We write this letter in response to the article [1], ‘Association between dynapenic obesity and risk of cardiovascular disease: The Hisayama study’. The study offers valuable insights into the role of dynapenic obesity as a significant risk factor for cardiovascular disease (CVD) among Japanese community residents, particularly highlighting the importance of weight management and maintaining muscle function in middle-aged populations. We commend the authors for their contribution and would like to offer some suggestions for further consideration.

First, the study was conducted within a Japanese community where participants share a relatively homogenous genetic and cultural background. As a result, the findings may not be directly applicable to populations with diverse genetic profiles, dietary habits and lifestyle factors in other countries or regions [2]. Future research could benefit from similar studies conducted in various geographical and cultural contexts, exploring how the relationship between dynapenic obesity and CVD risk may vary across different populations. This would enhance the generalizability of the findings and deepen our understanding of these associations across diverse genetic and environmental backgrounds.

Second, while the study included subgroup analyses by age and sex, additional stratifications could provide more precise insights. Future research should consider stratifying participants by levels of physical activity, insulin resistance or diabetes status, types of obesity, medication use, lifestyle factors and socio-economic status [3-5]. These analyses would allow for the development of more targeted and personalized intervention strategies aimed at reducing the risk of CVD associated with dynapenic obesity.

Third, although the study's 24-year follow-up is commendable, lifestyle factors such as diet, exercise, smoking and alcohol consumption were not tracked dynamically during the follow-up period. These variables may significantly impact muscle function, obesity and the risk of CVD. We recommend that future studies incorporate multiple data collection points throughout the follow-up period to monitor changes in lifestyle behaviours, providing a more comprehensive understanding of their role in the development of dynapenic obesity and CVD.

This study underscores the strong association between dynapenic obesity and CVD, emphasizing the critical need for managing muscle strength and body weight in preventing cardiovascular events. As healthcare professionals, we advocate for early screening and identification of dynapenic obesity. Multidisciplinary teams, including internists, nutritionists and physical therapists, can work together to develop personalized, integrated treatment plans. Additionally, enhancing patient education on the risks associated with dynapenic obesity and its impact on CVD prevention will empower individuals to take proactive steps in managing their health.

In conclusion, we greatly appreciate this study's contribution to the growing body of evidence linking dynapenic obesity and CVD. Building upon these findings, we can develop more tailored management strategies that focus on improving muscle function, promoting healthy ageing, reducing the burden of age-related diseases and ultimately improving the quality of life for older populations.

我们写这封信是为了回应文章 [1]，“动力减少性肥胖与心血管疾病风险之间的关联：久山研究”。该研究为动力减少性肥胖作为日本社区居民心血管疾病 （CVD） 的重要危险因素的作用提供了有价值的见解，特别强调了体重管理和维持中年人群肌肉功能的重要性。我们赞扬作者的贡献，并希望提供一些建议以供进一步考虑。

首先，该研究是在参与者具有相对同质的遗传和文化背景的日本社区内进行的。因此，这些发现可能并不直接适用于其他国家或地区具有不同遗传特征、饮食习惯和生活方式因素的人群 [2]。未来的研究可能受益于在不同地理和文化背景下进行的类似研究，探索动力减少性肥胖与 CVD 风险之间的关系在不同人群中如何变化。这将增强研究结果的普遍性，并加深我们对不同遗传和环境背景下的这些关联的理解。

其次，虽然该研究包括按年龄和性别划分的亚组分析，但额外的分层可以提供更精确的见解。未来的研究应考虑根据身体活动水平、胰岛素抵抗或糖尿病状况、肥胖类型、药物使用、生活方式因素和社会经济地位对参与者进行分层 [3-5]。这些分析将允许制定更具针对性和个性化的干预策略，旨在降低与动力减少性肥胖相关的 CVD 风险。

第三，尽管该研究的 24 年随访值得称赞，但在随访期间并未动态跟踪饮食、运动、吸烟和饮酒等生活方式因素。这些变量可能会显著影响肌肉功能、肥胖和 CVD 风险。我们建议未来的研究在整个随访期间纳入多个数据收集点，以监测生活方式行为的变化，从而更全面地了解它们在dynapenic obesity和CVD发展中的作用。

这项研究强调了动力减少性肥胖与 CVD 之间的密切关联，强调了管理肌肉力量和体重以预防心血管事件的迫切需求。作为医疗保健专业人员，我们倡导早期筛查和识别dynapenic obesity。包括内科医生、营养师和物理治疗师在内的多学科团队可以通力合作，制定个性化的综合治疗计划。此外，加强对患者关于动态性肥胖相关风险及其对 CVD 预防影响的教育将使个人能够采取积极措施来管理自己的健康。

总之，我们非常感谢这项研究对越来越多的将动力减少性肥胖与 CVD 联系起来的证据的贡献。基于这些发现，我们可以制定更有针对性的管理策略，专注于改善肌肉功能、促进健康老龄化、减轻与年龄相关的疾病负担，并最终改善老年人群的生活质量。