Sarcopenia in Chronic Obstructive Pulmonary Disease: Prevalence and Association With Disease Severity in an Indian Tertiary Care Cohort

BackgroundChronic obstructive pulmonary disease (COPD) has systemic effects beyond the lung, of which skeletal muscle deterioration is among the most consequential.Sarcopenia, defined by concurrent reductions in muscle mass, strength and physical performance, worsens disability and long-term outcomes.Indian data are sparse.The primary objective was to estimate sarcopenia prevalence among spirometry-confirmed, stable COPD patients at a tertiary care centre in northern India using European Working Group on Sarcopenia in Older People 2019 (EWGSOP2) criteria.The second pre-specified objective was to examine its association with COPD severity by Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage.Exploratory analyses examined associations with sex, age group and body mass index (BMI). MethodsThis prospective cross-sectional study was conducted at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, between March 2024 and June 2025.One hundred consecutive spirometry-confirmed COPD patients were enrolled.Sarcopenia was assessed using the three-component EWGSOP2 algorithm: a skeletal muscle index derived from bioelectrical impedance analysis (OMRON HBF-222T, Omron Healthcare, Kyoto, Japan) and applied against the EWGSOP2 appendicular skeletal muscle mass thresholds, handgrip strength by digital hand dynamometry, and gait speed obtained from the sixminute walk test.Sex-specific EWGSOP2 cut-offs were applied.BMI was classified using World Health Organization international cut-off points.Associations were tested by Pearson chi-square, with Fisher's exact test where expected cell counts fell below five.Prevalence is reported with 95% Wilson confidence intervals (CIs). ResultsThe cohort comprised 67 men and 33 women with a mean age of 56.69 years; 83 patients (83%) had severe or very severe airflow obstruction.Sarcopenia prevalence was 31% (95% CI 22.8-40.6),higher in men (40.3%) than women (12.1%; χ 2 = 8.21, df = 1, p = 0.004).Sarcopenia was absent in the three patients with mild disease, present in five of 14 with moderate disease (35.7%) and in 26 of 83 with severe-to-very-severe disease (31.3%); this distribution was not statistically significant (χ 2 = 1.50, df = 2, p = 0.473; Fisher's exact p = 0.632).Sarcopenic patients had lower gait speed (men 0.61 m/s, women 0.60 m/s), handgrip strength (21.87 kg, 14.53 kg) and muscle index (6.47,4.97) than non-sarcopenic patients.Mean BMI was lower in sarcopenic patients (19.58 versus 24.04 kg/m 2 , p < 0.001), and sarcopenia was associated with BMI category (χ 2 = 26.82,df = 3, p < 0.001), affecting 73.7% of underweight and 30.2% of normal-weight patients and no overweight patient. ConclusionsSarcopenia affected nearly one-third of this Indian tertiary care COPD cohort and was more frequent in men and in those with low BMI.Prevalence was numerically higher in moderate and advanced disease than in mild disease, but no significant gradient across GOLD strata could be demonstrated in a sample in which 83% of patients had severe or very severe obstruction; this reflects the narrow severity distribution rather than evidence against a relationship.The cross-sectional design does not permit any causal interpretation of the observed associations.Routine assessment of muscle mass, strength and performance is feasible in resource-limited settings.Adequately powered multicentre studies using Asian-specific criteria are needed.