Association of low calf circumference and underweight with sarcopenia in older adults with chronic kidney disease: a cross-sectional study

Objectives This community-based, cross-sectional study aimed to evaluate the association of calf circumference and body mass index (BMI) with sarcopenia in older adults with chronic kidney disease (CKD).Methods: Community-dwelling adults aged ≥60 years were enrolled in New Taipei City, Taiwan, between 1 January 2015, and 31 December 2022. CKD status was classified according to Kidney Disease Improving Global Outcomes guidelines, BMI according to Taiwanese criteria, and sarcopenia according to the Asian Working Group for Sarcopenia 2019 consensus. Polytomous and standard logistic regression models were used to estimate odds ratios (ORs) for sarcopenia, adjusting for age, sex, and major comorbidities.Results A total of 3,629 participants were included (mean age 72.1 ± 6.12 years; 46.7% men). After adjustment, underweight and low calf circumference were independently associated with sarcopenia and severe sarcopenia (adjusted OR = 5.47 and 11.60, respectively; p < 0.0001). Compared with participants with CKD stages G3–5 who had normal or overweight BMI and normal calf circumference, those with low calf circumference had significantly higher odds of sarcopenia across CKD stages. Interaction analysis demonstrated a significant joint association of underweight and low calf circumference with sarcopenia in CKD (adjusted OR = 5.45; p = 0.045).Conclusions Low calf circumference and underweight were independently and jointly associated with sarcopenia in community-dwelling older adults with pre-dialysis CKD. Combined assessment of calf circumference and BMI may facilitate sarcopenia identification in older adults with CKD. However, body size may influence this association, warranting further studies on optimal calf circumference normalization.