BackgroundDynapenic 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.MethodsA 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/m2), normal (18.5–24.9 kg/m2), or obese (≥25.0 kg/m2). 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.ResultsDuring 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.ConclusionsDynapenic 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.

中文翻译：

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力压性肥胖与心血管疾病风险之间的关联： 久山研究


背景动力减少性肥胖是一种以高肥胖水平结合肌肉功能障碍为特征的疾病。尽管高度肥胖和肌肉流失/功能障碍被认为协同增加心血管疾病 （CVD） 的风险，但很少有研究涉及动力减少性和肌肉减少性肥胖与 CVD 之间的关联。我们旨在使用来自日本一项基于人群的前瞻性纵向研究的数据来调查动力减少性肥胖与 CVD 事件发生率的相关性.方法共有 2490 名年龄在 40-79 岁之间的社区居住在日本人 （42.5% 为男性，平均年龄 57.7 ± 10.6 岁） 无 CVD 病史，中位随访时间为 24 年。握力按年龄和性别特异性三分位数分为低、中或高。体重指数 （BMI） 水平分为瘦 （<18.5 kg/m2）、正常 （18.5-24.9 kg/m2） 或肥胖 （≥25.0 kg/m2）。Dynapenic 肥胖被定义为握力低和肥胖。结果被定义为 CVD （定义为中风或冠心病） 的首次发展。使用 Cox 比例风险模型估计 CVD 发展的风险比 （HRs） 及其 95% 置信区间 （CIs），其中手握力高且 BMI 正常的参与者作为参考组。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） 作为介质。结果在随访期间，482 名参与者发生了 CVD 事件 （324 例中风和 209 例冠心病）。与参考组相比，动力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）。 按年龄组划分的分析显示，年龄小于 65 岁的动力性肥胖参与者患 CVD 的风险进一步增加 （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 被证明是一个重要的介质，解释了 13.8% 的动力减少性肥胖与 CVD 发展之间的关联，而 HOMA-IR 解释了 12.2% 的这种关系。结论Dynapenic obesity 是日本一般人群发生 CVD 的重要危险因素。这种关联在 <65 岁的人群中更为明显。炎症，可能还有葡萄糖代谢，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的体重控制，尤其是在中年，对于预防 CVD 的发展很重要。