Sarcopenic obesity is associated with cardiometabolic multimorbidity among Indian adults in the Longitudinal Aging Study in India

Abstract

Sarcopenic obesity (SO) a phenotype associated with worse metabolic outcomes than either sarcopenia or obesity alone. Its association with cardiometabolic multimorbidity (CMM) remains poorly characterized in South Asian populations, despite India’s disproportionate burden of both conditions. This cross-sectional analysis used data from 46,563 participants aged ≥ 50 years from the Longitudinal Aging Study in India. Possible sarcopenia was defined using Asian Working Group for Sarcopenia 2025 age-stratified handgrip strength cutoffs; obesity was defined as BMI ≥ 25 kg/m². Participants were classified as Normal, Sarcopenia only, Obesity only, or Sarcopenic obesity. CMM was defined as two or more of five self-reported conditions: hypertension, diabetes, chronic heart disease, stroke, and hypercholesterolemia. Weighted multivariable logistic regression examined the association between sarcopenia-obesity status and CMM, adjusting for age, sex, residence, education, wealth, physical activity, alcohol use, tobacco use, and functional limitation. CMM prevalence was 12.9%. Relative to the Normal group, odds of CMM were significantly elevated among participants with sarcopenic obesity (OR 3.14, 95% CI 2.56–3.85), followed by obesity only (OR 1.92, 95% CI 1.60–2.30), and sarcopenia only (OR 1.18, 95% CI 1.02–1.35). Higher wealth, education, urban residence, and functional limitation were also associated with higher odds of CMM, while daily physical activity was associated with lower odds. SO was associated with substantially higher odds of CMM than either sarcopenia or obesity alone among Indian adults aged 50 years and older, supporting integrated screening approaches assessing both muscle function and adiposity in this population.