Abstract
Background and aims: Sarcopenic obesity (SO) has been proposed as a risk factor for cognitive impairment. Yet evidence is inconsistent and often limited by heterogeneous definitions and lack of longitudinal assessments. This study aimed to examine associations of SO with all-cause and subtype-specific dementia, and to assess dose–response patterns and how longitudinal changes in body composition and muscle strength relate to dementia risk. Methods: We included 489,972 adults (mean age 56.5 ± 8.1 years) followed for a median of 13.6 years. SO was defined using the Sarcopenic Obesity Global Leadership Initiative (SOGLI) criteria. Cox models estimated hazard ratios (HRs) for all-cause dementia, Alzheimer's disease (AD), and vascular dementia. Restricted cubic spline (RCS) analysis assessed dose–response associations. Landmark analyses among 54,070 participants (median follow-up 4.1 years) evaluated how longitudinal changes in handgrip strength (HGS) and body composition related to subsequent dementia risk. Results: SO (HR = 1.34; 95% CI: 1.18–1.52) and sarcopenia (HR = 1.30; 95% CI: 1.14–1.48) were associated with higher all-cause dementia risk compared with the non-sarcopenic, non-obesity group, whereas obesity alone was associated with lower risk (HR = 0.91; 95% CI: 0.84–0.99). Age and sex modified these associations, with stronger associations observed among adults younger than 65 years and more pronounced risk elevations for sarcopenia (HR = 1.37; 95% CI: 1.07–1.75) and SO (HR = 1.55; 95% CI: 1.29–1.87) in males, whereas obesity showed inverse associations with dementia risk primarily in females (HR = 0.81; 95% CI: 0.71–0.92). RCS analyses showed J-shaped associations between fat mass percentage (%FM) and dementia risk in males, lower dementia risk at higher levels of %FM in older females, and strong inverse associations between HGS and dementia risk in both sexes. Landmark analyses showed that declines in HGS consistently predicted all-cause dementia. Conclusion: SO and sarcopenia are associated with dementia risk. HGS is a significant predictor of dementia risk supporting the inclusion of measures of muscle function in dementia prevention strategies.
Keywords
body composition, cognitive function, dementia, muscle strength, sarcopenic obesity
Document Type
Journal Article
Date of Publication
8-1-2026
Article Number
106696
ISSN
02615614
Volume
63
PubMed ID
42250474
Publication Title
Clinical Nutrition
Publisher
Elsevier
School
Nutrition and Health Innovation Research Institute / School of Medical and Health Sciences
RAS ID
95322
Funding Information
ZG is supported by the Curtin Higher Degree by Research (HDR) Scholarship and the Dementia Centre of Excellence (DCE) and Curtin enAble Institute Seed Funding. The salary of MS (M Sim) is supported by a project grant from the Western Australian Future Health Research and Innovation Fund. CJTH is supported by the Forrest Research Foundation Scholarship and the Edith Cowan University HDR Scholarship. CMP is partially supported by the Canada Research Chairs program. BCMS's Chair in Dementia at Curtin University is supported by Dementia Australia.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Recommended Citation
Guan, Z., Stephan, B. C., Donini, L. M., Godos, J., Grosso, G., Pereira, L. R., Prado, C. M., Toro-Huamanchumo, C. J., Wells, J. C., Sim, M., & Siervo, M. (2026). Sarcopenic obesity and dementia risk: Primary associations and landmark analyses of muscle strength and body composition trajectories. Clinical Nutrition, 63, Article 106696. https://doi.org/10.1016/j.clnu.2026.106696