Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
Exp Gerontol. 2024 Nov;197:112611. doi: 10.1016/j.exger.2024.112611. Epub 2024 Oct 21.
BACKGROUND: Sarcopenic obesity (SO) and osteoarthritis (OA) are highly prevalent musculoskeletal conditions that significantly impair health-related quality of life. AIM: This study investigated the association between SO and OA, and explored the potential mediating role of insulin resistance in this relationship. We utilized data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. METHODS: This cross-sectional analysis employs NHANES data collected from 1999 to 2018, including participants aged 18 years and older. SO was assessed using dual-energy X-ray absorptiometry (DXA) measurements. Insulin resistance was estimated using the triglyceride-glucose (TyG) index. OA status was based on self-reported physician diagnosis. Statistical analyses included weighted logistic regression, restricted cubic spline (RCS) interaction analysis, mediation analysis using structural equation modeling (SEM), and receiver operating characteristic (ROC) curve analysis. Subgroup analyses were conducted based on age, sex, and diabetes status. RESULTS: The sarcopenic obese group demonstrated the highest prevalence of OA (23.4 %), hypertension (47.8 %), and diabetes (12.0 %). Additionally, they exhibited elevated levels of triglycerides, cholesterol, glucose, blood urea nitrogen (BUN), creatinine, and uric acid. Logistic regression revealed significant positive associations between sarcopenic obesity, the TyG index, and OA risk. RCS analysis identified significant non-linear relationships and interactions of the TyG index with age, sex, and diabetes status on OA risk. Mediation analysis indicated that the TyG index mediated approximately 4.9 % of the effect of sarcopenic obesity on OA risk. ROC curve analysis demonstrated moderate diagnostic accuracy for the TyG index (AUC = 0.65), which improved when incorporated into the multivariate model (AUC = 0.78). Subgroup analyses confirmed significant associations between the TyG index and sarcopenic obesity with OA risk across different age, sex, and diabetes status categories. CONCLUSION: Our findings suggest a significant correlation between insulin resistance, as measured by the TyG index, and elevated OA risk in individuals with sarcopenic obesity. Targeting insulin resistance through future research may be a promising avenue to lower OA risk in this population.
背景：肌少症性肥胖（SO）和骨关节炎（OA）是两种高发的肌肉骨骼疾病，严重影响健康相关生活质量。
目的：本研究旨在探讨 SO 与 OA 之间的关联，并探究胰岛素抵抗在这一关系中的潜在中介作用。我们利用了 1999-2018 年国家健康和营养调查（NHANES）的数据。
方法：这是一项横断面分析，使用了 1999 年至 2018 年收集的 NHANES 数据，包括年龄在 18 岁及以上的参与者。SO 采用双能 X 射线吸收法（DXA）测量进行评估。胰岛素抵抗使用甘油三酯-葡萄糖（TyG）指数进行估计。OA 状态基于自我报告的医生诊断。统计分析包括加权逻辑回归、限制立方样条（RCS）交互分析、结构方程模型（SEM）中介分析和接收者操作特征（ROC）曲线分析。根据年龄、性别和糖尿病状态进行了亚组分析。
结果：肌少症性肥胖组的 OA（23.4%）、高血压（47.8%）和糖尿病（12.0%）患病率最高。此外，他们的甘油三酯、胆固醇、葡萄糖、血尿素氮（BUN）、肌酐和尿酸水平也较高。逻辑回归显示，肌少症性肥胖、TyG 指数与 OA 风险之间存在显著的正相关关系。RCS 分析发现，TyG 指数与年龄、性别和糖尿病状态对 OA 风险的非线性关系和交互作用具有显著意义。中介分析表明，TyG 指数介导了肌少症性肥胖对 OA 风险的约 4.9%的作用。ROC 曲线分析表明，TyG 指数对 OA 风险的诊断准确性中等（AUC=0.65），当纳入多变量模型时，诊断准确性提高（AUC=0.78）。亚组分析证实，在不同年龄、性别和糖尿病状态类别中，TyG 指数与肌少症性肥胖与 OA 风险之间存在显著关联。
结论：我们的研究结果表明，胰岛素抵抗与肌少症性肥胖患者 OA 风险升高之间存在显著相关性。通过未来的研究针对胰岛素抵抗进行干预，可能是降低该人群 OA 风险的一个有前途的途径。
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