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Among the 322 sarcopenic participants at 2-year follow-up, there was a significant increase in physical activity levels (baseline 80.02 to 4-year 92.94, P? http://www.selleckchem.com/products/XL184.html not shown). Nevertheless, physical activity was not significantly associated with the reversibility of sarcopenia, although it was significantly associated with a lower risk of incident sarcopenia. This observation is not unexpected, given the small number of reverted cases during the follow-up years, which could decrease the power to detect an association. In addition, the difference between the characteristics of participants included in the analyses for the development of sarcopenia and its reversibility exists. For example, participants with sarcopenia were older, had a higher prevalence of COPD and stroke, and had lower mean values on their MMSE score, PASE score, and BMI than those without sarcopenia; therefore factors associated with incident sarcopenia might be different from its reversibility. The present study had some limitations. Our cohort was more educated and more physically active than the general elderly population in Hong Kong; therefore, findings should not be generalized to those who are institutionalized or frailer, or with lower education levels. Nutrient quantitation might not be exact. The use of a food frequency questionnaire rather than 24-h recall might have overestimated the intake. Serum 25OHD levels were accurate; however, data were only available in a subsample http://www.selleckchem.com/products/CP-690550.html http://www.selleck.cn/products/MLN8237.html of men. Furthermore, those defaulting from follow-up were older, had more disabling diseases including sarcopenia and could have deteriorated more, which probably will result in an underestimation of incidence, particularly with longer duration of follow-up. In the present study, the proportion of missing cases differed between those with and without sarcopenia (2-year follow-up, 23.8% vs 13.7% and 4-year follow-up, 39.1% vs 20.4%); which could underestimate the true rate of muscle and functional loss in older adults over time if the rate was different between the two groups. For accurate data, we need to visit all participants at home if they do not come back. Finally, the number of participants who had returned to non-sarcopenic during follow-up was small (n?=?68 at 2-year, and n?=?48 at 4-year follow-up, respectively), thus findings warrant confirmation in larger studies with longer follow-up. In conclusion, the present study confirmed that sarcopenia incidence increased with age, but is potentially reversible, with several modifiable lifestyle-related factors as predictors. High BMI was protective against incident sarcopenia and its reversibility. Increasing physical activity and maintaining a healthy weight could be beneficial in the prevention of sarcopenia.