{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:49:36Z","timestamp":1791524976516,"version":"4.3.4"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5R37CA258761"],"award-info":[{"award-number":["5R37CA258761"]}],"id":[{"id":"10.13039\/100000002","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":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sarcopenic obesity is associated with a significant increase in morbidity and mortality, particularly in older adults. Common measures of sarcopenic obesity consider obesity and sarcopenia independently, despite their potentially synergistic harmful effects. The fat mass to fat\u2010free mass ratio (FM\/FFM) is an integrated measure of sarcopenic obesity that provides more useful information than measures that consider sarcopenia and obesity separately. The objectives of this study are to develop age\u2010 and sex\u2010specific FM\/FFM percentile curves for older adults and describe age\u2010 and sex\u2010related patterns of FM\/FFM percentiles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Data from the Canadian Longitudinal Study on Aging (CLSA) were used (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200928\u2009791). FM\/FFM was calculated as the ratio of total body fat mass (kg) to total body lean mass (kg) from dual\u2010energy X\u2010ray absorptiometry (DXA) scan. Weighted age\u2010 and sex\u2010specific FM\/FFM curves for the 1st, 5th, 25th, 50th, 75th, 95th and 99th percentiles were calculated using the LMS method. LMS provides a summary of the changing distribution of the measurement of interest by the three curves, lambda for the skewness (L), mu for the median (M) and sigma for the coefficient of variation (S). Weighted percentile curves were plotted with age (45\u201386\u2009years) on the\n                      <jats:italic>x<\/jats:italic>\n                      \u2010axis and FM\/FFM on the\n                      <jats:italic>y<\/jats:italic>\n                      \u2010axis for males and females, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean age of the CLSA at baseline was 59.6\u2009\u00b1\u200910.2\u2009years, and 47.4% were males. For men, FM\/FFM percentiles appear to increase slowly with aging and then stabilise after age 70. For women, FM\/FFM percentiles appear to start at a higher value and increase more rapidly with aging, stabilising but then showing a stronger downward trend than males after age 65. At the 50th percentile, the maximum FM\/FFM value is 0.42 at age 86\u2009years for males and 0.71 at age 68\u2009years for females.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The present study highlights the important age\u2010 and sex\u2010related differences in FM\/FFM percentiles in older adults. The FM\/FFM curves could be used as a tool for identifying older adults with sarcopenic obesity and examining health risks associated with sarcopenic obesity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.70399","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:58:34Z","timestamp":1791521914000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Age\u2010 and Sex\u2010Specific Percentile Curves for the FM\/FFM Ratio Using Data From the Canadian Longitudinal Study on Aging"],"prefix":"10.1002","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3133-6342","authenticated-orcid":false,"given":"Chris","family":"Kim","sequence":"first","affiliation":[{"name":"Epidemiology Division, Dalla Lana School of Public Health University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire E.","family":"Cook","sequence":"additional","affiliation":[{"name":"Epidemiology Division, Dalla Lana School of Public Health University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailey R.","family":"Banack","sequence":"additional","affiliation":[{"name":"Epidemiology Division, Dalla Lana School of Public Health University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"issue":"2","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"379","DOI":"10.14336\/AD.2021.1006","article-title":"Sarcopenic Obesity: An Emerging Public Health Problem","volume":"13","author":"Ji T.","year":"2022","journal-title":"Aging and Disease"},{"issue":"4","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1002\/jcsm.13502","article-title":"Sarcopenic Obesity and Health Outcomes: An Umbrella Review of Systematic Reviews With Meta\u2010Analysis","volume":"15","author":"Veronese N.","year":"2024","journal-title":"Journal of Cachexia, Sarcopenia and Muscle"},{"issue":"3","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1159\/000521241","article-title":"Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement","volume":"15","author":"Donini L. M.","year":"2022","journal-title":"Obesity Facts"},{"issue":"1","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1186\/s12877-024-04952-z","article-title":"Prevalence of Sarcopenic Obesity in the Older Non\u2010hospitalized Population: A Systematic Review and Meta\u2010Analysis","volume":"24","author":"Luo Y.","year":"2024","journal-title":"BMC Geriatrics"},{"issue":"8","key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.1016\/j.clnu.2019.11.024","article-title":"Critical Appraisal of Definitions and Diagnostic Criteria for Sarcopenic Obesity Based on a Systematic Review","volume":"39","author":"Donini L. M.","year":"2020","journal-title":"Clinical Nutrition"},{"issue":"6","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"2284","DOI":"10.1016\/j.clnu.2017.09.021","article-title":"Fat Mass to Fat\u2010Free Mass Ratio Reference Values From NHANES III Using Bioelectrical Impedance Analysis","volume":"37","author":"Xiao J.","year":"2018","journal-title":"Clinical Nutrition"},{"issue":"5","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/s41574-023-00943-z","article-title":"Sarcopenic Obesity in Older Adults: A Clinical Overview","volume":"20","author":"Prado C. M.","year":"2024","journal-title":"Nature Reviews. Endocrinology"},{"issue":"3","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","DOI":"10.1093\/ageing\/afae052","article-title":"The Conceptual Definition of Sarcopenia: Delphi Consensus From the Global Leadership Initiative in Sarcopenia (GLIS)","volume":"53","author":"Kirk B.","year":"2024","journal-title":"Age and Ageing"},{"key":"e_1_2_11_10_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.compbiomed.2021.104754","article-title":"A Systematic Literature Review on Obesity: Understanding the Causes & Consequences of Obesity and Reviewing Various Machine Learning Approaches Used to Predict Obesity","volume":"136","author":"Safaei M.","year":"2021","journal-title":"Computers in Biology and Medicine"},{"issue":"3","key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/S2213-8587(24)00316-4","article-title":"Definition and Diagnostic Criteria of Clinical Obesity","volume":"13","author":"Rubino F.","year":"2025","journal-title":"Lancet Diabetes and Endocrinology"},{"issue":"5","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.clnu.2012.06.010","article-title":"Sarcopenic Obesity: A Critical Appraisal of the Current Evidence","volume":"31","author":"Prado C. M.","year":"2012","journal-title":"Clinical Nutrition"},{"issue":"4","key":"e_1_2_11_13_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0214994","article-title":"Fat\u2010To\u2010Muscle Ratio Is a Useful Index for Cardiometabolic Risks: A Population\u2010Based Observational Study","volume":"14","author":"Chen Y.\u2010Y.","year":"2019","journal-title":"PLoS ONE"},{"key":"e_1_2_11_14_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.exger.2023.112155","article-title":"The Association Between Muscle\u2010To\u2010Fat Ratio and Cardiometabolic Risks: The China National Health Survey","volume":"175","author":"He H.","year":"2023","journal-title":"Experimental Gerontology"},{"key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.3389\/fendo.2021.765415","article-title":"Relationship of Fat Mass Index and Fat Free Mass Index With Body Mass Index and Association With Function, Cognition and Sarcopenia in Pre\u2010Frail Older Adults","volume":"12","author":"Merchant R. A.","year":"2021","journal-title":"Frontiers in Endocrinology"},{"issue":"4","key":"e_1_2_11_16_1","first-page":"261","article-title":"Fat\u2010To\u2010Muscle Ratio: A New Anthropometric Indicator for Predicting Metabolic Syndrome in the Han and Bouyei Populations From Guizhou Province, China","volume":"31","author":"Xu K.","year":"2018","journal-title":"Biomedical and Environmental Sciences"},{"issue":"4","key":"e_1_2_11_17_1","doi-asserted-by":"crossref","first-page":"539","DOI":"10.17269\/s41997-018-0060-7","article-title":"Population\u2010Level Trends in the Distribution of Body Mass Index in Canada, 2000\u20132014","volume":"109","author":"Lebel A.","year":"2018","journal-title":"Canadian Journal of Public Health"},{"issue":"12","key":"e_1_2_11_18_1","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1093\/aje\/kwac115","article-title":"A Framework for Descriptive Epidemiology","volume":"191","author":"Lesko C. R.","year":"2022","journal-title":"American Journal of Epidemiology"},{"issue":"6","key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1093\/ije\/dyz173","article-title":"Cohort Profile: The Canadian Longitudinal Study on Aging (CLSA)","volume":"48","author":"Raina P.","year":"2019","journal-title":"International Journal of Epidemiology"},{"issue":"10","key":"e_1_2_11_20_1","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1139\/apnm-2023-0618","article-title":"Development and Validation of Reference Equations for Dual\u2010Energy X\u2010Ray Absorptiometry\u2010Derived Measures of Fat\u2010Free Mass in Adults Aged 45\u201385 Years: Results From the Canadian Longitudinal Study on Aging","volume":"49","author":"Jenkins A. R.","year":"2024","journal-title":"Applied Physiology, Nutrition, and Metabolism"},{"key":"e_1_2_11_21_1","doi-asserted-by":"crossref","DOI":"10.1186\/2050-6511-14-53","article-title":"Lean Body Mass: The Development and Validation of Prediction Equations in Healthy Adults","volume":"14","author":"Yu S.","year":"2013","journal-title":"BMC Pharmacology and Toxicology"},{"issue":"10","key":"e_1_2_11_22_1","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1002\/sim.4780111005","article-title":"Smoothing Reference Centile Curves: The LMS Method and Penalized Likelihood","volume":"11","author":"Cole T. J.","year":"1992","journal-title":"Statistics in Medicine"},{"issue":"4850","key":"e_1_2_11_23_1","first-page":"4850","article-title":"LMS Parameters, Percentile, and Z\u2010Score Growth Curves for Axial Length in Chinese Schoolchildren in Wuhan","volume":"12","author":"Sanz Diez P.","journal-title":"Scientific Reports"},{"key":"e_1_2_11_24_1","unstructured":"R. J.Kuczmarski C. L.Ogden S. S.Guo et\u00a0al. \u201c2000 CDC Growth Charts for the United States: Methods and Development (Vital and Health Statistics Series 11 Data From the National Health Survey No. 246; DHHS Publication No. PHS 2002\u20101696) \u201d National Center for Health Statistics. (2002) https:\/\/www.cdc.gov\/nchs\/data\/series\/sr_11\/sr11_246.pdf."},{"issue":"2","key":"e_1_2_11_25_1","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.nut.2009.07.004","article-title":"Body Composition Changes With Aging: The Cause or the Result of Alterations in Metabolic Rate and Macronutrient Oxidation?","volume":"26","author":"St\u2010Onge M.\u2010P.","year":"2010","journal-title":"Nutrition"},{"key":"e_1_2_11_26_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.archger.2021.104389","article-title":"Reference Values of Skeletal Muscle Mass, Fat Mass and Fat\u2010To\u2010Muscle Ratio for Rural Middle Age and Older Adults in Western China","volume":"95","author":"Zhang J. X.","year":"2021","journal-title":"Archives of Gerontology and Geriatrics"},{"issue":"7","key":"e_1_2_11_27_1","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1017\/S1368980014001918","article-title":"Body Composition Indices of a Load\u2013Capacity Model: Gender\u2010 and BMI\u2010Specific Reference Curves","volume":"18","author":"Siervo M.","year":"2015","journal-title":"Public Health Nutrition"},{"issue":"12","key":"e_1_2_11_28_1","doi-asserted-by":"crossref","first-page":"3693","DOI":"10.1093\/aje\/kwaf181","article-title":"A Cross\u2010National Comparison of Obesity Using Body Mass Index\u2010For\u2010Age Percentiles: Results From the Canadian Longitudinal Study on Aging and the United States Health and Retirement Study","volume":"194","author":"Cook C. E.","year":"2025","journal-title":"American Journal of Epidemiology"},{"issue":"4","key":"e_1_2_11_29_1","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.maturitas.2009.12.012","article-title":"Ethnic Differences in Body Composition and the Associated Metabolic Profile: A Comparative Study Between Asians and Caucasians","volume":"65","author":"Wulan S. N.","year":"2010","journal-title":"Maturitas"},{"key":"e_1_2_11_30_1","doi-asserted-by":"crossref","DOI":"10.1155\/2019\/3548284","article-title":"Assessment of Body Composition in Health and Disease Using Bioelectrical Impedance Analysis (BIA) and Dual Energy X\u2010Ray Absorptiometry (DXA): A Critical Overview","volume":"2019","author":"Marra M.","year":"2019","journal-title":"Contrast Media & Molecular Imaging"},{"key":"e_1_2_11_31_1","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2024.1366229","article-title":"Analysis of Sarcopenic Obesity Prevalence and Diagnostic Agreement According to the 2022 ESPEN and EASO Consensus in Hospitalized Older Adults With Severe Obesity","volume":"15","author":"Danielewicz A. L.","year":"2022","journal-title":"Frontiers in Endocrinology"},{"issue":"3","key":"e_1_2_11_32_1","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.beem.2007.04.007","article-title":"Sexual Dimorphism of Body Composition","volume":"21","author":"Wells J. C. K.","year":"2007","journal-title":"Best Practice & Research Clinical Endocrinology & Metabolism"},{"issue":"4","key":"e_1_2_11_33_1","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.tpb.2012.06.002","article-title":"Sexual Dimorphism and Sexual Selection: A Unified Economic Analysis","volume":"82","author":"Cyrus Chu C. Y.","year":"2012","journal-title":"Theoretical Population Biology"},{"issue":"3","key":"e_1_2_11_34_1","doi-asserted-by":"crossref","first-page":"187","DOI":"10.4103\/jmh.jmh_123_21","article-title":"Weight, Shape, and Body Composition Changes at Menopause","volume":"12","author":"Fenton A.","year":"2021","journal-title":"Journal of Mid\u2010Life Health"},{"issue":"1","key":"e_1_2_11_35_1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1161\/ATVBAHA.119.313154","article-title":"Sex Differences in Genomic Drivers of Adipose Distribution and Related Cardiometabolic Disorders","volume":"40","author":"Lumish H. S.","year":"2020","journal-title":"Arteriosclerosis, Thrombosis, and Vascular Biology"},{"issue":"4","key":"e_1_2_11_36_1","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1007\/s13679-021-00453-x","article-title":"Sex\/Gender Differences in Obesity Prevalence, Comorbidities, and Treatment","volume":"10","author":"Cooper A. J.","year":"2021","journal-title":"Current Obesity Reports"},{"issue":"2","key":"e_1_2_11_37_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.advnut.2024.100364","article-title":"Beyond Traditional Body Composition Metrics: Load\u2010Capacity Indices Emerge as Predictors of Cardiometabolic Outcomes\u2014A Systematic Review and Meta\u2010Analysis","volume":"16","author":"Guan Z.","year":"2025","journal-title":"Advances in Nutrition"},{"issue":"1","key":"e_1_2_11_38_1","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1186\/s12877-024-05607-9","article-title":"The Value and Effectiveness of Geriatric Assessments for Older Adults With cancer: An Umbrella Review","volume":"24","author":"He S.","year":"2024","journal-title":"BMC Geriatrics"},{"issue":"1","key":"e_1_2_11_39_1","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1038\/s41467-020-20123-1","article-title":"Mechanisms of Muscle Atrophy and Hypertrophy: Implications in Health and Disease","volume":"12","author":"Sartori R.","year":"2021","journal-title":"Nature Communications"}],"container-title":["Journal of Cachexia, Sarcopenia and Muscle"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jcsm.70399","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jcsm.70399","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jcsm.70399","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:58:40Z","timestamp":1791521920000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jcsm.70399"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":38,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/jcsm.70399"],"URL":"https:\/\/doi.org\/10.1002\/jcsm.70399","archive":["Portico"],"relation":{},"ISSN":["2190-5991","2190-6009"],"issn-type":[{"value":"2190-5991","type":"print"},{"value":"2190-6009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2025-04-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70399"}}