Association Between High-Density Lipoprotein Cholesterol Levels and Sarcopenia in Elderly Koreans

<b>Background/Objectives</b>: High-density lipoprotein cholesterol (HDL-C) regulates muscle energy metabolism and function, enhancing glucose uptake and promoting glycogen synthesis. However, studies on the association between HDL-C levels and sarcopenia remain controversial. We therefore investigated the association between HDL-C levels and sarcopenia in elderly Koreans. <b>Methods</b>: This cross-sectional study was based on previously collected, anonymous health checkup data. Participants included 3776 individuals aged 65 years and older who underwent body composition analysis using a bioelectrical impedance meter during a health checkup in 2024. Sarcopenia was defined as an appendicular skeletal muscle index of <7.0 kg/m² for males and <5.7 kg/m² for females. Logistic regression analyses were performed for each variable, including HDL-C levels, to identify sarcopenia association expressed as odds ratios (ORs). Participants were further divided into four quartiles according to HDL-C levels, and comparative multivariable analyses were performed, with the quartile with the lowest HDL-C level serving as the reference. <b>Results</b>: Of the 3776 Koreans with a mean age of 70.5 years, sarcopenia was diagnosed in 23.1% (<i>n</i> = 872) of participants. Sarcopenia prevalence showed a steadily increasing trend from the lowest quartile group (Q1, <i>n</i> = 977) with HDL-C levels ≤48 mg/dL to the highest quartile group (Q4, <i>n</i> = 974) at ≥67 mg/dL (<i>p</i> < 0.001). After adjusting for sarcopenia-associated risk factors, a significant association was found between the condition and HDL-C levels (OR 1.01, 95% CI 1.00-1.02; <i>p</i> = 0.008). Q4 showed a consistent sarcopenia association compared with Q1, even after adjusting for all variables (OR 1.36, 95% CI 1.05-1.75; <i>p</i> = 0.018). <b>Conclusions:</b> In Koreans aged 65 years and older, we found an association between high HDL-C levels and sarcopenia.