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Several sarcopenia consensuses have newly introduced the premorbid concept of possible sarcopenia and recommended early lifestyle interventions. Bidirectional transitions of premorbid states have been revealed in several chronic diseases yet not clarified in sarcopenia. This study aims to investigate the underlying transition patterns of sarcopenia states.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study utilized three waves of data from a nationally representative survey, the China Health and Retirement Longitudinal Study (CHARLS), and included community\u2010dwelling individuals aged 60\u00a0years and older with at least two sarcopenia states assessments based on the Asian Working Group for Sarcopenia criteria 2019 (AWGS2019) between 2011 and 2015. The estimated transition intensity and probability between non\u2010sarcopenia, possible sarcopenia, sarcopenia, and death were investigated using multi\u2010stage Markov (MSM) models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study comprised 4395 individuals (49.2% female, median age 67\u00a0years) with a total of 10\u00a0778 records of sarcopenia state assessment, and the mean follow\u2010up period was 3.29\u00a0years. A total of 24.5% of individuals with a current state of possible sarcopenia returned to non\u2010sarcopenia, 60.3% remained possible sarcopenia, 6.7% progressed to sarcopenia, and 8.5% died by the next follow\u2010up. The transition intensity of recovery to non\u2010sarcopenia (0.252, 95% CI 0.231\u20130.275) was 2.8 times greater than the deterioration to sarcopenia (0.090, 95% CI 0.080\u20130.100) for individuals with possible sarcopenia. For individuals with possible sarcopenia, the estimated probabilities of recovering to non\u2010sarcopenia, progressing to sarcopenia, and transitioning to death within a 1\u2010year observation were 0.181, 0.066, and 0.035, respectively. For individuals with sarcopenia, the estimated probabilities of recovering to non\u2010sarcopenia, recovering to possible sarcopenia, and transitioning to death within 1\u2010year observation were 0.016, 0.125, and 0.075, respectively. In covariables analysis, age, sex, body mass index, physical function impairment, smoking, hypertension, and diabetes are important factors influencing bidirectional transitions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings highlight the bidirectional transitions of sarcopenia states among older adults and reveal a notable proportion of possible sarcopenia show potential for recovery in the natural course. Screening and intensifying interventions based on risk factors may facilitate a recovery transition.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.13541","type":"journal-article","created":{"date-parts":[[2024,7,13]],"date-time":"2024-07-13T01:14:44Z","timestamp":1720833284000},"page":"1915-1929","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":98,"title":["Bidirectional transitions of sarcopenia states in older adults: The longitudinal evidence from CHARLS"],"prefix":"10.1002","volume":"15","author":[{"given":"Ya\u2010Xi","family":"Luo","sequence":"first","affiliation":[{"name":"Department of Rehabilitation The Second Affiliated Hospital of Chongqing Medical University  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao\u2010Han","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation The Second Affiliated Hospital of Chongqing Medical 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