Longitudinal Association Between Possible Sarcopenia and Stroke Under the <scp>AWGS</scp> 2025 Criteria: A Nationwide Prospective Cohort Study With a 9‐Year Follow‐Up

BACKGROUND: The Asian Working Group for Sarcopenia (AWGS) introduced the concept of possible sarcopenia in 2019 to facilitate early detection and community-based prevention and updated its diagnostic criteria in 2025. However, longitudinal evidence based on the updated criteria remains scarce regarding whether possible sarcopenia predicts long-term stroke risk among middle-aged and older adults. METHODS: This prospective cohort study used nationally representative data from the China Health and Retirement Longitudinal Study collected between 2011 and 2020. A total of 6660 participants aged ≥ 50 years without a history of stroke at baseline were included. Cumulative stroke incidence was estimated using the Kaplan-Meier method and compared by log-rank tests. Cox proportional hazards models estimated hazard ratio (HR) and 95% confidence interval (CI), with sequential adjustment for sociodemographic characteristics, lifestyle factors, and chronic conditions. Sensitivity analyses assessed result robustness. RESULTS: At baseline, 15.03% of participants had possible sarcopenia. Over a median follow-up of 9 years, 689 incident stroke events occurred, yielding a cumulative incidence of 10.35%. Participants with possible sarcopenia had a higher stroke incidence than those with no possible sarcopenia (12.60% vs. 9.95%; log-rank p = 0.011). After full adjustment, possible sarcopenia was independently associated with increased stroke risk (HR = 1.27, 95% CI: 1.04-1.54). Sensitivity analyses showed that the association was stable across regression models, diagnostic criteria and inclusion criteria. CONCLUSION: Possible sarcopenia defined by the AWGS 2025 criteria is significantly associated with elevated stroke risk among middle-aged and older adults.