Sarcopenia was found in about one-third of patients with end-stage lung disease in a meta-analysis of 24 studies involving 6,800 patients. Prevalence was higher among patients aged 70 years and older (36% vs 33% in younger patients) and in men compared with women (33% vs 11%). Geographic differences were observed, with the highest prevalence in North America (42%), followed by Asia (34%) and Europe (23%).
Among disease subtypes, idiopathic pulmonary fibrosis had the greatest prevalence at 38%, compared with 31% in chronic obstructive pulmonary disease (COPD) and 28% in interstitial lung disease. Prevalence estimates also varied by diagnostic criteria and assessment tools. Studies using the Asian Working Group for Sarcopenia 2019 guidelines produced higher prevalence estimates than earlier definitions. Studies using bioelectrical impedance analysis reported higher rates than those using dual-energy X-ray absorptiometry.
Sarcopenia was associated with older age, lower body mass index, and increased inflammatory markers. In COPD, sarcopenia frequently coexisted with malnutrition. Patients with sarcopenia showed more severe airflow limitation, reduced activity, and poorer physical performance. Several studies linked sarcopenia with higher mortality, worse dyspnea, longer hospital stays, greater risk of comorbidities, and lower quality of life.
Lead study author Li Sheng, PhD, of the Department of Nursing at The Second Affiliated Hospital of Zhejiang University School of Medicine, and colleagues noted, “chronic hypoxemia, systemic inflammatory cascades, disruption of metabolic homeostasis, and long-term pharmacotherapy (e.g., glucocorticoid use), which synergistically drive the progressive depletion of skeletal muscle mass and function—a condition termed secondary sarcopenia.” These mechanisms, the authors wrote, may underlie the high prevalence observed in patients with advanced lung disease.
The researchers conducted systematic searches of PubMed, Web of Science, Embase, Cochrane Library, CINAHL, and Scopus through March 2025. Eligible studies were peer-reviewed, published in English, and cross-sectional. Two reviewers independently assessed study quality. Because of high heterogeneity, a random-effects model was applied. Sarcopenia was defined in most studies as low muscle mass with reduced strength or performance, measured with dual-energy X-ray absorptiometry or bioelectrical impedance, handgrip strength, and either a 6-minute walk or gait speed test.
The authors acknowledged several limitations, including the cross-sectional design of all included studies, substantial heterogeneity in diagnostic methods, and limited regional data. Notably, the North American estimate was derived from a single Mexican cohort, limiting generalizability.
The researchers reported no funding support and no conflicts of interest.
Source: Frontiers
