How Many Older Koreans Are at Risk? National Estimates of Food Insecurity and Sarcopenia Risk Based on ESPEN Guidelines

Purpose: Food insecurity and inadequate nutrient intake are major public health concerns in aging populations. Sarcopenia is influenced by nutrition and socioeconomic status. This study aimed to estimate the prevalence of food insecurity and sarcopenia risk among Korean older adults and examine associations with socioeconomic and lifestyle factors.Methods: A cross-sectional analysis of the 2019 Korea National Health and Nutrition Examination Survey (KNHANES) was conducted using a complex sample design. A total of 1,365 adults aged ≥65 years were included. Food insecurity, nutrient adequacy per European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines, and sarcopenia risk (defined by low handgrip strength) were assessed. Logistic regression determined associations with socioeconomic status, diet, and exercise.Results: Food insecurity affected 15.7% of older adults (weighted percentage). An estimated 40.9% had inadequate nutrient intake, and 24.6% were at risk of sarcopenia. Lower income was significantly associated with sarcopenia risk; compared to the lowest quintile, those in the second quintile had lower odds (OR = 0.61, 95% CI: 0.43–0.87). Lower education also increased risk, with high school graduates showing lower odds (OR = 0.45, 95% CI: 0.26–0.78) compared to those with elementary education or less. Notably, nutrient adequacy based on ESPEN guidelines was not significantly associated with sarcopenia risk. Resistance exercise ≥3 days/week was protective (OR = 0.48, 95% CI: 0.28–0.82).Conclusions: Socioeconomic disadvantage and physical inactivity are primary determinants of sarcopenia risk in Korean older adults. The lack of association between ESPEN-based nutrient adequacy and sarcopenia risk highlights the need to address structural socioeconomic determinants beyond simple nutrient supplementation.