The association between sarcopenia and incident chronic lung disease in the general population: A longitudinal study based on CHARLS data

Joint association of frailty index and biological age with chronic obstructive pulmonary disease: a cohort study from CHARLS

Chronic Obstructive Pulmonary Disease (COPD) is associated with frailty and ageing, but there is insufficient evidence from existing longitudinal studies. This research explored the longitudinal association between frailty, ageing and COPD. We used the China Health and Retirement Longitudinal Study (CHARLS) data to perform a cohort study. The study population was non-COPD patients in wave 1 (2011), and the outcome was the occurrence of COPD at the end of follow-up (wave 4-wave 5). Frailty was assessed using the CHARLS modified frailty index (CMFI), and ageing was evaluated using the biological age (BA). We used multivariate logistic regression to examine the longitudinal associations between CMFI and BA with COPD. Fitted curves were used to analyze the dose-response relationship of CMFI and BA with COPD. A 3D surface diagram was used to analyze the association between BA and CMFI with COPD. In addition, subgroup and sensitivity analyses were performed. 6452 non-COPD patients were enrolled in the study, and after follow-up, 616 participants were diagnosed with COPD. Logistic regression and fitted curves showed a positive correlation between CMFI and BA and the development of COPD. The risk of COPD increased by 19% for every one standard deviation (SD) increase in BA and 32% for every one SD increase in CMFI. A 3D surface diagram shows a joint association between CMFI and BA with the COPD. Subgroup and sensitivity analysis results are stable. This study found a joint association between CMFI and BA with COPD, suggesting that CMFI and BA are risk factors for the development of COPD.

Bidirectional longitudinal associations between estimated muscle mass and self-reported chronic lung disease in middle-aged and older adults: findings from the China health and retirement longitudinal study

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Association between serum cystatin C and chronic lung disease in middle-aged and elderly Chinese: a CHARLS cross-sectional study

The dose-response relationship between cystatin C (CysC) levels and chronic lung disease (CLD) development remains unclear and warrants further investigation. A more in-depth study of the relationship between serum CysC levels and CLD prevalence based on data from the China Health and Retirement Longitudinal Study (CHARLS). A cross-sectional analysis of 10,275 middle-aged and older adults aged 45 years and older was conducted using 2015 CHARLS data. Binary logistic regression models, restricted cubic spline curves (RCS), and threshold effects analyses were used to explore the association between different CysC levels and CLD prevalence in the middle-aged and older population, and subgroup analyses were performed to verify the robustness of the findings. When CysC was used as a categorical variable, the risk of CLD was increased by 38% in the T3 group compared with T1 (P < 0.001), and when CysC was used as a continuous variable, the risk of CLD was increased by 96% for each unit increase in CysC level (P < 0.001). In addition, there was a nonlinear relationship between CysC levels and the risk of CLD prevalence (P for non-linearity < 0.012), and the risk of CLD prevalence increased significantly with increasing CysC levels when CysC levels ≥ 0.754 mg/L. When CysC ≥ 0.754 mg/L, we need to be highly concerned about the risk of developing chronic lung disease in middle-aged and older populations, and those aged 45-64 years should be the focus of screening.

Association between possible sarcopenia, all-cause mortality, and adverse health outcomes in community-dwelling older adults in China

The relationship between possible sarcopenia and mortality remains ambiguous within Asian populations. To clarify this, we investigated the association in older adults residing in Chinese communities. Utilizing data from the China Health and Retirement Longitudinal Study, this population-based cohort study included individuals aged ≥ 60 years, followed from 2011 to 2012 through 2020. Possible sarcopenia was defined in accordance with the Asian Working Group on Sarcopenia 2019 criteria, and Cox proportional hazards regression was used to analyze its impact on mortality, while exploratory analyses were conducted to investigate the associations of possible sarcopenia with chronic diseases, functional independence, and hospitalization frequency. The study encompassed 5,160 participants (median age: 66 years), nearly half of whom (48.8%) were identified with possible sarcopenia. Over a 9-year follow-up period, there were 1216 recorded deaths. Analysis indicated that individuals with possible sarcopenia faced a significantly elevated mortality risk compared to their counterparts (HR: 1.79, 95% CI: 1.58-2.03; P < 0.001). Further, subgroup analyses confirmed a strong association between possible sarcopenia and all-cause mortality across various subgroups, including those related to sex, obesity status, and living environment. Additionally, exploratory analyses revealed that possible sarcopenia was significantly associated with an increased likelihood of heart disease (OR = 1.18, 95% CI: 1.03-1.34, P = 0.014) and stroke (OR = 1.41, 95% CI: 1.19-1.68, P < 0.001), as well as reduced functional independence (β = -0.17, 95% CI: -0.24--0.10, P < 0.001). Possible sarcopenia was also associated with a higher frequency of hospitalizations at baseline (Exp(β) = 1.50, 95% CI: 1.25-1.81, P < 0.001), although this association was no longer significant during the follow-up period. In conclusion, in Chinese community-dwelling older adults, possible sarcopenia was associated with an increased risk of all-cause mortality, several chronic diseases, and functional dependence. Thus, alleviating or preventing possible sarcopenia may improve health outcomes and extend the lifespan of these individuals.

Association between threat-related adverse childhood experiences and chronic lung diseases in a middle and older aged population: A cross-sectional and longitudinal study in China

OBJECTIVES

We investigated the association between threat-related adverse childhood experiences (ACEs) and the risk of chronic lung diseases (CLDs).

METHODS

The data used for this study were extracted from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey of respondents recruited from 450 villages/urban communities in 28 provinces. Threat-related ACEs were constructed using five adverse factors: household substance abuse, physical abuse, domestic violence, unsafe neighbourhood, and bullying). Participants were divided into three groups according to their number of threat-related ACEs at baseline and at follow-up. The association between threat-related ACEs and CLD prevalence in the cross-sectional study was calculated using logistic regression models. The association between threat-related ACEs and CLD onset was evaluated using Cox proportional regression models in the cohort study. Potential confounders were considered in both the cross-sectional and cohort studies.

RESULTS

The CLD prevalence in the total population, no exposure group, exposure to one threat-related ACE, and exposure to at least two threat-related ACEs were 10.07% (1320/13104), 9.20% (665/7232), 10.89% (421/3865), and 11.66% (234/2007), respectively. Exposure to one threat-related ACE (OR: 1.23, 95% CI: 1.07-1.41) and exposure to at least two threat-related ACEs (OR: 1.31, 95% CI: 1.11-1.55) were significantly associated with higher CLD prevalence rates. The cohort study included 11,645 participants. During the 7-year follow-up, 738 CLD incidents were identified. Similarly, exposure to one threat-related ACE (HR: 1.20, 95% CI: 1.01-1.43) and at least two threat-related ACEs (HR: 1.64, 95% CI: 1.35-2.00) were significantly associated with a higher CLD incidence risk.

CONCLUSIONS

Exposure to threat-related ACEs was significantly associated with a higher CLD prevalence risk and onset. It is crucial to identify individuals who have encountered childhood threats and prioritise the monitoring of their pulmonary function.

Influence of sarcopenia on surgical efficacy and mortality of percutaneous kyphoplasty in the treatment of older adults with osteoporotic thoracolumbar fracture

BACKGROUND

Sarcopenia is an age-related condition that causes loss of skeletal muscle mass and disability. Sarcopenia is closely related to the prognosis of patients suffering osteoporotic thoraco-lumbar compression fractures (OTLCF). The purpose of this study was to investigate the effect of sarcopenia on the efficacy of percutaneous kyphoplasty (PKP) in the treatment of older adults with OTLCF surgery and postoperative mortality.

METHODS

From February 2016 to June 2019, 101 patients who met the inclusion and exclusion criteria were included in this study. The grip strength of the dominant hand was measured using an electronic grip tester. The diagnostic cutoff value of grip strength for sarcopenia was <27 kg for males and <16 kg for females. The cross-sectional area (cm2) of the musculature at the level of the pedicle of the thoracic 12th vertebra (T12) was measured by chest CT. The skeletal muscle index (SMI) was calculated by dividing the muscle cross-sectional area at the T12 pedicle level by the square of the height. The diagnostic cut-off value of SMI at T12 level is 42.6 cm2/m2 for males and 30.6 cm2/m2 for females. Sarcopenia was diagnosed when the grip strength and SMI values were both lower than the diagnostic cut-off value. All included patients received PKP treatment for OTLCF. The age, gender, operation time, bleeding volume, time to ground, length of hospital stay, visual analog scale (VAS) score before operation and one month after operation, Oswestry Disability Index (ODI) one month after operation and the incidence of refracture within 36 months after operation were compared between the two groups. The survival curves of the two groups were analyzed by Kaplan Meier. Chi-square test was used to compare the differences in survival rates between the two groups at 12, 24, and 36 months after operation. Univariate and multivariate Cox regression analysis compared multivariate factors on OTLCF postoperative mortality.

RESULTS

There was no significant difference in gender, operation time, blood loss and preoperative VAS score between the two groups (χ2 = 1.750, p = 0.186; t = 1.195, p = 0.235; t = -0.582, p = 0.562; t = -1.513, p = 0.133), respectively. The patients in the sarcopenia group were older (t = 3.708, p = 0.000), and had longer postoperative grounding time and hospitalization time (t = 4.360, p = 0.000; t = 6.458, p = 0.000). The VAS scores and ODI scores one month postoperatively were also higher in sarcopenia group (t = 5.900, p = 0.000; t = 7.294, p = 0.000), and there was a statistical difference between the two groups. Interestingly, there was no significant difference in the incidence of spinal refracture within 36 months between the two groups (χ2 = 1.510, p = 0.219). The sarcopenia group had a higher mortality rate at 36 months after operation, and the difference was statistically significant (p = 0.002). Sarcopenia is an independent risk factor for long-term mortality in OTLCF patients received PKP surgery.

CONCLUSIONS

Patients with sarcopenia combined with OTLCF have poor postoperative recovery of limb function and a high risk of death in the long-term (36 months) after surgery. Active and effective intervention for sarcopenia is required during treatment.