Sarcopenic obesity and risk of falls: findings in Middle-aged and older Chinese population from CHARLS

Sarcopenic obesity (SO) is increasingly recognized as a significant health concern, particularly among older populations. Existing literature indicates that SO elevates the risk for various adverse health outcomes such as cardiovascular diseases, fractures, higher all-cause mortality. However, evidence regarding its impact on the risk of falls remains limited and inconclusive. Our study aimed to investigate the association between SO and fall incidents.

A total of 10,905 participants were enrolled from the baseline survey of the China Health and Retirement Longitudinal Study (CHARLS) 2015 wave. Participants were categorized into four groups according to sarcopenia and obesity status, with the neither sarcopenia nor obesity group serving as the reference. Logistic regression was utilized to evaluate the cross-sectional association between SO and falls. Furthermore, we tracked fall incidents reported in follow-up surveys conducted in CHARLS 2018 and 2020 wave. Cox regression analysis was performed to explore how SO affected the risk of falls. Stratified Cox analyses by age (< 60 vs. ≥60 years) were also performed.

In the cross-sectional analysis (2015), the SO group [OR (95% CI): 1.84 (1.42 ~ 2.37), P < 0.01] showed a higher risk of falls compared to the reference group; however, this association was not statistically significant after adjusting for potential confounding factors. In the longitudinal analysis (2015-2020), the SO group [HR (95%CI): 2.78 (2.03 ~ 3.80), P < 0.01] had a significantly increased risk of falls. The results remained similar after adjusting for age, sex [HR (95%CI): 1.44 (1.02 ~ 2.04), P < 0.05], and additional covariates [HR (95%CI): 1.43 (1.00 ~ 2.03), P < 0.05]. Notably, stratified Cox models showed that SO was significantly associated with fall risk in both age groups, with a stronger effect observed in participants under 60 years [HR (95%CI): 2.85 (1.13 ~ 7.17), P < 0.05] than in those aged 60 and above [HR (95%CI): 1.64 (1.08 ~ 2.50), P < 0.05].

Sarcopenic obesity is associated with an increased risk of falls among middle-aged and older adults, especially in longitudinal analyses. Age-stratified results suggest that the impact of SO on falls may be more pronounced in the middle-aged group. Our findings support the need for early identification and targeted interventions for individuals with SO to mitigate fall-related risks in aging populations.