Applying classification and regression tree analysis to identify risks of developing sarcopenia in the older population

Nga Thi Thuy Nguyen, Huyen Thi Thanh Vu, Huey Lan Hu, Kuan Chia Lin, Thanh Xuan Nguyen, Hui Chuan Huang*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background and objective: Variations in the risk factors for sarcopenia can lead to differences in the likelihood of developing sarcopenia among older adults; however, few studies have explored the interactions among the risk factors. This study examined the interactions among risk factors and identified a discriminative pathway for groups at risk of sarcopenia in community-dwelling older adults. Methods: A cross-sectional study was conducted between July and August 2019 to recruit 200 older adults from an outpatient department of a hospital providing care for older people. Data on various risk factors, namely demographics (age, gender, education, comorbidities, and body mass index [BMI]), dietary habits (weekly consumption of milk, coffee, and meat), lifestyle behaviours (vitamin D supplementation, smoking, drinking, and physical activity), and depression symptoms were collected. Sarcopenia was defined according to the Asian Working Group for Sarcopenia criteria. A classification and regression tree (CART) model was used to examine interactions among these factors and identify groups at risk of sarcopenia. Findings: The prevalence of sarcopenia was 38.5%. The CART model identified two end groups at differential risks of sarcopenia, with a minimum of one and a maximum of three risk factors. In the first group, low BMI (<18.5 kg/m2) was a predominant risk factor for sarcopenia among older people. In the second group, older adults with a normal BMI, aged ≥68 years, and without a regular walking habit had a higher probability of developing sarcopenia than did their counterparts. Conclusions: The interactive effects among older age, BMI, and walking may cause different probabilities of developing sarcopenia in the older population. Implications for practice: Older adults with a low or normal BMI but without a regular walking habit could be a predominant risk group for sarcopenia. The appropriate maintenance of body weight and regular walking activity is suggested to prevent sarcopenia in community-dwelling older adults.

Original languageEnglish
JournalInternational journal of older people nursing
StateAccepted/In press - 2022


  • body mass index
  • classification and regression tree
  • older age
  • risk factor
  • sarcopenia
  • walking


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