Setoyama Yu, Honda Takanori, Tajimi Takahiro, Sakata Satoko, Oishi Emi, Furuta Yoshihiko, Shibata Mao, Hata Jun, Kitazono Takanari, Nakashima Yasuharu, Ninomiya Toshiharu
Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Cachexia Sarcopenia Muscle. 2024 Dec;15(6):2338-2348. doi: 10.1002/jcsm.13564. Epub 2024 Oct 8.
Dynapenic obesity is a condition characterized by high adiposity levels combined with muscle dysfunction. Although high adiposity and muscle loss/dysfunction are thought to synergistically increase the risk of cardiovascular disease (CVD), few studies have addressed the association between dynapenic and sarcopenic obesity and CVD. We aimed to investigate the association of dynapenic obesity with incident CVD events using the data from a population-based prospective longitudinal study in Japan.
A total of 2490 community-dwelling Japanese aged 40-79 years (42.5% males, mean age 57.7 ± 10.6 years) without a history of CVD were followed up for a median of 24 years. Handgrip strength was classified as low, medium, or high by age- and sex-specific tertiles. Body mass index (BMI) levels were categorized as lean (<18.5 kg/m), normal (18.5-24.9 kg/m), or obese (≥25.0 kg/m). Dynapenic obesity was defined as having both low handgrip strength and obesity. The outcomes were defined as the first-ever development of CVD (defined as stroke or coronary heart disease). The hazard ratios (HRs) and their 95% confidence intervals (CIs) for the development of CVD were estimated using a Cox proportional hazards model, in which participants with high handgrip strength and normal BMI were used as a reference group. Mediation analyses used serum high-sensitivity C-reactive protein (hs-CRP) and homeostatic model assessment for insulin resistance (HOMA-IR) as mediators.
During the follow-up period, 482 participants developed CVD events (324 cases of stroke and 209 of coronary heart disease). The multivariable-adjusted risk of CVD increased significantly among participants with dynapenic obesity compared with the reference group (HR 1.49, 95% CI 1.03-2.17). An analysis by age groups showed a further increase in the risk of CVD among participants with dynapenic obesity aged less than 65 years (HR 1.66, 95% CI 1.04-2.65). In mediation analyses for participants aged less than 65 years, serum hs-CRP was shown to be a significant mediator explaining 13.8% of the association between dynapenic obesity and the development of CVD, while HOMA-IR explained 12.2% of this relationship.
Dynapenic obesity was a significant risk factor for the development of CVD in a general Japanese population. This association was more pronounced among those aged <65 years. Inflammation, and possibly glucose metabolism, might partly mediate this association. Our findings suggest that preventing muscle dysfunction as well as appropriate weight control, especially in middle-age, are important for preventing the development of CVD.
肌少性肥胖是一种以高肥胖水平与肌肉功能障碍相结合为特征的病症。尽管高肥胖和肌肉减少/功能障碍被认为会协同增加心血管疾病（CVD）的风险，但很少有研究探讨肌少性肥胖和肥胖症与CVD之间的关联。我们旨在利用日本一项基于人群的前瞻性纵向研究的数据，调查肌少性肥胖与CVD事件发生之间的关联。
共有2490名年龄在40 - 79岁之间（男性占42.5%，平均年龄57.7±10.6岁）且无CVD病史的日本社区居民接受了为期24年的随访。握力根据年龄和性别特定三分位数分为低、中、高。体重指数（BMI）水平分为消瘦（<18.5kg/m）、正常（18.5 - 24.9kg/m）或肥胖（≥25.0kg/m）。肌少性肥胖定义为握力低且肥胖。结局定义为首次发生CVD（定义为中风或冠心病）。使用Cox比例风险模型估计CVD发生的风险比（HRs）及其95%置信区间（CIs），其中以握力高且BMI正常的参与者作为参照组。中介分析使用血清高敏C反应蛋白（hs-CRP）和胰岛素抵抗稳态模型评估（HOMA-IR）作为中介变量。
在随访期间，482名参与者发生了CVD事件（324例中风和209例冠心病）。与参照组相比，肌少性肥胖参与者的多变量调整后CVD风险显著增加（HR 1.49，95% CI 1.03 - 2.17）。按年龄组分析显示，65岁以下肌少性肥胖参与者的CVD风险进一步增加（HR 1.66，95% CI 1.04 - 2.65）。在对65岁以下参与者的中介分析中，血清hs-CRP被证明是一个显著的中介变量，解释了肌少性肥胖与CVD发生之间关联的13.8%，而HOMA-IR解释了这种关系的12.2%。
肌少性肥胖是日本普通人群发生CVD的一个重要风险因素。这种关联在65岁以下人群中更为明显。炎症以及可能的糖代谢可能部分介导了这种关联。我们的研究结果表明，预防肌肉功能障碍以及适当控制体重，尤其是在中年时期，对于预防CVD的发生很重要。
