Prevalence of sarcopenia in COPD patients using AWGS criteria among Asian populations: a systematic review and meta-analysis

BACKGROUND: Sarcopenia is a critical comorbidity in chronic obstructive pulmonary disease (COPD), yet prevalence estimates in Asian populations using standardized Asian Working Group for Sarcopenia (AWGS) criteria remain uncertain. This review aimed to determine pooled sarcopenia prevalence in Asian COPD patients using AWGS criteria, compare AWGS-2014 versus AWGS-2019 estimates, and identify associated risk factors. METHODS: We systematically searched eight databases from inception to December 2024 for studies reporting sarcopenia prevalence in Asian COPD patients using AWGS-2014 or AWGS-2019 criteria. Pooled prevalence with 95% confidence intervals (CI) was calculated using random-effects meta-analysis with Freeman-Tukey double arcsine transformation. Quality was assessed using the Newcastle-Ottawa Scale. Subgroup analyses compared AWGS versions, and pooled odds ratios were calculated to examine risk factors. The review was registered with PROSPERO (CRD420251274827). RESULTS: Ten studies encompassing 2,371 COPD patients from five Asian countries were included. Eight studies used AWGS-2019, and two used AWGS-2014. Overall, the pooled sarcopenia prevalence was 31% (95% CI: 22-41%) with substantial heterogeneity (I²=89.9%). Individual study prevalence ranged from 9.5% to 52.5%. Subgroup analysis revealed no significant difference between AWGS-2014 (30%, 95% CI: 24-38%) and AWGS-2019 (31%, 95% CI: 22-42%) criteria (p = 0.916). All studies demonstrated high methodological quality (NOS scores: 8-10/10). Three independent risk factors were identified: older age (OR: 1.05 per year, 95% CI: 1.03-1.07), low BMI < 18.5 kg/m² (OR: 3.12, 95% CI: 1.98-4.92), and severe COPD stages 3-4 (OR: 2.74, 95% CI: 1.89-3.97). CONCLUSIONS: Approximately one-third of Asian COPD patients have sarcopenia, with comparable prevalence between AWGS versions. Findings support routine screening in high-risk subgroups and integrated care pathways addressing respiratory and musculoskeletal manifestations.