Yang Jing, Li Weixia, Zhao Ruixuan, Lu Jingjing, Cui Xinlu, Lin Jianlin, Cao Li
School of Public Health, Hainan Medical University, Haikou, China.
Faculty of Applied Sciences, Macao Polytechnic University, Macau, SAR, China.
BMC Public Health. 2025 May 13;25(1):1740. doi: 10.1186/s12889-025-22928-5.
The bidirectional relationship between muscle mass and chronic lung diseases (CLD) in middle-aged and older adults remains inadequately explored. This study aims to investigate the bidirectional association between estimated muscle mass and self-reported chronic lung diseases while elucidating the mediating mechanisms underlying this relationship.
This study utilized data from the nationally representative China Health and Retirement Longitudinal Study (2011-2018), focusing on individuals aged 45 years or older. Cox regression was used to investigate the bidirectional relationship between estimated muscle mass and self-reported CLD. Causal mediation analysis was employed to evaluate the role of 16 blood biomarkers as potential mediators. Sensitivity analysis using cross-lagged models was conducted to verify the robustness of the bidirectional association between estimated muscle mass and self-reported CLD.
Among 10,591 participants, 1,742 (16%) self-reported CLD during a median follow-up of 4.4 years. Participants with low estimated muscle mass had a 27% higher risk of developing self-reported CLD compared to those with normal muscle mass (HR = 1.27, 95% CI: 1.12-1.44). In a separate analysis of 6,067 participants, 708 (12%) experienced new-onset estimated low muscle mass, with those reporting CLD showing a 26% increased risk of muscle loss during a median follow-up of 2.5 years (HR = 1.26, 95% CI: 1.06-1.49). Notably, individuals with insufficient physical activity exhibited a significantly higher risk of self-reported CLD compared to those who engaged in regular exercise (HR = 1.91; 95% CI: 1.37-2.66). Additionally, the negative impact of low estimated muscle mass was more pronounced in male participants than in females (HR = 1.65; 95% CI: 1.33-2.03) over the same follow-up period. Causal mediation analysis suggested that cystatin C may mediate 0.61% of the association between estimated muscle mass and self-reported CLD.
There is a bidirectional relationship between self-reported CLD and low estimated muscle mass. Self-reported CLD may cause varying degrees of estimated muscle mass reduction across different population subgroups. Understanding this dynamic and its variations can enhance prevention and treatment strategies for both conditions.
中老年人群肌肉量与慢性肺部疾病（CLD）之间的双向关系尚未得到充分研究。本研究旨在探讨估计肌肉量与自我报告的慢性肺部疾病之间的双向关联，同时阐明这种关系背后的中介机制。
本研究利用了具有全国代表性的中国健康与养老追踪调查（2011 - 2018年）的数据，重点关注45岁及以上的个体。采用Cox回归分析估计肌肉量与自我报告的CLD之间的双向关系。采用因果中介分析评估16种血液生物标志物作为潜在中介的作用。使用交叉滞后模型进行敏感性分析，以验证估计肌肉量与自我报告的CLD之间双向关联的稳健性。
在10,591名参与者中，1,742名（16%）在中位随访4.4年期间自我报告患有CLD。与肌肉量正常的参与者相比，估计肌肉量低的参与者自我报告患CLD的风险高27%（HR = 1.27，95% CI：1.12 - 1.44）。在对6,067名参与者的单独分析中，708名（12%）出现了新的估计低肌肉量，报告患有CLD的参与者在中位随访2.5年期间肌肉量减少的风险增加了26%（HR = 1.26，95% CI：1.06 - 1.49）。值得注意的是，与经常锻炼的人相比，身体活动不足的个体自我报告患CLD的风险显著更高（HR = 1.91；95% CI：1.37 - 2.66）。此外，在相同的随访期内，估计肌肉量低对男性参与者的负面影响比对女性更明显（HR = 1.65；95% CI：1.33 - 2.03）。因果中介分析表明，胱抑素C可能介导估计肌肉量与自我报告的CLD之间关联的0.61%。
自我报告的CLD与估计肌肉量低之间存在双向关系。自我报告的CLD可能在不同人群亚组中导致不同程度的估计肌肉量减少。了解这种动态变化及其差异可以加强对这两种疾病的预防和治疗策略。
