Comparative analysis of sarcopenia diagnostic criteria and their components for predicting falls in community-dwelling older adults

Sarcopenia, defined by the age-related loss of skeletal muscle mass and function, is associated with increased risk of falls, disability, and mortality in older adults. However, the strength of the relationship between sarcopenia and falls varies across studies, largely due to differences in diagnostic criteria. This study aimed to examine the associations between four widely used sarcopenia definitions and fall incidence, and to identify which components of these definitions are most predictive of falls in community-dwelling older adults. We analyzed data from 1,991 participants (aged 70–84 years; 999 men, 992 women) enrolled in the Korean Frailty and Aging Cohort Study. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia 2019 (AWGS 2019), European Working Group on Sarcopenia in Older People 2 (EWGSOP2), International Working Group on Sarcopenia (IWGS), and Foundation for the National Institutes of Health (FNIH) criteria. Appendicular lean mass was measured using dual-energy X-ray absorptiometry, muscle strength by handgrip strength (HGS), and physical performance by gait speed, five-times sit-to-stand test (5STS), and Short Physical Performance Battery (SPPB). Fall incidence was self-reported over a two-year follow-up. Of the total participants, 399 (20.0%) reported at least one fall during follow-up. Fallers demonstrated significantly poorer 5STS and SPPB performance in both sexes, and lower HGS and slower gait speed in women, whereas muscle mass showed no significant association with falls in either sex. In quintile-based normalization unadjusted analyses, 5STS and SPPB remained significantly associated with falls in both sexes, and gait speed remained significant in women. Among the diagnostic criteria, slow gait speed in both sexes was significantly associated with fall risk in the unadjusted analysis. Sarcopenia diagnostic criteria that include physical performance measures—particularly gait speed—showed stronger associations with fall risk than those based mainly on muscle mass in unadjusted analyses. Although these associations were attenuated and became non-significant after adjustment, slow gait speed may still serve as a simple and practical indicator to screen older adults who could be at increased risk of falling. These findings suggest a potential role for physical performance assessments in sarcopenia-related fall risk evaluation.