ArticleFrontiers in nutrition2026
Equation-derived SMI not generalizable for DXA-defined low muscle mass in Chinese adults: external validation study.
Article in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Anthropometric equations are commonly used to estimate appendicular skeletal muscle mass (ASM) when direct body-composition measurements are unavailable. However, it remains unclear whether skeletal muscle index derived from predicted ASM (SMI_pred) can validly identify low muscle mass using thresholds developed for dual-energy X-ray absorptiometry (DXA). We externally validated the Wen et al. anthropometric equation against DXA in Chinese adults undergoing routine health examinations. Methods: This single-center retrospective external validation study included 501 Chinese adults who underwent whole-body DXA between 2016 and 2022. The published equation was applied without coefficient updating to calculate predicted ASM (ASM_pred), and SMI_pred was calculated as ASM_pred divided by height squared. Validation included Pearson correlation, Lin's concordance correlation coefficient (CCC), calibration, Bland-Altman agreement, and classification of DXA-defined low muscle mass by direct application of the Asian Working Group for Sarcopenia 2019 sex-specific DXA cut-offs. Simple linear recalibration was evaluated using repeated 10-fold cross-validation as a secondary analysis. Results: ASM_pred was strongly correlated with DXA-measured ASM (Pearson Conclusion: The Wen equation preserved strong association with DXA-measured absolute ASM but showed systematic bias and limited individual-level agreement. Performance deteriorated after derivation of SMI, and direct transfer of DXA-based AWGS thresholds to SMI_pred resulted in substantial under-detection of low muscle mass. Neither the original nor the locally recalibrated equation should be used as a stand-alone substitute for DXA when classification depends on fixed muscle-mass thresholds. Any use within a multivariable screening pathway requires separate validation of the complete screening rule.
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