Human Nutrition Unit, Clermont Auvergne University, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Centre de Recherche en Nutrition Humaine, Clermont-Ferrand, France.
Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
JAMA Netw Open. 2024 Mar 4;7(3):e243604. doi: 10.1001/jamanetworkopen.2024.3604.
Sarcopenia and obesity are 2 global concerns associated with adverse health outcomes in older people. Evidence on the population-based prevalence of the combination of sarcopenia with obesity (sarcopenic obesity [SO]) and its association with mortality are still limited.
To investigate the prevalence of sarcopenia and SO and their association with all-cause mortality.
DESIGN, SETTING, AND PARTICIPANTS: This large-scale, population-based cohort study assessed participants from the Rotterdam Study from March 1, 2009, to June 1, 2014. Associations of sarcopenia and SO with all-cause mortality were studied using Kaplan-Meier curves, Cox proportional hazards regression, and accelerated failure time models fitted for sex, age, and body mass index (BMI). Data analysis was performed from January 1 to April 1, 2023.
The prevalence of sarcopenia and SO, measured based on handgrip strength and body composition (BC) (dual-energy x-ray absorptiometry) as recommended by current consensus criteria, with probable sarcopenia defined as having low handgrip strength and confirmed sarcopenia and SO defined as altered BC (high fat percentage and/or low appendicular skeletal muscle index) in addition to low handgrip strength.
The primary outcome was all-cause mortality, collected using linked mortality data from general practitioners and the central municipal records, until October 2022.
In the total population of 5888 participants (mean [SD] age, 69.5 [9.1] years; mean [SD] BMI, 27.5 [4.3]; 3343 [56.8%] female), 653 (11.1%; 95% CI, 10.3%-11.9%) had probable sarcopenia and 127 (2.2%; 95% CI, 1.8%-2.6%) had confirmed sarcopenia. Sarcopenic obesity with 1 altered component of BC was present in 295 participants (5.0%; 95% CI, 4.4%-5.6%) and with 2 altered components in 44 participants (0.8%; 95% CI, 0.6%-1.0%). An increased risk of all-cause mortality was observed in participants with probable sarcopenia (hazard ratio [HR], 1.29; 95% CI, 1.14-1.47) and confirmed sarcopenia (HR, 1.93; 95% CI, 1.53-2.43). Participants with SO plus 1 altered component of BC (HR, 1.94; 95% CI, 1.60-2.33]) or 2 altered components of BC (HR, 2.84; 95% CI, 1.97-4.11) had a higher risk of mortality than those without SO. Similar results for SO were obtained for participants with a BMI of 27 or greater.
In this study, sarcopenia and SO were found to be prevalent phenotypes in older people and were associated with all-cause mortality. Additional alterations of BC amplified this risk independently of age, sex, and BMI. The use of low muscle strength as a first step of both diagnoses may allow for early identification of individuals at risk for premature mortality.
肌少症和肥胖是与老年人不良健康结局相关的两个全球性问题。关于肌少症与肥胖并存（肌少症性肥胖[SO]）的人群患病率及其与死亡率的关系的证据仍然有限。
调查肌少症和 SO 的患病率及其与全因死亡率的关系。
设计、地点和参与者：这项大规模的基于人群的队列研究评估了来自 2009 年 3 月 1 日至 2014 年 6 月 1 日 Rotterdam 研究的参与者。使用 Kaplan-Meier 曲线、Cox 比例风险回归和适用于性别、年龄和体重指数（BMI）的加速失效时间模型研究了肌少症和 SO 与全因死亡率的关系。数据分析于 2023 年 1 月 1 日至 4 月 1 日进行。
肌少症和 SO 的患病率，基于目前共识标准推荐的握力和身体成分（BC）（双能 X 射线吸收法）进行测量，可能的肌少症定义为握力低，确诊的肌少症和 SO 定义为除握力低外，BC 改变（高脂肪百分比和/或低四肢骨骼肌指数）。
主要结局是全因死亡率，通过与普通医生和中央市记录相关联的死亡率数据收集，直到 2022 年 10 月。
在 5888 名参与者的总人群中（平均[标准差]年龄，69.5[9.1]岁；平均[标准差]BMI，27.5[4.3]；3343[56.8%]女性），653 名（11.1%；95%CI，10.3%-11.9%）有疑似肌少症，127 名（2.2%；95%CI，1.8%-2.6%）有确诊肌少症。有 1 项 BC 改变指标的肌少症性肥胖在 295 名参与者中（5.0%；95%CI，4.4%-5.6%），有 2 项 BC 改变指标的在 44 名参与者中（0.8%；95%CI，0.6%-1.0%）。与没有 SO 的参与者相比，有疑似肌少症（危险比[HR]，1.29；95%CI，1.14-1.47）和确诊肌少症（HR，1.93；95%CI，1.53-2.43）的参与者全因死亡率风险更高。有 SO 且 BC 有 1 项改变指标（HR，1.94；95%CI，1.60-2.33]）或 2 项改变指标（HR，2.84；95%CI，1.97-4.11）的参与者死亡率风险更高。对于 BMI 为 27 或更高的参与者，SO 的结果相似。
在这项研究中，肌少症和 SO 被发现是老年人中普遍存在的表型，并与全因死亡率相关。BC 的其他改变独立于年龄、性别和 BMI 进一步放大了这种风险。使用低肌肉力量作为两种诊断的第一步可能有助于早期识别有过早死亡风险的个体。
