Dynamic trajectories of possible sarcopenia under the AWGS 2025 criteria and long-term prognosis: A national landmark cohort study

BACKGROUND: Possible sarcopenia is defined by low handgrip strength in the Asian Working Group for Sarcopenia (AWGS) 2025 consensus. Whether functional recovery under these criteria improves long-term prognosis remains unclear. METHODS: The study included 2761 community-dwelling participants aged ≥60 years from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018) who were free of baseline activities of daily living (ADL) disability. Participants were categorized into four trajectory subgroups based on their possible sarcopenia status in 2011 and 2013: Persistently Normal (72.0%), Reversed Possible Sarcopenia (10.8%), Progressive Possible Sarcopenia (10.8%), and Persistent Possible Sarcopenia (6.5%). Survey-weighted Cox and Fine-Gray competing risk models estimated hazard ratios (HRs) for all-cause mortality and severe ADL disability prevalent at the 2018 follow-up. RESULTS: During a median follow-up of 5.0 years, 258 all-cause deaths and 109 cases of prevalent severe ADL disability were documented. Persistent Possible Sarcopenia was independently associated with higher risks of all-cause mortality (HR 1.75, 95% CI 1.16-2.62) and the composite adverse outcome (HR 1.76, 95% CI 1.22-2.53), with significant ordinal trends. For the Reversed trajectory, severe ADL disability risk did not differ significantly from reference (subdistribution hazard ratio (sHR) 1.40, 95% CI 0.79-2.46). CONCLUSIONS: Persistently Normal handgrip strength predicts the most favorable prognosis, whereas Persistent Possible Sarcopenia carries higher risks of mortality and adverse outcomes. Whether sarcopenia reversal attenuates these risks awaits further study.