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Abstract: FR-PO547

Relative Sarcopenia and Mortality and the Modifying Effects of CKD and Adiposity

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1302 Health Maintenance, Nutrition, and Metabolism: Clinical


  • Ziolkowski, Susan, Stanford University School of Medicine , Palo Alto, California, United States
  • Long, Jin, Stanford University, Palo Alto, California, United States
  • Chertow, Glenn Matthew, Stanford University School of Medicine , Palo Alto, California, United States
  • Leonard, Mary B., Stanford School of Medicine, Stanford, California, United States

Conventional definitions of sarcopenia based on lean mass may fail to capture low lean mass relative to higher fat mass, i.e., relative sarcopenia. The objective of this study is to determine the associations of sarcopenia and relative sarcopenia with mortality independent of co-morbidities, and whether chronic kidney disease (CKD) and adiposity alter these associations.


Dual energy X-ray absorptiometry (DXA)-derived appendicular lean mass index (ALMI, kg/m2) and fat mass index (FMI, kg/m2) were assessed in 14,850 NHANES participants from 1999-2006 and were linked to death certificate data in the National Death Index with follow up through 2011. Sarcopenia was defined using sex and race/ethnicity-specific standard deviation scores compared with young adults (T-scores) as an ALMI T-score < −2 and relative sarcopenia as fat-adjusted ALMI (ALMIFMI) T-score < −2. Glomerular filtration rate (GFR) was estimated using creatinine- (eGFRCr) and cystatin C- (eGFRCys) based regression equations.


Three (3.0) percent of NHANES participants met criteria for sarcopenia and 8.7% met criteria for relative sarcopenia. Sarcopenia and relative sarcopenia were independently associated with mortality (HR sarcopenia 2.89, 95% CI, 2.17 to 3.86; HR relative sarcopenia 2.62, 95% CI, 2.14 to 3.20). The corresponding population attributable risks were 6.2% (95% CI, 4.3% to 7.5%) and 25.8% (95% CI, 17.3% to 31.2%), respectively. The risk of mortality associated with relative sarcopenia was attenuated among persons with higher FMI (p for interaction <0.01) and was not affected by CKD status for either sarcopenia or relative sarcopenia.


Sarcopenia and relative sarcopenia are significantly associated with mortality regardless of CKD status. Relative sarcopenia is nearly 3-fold more prevalent amplifying its associated mortality risk at the population level. The association between relative sarcopenia and mortality is attenuated in persons with higher FMI.


  • NIDDK Support