{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T16:39:07Z","timestamp":1792773547714,"version":"4.5.0"},"reference-count":37,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Calf circumference (CC) is a simple, noninvasive proxy for lower-limb muscle mass. However, evidence on the longitudinal association between CC change and incident falls remains scarce.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate whether progressive decline in CC is associated with higher odds of incident falls among community-dwelling older adults.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study used data from the Chinese Longitudinal Healthy Longevity Survey, a nationally representative prospective cohort. Participants aged 60 years or older with complete CC measurements at baseline (2018) and follow-up (2021) were included. Data were analyzed from January to March 2026.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Absolute CC change (in centimeters) and relative CC change (as a percentage) over 3 years, analyzed as continuous and categorical variables (absolute: no decrease, &amp;lt;3 cm, 3 to &amp;lt;5 cm, \u22655 cm; relative: no decrease, &amp;lt;10%, 10% to &amp;lt;20%, \u226520%). The no-decrease group, including individuals with no change and those with increased CC, served as the reference group.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The outcome of interest was incident falls, self-reported during the 2021 wave. Covariates included sociodemographic characteristics, falls history, health behaviors, functional status, and chronic diseases, all assessed via standardized questionnaires and evaluation. Odds of incident fall were assessed using inverse probability weighted logistic regression to address survival bias.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 7068 participants (mean [SD] age, 79.66 [10.32] years; 3835 [54.26%] female), 1671 participants (23.64%) reported incident falls over a median (IQR) follow-up of 3.07 (2.91-3.17) years. In fully adjusted models, each 1-cm absolute decrease in CC was associated with 3.2% higher odds of fall (odds ratio [OR], 1.03; 95% CI, 1.02-1.05) and each 10% relative decrease with 10.3% higher odds (OR, 1.10; 95% CI, 1.06-1.15). Compared with no decrease, an absolute decrease in CC of 5 cm or more was associated with 32.5% higher odds of fall (OR, 1.33; 95% CI, 1.10-1.60) and a relative decrease of 20% or more with 48.1% higher odds (OR, 1.48; 95% CI, 1.20-1.84).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of older adults, longitudinal decreases in CC, both absolute and relative, were associated with higher odds of incident falls. Monitoring CC change over time may serve as a practical, low-cost measure to support fall risk assessment.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.40127","type":"journal-article","created":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T15:30:26Z","timestamp":1792769426000},"page":"e2640127","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal Change in Calf Circumference and Incident Falls in Older Adults"],"prefix":"10.1001","volume":"9","author":[{"given":"Chi","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Basic Innovation Research, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Beijing Key Laboratory of Aging Mechanism and Intervention Research on Aging-Related Diseases, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yushan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zehong","family":"Huo","sequence":"additional","affiliation":[{"name":"Department of Basic Innovation Research, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Beijing Key Laboratory of Aging Mechanism and Intervention Research on Aging-Related Diseases, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Zeng","sequence":"additional","affiliation":[{"name":"Center for Healthy Aging and Development Studies, National School of Development, Raissun Institute for Advanced Studies, Peking University, Beijing, China"},{"name":"Center for the Study of Aging and Human Development and Geriatrics Division, Medical School of Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Yao","sequence":"additional","affiliation":[{"name":"Center for Healthy Ageing Transdisciplinary Sciences, China Center for Health Development Studies, Peking University, Beijing, China"},{"name":"State Key Laboratory of Vascular Homeostasis and Remodelling, Peking University, Beijing, China."},{"name":"Key Laboratory of Health System Reform and Governance, Peking University, National Health Commission, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,10,23]]},"reference":[{"issue":"9","key":"zoi261089r1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afac205","article-title":"World guidelines for falls prevention and management for older adults: a global initiative.","volume":"51","author":"Montero-Odasso","year":"2022","journal-title":"Age Ageing"},{"issue":"6","key":"zoi261089r2","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.1038\/s41562-026-02451-2","article-title":"Economic burden of falls for 190 countries and territories from 2020 to 2050 based on health-augmented macroeconomic modelling.","volume":"10","author":"Li","year":"2026","journal-title":"Nat Hum Behav"},{"key":"zoi261089r3","doi-asserted-by":"publisher","DOI":"10.2196\/73802","article-title":"Global, regional, and national burden of falls among older adults aged 65 years and above: secondary data analysis of the Global Burden of Disease Study 2021.","volume":"9","author":"Zhang","year":"2026","journal-title":"JMIR Aging"},{"issue":"11","key":"zoi261089r4","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1016\/j.jamda.2023.06.002","article-title":"Incidence and risk factors of falls among older people in nursing homes: systematic review and meta-analysis.","volume":"24","author":"Shao","year":"2023","journal-title":"J Am Med Dir Assoc"},{"issue":"1","key":"zoi261089r5","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1136\/injuryprev-2018-042982","article-title":"Incidence, risk factors and economic burden of fall-related injuries in older Chinese people: a systematic review.","volume":"25","author":"Peng","year":"2019","journal-title":"Inj Prev"},{"key":"zoi261089r6","doi-asserted-by":"publisher","first-page":"04170","DOI":"10.7189\/jogh.14.04170","article-title":"Unintentional fall mortality by place, sex, and age group among older Chinese adults, 2010-21.","volume":"14","author":"Huang","year":"2024","journal-title":"J Glob Health"},{"key":"zoi261089r7","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s41256-020-00133-8","article-title":"Sex differences in the association between marital status and the risk of cardiovascular, cancer, and all-cause mortality: a systematic review and meta-analysis of 7,881,040 individuals.","volume":"5","author":"Wang","year":"2020","journal-title":"Glob Health Res Policy"},{"key":"zoi261089r8","doi-asserted-by":"publisher","DOI":"10.1590\/1414-431x2024e13469","article-title":"Prevalence and risk factors for falls among older Chinese adults in the community: findings from the CLHLS study.","volume":"57","author":"Liang","year":"2024","journal-title":"Braz J Med Biol Res"},{"key":"zoi261089r9","doi-asserted-by":"publisher","DOI":"10.1016\/j.exger.2021.111262","article-title":"Sarcopenia and fall-related injury among older adults in five low- and middle-income countries.","volume":"147","author":"Veronese","year":"2021","journal-title":"Exp Gerontol"},{"issue":"6","key":"zoi261089r10","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.1007\/s40520-022-02078-z","article-title":"Prevalence, physical characteristics, and fall risk in older adults with and without possible sarcopenia.","volume":"34","author":"Lim","year":"2022","journal-title":"Aging Clin Exp Res"},{"issue":"10","key":"zoi261089r11","doi-asserted-by":"publisher","first-page":"1549","DOI":"10.1016\/j.jamda.2023.07.007","article-title":"Predictive capability of 5 sarcopenia diagnostic criteria for fall incidents in older Japanese women: the Otassha study.","volume":"24","author":"Wakaba","year":"2023","journal-title":"J Am Med Dir Assoc"},{"issue":"2","key":"zoi261089r12","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1002\/agm2.70082","article-title":"Interpretation of a focus shift from sarcopenia to muscle health in the Asian Working Group for Sarcopenia 2025 Consensus Update.","volume":"9","author":"Jianghan","year":"2026","journal-title":"Aging Med (Milton)"},{"issue":"3","key":"zoi261089r13","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian Working Group for Sarcopenia: 2019 Consensus Update on sarcopenia diagnosis and treatment.","volume":"21","author":"Chen","year":"2020","journal-title":"J Am Med Dir Assoc"},{"issue":"3","key":"zoi261089r14","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1002\/agm2.70088","article-title":"Biomarkers of Sarcopenia: Current Status and Future Perspectives.","volume":"9","author":"Luo","year":"2026","journal-title":"Aging Med (Milton)"},{"issue":"1","key":"zoi261089r15","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1002\/jpen.1440","article-title":"GLIM criteria for the diagnosis of malnutrition: a consensus report from the Global Clinical Nutrition Community.","volume":"43","author":"Jensen","year":"2019","journal-title":"JPEN J Parenter Enteral Nutr"},{"issue":"6","key":"zoi261089r16","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1016\/j.eurger.2016.01.005","article-title":"Calf circumference and risk of falls among Peruvian older adults.","volume":"7","author":"D\u00edaz-Villegas","year":"2016","journal-title":"Eur Geriatr Med"},{"issue":"2","key":"zoi261089r17","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1053\/j.jrn.2022.08.003","article-title":"Calf circumference predicts falls in older adults on hemodialysis.","volume":"33","author":"Rodrigues","year":"2023","journal-title":"J Ren Nutr"},{"issue":"10079","key":"zoi261089r18","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1016\/S0140-6736(17)30548-2","article-title":"Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: a cohort study.","volume":"389","author":"Zeng","year":"2017","journal-title":"Lancet"},{"issue":"6","key":"zoi261089r19","doi-asserted-by":"publisher","first-page":"1679","DOI":"10.1093\/ajcn\/nqab029","article-title":"Calf circumference: cutoff values from the NHANES 1999-2006.","volume":"113","author":"Gonzalez","year":"2021","journal-title":"Am J Clin Nutr"},{"issue":"10","key":"zoi261089r20","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1111\/ggi.13756","article-title":"Impact of edema on length of calf circumference in older adults.","volume":"19","author":"Ishida","year":"2019","journal-title":"Geriatr Gerontol Int"},{"issue":"5","key":"zoi261089r21","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1093\/gerona\/glu010","article-title":"The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates.","volume":"69","author":"Studenski","year":"2014","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"zoi261089r22","doi-asserted-by":"publisher","DOI":"10.1016\/j.dialog.2023.100134","article-title":"Katz index of activities of daily living in assessing functional status of older people: reliability and validity of Sinhala version.","volume":"2","author":"Rathnayake","year":"2023","journal-title":"Dialogues Health"},{"issue":"2","key":"zoi261089r23","doi-asserted-by":"publisher","first-page":"487","DOI":"10.3233\/JAD-160119","article-title":"Mini-Mental State Examination in elderly Chinese: a population-based normative study.","volume":"53","author":"Li","year":"2016","journal-title":"J Alzheimers Dis"},{"key":"zoi261089r24","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.ijnurstu.2019.04.008","article-title":"Psychometric properties of the Chinese version of the Center for Epidemiologic Studies Depression Scale-Revised in patients with cancer: a cross-sectional study.","volume":"97","author":"Li","year":"2019","journal-title":"Int J Nurs Stud"},{"issue":"28","key":"zoi261089r25","doi-asserted-by":"publisher","first-page":"3661","DOI":"10.1002\/sim.6607","article-title":"Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies.","volume":"34","author":"Austin","year":"2015","journal-title":"Stat Med"},{"issue":"3","key":"zoi261089r26","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.clnu.2023.01.002","article-title":"Calf circumference change and all-cause mortality among community-dwelling Chinese older people.","volume":"42","author":"Wang","year":"2023","journal-title":"Clin Nutr"},{"key":"zoi261089r27","doi-asserted-by":"publisher","DOI":"10.1016\/j.nut.2025.112849","article-title":"Longitudinal changes in calf circumference and health outcomes among community-dwelling older adults in southern Brazil.","volume":"139","author":"Bolaji","year":"2025","journal-title":"Nutrition"},{"key":"zoi261089r28","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1016\/j.clnesp.2025.05.044","article-title":"Relationship between longitudinal changes in calf circumference and skeletal muscle mass.","volume":"68","author":"Kawakami","year":"2025","journal-title":"Clin Nutr ESPEN"},{"issue":"1","key":"zoi261089r29","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2025.104269","article-title":"Association between changes in calf and mid-upper arm circumference and prognosis in cardiovascular disease patients.","volume":"36","author":"Sato","year":"2026","journal-title":"Nutr Metab Cardiovasc Dis"},{"issue":"9","key":"zoi261089r30","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1007\/s12603-022-1838-0","article-title":"Calf circumference and all-cause mortality: a systematic review and meta-analysis based on trend estimation approaches.","volume":"26","author":"Li","year":"2022","journal-title":"J Nutr Health Aging"},{"key":"zoi261089r31","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1007\/978-3-319-70178-3","article-title":"Sex differences in muscle wasting.","volume":"1043","author":"Anderson","year":"2017","journal-title":"Adv Exp Med Biol"},{"issue":"9868","key":"zoi261089r32","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1016\/S0140-6736(12)62167-9","article-title":"Frailty in elderly people.","volume":"381","author":"Clegg","year":"2013","journal-title":"Lancet"},{"issue":"8","key":"zoi261089r33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jnha.2024.100290","article-title":"Diagnostic and prognostic value of calf circumference for sarcopenia in community-dwelling older adults.","volume":"28","author":"\u00c1lvarez-Bustos","year":"2024","journal-title":"J Nutr Health Aging"},{"issue":"1","key":"zoi261089r34","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1186\/s12877-022-03644-w","article-title":"Calf circumference predicts frailty in older adults: the Chinese longitudinal healthy longevity survey.","volume":"22","author":"Xu","year":"2022","journal-title":"BMC Geriatr"},{"issue":"7","key":"zoi261089r35","doi-asserted-by":"publisher","first-page":"5362","DOI":"10.3390\/ijerph20075362","article-title":"Relationship between muscle strength and gait parameters in healthy older women and men.","volume":"20","author":"Stotz","year":"2023","journal-title":"Int J Environ Res Public Health"},{"issue":"5","key":"zoi261089r36","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.1007\/s41999-024-01034-6","article-title":"Association of body mass index-adjusted calf circumference with appendicular skeletal muscle mass and fall risk in older adults.","volume":"15","author":"Miyahara","year":"2024","journal-title":"Eur Geriatr Med"},{"issue":"1","key":"zoi261089r37","doi-asserted-by":"publisher","DOI":"10.1111\/ggi.70354","article-title":"Association of BMI-adjusted calf circumference and age-specific cutoff values with in-hospital falls among older adults: a multicenter prospective study.","volume":"26","author":"Miyahara","year":"2026","journal-title":"Geriatr Gerontol Int"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2855780\/zhang_2026_oi_261089_1792177283.81199.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T15:30:27Z","timestamp":1792769427000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2855780"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,23]]},"references-count":37,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.40127","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,23]]}}}