Evidence mapPaperPMID 42444090Full record

ArticleJournal of cachexia, sarcopenia and muscle2026

DXA-Measured Total and Regional Fat-to-Lean Mass Ratio and Mortality Risk in Chinese Older Adults: A 20-Year Prospective Study.

Yafei Wu, Ting Zhang, Shuyi Li, Jason Leung, Timothy Kwok

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Article in Journal of cachexia, sarcopenia and muscle, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

5 authors.

Yafei WuDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.ORCID https://orcid.org/0000-0003-3937-0263
Ting ZhangDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Shuyi LiDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Jason LeungJockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong SAR, China.
Timothy KwokDepartment of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.

Funding

National Institutes of Health R01 AR049439-01A1Research Grants Council Earmarked CUHK4101/02 M
6 · The paper itself

Abstract

backgroundThe association of fat-to-lean mass ratio (FLR) with mortality remains unclear in older adults. This study aimed to investigate the sex-specific associations of total and regional FLR with mortality in older Chinese adults.

methodsThis analysis included 2000 men (mean age: 72.4 ± 5.0 years) and 2000 women (mean age: 72.6 ± 5.4 years) aged ≥ 65 years from the Hong Kong OS cohort. Total and regional (trunk, abdominal, arms, legs) FLRs were measured using DXA at baseline. Mortality was ascertained via Hong Kong death registry. Multivariable Cox and Fine-Gray competing risk models were used to assess the associations of FLR with all-cause, cardiovascular (CVD) and cancer mortality, with results presented as hazard ratios (HRs) and 95% confidence intervals (CIs). C-index was used to quantify the discriminative ability of FLR measures and BMI in estimating mortality risk.

resultsOver a median follow-up of 18.2 years (IQR: 11.6-20.7), 2446 deaths (CVD: 511, cancer: 644) occurred. The 1-, 10- and 20-year survival rates were 0.990, 0.753 and 0.354 for men, and 0997, 0.858 and 0.500 for women. In men, FLR was inversely associated with all-cause mortality when analysed continuously for whole-body (HR per SD increase: 0.94, 95% CI: 0.89-1.00), trunk (HR: 0.92, 0.87-0.97), abdominal (HR: 0.92, 0.86-0.97) and arm FLR (HR: 0.94, 0.89-1.00), with all p < 0.05. In categorical analyses, men in the lowest tertile (T1) of whole-body, trunk, abdominal and arm FLR had significantly higher mortality risk compared to those in the middle tertile (HRs > 1, all p < 0.05). In women, trunk (HR per SD increase: 0.94, 0.88-1.00, p = 0.041) and abdominal FLRs (HR: 0.91, 0.85-0.97) were inversely associated with all-cause mortality, with T1 of abdominal FLR showing increased risk (HR: 1.18, 1.01-1.37) compared to T2. Restricted cubic splines revealed L-shaped associations for most FLR measures (p-nonlinearity < 0.05), except leg FLR in women (P-nonlinearity = 0.060). For cause-specific mortality, no significant associations were observed for CVD mortality in either sex, only leg FLR was inversely associated with cancer mortality in men (HR per SD increase: 0.89, 0.80-0.99; HR for T1 vs. T2: 1.29, 1.00-1.66, both p < 0.05), but not in women. All FLR measures showed higher discriminative ability than BMI for mortality prediction (all p < 0.01).

conclusionsIn Chinese older adults, lower FLR was associated with higher all-cause mortality in an L-shaped relationship for both sexes, but showed no significant association with CVD mortality. Lower leg FLR was associated with increased cancer mortality only in men. FLR measures were more predictive than BMI for mortality risk stratification.

Indexed as

Absorptiometry, PhotonAdipose TissueBody CompositionAgedAged, 80 and overBody Mass IndexEast Asian PeopleFemaleHong KongHumansMaleProspective StudiesRisk Factorsdual‐energy x‐ray absorptiometryfat‐to‐lean mass ratiomortalityolder adults

Identifiers

PMID42444090
PMCPMC13365363

What Socratic holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.