Changing sarcopenia diagnostic criteria from AWGS2019 to 2025 impacts prevalence and postoperative risk prediction

The Asian Working Group for Sarcopenia (AWGS) updated its diagnostic criteria in 2025, shifting focus from diagnosing sarcopenia in older adults towards promoting muscle health across the lifespan. How this update impacts the diagnosis prevalence and prediction for health outcomes in surgical patients is unknown. We analyzed elective surgical patients previously assessed using the modified 2019 criteria, reclassifying them under the 2025 criteria, a body-mass-index-adjusted variant, and a muscle-specific-strength variant. Here we show that among 779 patients (56.0% male participants; mean age 65.5 ± 11.3 years), sarcopenia prevalence is similar between the modified AWGS2019 (23.4%) and AWGS2025 (23.9%) criteria. Under AWGS2025, 43.7% of patients previously classified as non-sarcopenia are reclassified as having low muscle strength. They are more likely to be discharged to a community hospital rather than home (adjusted relative risk 2.23, 95% confidence interval 1.40–3.56, p < 0.001). The body-mass-index-adjusted variant increases prevalence to 29.8%, with 124 of 261 (47.5%) low-muscle-strength patients reclassified as having sarcopenia, predominantly in the presence of obesity and showing a non-significant trend toward better short-term outcomes. The muscle-specific-strength variant decreases prevalence to 16.8% and performs less well than standard AWGS2025 in reclassifying risk for prolonged hospitalization. The AWGS2025 criteria further stratify patients previously classified as non-sarcopenia, identifying a subgroup with low muscle strength and normal muscle mass who require more post-discharge support. We recommend the body-mass-index-adjusted variant for routine surgical practice to optimize resource allocation and personalized perioperative care. As people age, they can lose muscle mass and strength and develop a condition called sarcopenia. In 2025, the Asian Working Group for Sarcopenia (AWGS) changed how sarcopenia is diagnosed. It was unclear how this change, from AWGS2019 to AWGS2025, would affect patients after surgery. We studied 779 patients who had major surgery and compared their postoperative outcomes. AWGS2025 did not change sarcopenia prevalence significantly, but identified a subgroup with weak muscle strength despite having normal muscle mass. These patients were more likely to need extra support after discharge. We recommend a version of AWGS2025 that accounts for body mass index, which better identifies patients at risk, helping doctors plan care and allocate resources after surgery. Liu et al compare the updated 2025 sarcopenia diagnostic criteria against 2019 criteria in a major surgical cohort, assessing impacts on prevalence and prediction of postoperative outcomes. The updated criteria identify a subgroup with low muscle strength who are at higher risk of needing post-discharge support, without affecting overall prevalence.