Who Gets Sarcopenia? Key Risk Factors & High-Risk Groups Explained

Who Gets Sarcopenia? Risk Factors and High-Risk Groups Explained

Sarcopenia—the progressive, silent loss of muscle mass, strength, and function—affects millions worldwide and can begin much earlier than you think. While commonly associated with old age, this decline can start in your 30s or 40s and represents a lifelong process (Gao et al., 2025). Understanding the risk factors and identifying the groups most vulnerable is key to early intervention and preserving mobility and independence (Zhang et al., 2025).

Studies suggest sarcopenia affects approximately 10–27% of older adults globally, with rates skyrocketing to over 60% in certain high-risk patient populations (Yuan & Larsson, 2023).

Clinical Pearls

1. Sarcopenia begins decades before old age.
Muscle decline is a lifelong process influenced by early-life nutrition, physical activity, and health status—prevention must begin in midlife or earlier.

2. Low muscle strength predicts adverse outcomes better than low muscle mass.
According to EWGSOP2, muscle strength (e.g., grip strength) is the most reliable indicator for diagnosing sarcopenia and predicting disability and mortality.

3. Chronic diseases accelerate muscle loss through shared pathways.
Conditions like diabetes, heart failure, and CKD amplify inflammation, oxidative stress, and anabolic resistance—key mechanisms driving sarcopenia.

4. Malnutrition and inflammation are silent drivers of sarcopenia.
Low serum albumin, prealbumin, and elevated CRP or IL-6 levels often indicate subclinical malnutrition and inflammation contributing to muscle catabolism.

5. Resistance training remains the cornerstone of prevention and treatment.
No pharmacologic therapy can currently match the efficacy of progressive resistance exercise combined with adequate protein intake in halting muscle decline.

What Exactly Is Sarcopenia?

Sarcopenia is defined by the progressive loss of skeletal muscle mass, strength, and function (Sayer et al., 2024).

• The European Working Group on Sarcopenia in Older People (EWGSOP) primarily diagnoses it based on low muscle strength (e.g., grip strength), with reduced muscle quantity and quality providing further confirmation (Sayer et al., 2024).

• The Asian Working Group for Sarcopenia (AWGS) uses age-related muscle mass loss combined with either low muscle strength or poor physical performance.

Clinical Pearl: Low muscle strength is a more reliable indicator for diagnosing sarcopenia and predicting disability and mortality than low muscle mass alone (Sayer et al., 2024).

The Eight Key Categories of Sarcopenia Risk Factors

Recent reviews categorize risk factors across eight distinct domains, highlighting the complexity of this condition (Zhang et al., 2025; Gao et al., 2025).

1. Sociodemographic Factors

• Age: The single strongest predictor. Risk increases substantially after age 60, but the foundation for decline is set decades earlier (Gao et al., 2025).

• Sex: Men may show greater absolute decline, while women face accelerated loss due to menopause-related hormonal changes.

• Socioeconomic Status: Lower status is linked to limited access to nutritious food, healthcare, and opportunities for physical activity.

2. Health Behavior Factors (Most Modifiable)

• Physical Inactivity: The most significant and controllable risk. Muscles not regularly challenged through resistance training weaken and shrink (Sayer et al., 2024).

• Nutritional Status: Malnutrition and inadequate protein intake starve muscles of necessary building blocks.

• Smoking: Accelerates muscle loss via increased inflammation and oxidative stress.

• Sleep Duration: Both insufficient and excessive sleep are associated with increased risk, disrupting hormonal processes vital for muscle health.

3. Health Condition Factors

Chronic diseases accelerate muscle loss through shared pathways like chronic inflammation and anabolic resistance (Sayer et al., 2024).

• Diabetes: A significant predictor; metabolic dysregulation, insulin resistance, and chronic inflammation rapidly accelerate decline.

• Cognitive Impairment/Dementia: Creates a bidirectional link, leading to reduced activity and poor nutrition.

• Cardiovascular Disease (Heart Failure/Stroke): Increases risk through reduced physical capacity and chronic inflammation.

• Chronic Diseases: Chronic kidney disease (CKD), liver disease, respiratory conditions, and depression all accelerate muscle wasting (Yuan & Larsson, 2023).

4. Anthropometric Factors

• Body Mass Index (BMI): Both low BMI (four times the risk compared to normal) and unintentional changes in BMI are powerful predictors.

• Calf Circumference: A small calf circumference is a simple, effective marker reflecting reduced lower-leg muscle mass.

  • Note: Overweight and obese individuals can also develop sarcopenia (sarcopenic obesity), placing them at high risk for disability.

5. Biomarker Factors

Laboratory values often indicate subclinical malnutrition and inflammation driving muscle catabolism:

• Low Albumin/Prealbumin: Reflects poor nutritional status and protein reserves.

• Elevated CRP/IL-6: Indicates chronic low-grade inflammation, which accelerates muscle degradation.

• Low Serum Creatinine: May reflect reduced overall muscle mass.

6. Early Life Factors

Muscle health is a life-course issue (Gao et al., 2025). Low birth weight and poor childhood growth patterns limit peak muscle mass in early adulthood, setting a lower baseline for age-related decline.

7. Psychosocial Factors

Social isolation, loneliness, and the stress of adverse life events can reduce motivation for self-care, activity, and proper nutrition.

8. Living Environment Factors

Limited access to safe exercise spaces, "food deserts" that restrict nutritious options, and environments discouraging outdoor activity contribute to risk.

Identifying High-Risk Groups for Screening

1. Very High-Risk Group: This category includes adults over 80 years old and those with severely compromised health status. Specific populations at very high risk include individuals with multimorbidity (multiple chronic conditions), patients with certain cancers (especially digestive system cancers), those with Chronic Kidney Disease (CKD) on dialysis, and nursing home residents with limited mobility.

2. High-Risk Group (Age/Activity): Adults aged 65–79 form a significant high-risk demographic, particularly when they are physically inactive.

3. High-Risk Group (Chronic Illness/Mental Health): Also in the high-risk category are individuals dealing with chronic conditions like diabetes or heart failure, or those struggling with cognitive impairment or depression.

4. High-Risk Group (Lifestyle/Nutrition): This group is further defined by lifestyle and nutritional factors, specifically including current smokers and adults who are underweight with a BMI below 18.5.

5. Moderate-Risk Group: This category is generally defined by less severe age and lifestyle factors, including adults aged 60–64 with sedentary lifestyles. It also encompasses individuals with chronic inflammatory conditions, those with poor dietary protein intake, and people recovering from major surgery or prolonged hospitalization.

Identifying high-risk groups allows for targeted screening and preventive interventions (Zhang et al., 2025).

What Can Be Done? Prevention and Treatment

Sarcopenia is not an inevitable fate. The cornerstone of prevention and treatment is lifestyle intervention (Sayer et al., 2024).

1. Resistance Training: Engaging in regular, progressive resistance exercise (weight training, bodyweight exercises) 2–3 times weekly is the single most effective intervention for halting and reversing muscle decline.

2. Adequate Protein Intake: Older adults need higher amounts—typically 1.0–1.2 grams of protein per kilogram of body weight daily—to maintain and repair muscle mass.

3. Manage Chronic Conditions: Work with your healthcare team to optimize the control of diabetes, heart disease, and other conditions, as they accelerate muscle loss (Yuan & Larsson, 2023).

4. Quit Smoking and Prioritize Sleep: These simple steps remove major muscle-wasting accelerators.

5. Get Screened: If you are in a high-risk group, ask your doctor about screening tests like grip strength measurement or body composition analysis.

Frequently Asked Questions (FAQs)

1. Can young or middle-aged adults develop sarcopenia?
Yes. While typically associated with aging, sarcopenia can begin as early as the 30s—especially in sedentary individuals, those with chronic diseases, or those with poor nutrition.

2. Why do some people lose muscle faster than others with age?
Rates of decline depend on genetics, hormonal changes, diet, physical activity, inflammation, and comorbidities. Lifestyle and metabolic health explain most differences.

3. Is sarcopenia more common in men or women?
Men often show a greater absolute decline due to higher baseline muscle mass, but women experience accelerated loss around menopause due to estrogen decline and reduced activity.

4. How is sarcopenia different from general frailty?
Frailty is a broader geriatric syndrome involving weakness, weight loss, and exhaustion; sarcopenia specifically refers to loss of skeletal muscle mass and strength—though both overlap.

5. Do overweight or obese individuals get sarcopenia?
Yes—this is called sarcopenic obesity. Despite excess fat, these individuals have low muscle mass and function, placing them at high risk for disability and metabolic disease.

6. What laboratory tests help identify sarcopenia risk?
Low serum albumin, prealbumin, creatinine, or elevated inflammatory markers (CRP, IL-6) can signal poor muscle health or increased catabolic activity.

7. Can sarcopenia be reversed once diagnosed?
In many cases, yes. Targeted resistance training, optimal protein intake, and management of chronic disease can significantly restore strength and function—even in advanced age.

The Bottom Line: Investing in muscle health starts in midlife. The earlier you recognize and act on these risk factors, the greater your chances of preserving future health and independence.

This information is for educational purposes only and should not replace professional medical advice. Always consult with your healthcare provider for personalized recommendations based on your individual health status and risk factors.

Related Articles

Sarcopenia: The Complete Guide to Age-Related Muscle Loss and How to Fight It | Dr T.S. DIDWAL

Prevent Sarcopenia & Osteoporosis: Your Guide to Strong Bones & Muscles | DR T S DIDWAL

How Sarcopenia Is Diagnosed: Tests, Criteria, and Early Warning Signs Explained | DR T S DIDWAL

Citations

Zhang, S., Yang, X., An, N., Lv, M., Yang, L., Liu, R., Hu, S., Chen, W., Feng, W., & Mao, Y. (2025). Risk Factors and Predictive Models for Sarcopenia in Older Adults. Aging medicine (Milton (N.S.W)), 8(3), 192–199. https://doi.org/10.1002/agm2.70012

Gao, Y., Huang, Y., An, R., Yang, Y., Chen, X., & Wan, Q. (2025). Risk factors for sarcopenia in community setting across the life course: A systematic review and a meta-analysis of longitudinal studies. Archives of gerontology and geriatrics, 133, 105807. https://doi.org/10.1016/j.archger.2025.105807

Sayer, A.A., Cooper, R., Arai, H. et al. Sarcopenia. Nat Rev Dis Primers 10, 68 (2024). https://doi.org/10.1038/s41572-024-00550-w

Yuan, S., & Larsson, S. C. (2023). Epidemiology of sarcopenia: Prevalence, risk factors, and consequences. Metabolism: clinical and experimental, 144, 155533. https://doi.org/10.1016/j.metabol.2023.155533