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The objective of this study is to determine the associations of sarcopenia and relative sarcopenia with mortality independent of co\u2010morbidities, and whether chronic kidney disease (CKD) and adiposity alter these associations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Dual energy X\u2010ray absorptiometry\u2010derived appendicular lean mass index (ALMI, kg\/m<jats:sup>2<\/jats:sup>) and fat mass index (FMI, kg\/m<jats:sup>2<\/jats:sup>) were assessed in 14\u00a0850 National Health and Nutrition Examination Survey participants from 1999 to 2006 and were linked to death certificate data in the National Death Index with follow\u2010up through 2011. Sarcopenia was defined using sex\u2010specific and race\/ethnicity\u2010specific standard deviation scores compared with young adults (T\u2010scores) as an ALMI T\u2010score\u00a0&lt;\u00a0\u22122 and relative sarcopenia as fat\u2010adjusted ALMI (ALMI<jats:sub>FMI<\/jats:sub>) T\u2010score\u00a0&lt;\u00a0\u22122. Glomerular filtration rate (GFR) was estimated using creatinine\u2010based (eGFR<jats:sub>Cr<\/jats:sub>) and cystatin C\u2010based (eGFR<jats:sub>Cys<\/jats:sub>) regression equations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three (3.0) per cent of National Health and Nutrition Examination Survey participants met criteria for sarcopenia and 8.7% met criteria for relative sarcopenia. Sarcopenia and relative sarcopenia were independently associated with mortality (HR sarcopenia 2.20, 95% CI 1.69 to 2.86; HR relative sarcopenia 1.60, 95% CI 1.31 to 1.96). The corresponding population attributable risks were 5.2% (95% CI 3.4% to 6.4%) and 8.4% (95% CI 4.8% to 11.2%), respectively. Relative sarcopenia remained significantly associated with mortality (HR 1.32, 95% CI 1.08 to 1.61) when limited to the subset who did not meet the criteria for sarcopenia. The risk of mortality associated with relative sarcopenia was attenuated among persons with higher FMI (<jats:italic>P<\/jats:italic> for interaction &lt;0.01) and was not affected by CKD status for either sarcopenia or relative sarcopenia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Sarcopenia and relative sarcopenia are significantly associated with mortality regardless of CKD status. Relative sarcopenia is nearly three\u2010fold more prevalent amplifying its associated mortality risk at the population level. The association between relative sarcopenia and mortality is attenuated in persons with higher FMI.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcsm.12396","type":"journal-article","created":{"date-parts":[[2019,2,20]],"date-time":"2019-02-20T05:10:54Z","timestamp":1550639454000},"page":"338-346","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Relative sarcopenia and mortality and the modifying effects of chronic kidney disease and adiposity"],"prefix":"10.1002","volume":"10","author":[{"given":"Susan L.","family":"Ziolkowski","sequence":"first","affiliation":[{"name":"Department of Medicine Stanford University School of Medicine  Stanford CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Medicine Stanford University School of Medicine  Stanford CA 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