Sarcopenia and obesity may work additively rather than synergistically to increase mortality risk in older adults with CKD according to new cross-sectional study from Romania.
Sarcopenia and Obesity
Body composition changes in older individuals with CKD are a common occurrence. Sarcopenic obesity is a high-risk nutritional phenotype that can be associated with older adults who have CKD – those with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² and/or albuminuria ≥30 mg/g.
This study set out to determine whether sarcopenia and obesity worked additively or synergistically to increase mortality risk in older adults with CKD. Investigators performed a cross-sectional study of 222 adults aged 70 or over with CKD and made geriatric and multimodal body composition assessments.
Participants in the study were grouped into four classes; no sarcopenia and no obesity (n=59, 26.6%), obesity only (n=62, 27.9%), sarcopenia only (n=74, 33.3%), and sarcopenic obesity (n=27, 12.2%).
Sarcopenia and Obesity May Work Additively
Sarcopenia, obesity, lower estimated glomerular filtration rate (eGFR) and lower serum albumin were found to independently elevate mortality risk through multivariable analyses.
Multivariable analyses showed that obesity and sarcopenia elevated estimated 10-year mortality risk independently and had mortality risk scores (measured between 0 and 1) of 0.83 and 0.97 respectively. Sarcopenia-related phenotypes were shown to increase mortality risk (p<0.001) as well as disability risk (p=0.046).
There was no significant interaction between sarcopenia and obesity (B = −0.062, 95% CI −0.184-0.060; p=0.318) suggesting that these are effects that work additively as opposed to synergistically on mortality risk.
Limitations and Implications
The authors noted several limitations, primarily the cross-sectional design of the study meant that the variables were assessed at one point in time, preventing any cause inference.
Additionally, there were a small number of individuals with sarcopenic obesity meaning that interaction effects may have been difficult to detect. Moreover, the definition of obesity to solely focus on BMI, may have contributed to misclassification as visceral and subcutaneous fat was not differentiated.
Finally, cofounding effects including CKD aetiology, physical activity, comorbidity burdens and use of medications were not incorporated into the models, potentially causing residual confounding.
Due to this, the results should be interpreted tentatively because of the limitations mentioned, however, there are potential clinical implications of this study. These include the mitigation of geriatric risk in CKD populations through muscle health interventions, physical activity and optimised nutrition.
Conclusion
Sarcopenia and obesity both independently elevate mortality risk levels with sarcopenia showing a stronger association, however, they do not exhibit interactive effects suggesting additive rather than synergistic effects of sarcopenic-obesity in older adults with CKD.
Given that these findings are based on estimated risk scores and not observed clinical outcomes future prospective studies should provide observed clinical outcomes to verify the findings of this study.
Reference
Donca V et al. Sarcopenic obesity and body composition phenotypes in older adults with chronic kidney disease: associations with estimated mortality risk. Sci Rep. 2026; DOI: 10.1038/s41598-026-53294-w .
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