ORIGINAL RESEARCH article
Front. Med.
Sec. Geriatric Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1640410
Predicted Skeletal Muscle Index as a Scalable Marker for Sarcopenia Risk and Mortality in Older Chinese Adults
Provisionally accepted
- 1Affiliated Hospital of Chengde Medical University, Chengde, China
- 2Chengde Central Hospital, Chengde, China
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Background & Aims: Sarcopenia, characterized by age-related loss of muscle mass and function, increases adverse outcomes in older adults. The predicted skeletal muscle mass index (pSMI), derived from serum creatinine and cystatin C, may serve as a practical biomarker. This study evaluated pSMI's ability to predict sarcopenia and mortality in older Chinese adults. Methods: We analyzed 5,982 adults aged ≥60 years from the 2015 China Health and Retirement Longitudinal Study (CHARLS). pSMI was calculated using a sex-specific formula and categorized into quartiles. Sarcopenia was defined per Asian Working Group for Sarcopenia 2019 criteria. All-cause mortality was tracked over five years (2015)(2016)(2017)(2018)(2019)(2020). Logistic regression assessed pSMI's association with sarcopenia, and Cox models evaluated mortality risk, adjusting for demographics, behaviors, comorbidities, and inflammatory markers. Results: Sarcopenia prevalence decreased from 55-67% in the lowest pSMI quartile (Q1) to 0.4% in the highest (Q4). Higher pSMI reduced sarcopenia odds by 97-99% in Q3-Q4 vs. Q1 (p<0.001). Five-year mortality fell from 23.4% (men) and 13.6% (women) in Q1 to 9.0% and 3.9% in Q4. Adjusted hazard ratios for mortality in Q4 vs. Q1 were 0.47 (95% CI: 0.32-0.70, men) and 0.38 (95% CI: 0.22-0.65, women).Chinese adults. To our knowledge, this represents the first largescale validation of pSMI's prognostic value for mortality risk independent of baseline sarcopenia in a nationally representative older Chinese cohort. As a blood-based biomarker, pSMI may serve as a practical screening tool and prognostic marker, facilitating timely interventions such as nutritional support and resistance exercise.
Keywords: Sarcopenia, Predicted Skeletal Muscle Index, Mortality, older adults, Blood-based biomarker
Received: 04 Aug 2025; Accepted: 07 Aug 2025.
Copyright: © 2025 Liu, Qi, Wang, Zhao, Zhang, Ma, Huang and Dong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ya Liu, Affiliated Hospital of Chengde Medical University, Chengde, China
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