Residing in low-income, low-food-access neighborhoods was associated with significantly higher odds of sarcopenia among lung transplant candidates (OR 18.5; 95% CI 1.83-187; p=0.013).
Cross-Sectional (n=143)
No
Are built environment exposures, such as food access and walkability, associated with sarcopenia in lung transplant candidates?
Among lung transplant candidates, residing in low-income neighborhoods with poor access to healthy food is independently associated with significantly higher odds of sarcopenia.
Effect estimate: OR 18.5 (95% CI 1.83-187)
Absolute Event Rate: 40.5% vs 20.6%
p-value: p=0.013
Abstract Rationale Sarcopenia, the loss of muscle mass and function, is associated with increased morbidity and mortality in individuals with advanced lung disease. The built environment, including walkability, food access, and green spaces, may influence physical activity and nutrition. However, their relationship to sarcopenia among lung transplant candidates is not well understood. We evaluated whether built environment exposures are associated with sarcopenia in this population. Methods We conducted a cross-sectional study of adult lung transplant candidates at a single center (University of California, San Francisco). Home addresses were geocoded and assigned census tract-level estimates of neighborhood features: Walkability Index (higher=more walkable), Low-income Low-access to food status (LILA; yes/no), Social Vulnerability Index (SVI; higher=worse), and park access (percent of tract land that is park). Sarcopenia was defined as the appendicular skeletal muscle index (kg/m2) in the lowest sex-specific quartile using bioelectrical impedance. We used multivariable logistic regression clustered by census tract to evaluate associations between built environment exposures and sarcopenia, adjusting for BMI, sex, race/ethnicity, insurance, and rurality. Sensitivity analysis used the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria, defined by low muscle quantity plus impaired strength or performance. Results We analyzed 143 participants (mean age 58.5; 53% female, 22% Hispanic, 62% White; mean BMI 26.4). Interstitial lung diseases (51%), COPD (15%), and pulmonary hypertension (8%) were common diagnoses. Most resided in urban areas (90%); 25% lived in LILA tracts, and 20% in high-vulnerability communities. Sarcopenia was more common in LILA-designated areas (40.5% vs. 20.6%, p = 0.012). In unadjusted models, LILA status was associated with greater odds of sarcopenia (OR 2.76; 95% CI: 1.21-6.27, p = 0.029). In adjusted models, LILA remained associated with sarcopenia (OR 18.5; 95% CI: 1.83-187, p = 0.013). SVI and park access showed similar direction but were not significant (SVI OR 0.40; 95% CI: 0.15-1.07, p = 0.067; park access OR 0.56; 95% CI: 0.31-1.00, p = 0.052). Walkability was not associated with sarcopenia (OR 0.81; 95% CI: 0.43-1.49, p = 0.49). The EWGSOP2 sensitivity analysis showed consistent direction but wider confidence intervals. Conclusions Among lung transplant candidates, residing in low-income neighborhoods with poor access to healthy food was independently associated with sarcopenia after adjusting for BMI and demographic factors. These findings highlight the role of structural neighborhood conditions, particularly food access, together with other determinants such as social vulnerability and green spaces. Future work should pilot interventions to improve food access and reduce sarcopenia risk. This abstract is funded by: R01-HL134851
Seijo et al. (2026) conducted a cross-sectional in Lung transplant candidates (n=143). Low-income Low-access to food status (LILA) vs. Non-LILA status was evaluated on Sarcopenia (OR 18.5, 95% CI 1.83-187, p=0.013). Residing in low-income, low-food-access neighborhoods was associated with significantly higher odds of sarcopenia among lung transplant candidates (OR 18.5; 95% CI 1.83-187; p=0.013).