≥50岁成年人中风与肌肉减少症风险之间关联的洞察：来自两个大型人群纵向队列的横断面证据

Insights Into the Association Between Stroke and Sarcopenia Risk in Adults Aged ≥ 50 Years: Cross-Sectional Evidence From Two Large Population Longitudinal Cohorts.

作者信息

Wang Xin, Zhang Jie, Xu Jing, Li Ting, Ye Qing

机构信息

Center For Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, People's Republic of China.

出版信息

Brain Behav. 2025 Aug;15(8):e70763. doi: 10.1002/brb3.70763.

DOI:10.1002/brb3.70763

PMID:40791098

Abstract

BACKGROUND AND AIM

Evidence has already shown that sarcopenia is linked to an elevated risk of cardiovascular disease (CVD). However, the association between stroke and sarcopenia risk remains underexplored in stroke and non-stroke populations. This study investigated the stroke-sarcopenia relationship.

METHODS

We conducted a cross-sectional analysis using data from Wave 3 (2015-2016) of the China Health and Retirement Longitudinal Study (CHARLS) and Wave 14 (2018-2019) of the Health and Retirement Study (HRS), focusing on ≥ 50 years adults. Missing data were imputed using the Python miceforest package with a random forest algorithm. All types of stroke were identified via self-reported records where individuals had received a confirmed diagnosis from a physician. Sarcopenia status was evaluated using muscle strength (evaluated with grip strength in CHARLS and HRS), muscle mass (evaluated with appendicular skeletal muscle), and physical performance (evaluated with gait speed, the five-repetition chair test, and the short physical performance battery). Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the primary analysis, with generalized estimating equation (GEE) models employed in sensitivity analyses to ensure result robustness.

RESULTS

The study comprised 16,859 participants from CHARLS (51% female, mean age 62.9 years) and 16,692 from HRS (41% female, mean age 67.6 years). In CHARLS, stroke was associated with significantly increased risks of possible sarcopenia (OR: 2.07, 95% CI: 1.49-2.99), sarcopenia (OR: 1.93, 95% CI: 1.23-3.06), and severe sarcopenia (OR: 3.42, 95% CI: 2.22-5.34). In HRS, stroke was linked to elevated risks of possible sarcopenia (OR: 3.11, 95% CI: 2.75-3.52) and severe sarcopenia (OR: 2.20, 95% CI: 1.24-3.65). Self-care ability, nutritional status, and inflammatory factors were identified as key mediators, with findings remaining consistent across subgroups and sensitivity analyses.

CONCLUSIONS

Stroke was associated with increased risk for sarcopenia and its severe forms in adults aged ≥ 50 years. We recommend sarcopenia risk evaluation in poststroke patients with accessible tools, also emphasizing that functional rehabilitation, nutritional optimization, and inflammation control hold promise to alleviate sarcopenia risk and enhance long-term outcomes.

摘要

背景与目的

已有证据表明，肌肉减少症与心血管疾病（CVD）风险升高有关。然而，在中风和非中风人群中，中风与肌肉减少症风险之间的关联仍未得到充分研究。本研究调查了中风与肌肉减少症之间的关系。

方法

我们使用中国健康与养老追踪调查（CHARLS）第3轮（2015 - 2016年）和健康与退休研究（HRS）第14轮（2018 - 2019年）的数据进行横断面分析，重点关注年龄≥50岁的成年人。使用Python的miceforest包和随机森林算法对缺失数据进行插补。所有类型的中风均通过自我报告记录确定，即个体已从医生处获得确诊诊断。使用肌肉力量（在CHARLS和HRS中用握力评估）、肌肉质量（用四肢骨骼肌评估）和身体表现（用步速、五次重复坐椅试验和简短身体表现测试评估）来评估肌肉减少症状态。逻辑回归模型估计主要分析的比值比（OR）和95%置信区间（CI），敏感性分析采用广义估计方程（GEE）模型以确保结果的稳健性。

结果

该研究包括来自CHARLS的16859名参与者（51%为女性，平均年龄62.9岁）和来自HRS的16692名参与者（41%为女性，平均年龄67.6岁）。在CHARLS中，中风与可能的肌肉减少症（OR：2.07，95% CI：1.49 - 2.99）、肌肉减少症（OR：1.93，95% CI：1.23 - 3.06）和严重肌肉减少症（OR：3.42，95% CI：2.22 - 5.34）风险显著增加相关。在HRS中，中风与可能的肌肉减少症（OR：3.11，95% CI：2.75 - 3.52）和严重肌肉减少症（OR：2.20，95% CI：1.24 - 3.65）风险升高相关。自我护理能力、营养状况和炎症因子被确定为关键中介因素，各亚组和敏感性分析的结果保持一致。