Cross-sectional study of 124 PD patients versus matched controls found similar sarcopenia prevalence but PD patients had worse balance, higher fall risk, reduced handgrip strength and appendicular muscle mass at lower percentiles, smaller calf circumference and lower fat mass despite higher protein…

Signals subtle yet clinically relevant declines in muscle mass and function in mild-to-moderate PD that can guide rehabilitation, nutritional interventions, and selection of trial endpoints for mobility/fall prevention, though it provides limited direct molecular targets for drug discovery.

OBJECTIVE: To compare sarcopenia prevalence, body composition, physical performance, and related clinical features between middle-aged and older patients with mild-to-moderate Parkinson's disease (PD) and matched controls. METHODS: A cross-sectional study carried out at a tertiary hospital in Brazil. Patients with PD in Hoehn and Yahr stages 1-3 and controls matched for age, sex and comorbidities were assessed. We measured handgrip strength with a hand dynamometer. Body composition and muscle mass were evaluated using DEXA. Sarcopenia was diagnosed following EWGSOP2 criteria. Clinical, cognitive and nutritional assessments were also performed. RESULTS: The study population comprised 250 patients (124 with PD), of whom one hundred and nine (43.6%) were female. The median age was 69.5 (IQR 61.9 - 76). Similar prevalences of sarcopenia were found among PD patients (9.7%) and controls (11.1%). PD patients had higher SARC-F scores, worse balance, higher gait speed, and more frequent falls. After adjustment for age, hypertension, and type 2 diabetes, quantile regression showed a downward trend in handgrip strength and appendicular skeletal muscle mass index among PD patients, with a significant muscle mass reduction at the 40th percentile. PD patients also had lower calf circumference and fat mass, despite higher protein intake. CONCLUSION: Patients with PD had worse balance, greater fall risk, and lower muscle mass and calf circumference compared to controls, despite similar sarcopenia prevalence. These results highlight subtle but potentially clinically relevant impairments that may not be captured by traditional mean-based analyses and categorical sarcopenia diagnosis.