{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T23:38:56Z","timestamp":1791070736733,"version":"4.1.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":39,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Geriatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Emerging evidence suggests that sarcopenia may be a significant risk factor for Type 2 Diabetes Mellitus (T2DM). However, existing research has predominantly relied on single baseline assessments, leaving the impact of its dynamic progression over time unclear. This study aimed to prospectively evaluate how transitions in sarcopenia status influence the incidence of T2DM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from the China Health and Retirement Longitudinal Study (CHARLS). Sarcopenia was defined according to the 2019 AWGS criteria and classified as non-sarcopenia, possible sarcopenia, or sarcopenia. Changes in status were determined by comparing classifications at baseline (2011year) and a two-year follow-up(2013year). Incident T2DM was identified through elevated fasting plasma glucose, random plasma glucose, HbA1c levels, or self-reported physician diagnosis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models, adjusted for multiple potential confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3,673 eligible participants (51.3% male; mean age 68.21 years), regression analysis revealed that recovery from sarcopenia to a non-sarcopenic state was associated with a significantly lower risk of T2DM (HR\u2009=\u20090.61, 95% CI: 0.40\u20130.93) compared to those who remained sarcopenic. While progression to a worse sarcopenia state showed a trend towards higher T2DM risk, this association was not statistically significant. Subgroup analyses indicated that the protective association of sarcopenia reversal was significant in men (HR\u2009=\u20090.43, 95% CI: 0.24\u20130.78) and participants aged\u2009\u2265\u200965 years (HR\u2009=\u20090.60, 95% CI: 0.37\u20130.99), but not in women or those under 65.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The longitudinal trajectory of sarcopenia status is associated with the risk of developing T2DM. Notably, improvement from sarcopenia is linked to a reduced risk, whereas progression may indicate an elevated risk, underscoring the potential clinical value of monitoring and managing sarcopenia dynamics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12877-026-07169-4","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T04:53:18Z","timestamp":1773377598000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sarcopenia changes and incident type 2 diabetes mellitus: a prospective analysis of the CHARLS cohort"],"prefix":"10.1186","volume":"26","author":[{"given":"Lingli","family":"Gao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuoshuo","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixun","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidian","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodong","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"issue":"1","key":"7169_CR1","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1038\/s41572-024-00550-w","volume":"10","author":"AA Sayer","year":"2024","unstructured":"Sayer AA, Cooper R, Arai H, Cawthon PM, Ntsama Essomba MJ, Fielding RA, et al. Sarcopenia. Nat Rev Dis Primers. 2024;10(1):68. https:\/\/doi.org\/10.1038\/s41572-024-00550-w.","journal-title":"Nat Rev Dis Primers"},{"issue":"2","key":"7169_CR2","doi-asserted-by":"publisher","first-page":"93","DOI":"10.14283\/jfa.2019.10","volume":"8","author":"S Goates","year":"2019","unstructured":"Goates S, Du K, Arensberg MB, Gaillard T, Guralnik J, Pereira SL. Economic impact of hospitalizations in US adults with sarcopenia. J Frailty Aging. 2019;8(2):93\u20139. https:\/\/doi.org\/10.14283\/jfa.2019.10.","journal-title":"J Frailty Aging"},{"issue":"3","key":"7169_CR3","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","volume":"21","author":"LK Chen","year":"2020","unstructured":"Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al. Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc. 2020;21(3):300\u20137. https:\/\/doi.org\/10.1016\/j.jamda.2019.12.012.","journal-title":"J Am Med Dir Assoc"},{"key":"7169_CR4","doi-asserted-by":"publisher","first-page":"155533","DOI":"10.1016\/j.metabol.2023.155533","volume":"144","author":"S Yuan","year":"2023","unstructured":"Yuan S, Larsson SC. Epidemiology of sarcopenia: Prevalence, risk factors, and consequences. Metabolism. 2023;144:155533. https:\/\/doi.org\/10.1016\/j.metabol.2023.155533.","journal-title":"Metabolism"},{"key":"7169_CR5","doi-asserted-by":"publisher","unstructured":"Izzo A, Massimino E, Riccardi G, Della Pepa G. A narrative review on sarcopenia in type 2 diabetes mellitus: prevalence and associated factors. Nutrients. 2021;13(1). https:\/\/doi.org\/10.3390\/nu13010183.","DOI":"10.3390\/nu13010183"},{"issue":"1","key":"7169_CR6","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1186\/s12877-023-04104-9","volume":"23","author":"C Luo","year":"2023","unstructured":"Luo C, Liu RY, Zhang GW, Hu F, Jin YH, Liu BY. Possible sarcopenia and risk of new-onset type 2 diabetes mellitus in older adults in china: a 7-year longitudinal cohort study. BMC Geriatr. 2023;23(1):404. https:\/\/doi.org\/10.1186\/s12877-023-04104-9.","journal-title":"BMC Geriatr"},{"key":"7169_CR7","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1016\/j.clnesp.2025.02.026","volume":"66","author":"Y Zhang","year":"2025","unstructured":"Zhang Y, Gong M, Feng XM, Yan YX. Bidirectional association between sarcopenia and diabetes: A prospective cohort study in middle-aged and elderly adults. Clin Nutr ESPEN. 2025;66:556\u201363. https:\/\/doi.org\/10.1016\/j.clnesp.2025.02.026.","journal-title":"Clin Nutr ESPEN"},{"key":"7169_CR8","doi-asserted-by":"publisher","unstructured":"Rondanelli M, Gasparri C, Cavioni A, Sivieri C, Barrile GC, Mansueto F, et al. A patented dietary supplement (Hydroxy-Methyl-Butyrate, Carnosine, Magnesium, Butyrate, Lactoferrin) is a promising therapeutic target for Age-Related sarcopenia through the regulation of gut permeability: A randomized controlled trial. Nutrients. 2024;16(9). https:\/\/doi.org\/10.3390\/nu16091369.","DOI":"10.3390\/nu16091369"},{"issue":"4","key":"7169_CR9","doi-asserted-by":"publisher","first-page":"e255","DOI":"10.1016\/S2666-7568(24)00009-6","volume":"5","author":"T Kawahara","year":"2024","unstructured":"Kawahara T, Suzuki G, Mizuno S, Tominaga N, Toda M, Toyama N, et al. Active vitamin D treatment in the prevention of sarcopenia in adults with prediabetes (DPVD ancillary study): a randomised controlled trial. Lancet Healthy Longev. 2024;5(4):e255. https:\/\/doi.org\/10.1016\/S2666-7568(24)00009-6.","journal-title":"Lancet Healthy Longev"},{"key":"7169_CR10","doi-asserted-by":"publisher","unstructured":"Liu M, Li J, Xu J, Chen Y, Chien C, Zhang H, et al. Graded progressive Home-Based resistance combined with aerobic exercise in Community-Dwelling older adults with sarcopenia: A randomized controlled trial. Clin Interv Aging. 2024;19:1581\u201395. https:\/\/doi.org\/10.2147\/CIA.S473081.","DOI":"10.2147\/CIA.S473081"},{"issue":"1","key":"7169_CR11","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1186\/s12916-024-03841-x","volume":"22","author":"Q Zeng","year":"2024","unstructured":"Zeng Q, Zhao L, Zhong Q, An Z, Li S. Changes in sarcopenia and incident cardiovascular disease in prospective cohorts. BMC Med. 2024;22(1):607. https:\/\/doi.org\/10.1186\/s12916-024-03841-x.","journal-title":"BMC Med"},{"issue":"1","key":"7169_CR12","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1093\/ije\/dys203","volume":"43","author":"Y Zhao","year":"2014","unstructured":"Zhao Y, Hu Y, Smith JP, Strauss J, Yang G. Cohort profile: the China health and retirement longitudinal study (CHARLS). Int J Epidemiol. 2014;43(1):61\u20138. https:\/\/doi.org\/10.1093\/ije\/dys203.","journal-title":"Int J Epidemiol"},{"issue":"4","key":"7169_CR13","first-page":"551","volume":"20","author":"X Wen","year":"2011","unstructured":"Wen X, Wang M, Jiang CM, Zhang YM. Anthropometric equation for Estimation of appendicular skeletal muscle mass in Chinese adults. Asia Pac J Clin Nutr. 2011;20(4):551\u20136.","journal-title":"Asia Pac J Clin Nutr"},{"issue":"2","key":"7169_CR14","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1002\/jcsm.12163","volume":"8","author":"M Yang","year":"2017","unstructured":"Yang M, Hu X, Wang H, Zhang L, Hao Q, Dong B. Sarcopenia predicts readmission and mortality in elderly patients in acute care wards: a prospective study. J Cachexia Sarcopenia Muscle. 2017;8(2):251\u20138. https:\/\/doi.org\/10.1002\/jcsm.12163.","journal-title":"J Cachexia Sarcopenia Muscle"},{"issue":"8","key":"7169_CR15","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1007\/s12603-014-0540-2","volume":"18","author":"S Alexandre Tda","year":"2014","unstructured":"Alexandre Tda S, Duarte YA, Santos JL, Wong R, Lebr\u00e3o ML. Sarcopenia according to the European working group on sarcopenia in older people (EWGSOP) versus dynapenia as a risk factor for mortality in the elderly. J Nutr Health Aging. 2014;18(8):751\u20136. https:\/\/doi.org\/10.1007\/s12603-014-0540-2.","journal-title":"J Nutr Health Aging"},{"issue":"11","key":"7169_CR16","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1007\/s12603-023-2001-2","volume":"27","author":"X Zhang","year":"2023","unstructured":"Zhang X, Ding L, Hu H, He H, Xiong Z, Zhu X. Associations of Body-Roundness index and sarcopenia with cardiovascular disease among Middle-Aged and older adults: findings from CHARLS. J Nutr Health Aging. 2023;27(11):953\u20139. https:\/\/doi.org\/10.1007\/s12603-023-2001-2.","journal-title":"J Nutr Health Aging"},{"issue":"2","key":"7169_CR17","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1002\/jcsm.12905","volume":"13","author":"S Qiu","year":"2022","unstructured":"Qiu S, Cai X, Yuan Y, Xie B, Sun Z, Wang D, et al. Muscle strength and prediabetes progression and regression in middle-aged and older adults: a prospective cohort study. J Cachexia Sarcopenia Muscle. 2022;13(2):909\u201318. https:\/\/doi.org\/10.1002\/jcsm.12905.","journal-title":"J Cachexia Sarcopenia Muscle"},{"issue":"Suppl 1","key":"7169_CR18","doi-asserted-by":"publisher","first-page":"S17","DOI":"10.2337\/dc22-S002","volume":"45","author":"American Diabetes Association Professional Practice C","year":"2022","unstructured":"American Diabetes Association Professional Practice C. 2. Classification and diagnosis of diabetes: standards of medical care in Diabetes-2022. Diabetes Care. 2022;45(Suppl 1):S17\u201338. https:\/\/doi.org\/10.2337\/dc22-S002.","journal-title":"Diabetes Care"},{"key":"7169_CR19","doi-asserted-by":"publisher","unstructured":"Daily JW, Park S. Sarcopenia is a cause and consequence of metabolic dysregulation in aging humans: effects of gut Dysbiosis, glucose dysregulation, diet and lifestyle. Cells. 2022;11(3). https:\/\/doi.org\/10.3390\/cells11030338.","DOI":"10.3390\/cells11030338"},{"issue":"6","key":"7169_CR20","doi-asserted-by":"publisher","first-page":"719","DOI":"10.4093\/dmj.2023.0112","volume":"47","author":"J Mesinovic","year":"2023","unstructured":"Mesinovic J, Fyfe JJ, Talevski J, Wheeler MJ, Leung GKW, George ES, et al. Type 2 diabetes mellitus and sarcopenia as comorbid chronic diseases in older adults: established and emerging treatments and therapies. Diabetes Metab J. 2023;47(6):719\u201342. https:\/\/doi.org\/10.4093\/dmj.2023.0112.","journal-title":"Diabetes Metab J"},{"key":"7169_CR21","doi-asserted-by":"publisher","unstructured":"Lisco G, Disoteo OE, De Tullio A, De Geronimo V, Giagulli VA, Monzani F, et al. Sarcopenia and diabetes: A detrimental liaison of advancing age. Nutrients. 2023;16(1). https:\/\/doi.org\/10.3390\/nu16010063.","DOI":"10.3390\/nu16010063"},{"issue":"5","key":"7169_CR22","doi-asserted-by":"publisher","first-page":"1470","DOI":"10.1210\/clinem\/dgab884","volume":"107","author":"L Feng","year":"2022","unstructured":"Feng L, Gao Q, Hu K, Wu M, Wang Z, Chen F, et al. Prevalence and risk factors of sarcopenia in patients with diabetes: A Meta-analysis. J Clin Endocrinol Metab. 2022;107(5):1470\u201383. https:\/\/doi.org\/10.1210\/clinem\/dgab884.","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"7169_CR23","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1507\/endocrj.ej13-0244","volume":"61","author":"SS Moon","year":"2014","unstructured":"Moon SS. Low skeletal muscle mass is associated with insulin resistance, diabetes, and metabolic syndrome in the Korean population: the Korea National health and nutrition examination survey (KNHANES) 2009\u20132010. Endocr J. 2014;61(1):61\u201370. https:\/\/doi.org\/10.1507\/endocrj.ej13-0244.","journal-title":"Endocr J"},{"issue":"5","key":"7169_CR24","doi-asserted-by":"publisher","first-page":"1915","DOI":"10.1002\/jcsm.13541","volume":"15","author":"YX Luo","year":"2024","unstructured":"Luo YX, Zhou XH, Heng T, Yang LL, Zhu YH, Hu P, et al. Bidirectional transitions of sarcopenia States in older adults: the longitudinal evidence from CHARLS. J Cachexia Sarcopenia Muscle. 2024;15(5):1915\u201329. https:\/\/doi.org\/10.1002\/jcsm.13541.","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"7169_CR25","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.2147\/DMSO.S410834","volume":"16","author":"H Chen","year":"2023","unstructured":"Chen H, Huang X, Dong M, Wen S, Zhou L, Yuan X. The association between sarcopenia and diabetes: from pathophysiology mechanism to therapeutic strategy. Diabetes Metab Syndr Obes. 2023;16:1541\u201354. https:\/\/doi.org\/10.2147\/DMSO.S410834.","journal-title":"Diabetes Metab Syndr Obes"},{"key":"7169_CR26","doi-asserted-by":"publisher","unstructured":"Lopez-Pedrosa JM, Camprubi-Robles M, Guzman-Rolo G, Lopez-Gonzalez A, Garcia-Almeida JM, Sanz-Paris A, et al. The vicious cycle of type 2 diabetes mellitus and skeletal muscle atrophy: Clinical, Biochemical, and nutritional bases. Nutrients. 2024;16(1). https:\/\/doi.org\/10.3390\/nu16010172.","DOI":"10.3390\/nu16010172"},{"key":"7169_CR27","doi-asserted-by":"publisher","unstructured":"Yoshida T, Delafontaine P. Mechanisms of IGF-1-Mediated regulation of skeletal muscle hypertrophy and atrophy. Cells. 2020;9(9). https:\/\/doi.org\/10.3390\/cells9091970.","DOI":"10.3390\/cells9091970"},{"key":"7169_CR28","doi-asserted-by":"publisher","first-page":"111823","DOI":"10.1016\/j.exger.2022.111823","volume":"164","author":"X Zhang","year":"2022","unstructured":"Zhang X, Li H, He M, Wang J, Wu Y, Li Y. Immune system and sarcopenia: presented relationship and future perspective. Exp Gerontol. 2022;164:111823. https:\/\/doi.org\/10.1016\/j.exger.2022.111823.","journal-title":"Exp Gerontol"},{"issue":"4","key":"7169_CR29","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.2337\/diabetes.53.4.1082","volume":"53","author":"M Aragno","year":"2004","unstructured":"Aragno M, Mastrocola R, Catalano MG, Brignardello E, Danni O, Boccuzzi G. Oxidative stress impairs skeletal muscle repair in diabetic rats. Diabetes. 2004;53(4):1082\u20138. https:\/\/doi.org\/10.2337\/diabetes.53.4.1082.","journal-title":"Diabetes"},{"issue":"9","key":"7169_CR30","doi-asserted-by":"publisher","first-page":"10.2835","DOI":"10.1016\/j.dsx.2023.102835","volume":"17","author":"A Marcotte-Ch\u00e9nard","year":"2023","unstructured":"Marcotte-Ch\u00e9nard A, Oliveira B, Little JP, Candow DG. Sarcopenia and type 2 diabetes: pathophysiology and potential therapeutic lifestyle interventions. Diabetes Metab Syndr. 2023;17(9):102835. https:\/\/doi.org\/10.1016\/j.dsx.2023.102835.","journal-title":"Diabetes Metab Syndr"},{"issue":"1","key":"7169_CR31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3803\/EnM.2020.35.1.1","volume":"35","author":"G Kim","year":"2020","unstructured":"Kim G, Kim JH. Impact of skeletal muscle mass on metabolic health. Endocrinol Metab (Seoul). 2020;35(1):1\u20136. https:\/\/doi.org\/10.3803\/EnM.2020.35.1.1.","journal-title":"Endocrinol Metab (Seoul)"},{"key":"7169_CR32","doi-asserted-by":"publisher","first-page":"1057","DOI":"10.2147\/DMSO.S186600","volume":"12","author":"J Mesinovic","year":"2019","unstructured":"Mesinovic J, Zengin A, De Courten B, Ebeling PR, Scott D. Sarcopenia and type 2 diabetes mellitus: a bidirectional relationship. Diabetes Metab Syndr Obes. 2019;12:1057\u201372. https:\/\/doi.org\/10.2147\/DMSO.S186600.","journal-title":"Diabetes Metab Syndr Obes"},{"key":"7169_CR33","doi-asserted-by":"publisher","first-page":"1521736","DOI":"10.3389\/fpubh.2025.1521736","volume":"13","author":"M Qiao","year":"2025","unstructured":"Qiao M, Wang H, Qin M, Xing T, Li Y. Development and validation of a predictive model for the risk of possible sarcopenia in middle-aged and older adult diabetes mellitus in China. Front Public Health. 2025;13:1521736. https:\/\/doi.org\/10.3389\/fpubh.2025.1521736.","journal-title":"Front Public Health"},{"issue":"5","key":"7169_CR34","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/j.pcd.2014.05.003","volume":"9","author":"S Pastorino","year":"2015","unstructured":"Pastorino S, Richards M, Hardy R, Abington J, Wills A, Kuh D, et al. Validation of self-reported diagnosis of diabetes in the 1946 British birth cohort. Prim Care Diabetes. 2015;9(5):397\u2013400. https:\/\/doi.org\/10.1016\/j.pcd.2014.05.003.","journal-title":"Prim Care Diabetes"},{"issue":"1","key":"7169_CR35","doi-asserted-by":"publisher","first-page":"3697","DOI":"10.1038\/s41598-019-40090-y","volume":"9","author":"JW Noh","year":"2019","unstructured":"Noh JW, Chang Y, Park M, Kwon YD, Ryu S. Self-rated health and the risk of incident type 2 diabetes mellitus: A cohort study. Sci Rep. 2019;9(1):3697. https:\/\/doi.org\/10.1038\/s41598-019-40090-y.","journal-title":"Sci Rep"}],"container-title":["BMC Geriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12877-026-07169-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12877-026-07169-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12877-026-07169-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:50:39Z","timestamp":1781639439000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12877-026-07169-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,13]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["7169"],"URL":"https:\/\/doi.org\/10.1186\/s12877-026-07169-4","relation":{},"ISSN":["1471-2318"],"issn-type":[{"value":"1471-2318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,13]]},"assertion":[{"value":"21 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The China Health and Retirement Longitudinal Study (CHARLS) was approved by the Institutional Review Board at Peking University. The IRB approval number for the main household survey, including anthropometrics, is IRB00001052-11015. All participants in the original CHARLS survey provided written informed consent.As this study is a secondary analysis of the existing, de-identified public data from CHARLS, additional ethics approval was not required for this analysis.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"556"}}