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Objective <p>This study aimed to examine the associations of sarcopenic obesity, obesity only, and sarcopenia only with advanced cardiovascular-kidney-metabolic (CKM) syndrome and incident cardiovascular disease (CVD), and to assess whether sarcopenia and obesity were jointly associated with long-term cardiovascular risk.</p> Research design and methods <p>We adopted a dual-cohort design combining longitudinal discovery and cross-sectional validation. The discovery cohort included 7,759 participants from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2018). Body composition phenotypes were classified into four groups: Normal, Obesity Only, Sarcopenia Only, and Sarcopenic Obesity (SO). Sarcopenia was defined by AWGS 2019 criteria. CKM syndrome was staged (0–4) according to the 2023 American Heart Association (AHA) Presidential Advisory. Cox proportional hazards models were used to estimate the association between body composition phenotypes and incident CVD during follow-up. In participants with complete CKM staging data at both 2011 and 2015, a descriptive 4-year observed CKM transition probability matrix was constructed to describe stage movement from 2011 to 2015. External consistency was examined using data from 3,936 participants in NHANES 2011–2018, where muscle mass was measured by dual-energy X-ray absorptiometry (DXA).</p> Results <p>In the CHARLS longitudinal cohort, sarcopenic obesity showed the highest cumulative incidence of CVD events (29.3%). After full adjustment, sarcopenic obesity was associated with a more than two-fold higher risk of incident CVD compared with the Normal group (HR 2.07, 95% CI 1.76–2.45), followed by Obesity Only (HR 1.51, 95% CI 1.31–1.74) and Sarcopenia Only (HR 1.23, 95% CI 1.03–1.45). A positive additive interaction between sarcopenia and obesity was observed (RERI = 0.34, P = 0.027). This association remained consistent in the restricted analysis among participants free of advanced CKM at baseline. In the descriptive four-year transition analysis, early CKM stages frequently moved toward higher-risk stages, whereas advanced stages were more persistent. In NHANES, sarcopenic obesity was associated with the highest likelihood of prevalent advanced CKM syndrome (OR 2.04, 95% CI 1.53–2.70).</p> Conclusion <p>Sarcopenic obesity was consistently associated with a greater burden of advanced CKM and a higher risk of incident CVD in the CHARLS longitudinal cohort, with similar cross-sectional associations observed in the NHANES validation cohort. Although causal relationships cannot be established, these findings suggest that sarcopenic obesity may serve as a clinically useful phenotypic marker for identifying individuals at increased cardiometabolic risk.</p>

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Association of sarcopenic obesity with advanced cardiovascular-kidney-metabolic syndrome and incident cardiovascular disease: a longitudinal and cross-sectional study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月30日

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  • Roushan Zhang,
  • Dianping Yu,
  • Xin Liu,
  • Hui Xue,
  • Jiajun Xie,
  • Li Wang

摘要

Objective

This study aimed to examine the associations of sarcopenic obesity, obesity only, and sarcopenia only with advanced cardiovascular-kidney-metabolic (CKM) syndrome and incident cardiovascular disease (CVD), and to assess whether sarcopenia and obesity were jointly associated with long-term cardiovascular risk.

Research design and methods

We adopted a dual-cohort design combining longitudinal discovery and cross-sectional validation. The discovery cohort included 7,759 participants from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2018). Body composition phenotypes were classified into four groups: Normal, Obesity Only, Sarcopenia Only, and Sarcopenic Obesity (SO). Sarcopenia was defined by AWGS 2019 criteria. CKM syndrome was staged (0–4) according to the 2023 American Heart Association (AHA) Presidential Advisory. Cox proportional hazards models were used to estimate the association between body composition phenotypes and incident CVD during follow-up. In participants with complete CKM staging data at both 2011 and 2015, a descriptive 4-year observed CKM transition probability matrix was constructed to describe stage movement from 2011 to 2015. External consistency was examined using data from 3,936 participants in NHANES 2011–2018, where muscle mass was measured by dual-energy X-ray absorptiometry (DXA).

Results

In the CHARLS longitudinal cohort, sarcopenic obesity showed the highest cumulative incidence of CVD events (29.3%). After full adjustment, sarcopenic obesity was associated with a more than two-fold higher risk of incident CVD compared with the Normal group (HR 2.07, 95% CI 1.76–2.45), followed by Obesity Only (HR 1.51, 95% CI 1.31–1.74) and Sarcopenia Only (HR 1.23, 95% CI 1.03–1.45). A positive additive interaction between sarcopenia and obesity was observed (RERI = 0.34, P = 0.027). This association remained consistent in the restricted analysis among participants free of advanced CKM at baseline. In the descriptive four-year transition analysis, early CKM stages frequently moved toward higher-risk stages, whereas advanced stages were more persistent. In NHANES, sarcopenic obesity was associated with the highest likelihood of prevalent advanced CKM syndrome (OR 2.04, 95% CI 1.53–2.70).

Conclusion

Sarcopenic obesity was consistently associated with a greater burden of advanced CKM and a higher risk of incident CVD in the CHARLS longitudinal cohort, with similar cross-sectional associations observed in the NHANES validation cohort. Although causal relationships cannot be established, these findings suggest that sarcopenic obesity may serve as a clinically useful phenotypic marker for identifying individuals at increased cardiometabolic risk.