Impact of the Updated Asian Working Group for Sarcopenia 2025 Criteria on the Prevalence and Clinical Characteristics of Sarcopenic Obesity in Older Patients With Heart Failure.

BACKGROUND: The Asian Working Group for Sarcopenia (AWGS) updated its diagnostic criteria in 2025 by incorporating body mass index (BMI)-adjusted skeletal muscle mass. This revision may influence the prevalence and clinical interpretation of sarcopenic obesity in heart failure (HF). METHODS AND RESULTS: We conducted a single-center retrospective cohort study of 589 patients aged ≥65 years who were hospitalized for HF. Application of the AWGS 2025 criteria significantly altered classification, increasing the prevalence of sarcopenic obesity from 7.8% to 13.6%. Among the 4 groups defined by sarcopenia (AWGS 2025) and obesity, patients with sarcopenia without obesity had the worst prognosis, whereas those with sarcopenic obesity had preserved survival (log-rank P=0.038). Following the transition from the AWGS 2019 to AWGS 2025 criteria, newly classified patients with sarcopenic obesity were more frequently female and had a higher BMI with preserved height-adjusted muscle mass compared with patients with persistent sarcopenic obesity. Mortality and gait speed were comparable between the persistent and newly classified sarcopenic obesity groups (both P>0.05). The AWGS 2025 sarcopenia-obesity phenotype classification showed no improvement in discrimination or the Akaike information criterion for prognosis compared with the AWGS 2019 classification (both P>0.05). CONCLUSIONS: The AWGS 2025 criteria increase the prevalence of sarcopenic obesity by identifying a distinct phenotype in patients with HF. However, this expanded classification does not improve risk stratification.