Longitudinal Association Between Possible Sarcopenia and Stroke Under the AWGS 2025 Criteria: A Nationwide Prospective Cohort Study With a 9-Year Follow-Up.

Abstract

The Asian Working Group for Sarcopenia (AWGS) introduced the concept of possible sarcopenia in 2019 to facilitate early detection and community-based prevention and updated its diagnostic criteria in 2025. However, longitudinal evidence based on the updated criteria remains scarce regarding whether possible sarcopenia predicts long-term stroke risk among middle-aged and older adults. This prospective cohort study used nationally representative data from the China Health and Retirement Longitudinal Study collected between 2011 and 2020. A total of 6660 participants aged ≥ 50 years without a history of stroke at baseline were included. Cumulative stroke incidence was estimated using the Kaplan-Meier method and compared by log-rank tests. Cox proportional hazards models estimated hazard ratio (HR) and 95% confidence interval (CI), with sequential adjustment for sociodemographic characteristics, lifestyle factors, and chronic conditions. Sensitivity analyses assessed result robustness. At baseline, 15.03% of participants had possible sarcopenia. Over a median follow-up of 9 years, 689 incident stroke events occurred, yielding a cumulative incidence of 10.35%. Participants with possible sarcopenia had a higher stroke incidence than those with no possible sarcopenia (12.60% vs. 9.95%; log-rank p = 0.011). After full adjustment, possible sarcopenia was independently associated with increased stroke risk (HR = 1.27, 95% CI: 1.04-1.54). Sensitivity analyses showed that the association was stable across regression models, diagnostic criteria and inclusion criteria. Possible sarcopenia defined by the AWGS 2025 criteria is significantly associated with elevated stroke risk among middle-aged and older adults.