๐ค Authors: Xinyi Yu, Jincheng Chao, Xin Wang, Siyi Dun, Huajing Song, Yuqi Guo, Hua Zhang, Yanli Yao, Zhendong Liu, Juan Wang, Weike Liu
Sarcopenic obesity and the risk of atrial fibrillation in non-diabetic older adults: A prospective cohort study.
Evidence of an association between sarcopenic obesity (SO) and the risk of long-term atrial fibrillation (AF) is lacking, and the underlying involvement of insulin resistance (IR) and inflammation is not clear. This community-based prospective cohort study evaluated sarcopenia, obesity, and baseline clinical characteristics in 4321 non-diabetic older adults between 2007 and 2011.
Sarcopenia was identified using skeletal muscle mass/body weight (SMM/BW), appendicular lean mass (ALM)/BW, and handgrip strength (HGS), and obesity was identified by fat mass (FM)/BW. The association of sarcopenia and obesity with AF risk was determined by Kaplan-Meier analysis and a Cox proportional hazards model.
Interaction analysis, a restricted cubic splines model, mediation analysis, and a Fine-Gray competing-risk model were also used. Over an average of 10.9 years of follow-up, 546 (11.98 per 1000 person-years) participants developed AF.
Low SMM/BW, low ALM/BW, low HGS, high FM/BW, sarcopenia and obesity, were significantly associated with an increased AF risk. There was a significant synergistic relationship between sarcopenia and obesity in the increased AF risk [hazard ratio (HR): 2.029, 95ย % confidence interval (CI): 1.639-2.512].
Compared with participants without sarcopenia and obesity, AF risk was the highest in those with SO (HR: 2.669, 95ย % CI: 2.110-3.377], followed by sarcopenia alone (HR: 1.980, 95%CI: 1.453-2.699) and obesity (HR: 1.839, 95%CI: 1.475-2.292). Mediation analysis found that estimated glucose disposal rate (a surrogate marker of IR), high-sensitivity C-reactive protein, and galectin-3 were mediating factors in the increased AF risk caused by SO, accounting for 34.87ย %, 27.56ย %, and 21.05ย % of the total effect, respectively.
SO significantly increased AF risk in these non-diabetic older individuals. Sarcopenia and obesity not only acted alone but also exhibit had a synergistic relationship to increase AF risk.
IR and inflammation mediated the increased AF risk associated with SO.
