Height- and Body Mass Index-Based Sarcopenia　- Prognostic and Functional Implications in Older Patients Hospitalized...

The 2025 Asian Working Group for Sarcopenia (AWGS) updated diagnostic criteria redefine sarcopenia based on low muscle strength and low skeletal muscle mass, incorporating body mass index (BMI)-adjusted appendicular skeletal muscle mass (ASM) alongside height-adjusted ASM. The clinical relevance of these definitions in heart failure (HF) patients remains unclear.

This retrospective study included 594 patients aged ≥65 years hospitalized for HF (2016-2024). Sarcopenia was defined according to AWGS 2025 criteria as H-sarcopenia (height-adjusted ASM) or B-sarcopenia (BMI-adjusted ASM). The primary outcome was all-cause mortality. Physical function was assessed using gait speed. We analyzed associations using Cox proportional hazards and linear regression models. The prevalence of H-sarcopenia and B-sarcopenia was similar (24.2% vs. 25.1%, respectively), but BMI-dependent patterns differed, with the prevalence of H-sarcopenia decreasing and B-sarcopenia increasing as BMI increased. H-sarcopenia was independently associated with higher mortality (adjusted hazard ratio 1.48; 95% confidence interval 1.04-2.12), although its prognostic impact was attenuated at higher BMI. B-sarcopenia was not associated with mortality. Both sarcopenia definitions were associated with slower gait speed (P<0.001), but B-sarcopenia showed superior model performance (P<0.001 for the difference in root mean square error).

In patients hospitalized with HF, H-sarcopenia and B-sarcopenia had distinct prognostic and functional implications: H-sarcopenia was related to mortality, particularly for lower BMI, whereas B-sarcopenia better reflected physical function, supporting outcome-specific sarcopenia definitions.