Association of Sarcopenia and Sarcopenic Obesity With Mortality: A Comparison of the AWGS 2019 and 2025 Criteria

Abstract The Asian Working Group for Sarcopenia (AWGS) updated its diagnostic criteria in 2025, but their prognostic implications remain uncertain. We compared the associations of the AWGS 2019 and 2025 criteria with mortality and examined mortality across sarcopenia–obesity phenotypes. This prospective cohort study included 382 community-dwelling older adults from the Hallym Aging Study, followed through December 2023. Sarcopenia was defined using the AWGS 2019 and 2025 criteria, primarily using height-adjusted appendicular skeletal muscle mass, and obesity using sex-specific body fat percentage thresholds. During a median follow-up of 12.7 years, 128 participants (33.5%) died. Sarcopenia prevalence was lower with AWGS 2025 than AWGS 2019 (12.3% vs. 26.2%). After full adjustment, AWGS 2025-defined sarcopenia was associated with a but borderline-significant risk of all-cause mortality (HR 1.58, 95% CI 1.00–2.51; p = 0.052), whereas AWGS 2019-defined sarcopenia was not (HR 1.30, 95% CI 0.89–1.92). Significant associations were observed in women (HR 2.73, 95% CI 1.20–6.25) and participants without obesity (HR 1.75, 95% CI 1.02–3.00). Sarcopenia only was associated with higher mortality (HR 1.78, 95% CI 1.06–3.00), whereas obesity only and sarcopenic obesity were not. These findings highlight the impact of diagnostic criteria on sarcopenia prevalence and its association with mortality.