Sarcopenic obesity is a new category of obesity and is a specific condition of sarcopenia. This study aimed to find the relationship of the basal metabolic rate (BMR) and body water distribution with muscle health and their prospective roles in screening for sarcopenic obesity and sarcopenia. The role of nutrients such as carbohydrates in the relationship was further detected. A total of 402 elderly subjects were recruited. Body composition was estimated by bioelectrical impedance analysis. Sarcopenia was defined by the Asian Working Group for Sarcopenia 2019. The cutoff values were determined by the receiver operating characteristic curve. Mediation analyses were performed using SPSS PROCESS. Higher BMR and BMR/body surface area (BSA) were protective factors against sarcopenic obesity (OR = 0.047, p = 0.004; OR = 0.035, p = 0.002) and sarcopenia (OR = 0.085, p = 0.001; OR = 0.100, p = 0.003) in elderly people. Low extracellular water (ECW)/intracellular water (ICW) and ECW/total body water (TBW) were negatively correlated with the skeletal muscle index (SMI). The intake of dietary carbohydrates in people with sarcopenic obesity was the lowest, but in subjects with obesity, it was the highest (p = 0.023). The results of the moderated mediation model showed that BMR fully mediated the positive relationship between carbohydrates and SMI, which was more obvious in the population with an abnormal body water distribution. BMR or BMR/BSA had the potential role of predicting a higher risk of sarcopenic obesity and sarcopenia. Higher BMR and lower ECW/ICW and ECW/TBW may benefit muscle health. The overconsumption of carbohydrates (especially > AMDR) might be a risk factor for obesity. Moderate dietary carbohydrate intake might promote SMI by regulating BMR and body water distribution in the elderly.
Keywords: basal metabolic rate; body water; carbohydrates; sarcopenia; sarcopenic obesity.