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Epidemiology and Population Health

Clinical characteristics and survival in sarcopenic obesity defined by the Japanese working group on sarcopenic obesity criteria versus existing definitions in older adults: findings from the Otassha study

International Journal of Obesity (2026)Cite this article

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Abstract

Background

The Japanese Working Group on Sarcopenic Obesity (JWGSO) recently published diagnostic criteria for sarcopenic obesity specific to Asian populations. This study aimed to estimate the prevalence and evaluate the characteristics and validity of sarcopenic obesity as defined by the JWGSO.

Methods

We analysed longitudinal data from 736 community-dwelling older adults aged ≥65 years from the 2012 Otassha Study. Sarcopenic obesity was diagnosed using JWGSO and European Society for Clinical Nutrition and Metabolism/European Association for the Study of Obesity (ESPEN/EASO) criteria. Physical function, body composition, gonalgia, and mobility were compared between participants with and without sarcopenic obesity according to each criterion. Agreement between JWGSO-defined sarcopenic obesity and conventional sarcopenia with obesity or ESPEN/EASO definitions was evaluated using Cohen’s kappa coefficient. Survival over approximately an 8-year follow-up was evaluated using Kaplan–Meier curves and log-rank tests. Cox proportional hazards models were applied, and when the proportional hazards assumption was violated, analyses were stratified into early and late follow-up periods.

Results

Sarcopenic obesity was present in 57 participants (7.7%) per JWGSO criteria and 55 participants (7.5%) per ESPEN/EASO criteria. Regardless of definition, participants with sarcopenic obesity were older; had lower walking speed, grip strength, and balance; and exhibited higher prevalence of conventional sarcopenia, knee osteoarthritis, and reduced mobility function (p = 0.022 to p < 0.001). Agreement between JWGSO and conventional sarcopenic obesity and ESPEN/EASO definitions was fair (K = 0.345) and substantial (K = 0.671), respectively. JWGSO-defined sarcopenic obesity was not significantly associated with mortality in the early follow-up but was linked to increased mortality risk in the late period (HR 3.75, 95% CI 1.66–8.50, p = 0.002).

Conclusion

Sarcopenic obesity defined by the JWGSO is distinct from conventional sarcopenia with obesity and ESPEN/EASO-defined sarcopenic obesity. This population-specific criterion may improve identification of older Japanese adults at higher risk of poor physical function and mortality, although further validation is warranted.

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Acknowledgements

We express our gratitude to the local authorities of Itabashi Ward for their support; our study was supported by the Itabashi Ward office staff and local residents.

Funding

This work was supported by Research and Development Grants for Longevity Science (grant numbers: 15dk0107004h0003); Health and Labour Sciences Research Grants [H24-Choju-Ippan-002 and H25-Choju-Ippan-005] from the Ministry of Health, Labour and Welfare of Japan; and JSPS KAKENHI (grant numbers: 23K11959; 23K09687; 23K06919).

Author information

Authors and Affiliations

  1. Department of Physical Therapy, Takasaki University of Health and Welfare, Gunma, Japan

    Takeshi Kera

  2. Research Team for Human Care, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

    Takeshi Kera, Hisashi Kawai, Manami Ejiri, Keigo Imamura & Shuichi Obuchi

  3. Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

    Hiroyuki Sasai & Hirohiko Hirano

  4. Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan

    Yoshinori Fujiwara

  5. Department of Social Medicine, Hirosaki University School of Medicine, Aomori, Japan

    Kazushige Ihara

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  1. Takeshi Kera
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Contributions

Conceptualisation: TK and KI. Methodology: HK, HH, YF, KI (Kazushige Ihara), HK, and SO. Formal analysis: TK and KI. Data curation: HK and ME. Writing—original draft: TK, KI, and HS. Writing—review and editing: HK and SO. Funding acquisition: HK, KI and SO. Supervision: SO.

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Correspondence to Takeshi Kera.

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41366_2026_2051_MOESM1_ESM.docx (download DOCX )

Supplemental Table. Diagnostic criteria and cut-off values for sarcopenic obesity according to JWGSO and ESPEN/EASO, and for sarcopenia according to AWGS

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Kera, T., Kawai, H., Ejiri, M. et al. Clinical characteristics and survival in sarcopenic obesity defined by the Japanese working group on sarcopenic obesity criteria versus existing definitions in older adults: findings from the Otassha study. Int J Obes (2026). https://doi.org/10.1038/s41366-026-02051-0

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