{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T22:16:28Z","timestamp":1778969788228,"version":"3.51.4"},"reference-count":40,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T00:00:00Z","timestamp":1760486400000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011033","name":"Agencia Estatal de Investigaci\u00f3n","doi-asserted-by":"publisher","award":["PCI2020\u2010120683\u20102"],"award-info":[{"award-number":["PCI2020\u2010120683\u20102"]}],"id":[{"id":"10.13039\/501100011033","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Sarcopenic obesity (SO) is a clinical condition defined by the coexistence of high body fat mass and low muscle function and mass, which increases the risk of adverse health outcomes, including disability and mortality. Early detection and frequent monitoring of SO are essential for preventive interventions and management strategies. The current binary approach for SO diagnosis is limited in capturing the spectrum of SO or its progression over time. The main objective of this study was to develop a continuous SOP\n                      <jats:italic>i<\/jats:italic>\n                      that integrates diagnostic criteria such as muscle function and body composition. We aimed to evaluate the association between SOP\n                      <jats:italic>i<\/jats:italic>\n                      and all\u2010cause mortality, to identify baseline\u2010related factors with SOP\n                      <jats:italic>i<\/jats:italic>\n                      and to assess changes in the SOP\n                      <jats:italic>i<\/jats:italic>\n                      over time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Participants from the Rotterdam Study with baseline and follow\u2010up measures of handgrip strength (HGS), dual\u2010energy X\u2010ray absorptiometry\u2010measured appendicular lean mass index (ALM\/kg) and body fat percentage (BF%) were included. SOP\n                      <jats:italic>i<\/jats:italic>\n                      was calculated as a sex\u2010specific equation integrating z\u2010scores (Z) of (BF%)\u2014(HGS)\u2014(ALM\/kg). Cox regression and multivariable linear regression models were fitted to evaluate mortality risk and associated factors with SOP\n                      <jats:italic>i<\/jats:italic>\n                      , respectively. Subgroup analysis of SOP\n                      <jats:italic>i<\/jats:italic>\n                      changes was performed by linear mixed\u2010effects models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the total population (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095888, age 69.5\u2009\u00b1\u20099.1\u2009years, BMI 27.5\u2009\u00b1\u20094.3\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , 56.8% females) and over the 9.9\u2010year median follow\u2010up period, 1538 (26.1%) participants died. Each standard deviation (SD) increase in sex\u2010specific SOP\n                      <jats:italic>i<\/jats:italic>\n                      was associated with a 10% higher risk of premature death (HR\u2009=\u20091.10 [95%CI: 1.07; 1.13]). Thirteen factors were associated with high SOP\n                      <jats:italic>i<\/jats:italic>\n                      , such as reduced physical activity, higher triglyceride\u2010glucose index, HOMA\u2010IR, systemic inflammation, osteopenia, hypertension, liver steatosis, asthma, coronary heart disease, oral corticosteroid use, lower protein intake, lower quality of life and lower educational status.\n                    <\/jats:p>\n                    <jats:p>\n                      In participants with obesity, lower physical activity and\/or insulin resistance (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091682), a significantly higher and faster increase in SOP\n                      <jats:italic>i<\/jats:italic>\n                      was observed compared to participants without these factors (males: \u03b2\u2009=\u20092.63 [95%CI: 2.22; 3.03]; females: \u03b2\u2009=\u20092.90 [95%CI: 2.58; 3.23]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      SOP\n                      <jats:italic>i<\/jats:italic>\n                      is a significant predictor of premature death and can identify associated factors, particularly useful among persons at risk of SO. SOP\n                      <jats:italic>i<\/jats:italic>\n                      is higher and increases faster in individuals with specific phenotypes. SOP\n                      <jats:italic>i<\/jats:italic>\n                      integrates prognosis information, which could be used as a risk indicator and for prevention of SO.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.70099","type":"journal-article","created":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T05:31:28Z","timestamp":1760592688000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sarcopenic Obesity Phenotype Index (SOP\n                    <i>i<\/i>\n                    ): A Population\u2010Based Study"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4744-2618","authenticated-orcid":false,"given":"Elizabeth","family":"Benz","sequence":"first","affiliation":[{"name":"Human Nutrition Unit Clermont Auvergne University, Institut National de Recherche Pour l'Agriculture, l'Alimentation et l'Environnement, Centre de Recherche en Nutrition Humaine  Clermont\u2010Ferrand France"},{"name":"Department of Epidemiology Erasmus MC, University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre","family":"Pinel","sequence":"additional","affiliation":[{"name":"Human Nutrition Unit Clermont Auvergne University, Institut National de Recherche Pour l'Agriculture, l'Alimentation et l'Environnement, Centre de Recherche en Nutrition Humaine  Clermont\u2010Ferrand France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christelle","family":"Guillet","sequence":"additional","affiliation":[{"name":"Human Nutrition Unit Clermont Auvergne University, Institut National de Recherche Pour l'Agriculture, l'Alimentation et l'Environnement, Centre de Recherche en Nutrition Humaine  Clermont\u2010Ferrand France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederic","family":"Capel","sequence":"additional","affiliation":[{"name":"Human Nutrition Unit Clermont Auvergne University, Institut National de Recherche Pour l'Agriculture, l'Alimentation et l'Environnement, Centre de Recherche en Nutrition Humaine  Clermont\u2010Ferrand France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Pereira","sequence":"additional","affiliation":[{"name":"Unit of Biostatistics Clermont\u2010Ferrand University Hospital  Clermont\u2010Ferrand France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitris","family":"Rizopoulos","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Erasmus MC, University Medical Center Rotterdam  Rotterdam the Netherlands"},{"name":"Department of Biostatistics Erasmus MC, University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfonso\u00a0J.","family":"Cruz\u2010Jentoft","sequence":"additional","affiliation":[{"name":"Servicio de Geriatria Hospital Universitario Ramon y Cajal (IRYCIS)  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doris","family":"Eglseer","sequence":"additional","affiliation":[{"name":"Institute of Nursing Science Medical University of Graz  Graz Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Topinkova","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, First Faculty of Medicine Charles University and General University Hospital, Prague, Czech Republic, and University of South Bohemia, Faculty of Health and Social Sciences  Ceske Budejovice Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rocco","family":"Barazzoni","sequence":"additional","affiliation":[{"name":"Department of Medical, Surgical and Health Sciences University of Trieste  Trieste Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo\u00a0M.","family":"Donini","sequence":"additional","affiliation":[{"name":"Department of Experimental Medicine, Section of Medical Pathology, Endocrinology and Human Nutrition Sapienza University of Rome  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Rivadeneira","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Erasmus University MC  Rotterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marinka","family":"Steur","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Erasmus MC, University Medical Center Rotterdam  Rotterdam the Netherlands"},{"name":"Division of Human Nutrition and Health Wageningen University  Wageningen the 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