**3. Results**

#### *3.1. Population and Diagnosis of Malnutrition*

Of the 534 older adults included in the SarcoPhAge study, 510 were free from sarcopenia, as diagnosed with the EWGSOP2 definition, and they constituted our baseline population. Of those 510 participants, 416 were interviewed throughout the four-year follow-up period (94 individuals were either lost to follow-up, refused to participate, were unable to continue the study, or were dead) (Figure 1).

**Figure 1.** Flow chart of the study. European Society of Clinical Nutrition and Metabolism (ESPEN) and sarcopenia and physical impairment with advancing age (SarcoPhAge).

Finally, only 336 participants had the blood samples available that were needed to assess inflammation for the diagnosis of malnutrition according to the GLIM criteria. Our final study population at baseline was therefore composed of 336 participants (Figure 1), 55.4% women, aged 72.5 ± 5.8 years with a mean of four concomitant diseases per participant and a mean of 5.6 daily consumed drugs per participant. The population was free from cognitive disorders, with an MMSE mean score of 28.3 ± 1.8 points out of 30 (Table 2).


**Table 2.** Baseline characteristics of participants in the SarcoPhAge study (*n* = 336).

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#### *Nutrients* **2019**, *11*, 2883

Malnutrition, according to the ESPEN criteria, was present in 19 individuals (5.65%) and, according to the GLIM criteria, was present in 59 individuals (17.6%). Agreement between both definitions was low, with a Cohen kappa coe fficient of 0.30 (95% CI 0.16–0.43). Once diagnosed with either the ESPEN or the GLIM criteria, malnourished participants presented a significantly lower BMI, a lower amount of lean mass, and ALMI as well as a lower muscle strength (the latest being applicable for male participants only) than well-nourished individuals (all *p*-values < 0.05). Participants diagnosed with malnutrition using the GLIM criteria also presented a higher number of concomitant diseases than well-nourished participants (*p* = 0.005). No other significant di fferences between groups were observed for the collected characteristics of the population.

#### *3.2. Incidence of Sarcopenia*

From baseline to four years of follow-up, 46 new cases of sarcopenia (13.7%) and 26 new cases of severe sarcopenia (7.74%) were reported. In participants diagnosed with malnutrition at baseline, regardless of the criteria used for the diagnosis, the incidence of sarcopenia was significantly higher than that in well-nourished individuals (Table 3). Among the 19 individuals with malnutrition according to the ESPEN criteria, seven (36.8%) developed sarcopenia throughout the four-year follow-up period, compared to 12.3% in the group of well-nourished participants. After adjusting for age, sex, the number of concomitant diseases, the number of drugs consumed, cognitive status, and the level of physical activity, an HR of 4.28 (95% CI 1.86–9.86) was found, revealing that malnourished participants, according to the ESPEN criteria, had a 4.28-fold higher risk of becoming sarcopenic within four years. The HR for severe sarcopenia was 3.86 (95% CI 1.29–11.54). Among the 59 individuals with malnutrition according to the GLIM criteria, 16 (27.1%) developed sarcopenia, compared to 10.8% among well-nourished participants (*p* = 0.001). An adjusted HR of 3.23 (95% CI 1.73–6.05) was found for the association with sarcopenia and of 2.87 (95% CI 1.25–6.56) for the association with severe sarcopenia.

Figure 2 depicts the analysis of the four-year incidence of sarcopenia and severe sarcopenia for participants with baseline malnutrition according to the GLIM and ESPEN criteria. Still, confirmed with Kaplan-Meier analyses, a significant impact of malnutrition on the onset of sarcopenia and severe sarcopenia was found, regardless of the definition used for malnutrition (log rank *p* < 0.001 for all Kaplan-Meier curves) (Figure 2A–D).

**Figure 2.** (**A**) Incidence of sarcopenia in participants with or without malnutrition according to the ESPEN criteria; (**B**) incidence of severe sarcopenia in participants with or without malnutrition according to the ESPEN criteria; ( **C**) incidence of sarcopenia in participants with or without malnutrition according to the GLIM criteria; and ( **D**) incidence of severe sarcopenia in participants with or without malnutrition according to the GLIM criteria.

