Height- and BMI-adjusted AWGS 2025 criteria classified approximately one in five patients differently after stroke, and discordant groups exhibited distinct clinical characteristics beyond expected body-size differences, highlighting the importance of considering the indexing method when interpreting sarcopenia classifications.
Key Findings
Results
Height-adjusted and BMI-adjusted AWGS 2025 definitions of confirmed sarcopenia classified 21.2% of post-acute stroke rehabilitation patients differently.
The retrospective study included 864 patients undergoing post-acute stroke rehabilitation.
Discordant classification occurred in 183 patients (21.2%; 95% CI, 18.6%-24.0%).
Confirmed sarcopenia was defined as low handgrip strength combined with either height- or BMI-adjusted low muscle mass.
Patients were classified into four groups: Neither, Height-only, BMI-only, and Both.
Results
Agreement between the height-adjusted and BMI-adjusted definitions was moderate.
Cohen's kappa was 0.578.
Agreement between definitions was quantified across all 864 patients.
Results
Compared with the Height-only group, the BMI-only group had higher BMI, serum albumin, and phase angle.
This comparison was between the two discordant groups.
The abstract states these differences go beyond expected body-size differences.
Results
In adjusted analyses, higher albumin, higher phase angle, and greater medication count were associated with BMI-only rather than Height-only classification.
Albumin: OR per 0.5 g/dL, 1.71 (95% CI, 1.10-2.64).
Phase angle: OR per degree, 1.93 (95% CI, 1.23-3.04).
Medication count: OR per drug, 1.17 (95% CI, 1.03-1.32).
The multivariable logistic regression included 182 patients.
Results
Sensitivity analysis with Firth estimates gave similar results, but internal validation indicated model overfitting.
Firth penalized regression estimates were similar to the primary logistic regression.
Internal validation indicated overfitting, suggesting the model estimates should be interpreted cautiously.
Results
Adjusted discharge outcomes did not clearly differ between the two discordant groups.
Discharge outcomes were examined in exploratory analyses.
Comparison was between Height-only and BMI-only groups after adjustment.
What This Means
This study looked at how sarcopenia (loss of muscle mass and strength) is diagnosed in people recovering from stroke. The 2025 Asian guidelines allow muscle mass to be adjusted either for height or for body mass index (BMI). The researchers asked whether the choice changes who is labeled as having sarcopenia, using records from 864 stroke rehabilitation patients.
About one in five patients (21.2%) got a different result depending on which adjustment was used, and agreement between the two methods was only moderate. Patients flagged only by the BMI-based method tended to have higher BMI, albumin (a nutrition-related blood marker), and phase angle (a measure related to cell health and muscle quality), and took more medications. Statistical checks suggested the model was somewhat overfitted, so these associations should be treated cautiously. Short-term outcomes at hospital discharge did not clearly differ between the two discordant groups.
This research suggests that the method used to adjust muscle mass can meaningfully change who is classified as having sarcopenia after stroke. Clinicians and researchers may need to consider which indexing method was used when interpreting sarcopenia diagnoses. The study was retrospective and from a single type of rehabilitation setting, so it cannot show which method is better.
Yoshimura Y, Matsumoto A, Yoneda K, Shimazu S. (2026). Discordance Between Height- and BMI-Adjusted AWGS 2025 Definitions of Confirmed Sarcopenia After Stroke.. Geriatrics & gerontology international. https://doi.org/10.1111/ggi.70898