@article{QIMS155068,
author = {Ling Wang and Fangfang Duan and Yandong Liu and Dong Yan and Kai Li and Wenkai Wu and Yi Yuan and Quanzhong Ren and Kangkang Ma and Fengyun Zhou and Zitong Cheng and Jian Geng and Renxian Wang and Xiaoguang Cheng and Wenshuang Zhang},
title = {Reference values and cut-points for trunk myopenia and myosteatosis in Chinese adults: a secondary analysis of the China Action on Spine and Hip study},
journal = {Quantitative Imaging in Medicine and Surgery},
volume = {16},
number = {7},
year = {2026},
keywords = {},
abstract = {Background: Sarcopenia is a prevalent condition associated with adverse health outcomes, necessitating accurate assessment of skeletal muscle quantity and quality. Computed tomography (CT) is the gold-standard imaging modality for evaluating trunk skeletal muscle area (TrSMA) and density (TrSMD), with opportunistic CT offering a means to assess these metrics without additional radiation exposure. However, the clinical application of CT-based sarcopenia assessment in Chinese populations is hindered by the absence of large-scale, population-specific reference values and cut-off points, particularly for both myopenia (low muscle mass) and myosteatosis (fatty infiltration). This study aims to establish sex- and age-specific percentile reference values and diagnostic cut-off points for CT-derived TrSMA and TrSMD at the L1 and L3 vertebral levels with a large cohort of community-dwelling Chinese adults.Methods: We retrospectively analyzed abdominal CT scans from 4,016 community‑dwelling Chinese adults (21–80 years) across 12 regions. TrSMA and TrSMD at L1 and L3 were segmented using OsiriX. Sex- and age-specific percentile curves were modeled using the lambda-mu-sigma (LMS) method within the generalized additive models for location, scale, and shape (GAMLSS) framework. Estimated age-related differences in TrSMA and TrSMD from ages 25 to 75 years were calculated using LMS-derived medians. Sex‑specific cut‑off points for myopenia and myosteatosis were defined in the 21- to 40-year subgroup using the mean minus two standard deviations (M‑2SD) approach.Results: From ages 25 to 75 years, LMS-derived L1/L3-TrSMA values were lower by 0.45%/0.55% per year in men and 0.33%/0.41% per year in women; corresponding differences in L1/L3-TrSMD were 0.38%/0.35% and 0.55%/0.52% per year. More pronounced age-related decreases were observed in peri- and postmenopausal women and older men. M‑2SD cut‑offs at L1 were 96.0 cm2 and 29.8 Hounsfield Unit (HU) (men), 63.1 cm2 and 26.4 HU (women); at L3 were 122.3 cm2 and 31.7 HU (men), 75.4 cm2 and 27.5 HU (women).Conclusions: We provide the first CT‑based, sex‑ and age‑specific reference values and cut‑points for trunk myopenia and myosteatosis in Chinese adults, facilitating standardized sarcopenia diagnosis and research.},
issn = {2223-4306}, url = {https://qims.amegroups.org/article/view/155068}
}