Sarcopenia and Depression in Older Adults: 2-Year Findings From the Korean Frailty and Aging Cohort Study

OBJECTIVE: To investigate sex-specific associations of sarcopenia and its diagnostic components with the 2-year incidence of depression in community-dwelling older adults. DESIGN: Prospective cohort study with a 2-year follow-up. SETTING AND PARTICIPANTS: Data were drawn from the nationwide Korean Frailty and Aging Cohort Study. A total of 1442 community-dwelling Korean adults aged 70-84 years without depression at baseline were included. METHODS: Sarcopenia was defined according to the 2019 Asian Working Group for Sarcopenia criteria. Depression risk was assessed using the Korean version of the 15-item Short-Form Geriatric Depression Scale, with incident depression defined as a score ≥8. Sex-stratified logistic regression analyses were performed using directed acyclic graph-informed lean models, with sex-specific adjustments for age, cognitive function, physical activity, and socioeconomic factors. RESULTS: Over the 2-year follow-up, 44 men (5.7%) and 60 women (9.0%) developed depression. Sarcopenia was independently associated with incident depression in women [odds ratio (OR), 2.27; 95% confidence interval (CI), 1.21-4.24] but not in men. Among the diagnostic components, impaired physical performance was associated with incident depression in women (OR, 2.04; 95% CI, 1.13-3.69), with prolonged 5-times sit-to-stand (5-STS) performance showing the strongest association (OR, 1.80; 95% CI, 1.03-3.13). In men, overall sarcopenia was not significant; however, slow gait speed was associated with incident depression (OR, 2.05; 95% CI, 1.03-4.06). Additional factors associated with incident depression included low physical activity and higher comorbidity burden in men, and low economic status and poorer cognitive function in women. CONCLUSIONS AND IMPLICATIONS: Sarcopenia-particularly impaired physical performance-was associated with incident depression in older adults, with clinically meaningful sex-specific patterns. Incorporating simple physical performance measures into routine geriatric assessments may help identify individuals at high risk of late-life depression.