Longitudinal Change in Calf Circumference and Incident Falls in Older Adults
7 affiliations
- 1Department of Basic Innovation Research, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Beijing Key Laboratory of Aging Mechanism and Intervention Research on Aging-Related Diseases, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- 2Department of Geriatrics, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- 3Center for Healthy Aging and Development Studies, National School of Development, Raissun Institute for Advanced Studies, Peking University, Beijing, China
- 4Center for the Study of Aging and Human Development and Geriatrics Division, Medical School of Duke University, Durham, North Carolina
- 5Center for Healthy Ageing Transdisciplinary Sciences, China Center for Health Development Studies, Peking University, Beijing, China
- 6State Key Laboratory of Vascular Homeostasis and Remodelling, Peking University, Beijing, China.
- 7Key Laboratory of Health System Reform and Governance, Peking University, National Health Commission, Beijing, China
Abstract
Importance: Calf circumference (CC) is a simple, noninvasive proxy for lower-limb muscle mass. However, evidence on the longitudinal association between CC change and incident falls remains scarce.
Objective: To investigate whether progressive decline in CC is associated with higher odds of incident falls among community-dwelling older adults.
Design, Setting, and Participants: This cohort study used data from the Chinese Longitudinal Healthy Longevity Survey, a nationally representative prospective cohort. Participants aged 60 years or older with complete CC measurements at baseline (2018) and follow-up (2021) were included. Data were analyzed from January to March 2026.
Exposures: Absolute CC change (in centimeters) and relative CC change (as a percentage) over 3 years, analyzed as continuous and categorical variables (absolute: no decrease, <3 cm, 3 to <5 cm, ≥5 cm; relative: no decrease, <10%, 10% to <20%, ≥20%). The no-decrease group, including individuals with no change and those with increased CC, served as the reference group.
Main Outcomes and Measures: The outcome of interest was incident falls, self-reported during the 2021 wave. Covariates included sociodemographic characteristics, falls history, health behaviors, functional status, and chronic diseases, all assessed via standardized questionnaires and evaluation. Odds of incident fall were assessed using inverse probability weighted logistic regression to address survival bias.
Results: Among 7068 participants (mean [SD] age, 79.66 [10.32] years; 3835 [54.26%] female), 1671 participants (23.64%) reported incident falls over a median (IQR) follow-up of 3.07 (2.91-3.17) years. In fully adjusted models, each 1-cm absolute decrease in CC was associated with 3.2% higher odds of fall (odds ratio [OR], 1.03; 95% CI, 1.02-1.05) and each 10% relative decrease with 10.3% higher odds (OR, 1.10; 95% CI, 1.06-1.15). Compared with no decrease, an absolute decrease in CC of 5 cm or more was associated with 32.5% higher odds of fall (OR, 1.33; 95% CI, 1.10-1.60) and a relative decrease of 20% or more with 48.1% higher odds (OR, 1.48; 95% CI, 1.20-1.84).
Conclusions and Relevance: In this cohort study of older adults, longitudinal decreases in CC, both absolute and relative, were associated with higher odds of incident falls. Monitoring CC change over time may serve as a practical, low-cost measure to support fall risk assessment.
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BibTeX
@article{zhang2026longitudinal,
title = {{Longitudinal Change in Calf Circumference and Incident Falls in Older Adults}},
author = {Chi Zhang and Ji Shen and Yushan Zhang and Zehong Huo and Yi Zeng and Jie Zhang and Yao Yao},
journal = {JAMA Network Open},
year = {2026},
month = oct,
doi = {10.1001/jamanetworkopen.2026.40127},
url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855780},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Longitudinal Change in Calf Circumference and Incident Falls in Older Adults
AU - Chi Zhang
AU - Ji Shen
AU - Yushan Zhang
AU - Zehong Huo
AU - Yi Zeng
AU - Jie Zhang
AU - Yao Yao
PY - 2026
DA - 2026/10/01
JO - JAMA Network Open
DO - 10.1001/jamanetworkopen.2026.40127
UR - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855780
AB - Importance: Calf circumference (CC) is a simple, noninvasive proxy for lower-limb muscle mass. However, evidence on the longitudinal association between CC change and incident falls remains scarce. Objective: To investigate whether progressive decline in CC is associated with higher odds of incident falls among community-dwelling older adults. Design, Setting, and Participants: This cohort study used data from the Chinese Longitudinal Healthy Longevity Survey, a nationally representative prospective cohort. Participants aged 60 years or older with complete CC measurements at baseline (2018) and follow-up (2021) were included. Data were analyzed from January to March 2026. Exposures: Absolute CC change (in centimeters) and relative CC change (as a percentage) over 3 years, analyzed as continuous and categorical variables (absolute: no decrease, <3 cm, 3 to <5 cm, ≥5 cm; relative: no decrease, <10%, 10% to <20%, ≥20%). The no-decrease group, including individuals with no change and those with increased CC, served as the reference group. Main Outcomes and Measures: The outcome of interest was incident falls, self-reported during the 2021 wave. Covariates included sociodemographic characteristics, falls history, health behaviors, functional status, and chronic diseases, all assessed via standardized questionnaires and evaluation. Odds of incident fall were assessed using inverse probability weighted logistic regression to address survival bias. Results: Among 7068 participants (mean [SD] age, 79.66 [10.32] years; 3835 [54.26%] female), 1671 participants (23.64%) reported incident falls over a median (IQR) follow-up of 3.07 (2.91-3.17) years. In fully adjusted models, each 1-cm absolute decrease in CC was associated with 3.2% higher odds of fall (odds ratio [OR], 1.03; 95% CI, 1.02-1.05) and each 10% relative decrease with 10.3% higher odds (OR, 1.10; 95% CI, 1.06-1.15). Compared with no decrease, an absolute decrease in CC of 5 cm or more was associated with 32.5% higher odds of fall (OR, 1.33; 95% CI, 1.10-1.60) and a relative decrease of 20% or more with 48.1% higher odds (OR, 1.48; 95% CI, 1.20-1.84). Conclusions and Relevance: In this cohort study of older adults, longitudinal decreases in CC, both absolute and relative, were associated with higher odds of incident falls. Monitoring CC change over time may serve as a practical, low-cost measure to support fall risk assessment.
SN - 2574-3805
ER -