The association between sarcopenia in the elderly population of China and the risk of falls：a prospective cohort study from CHARLS

BackgroundSarcopenia is associated with increased fall risk, but its graded relationship with severity and age-specific patterns warrants further investigation in middle-aged and older adults. ObjectiveTo investigate the association between sarcopenia severity and fall risk among adults aged [≥]45 years and provide evidence for early intervention. MethodsUtilizing data from the China Health and Retirement Longitudinal Study (CHARLS) database (baseline 2011 to follow-up 2020), 9,608 participants without sarcopenia at baseline were included. Binary logistic regression analyses (univariate, multivariate, and interaction analyses) were employed to assess the association between sarcopenia severity and fall risk. The nonlinear effect of age was examined using restricted cubic splines (RCS curves). ResultsThe overall fall incidence rate among participants with sarcopenia was 18.88% (1,814/9,608). Fall incidence exhibited a graded increase with sarcopenia severity: non-sarcopenia group: 16.89% (1,108/6,560), possible sarcopenia group: 21.54% (439/2,038), confirmed sarcopenia group: 26.11% (217/831), and severe sarcopenia group: 27.93% (50/179). Multivariate logistic regression revealed a graded increase in fall risk with sarcopenia severity: possible sarcopenia (OR=1.28,CI[1.13-1.45]), confirmed sarcopenia (OR=1.36,CI[1.14-1.63]), and severe sarcopenia (OR=1.44,CI[1.02-2.03]). RCS curves identified a biphasic risk pattern: a modest rise between ages 45-60 and a steep increase after age 70, with 70 years as the inflection point. The subgroup analysis revealed that fall risk was significantly elevated in individuals with sarcopenia who were male, or who had a history of smoking, alcohol consumption, stroke, arthritis, or pain. Key interactions included a 2.96-fold risk in those aged 45-60 with severe sarcopenia (OR=2.96,[1.24-7.06]) and a 4.46-fold risk in those with confirmed sarcopenia and stroke (OR=4.46,[1.45-13.68]). ConclusionSarcopenia is an independent risk factor for falls, with risk increasing in a severity-dependent graded manner. Early identification of high-risk individuals and implementation of graded interventions are crucial.