Associations between sarcopenic obesity and risk of falls: a population-based cohort study among middle-aged and older adults using the CHARLS

Although previous research has established a strong link between sarcopenia and fall risk in middle-aged and older adults, the effects of sarcopenic obesity and possible sarcopenic obesity on fall risk remain underexplored in large-scale studies. This longitudinal analysis aimed to examine these associations using nationally representative cohort data. We analyzed data from the China Health and Retirement Longitudinal Study (CHARLS), including 9,996 participants aged 45 and older with available body composition measurements. Participants were categorized into four groups based on Asian Working Group for Sarcopenia (AWGS) criteria and median waist circumference (WC): (1) normal WC without sarcopenia (control group), (2) normal WC with sarcopenia, (3) obesity without sarcopenia, and (4) obesity with sarcopenia. Cox proportional hazards model was used to estimate adjusted hazard ratios (HRs), 95% confidence intervals (CIs), and P-values, with the control group as the reference. The model was sequentially adjusted for demographic (age, sex, residence), socioeconomic (education), and behavioral (smoking, alcohol) variables. Compared to participants with normal WC and no sarcopenia (reference group), those with sarcopenic obesity had a significantly higher risk of falls (HR = 1.25; 95% CI: 1.00–1.56; P = 0.048), even after adjusting for demographic, socioeconomic, and behavioral factors. Similarly, possible sarcopenic obesity was linked to a modest but statistically significant increase in fall risk (HR = 1.12; 95% CI: 1.02–1.24; P = 0.021). Subgroup analyses revealed that the fourth quartile showed a trend toward higher fall risk across all subgroups, especially among individuals aged ≥ 60 years and males. However, in most Subgroups, the 95% CIs cross 1, suggesting limited statistical significance in some strata. Both sarcopenic obesity and possible sarcopenic obesity are associated with an elevated risk of falls. Middle-aged and older adults should adopt preventive strategies, such as maintaining regular physical activity, to preserve muscle mass and reduce the risk of falls.