At the 27th Annual Conference of the Chinese Society of Diabetes (CDS 2025), Professor Shen Jie from the Eighth Affiliated Hospital of Southern Medical University systematically elaborated on diagnostic approaches for postmenopausal sarcopenic obesity in this specific population.
The European Working Group on Sarcopenia in Older People (EWGSOP2) clearly states that low muscle strength is the primary criterion for diagnosing sarcopenia, while muscle mass serves only as a confirmatory indicator, and physical performance is used for severity grading. Multiple prospective studies have shown that muscle strength is a better predictor of mortality, fall risk and functional decline than muscle mass.
For Asian populations, the AWGS 2023 recommends more sensitive diagnostic thresholds for Asian women:grip strength < 18 kg,gait speed < 1.0 m/s,skeletal muscle index (SMI, measured by DXA) < 5.4 kg/m².
It also emphasizes the importance of early screening in menopause clinics, osteoporosis clinics and routine physical examinations.Compared with European and American women, postmenopausal Asian women generally have lower height and muscle mass. Adopting the Asian-specific thresholds recommended by AWGS helps to sensitively identify muscle weakness and high-risk individuals during perimenopause and early postmenopause.
In addition, the diagnosis of SO must incorporate obesity indicators, for which body mass index (BMI) is unreliable.The key feature of SO is not “excess body weight” but abnormal fat distribution.Menopausal and postmenopausal women often undergo a shift from “gluteofemoral obesity” to “abdominal/visceral obesity”. Even with little change in BMI, visceral fat and waist circumference may increase significantly. This fat redistribution is closely associated with cardiometabolic risk and SO.Therefore, diagnosing SO requires combining sarcopenia criteria with visceral fat, waist circumference or body fat percentage, rather than relying solely on BMI, which would easily miss individuals with normal weight but elevated visceral fat.
Imaging studies suggest that IMAT (intramuscular adipose tissue) and HU values are important markers reflecting reduced skeletal muscle quality.Increased IMAT and decreased muscle HU values are associated with weakened muscle strength, slower gait speed and higher fall risk.Moreover, IMAT is regarded as an early imaging change in the latent stage of sarcopenic obesity, when muscle mass remains within the normal range but muscle quality has already declined.
In clinical practice, dual-energy X-ray absorptiometry (DXA) remains the commonly used tool for assessing appendicular lean mass and bone mineral density, and can be used to estimate appendicular skeletal muscle index and assist in sarcopenia diagnosis.CT and MRI have advantages in quantifying visceral fat and intramuscular fat, providing detailed information on fat distribution and muscle quality for SO, especially suitable for research and precise evaluation of high-risk populations.Ultrasound, as a portable method, is appropriate for large-scale screening in menopause clinics.