Risk Factors for Sarcopenic Obesity in Adults: A Case-Control Study Using Bioelectrical Impedance Analysis

Objective: Sarcopenic obesity (SO) is the coexistence of excess adiposity and low muscle mass or function, with underrecognized prevalence and poorly defined risk factors in adults.¹ Our main purpose was to identify clinical, pharmacologic, and lifestyle factors associated with SO among Mexican adults using bioelectrical impedance analysis. Methods: This retrospective, observational, case-control study analyzed records from a tertiary-care center (2022–2024). Adults ≥30 years who underwent bioelectrical impedance analysis were included. Sarcopenia was defined by appendicular lean mass /height², based on the criteria proposed by the European Working Group on Sarcopenia in Older People 2.² Low muscle mass was defined as appendicular lean mass/height² < 7.0 kg/m² for men and <5.5 kg/m² for women, and obesity by BFP (≥25% men, ≥35% women). Multivariable logistic regression identified predictors of SO. Results: A total of 56 patients were classified as SO and 407 as non-SO controls. The overall mean (SD) age was 52.3 (10.2) years and males were the predominant sex [252 (54.4%)]. Female sex, lower physical activity, and lower body mass index were significantly associated with SO in univariate analyses. In the multivariable model (Nagelkerke R² = 0.499), protective factors included metformin use (odds ratio [OR] = 0.181), P =.005) and increased physical activity (OR = 0.996, P =.020). Risk factors included proton pump inhibitor use (OR = 6.252, P =.003), elevated triglycerides (OR = 1.007, P =.015), and history of dyslipidemia (OR = 2.492, P =.044). Conclusions: SO was significantly associated with modifiable factors. Despite neutral effects in prior studies, in this study metformin use and regular exercise were protective, whereas proton pump inhibitor use, elevated triglycerides, and dyslipidemia were risk factors. These findings highlight the need for targeted prevention strategies beyond body mass index, especially in adult populations.