese people whereas another criteria consider ASM adjusted for total fat mass. We have shown that ASM adjusted for fat seems to be more appropriate for sarcopenia diagnosis.


Since the prevalence of overweight and obesity is a growing public health issue, the aim of this study was to evaluate the prevalence and risk factors associated with sarcopenia, based on these two criteria, among older women.


Six hundred eleven community-dwelling women were evaluated by specific questionnaire including clinical data. Body composition and bone mineral density were evaluated by dual X-ray absorptiometry. Logistic regression models were used to identify factors independently related to sarcopenia by ASM/h2 and ASM adjusted for total fat mass criteria.


The prevalence of overweight/obesity was high (74.3 %). The frequency of sarcopenia was lower using the criteria of ASM/h2 (3.7 %) than ASM adjusted for fat (19.9 %) (P < 0.0001). We also note that less than 5 %(1/23) of sarcopenic women, according to ASM/h2, had overweight/obesity, whereas 60 % (74/122) of sarcopenic women by ASM adjusted for fat had this complication. Using ASM/h2, the associated factors observed in regression models were femoral neck T-score (OR = 1.90; 95 % CI 1.06–3.41; P = 0.03) and current alcohol intake (OR = 4.13, 95 % CI 1.18–14.45, P = 0.03). In contrast, we have identified that creatinine (OR = 0.21; 95 % CI 0.07–0.63; P = 0.005) and the White race (OR = 1.81; 95 % CI 1.15–2.84; P = 0.01) showed a significant association with sarcopenia using ASM adjusted for fat.


In women with overweight/obesity, ASM adjusted for fat seems to be the more appropriate criteria for sarcopenia diagnosis. This finding has relevant public health implications, considering the high prevalence of overweight/obesity in older women.

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This work was supported by grants from the Fundação de Amparo e Pesquisa do Estado de São Paulo (FAPESP) #03/09313-0 and #04/12694-8, Conselho Nacional de Ciência e Tecnologia #300559/2009-7 (RMRP), Federico Foundation (EB, RMRP) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (JBL, CPF).

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Correspondence to R. M. R. Pereira.

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Domiciano, D.S., Figueiredo, C.P., Lopes, J.B. et al. Discriminating sarcopenia in community-dwelling older women with high frequency of overweight/obesity: the São Paulo Ageing & Health Study (SPAH). Osteoporos Int 24, 595–603 (2013). https://doi.org/10.1007/s00198-012-2002-1

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  • Appendicular muscle mass
  • Fat mass
  • Obesity
  • Prevalence
  • Sarcopenia
  • Women