Tabara Yasuharu, Matsumoto Takeshi, Murase Kimihiko, Kawaguchi Takahisa, Setoh Kazuya, Wakamura Tomoko, Hirai Toyohiro, Chin Kazuo, Matsuda Fumihiko
Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan.
Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Cachexia Sarcopenia Muscle. 2025 Feb;16(1):e13690. doi: 10.1002/jcsm.13690.
Diaphragm thickness is a potential marker of sarcopenia in addition to muscle mass and strength at extremities. We aimed to clarify the descriptive epidemiology and prognostic significance of diaphragm thickness in the general population.
The study participants were 3324 community residents (mean age: 61.4 ± 12.8 years) who participated in a longitudinal cohort study. Clinical parameters were obtained during the follow-up survey of the study population. Diaphragm thickness was measured from B-mode ultrasound images obtained in a supine position. Clinical and physical factors independently associated with diaphragm thickness were assessed by a linear regression model and a causal mediation analysis. All-cause mortality was determined by reviewing residential registry records. Prognostic significance of diaphragm thickness for all-cause mortality was examined using a Cox proportional hazard model analysis.
Diaphragm thickness was greater in men than women (end-expiration, β = 0.161, p < 0.001; end-inspiration, β = 0.156, p < 0.001) and associated with waist circumference (end-expiration, β = 0.259, p < 0.001; end-inspiration, β = 0.128, p < 0.001). Handgrip strength, smoking habit, insulin resistance and exercise habit were not associated with diaphragm thickness. Skeletal muscle mass index showed apparent association with diaphragm thickness, though this association was not observed after adjusting for waist circumference. Over a mean follow-up of 1686 days (15 358 person-years), there were 56 cases of all-cause mortality. Weak handgrip strength (hazard ratio = 0.95, p = 0.044) and low forced vital capacity (hazard ratio = 0.57, p = 0.045) were associated with all-cause mortality, though none of the diaphragm thickness parameters showed a significant association (thickness at end-expiration, p = 0.722; thickness at end-inspiration, p = 0.277; thickening fraction, p = 0.219).
Waist circumference but not parameters of sarcopenia was independently associated with diaphragm thickness. Diaphragm thickness was not associated with all-cause mortality. Diaphragm thickness may not be a marker of systemic sarcopenia.
除了四肢肌肉量和力量外，膈肌厚度是肌肉减少症的一个潜在标志物。我们旨在阐明普通人群中膈肌厚度的描述性流行病学及其预后意义。
研究参与者为3324名社区居民（平均年龄：61.4±12.8岁），他们参与了一项纵向队列研究。在对研究人群的随访调查中获取临床参数。从仰卧位获得的B超图像测量膈肌厚度。通过线性回归模型和因果中介分析评估与膈肌厚度独立相关的临床和身体因素。通过查阅居民登记记录确定全因死亡率。使用Cox比例风险模型分析检查膈肌厚度对全因死亡率的预后意义。
男性的膈肌厚度大于女性（呼气末，β = 0.161，p < 0.001；吸气末，β = 0.156，p < 0.001），且与腰围相关（呼气末，β = 0.259，p < 0.001；吸气末，β = 0.128，p < 0.001）。握力、吸烟习惯、胰岛素抵抗和运动习惯与膈肌厚度无关。骨骼肌质量指数与膈肌厚度有明显关联，不过在调整腰围后未观察到这种关联。在平均1686天（15358人年）的随访中，有56例全因死亡病例。握力弱（风险比 = 0.95，p = 0.044）和用力肺活量低（风险比 = 0.57，p = 0.045）与全因死亡率相关，不过膈肌厚度参数均未显示出显著关联（呼气末厚度，p = 0.722；吸气末厚度，p = 0.277；增厚率，p = 0.219）。
腰围而非肌肉减少症参数与膈肌厚度独立相关。膈肌厚度与全因死亡率无关。膈肌厚度可能不是全身性肌肉减少症的标志物。
