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Muscle mass is a fundamental and objective component of sarcopenia. In some studies, relative muscle loss has been used to define sarcopenia. Methylmalonic acid (MMA) is a biomarker of mitochondrial dysfunction and vitamin B12 deficiency. Evidence has shown a negative link between MMA and muscle function, yet population\u2010level evidence on its predictive and prognostic value in low muscle mass and sarcopenia remains scarce. This cohort study analyzes 10,414 U.S. adults from the National Health and Nutrition Examination Survey. Incidence of low muscle mass is evaluated with adjusted logistic regression, while all\u2010cause mortality risk in this population is assessed using Cox regression and Kaplan\u2013Meier analysis. Restricted cubic splines (RCS) model MMA\u2010mortality dose\u2013response. Subgroup and sensitivity analyses test robustness. After full covariate adjustment, elevated MMA level independently predicts low muscle mass incidence (OR\u2009=\u20091.30, 95% CI: 1.08\u20131.56,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.007) and all\u2010cause mortality (HR\u2009=\u20092.17, 95% CI: 1.64\u20132.89,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) in this population. RCS analysis demonstrates a monotonic mortality increase with rising MMA concentrations (\n                    <jats:italic>p<\/jats:italic>\n                    for overall\u2009&lt;\u20090.001), with no evidence of nonlinearity (\n                    <jats:italic>p<\/jats:italic>\n                    for nonlinear\u2009=\u20090.057). Kaplan\u2013Meier survival curve exhibits significant mortality divergence across MMA tertiles (log\u2010rank\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), especially in the elder low muscle mass population. Subgroup analysis identifies higher mortality associations in lifetime alcohol abstainers (HR\u2009=\u20093.60, 95% CI: 2.34\u20135.53,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and diabetic\/borderline populations (HR\u2009=\u20093.49, 95% CI: 2.35\u20135.20,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) with low muscle mass. Notably, MMA has significant interaction effects with congestive heart failure (\n                    <jats:italic>p<\/jats:italic>\n                    for interaction\u2009=\u20090.002). Sensitivity analysis corroborates the robustness of these associations. Serum MMA could serve as a dual biomarker for independently predicting low muscle mass incidence and post\u2010diagnosis mortality. These findings underscore the clinical utility for early risk detection and prognosis stratification as well as call for trials targeting MMA reduction to mitigate sarcopenia pathogenesis, progression, and prognosis.\n                  <\/jats:p>","DOI":"10.1002\/fsn3.70841","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T11:55:05Z","timestamp":1756900505000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Role of Methylmalonic Acid in the Risk of Sarcopenia and All\u2010Cause Mortality Among Individuals With Sarcopenia: Evidence From\n                    <scp>NHANES<\/scp>"],"prefix":"10.1002","volume":"13","author":[{"given":"Ping","family":"Zhu","sequence":"first","affiliation":[{"name":"State Key Laboratory for Innovation and Transformation of Luobing Theory; Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology Qilu Hospital of Shandong University  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology People's Hospital of Lixia District of Jinan  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue\u2010Chun","family":"Liu","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Innovation and Transformation of Luobing Theory; Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology Qilu Hospital of Shandong University  Jinan China"},{"name":"Department of Zero\u2010Magnetic Medicine Qilu Hospital of Shandong University  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Song","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Innovation and Transformation of Luobing Theory; Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology Qilu Hospital of Shandong University  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Lu","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Innovation and Transformation of Luobing Theory; Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology Qilu Hospital of Shandong University  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi\u2010Cheng","family":"Yang","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Innovation and Transformation of Luobing Theory; Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology Qilu Hospital of Shandong University  Jinan China"},{"name":"School of Nursing and Rehabilitation, Cheeloo College of Medicine Shandong University  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Pan","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Innovation and Transformation of Luobing Theory; Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology Qilu Hospital of Shandong University  Jinan China"},{"name":"Department of Geriatric Medicine &amp; Laboratory of Gerontology and Anti\u2010Aging Research Qilu Hospital of Shandong University  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya\u2010Qiong","family":"Jiao","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Innovation and Transformation of Luobing Theory; Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology Qilu Hospital of Shandong University  Jinan China"},{"name":"Department of Zero\u2010Magnetic Medicine Qilu Hospital of Shandong University  Jinan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya\u2010Fei","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Life Science Imperial College  London 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