欧洲临床营养与代谢学会（ESPEN）和欧洲肥胖研究协会（EASO）最近发布了第一个关于肌肉量不足性肥胖（SO）诊断标准的国际共识，建议采用调整身体重量的骨骼肌质量（SMM/W）来确定肌肉量低下。身体质量指数调整的SMM（SMM/BMI）与身体表现的关联似乎比SMM/W更好。因此，我们通过使用SMM/BMI修改了ESPEN/EASO标准。我们的目的是（1）评估ESPEN/EASO定义的SO（SOESPEN）和经过修改的ESPEN/EASO定义的SO（SOESPEN-M）与其他常用SO定义的一致性，以及（2）比较不同的SO定义在前瞻性晚期非小细胞肺癌（NSCLC）队列中预测死亡率的能力。这项前瞻性研究包括晚期NSCLC患者。我们根据五个不同的诊断标准定义了SO：SOESPEN、SOESPEN-M、亚洲肌肉量不足工作组（AWGS）确定BMI相关的肌肉量不足性肥胖（SOAWGS）、计算机断层扫描测定肌肉不足性肥胖（SOCT）和脂肪质量与脂肪无质量比率>0.8（SOFM）。结果显示全因死亡率为488例（76.4%），639名参与者（平均年龄58.6岁，女性229人）。死亡组SMM/BMI显著低于幸存组（男性：p=0.001，女性：p<0.001），但SMM/W未达到显著水平。只有3例（0.47%）参与者符合五个SO诊断标准。SOESPEN与SOESPEN-M的一致性极好（Cohen's kappa=0.896），与SOAWGS存在中度一致性（Cohen's kappa=0.415），但与SOCT和SOFM存在较差的一致性(Cohen's kappa=0.078和0.092)。在充分调整潜在混淆因素后，SOESPEN（HR 1.54，95% CI 1.26-1.89）、SOESPEN-M（HR 1.56，95% CI 1.26-1.92）和SOAWGS（HR 1.43，95% CI 1.14-1.78）与死亡率显著相关。然而，SOCT（HR 1.17，95% CI 0.87-1.58）和SOFM（HR 1.15，95% CI 0.90-1.46）与死亡率无显著关联。虽然SMM/BMI与生存率更相关，但SOESPEN-M没有在预测生存方面比SOESPEN表现出优势。 版权所有2023年Elsevier Ltd和欧洲临床营养与代谢学会。保留所有权利。

The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recently released the first international consensus on the diagnostic criteria for sarcopenic obesity (SO), which recommended skeletal muscle mass adjusted for body weight (SMM/W) to determine low muscle mass. SMM adjusted for body mass index (SMM/BMI) appeared to be better associated with physical performance than SMM/W. Thus, we modified the ESPEN/EASO criteria by using SMM/BMI. We aimed (1) to evaluate the agreement of the ESPEN/EASO-defined SO (SOESPEN) and the modified ESPEN/EASO-defined SO (SOESPEN-M) with other commonly used SO definitions, and (2) to compare different SO definitions for predicting mortality in a prospective cohort with advanced non-small cell lung cancer (NSCLC).This prospective study included patients with advanced NSCLC. We defined SO according to five different diagnostic criteria: SOESPEN, SOESPEN-M, Asian Working Group for Sarcopenia (AWGS)-determined sarcopenia with BMI-determined obesity (SOAWGS), computed tomography-derived sarcopenia with BMI-determined obesity (SOCT), and fat mass to fat-free mass ratio >0.8 (SOFM). The outcome was all-cause mortality.Of the 639 participants (mean age 58.6 years, 229 women) we studied, 488 (76.4%) died during the median follow-up period of 25 months. SMM/BMI was significantly lower in the death group than in the survivor group (men: p = 0.001, women: p < 0.001), but SMM/W was not. Only 3 (0.47%) participants met all five SO diagnostic criteria. SOESPEN showed an excellent agreement with SOESPEN-M (Cohen's kappa = 0.896), a moderate agreement with SOAWGS (Cohen's kappa = 0.415), but poor agreements with SOCT and SOFM (Cohen's kappa = 0.078 and 0.092, respectively). After full adjustment for potential confounders, SOESPEN (HR 1.54, 95% CI 1.26-1.89), SOESPEN-M (HR 1.56, 95% CI 1.26-1.92), and SOAWGS (HR 1.43, 95% CI 1.14-1.78) were significantly associated with mortality. However, SOCT (HR 1.17, 95% CI 0.87-1.58) and SOFM (HR 1.15, 95% CI 0.90-1.46) showed no significant association with mortality.SOESPEN showed an excellent agreement with SOESPEN-M, a moderate agreement with SOAWGS, but poor agreements with SOCT and SOFM. SOESPEN, SOESPEN-M, and SOAWGS were independent prognostic factors for mortality in our study population, but SOCT and SOFM were not. Although SMM/BMI was better associated with survival than SMM/W, SOESPEN-M did not show an advantage in predicting survival over SOESPEN.Copyright © 2023 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.