PP121 - IMPACT OF SARCOPENIA ON CLINICAL OUTCOMES AND RESPONSE TO NUTRITIONAL THERAPY IN PATIENTS WITH AND WITHOUT OBESITY: A SECONDARY ANALYSIS OF THE RANDOMIZED EFFORT TRIAL

PP121

IMPACT OF SARCOPENIA ON CLINICAL OUTCOMES AND RESPONSE TO NUTRITIONAL THERAPY IN PATIENTS WITH AND WITHOUT OBESITY: A SECONDARY ANALYSIS OF THE RANDOMIZED EFFORT TRIAL

V. Haller^1,2,*, C. Wunderle¹, P. Tribolet^1,3,4, R. Barazzoni⁵, P. Schuetz^1,6

¹Medical University Department, Division of General Internal and Emergency Medicine, Division of Endocrinology, Diabetes and Metabolism, Kantonsspital Aarau, Aarau, Switzerland, ²Department of Nutritional Science, Justus Liebig University Giessen, Giessen, Germany, ³Faculty of Life Sciences, University of Vienna, Vienna, Austria, ⁴Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland, ⁵Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy, ⁶Medical Faculty, University of Basel, Basel, Switzerland

Rationale: Malnutrition often leads to a loss of muscle mass and strength, contributing to the development of sarcopenia. However, the prognostic impact of sarcopenia remains understudied, especially in patients with obesity. This analysis investigated the long-term clinical implications of sarcopenia in medical inpatients at nutritional risk, comparing those with and without obesity.

Methods: This secondary analysis of the multicenter, randomized, controlled Effect of early nutritional therapy on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT) evaluated the impact of sarcopenia on clinical outcomes and nutritional therapy response in 1,792 patients at nutritional risk. Using modified international consensus algorithms, patients were categorized into four sarcopenia/obesity phenotypes. The primary endpoint was 5-year all-cause mortality.

Results: Sarcopenia significantly increased 5-year mortality in patients without obesity (adj. HR 1.65, 95% CI 1.40–1.95, p < 0.001) and with obesity (adj. HR 1.82, 95% CI 1.06–3.12, p = 0.029). Patients with sarcopenic obesity exhibited the highest risk for adverse outcomes, particularly for functional decline (adj. HR 5.75, 95% CI 2.21–14.99, p < 0.001). While nutritional therapy improved outcomes overall, patients with sarcopenic obesity showed no significant benefit (HR 1.40, 95% CI 0.17–11.17, p = 0.75, for 30-day mortality).

Conclusion: In hospitalized patients at nutritional risk, sarcopenia is a major determinant of long-term mortality. Concurrent obesity amplifies the risk of adverse outcomes, challenging the concept of an “obesity paradox”. These results emphasize that muscle status, rather than body mass index, is the principal prognostic factor and support implementing body composition-based screening, assessment, and intervention strategies.

Disclosure of Interest: V. Haller: None declared, C. Wunderle Speakers Bureau of: Nestlé Health Science, Nutricia Danone, BBraun, Baxter, Abbott Nutrition , P. Tribolet Speakers Bureau of: Nestlé Health Science, Abbott Nutrition, R. Barazzoni: None declared, P. Schuetz Grant / Research Support from: Roche, Thermo Fisher, bioMérieux, Nestlé Health Science, Abbott Nutrition