背景:肌肉减少症,与年龄相关的肌肉质量和功能丧失,带来多种不良结果,包括残疾和死亡。一些肌少症共识新引入了可能的肌少症的病前概念,并建议进行早期生活方式干预。在几种慢性疾病中已经揭示了病前状态的双向转变,但在肌肉减少症中尚未阐明。本研究旨在探讨肌少症状态的潜在转变模式。
方法:该研究利用了来自全国代表性调查的三波数据,中国健康与退休纵向研究(CHARLS),并纳入了2011年至2015年期间根据亚洲工作组2019年肌肉减少症标准(AWGS2019)进行的至少两次肌肉减少症状态评估的60岁及以上的社区居民。估计非肌肉减少症之间的过渡强度和概率,可能的肌少症,少肌症,使用多阶段马尔可夫(MSM)模型调查死亡。
结果:该研究包括4395名个体(49.2%为女性,中位年龄67岁),总共有10.778条肌肉减少症状态评估记录,平均随访时间为3.29年。目前有可能的肌肉减少症的个体中,共有24.5%的人恢复为非肌肉减少症,60.3%仍有可能的肌少症,6.7%进展为肌肉减少症,8.5%在下一次随访时死亡。对于可能患有肌肉减少症的个体,恢复到非肌肉减少症的过渡强度(0.252,95%CI0.231-0.275)是肌肉减少症恶化(0.090,95%CI0.080-0.100)的2.8倍。对于可能患有肌少症的人,恢复为非肌肉减少症的估计概率,进展为肌肉减少症,和在1年观察内过渡至死亡的发生率分别为0.181,0.066和0.035.对于患有肌少症的人,恢复为非肌肉减少症的估计概率,恢复到可能的肌少症,和在1年观察内过渡至死亡分别为0.016,0.125和0.075.在协变量分析中,年龄,性别,身体质量指数,身体功能受损,吸烟,高血压,和糖尿病是影响双向转变的重要因素。
结论:研究结果强调了老年人中肌肉减少症状态的双向转变,并揭示了相当比例的可能的肌肉减少症显示出在自然过程中恢复的潜力。基于风险因素的筛查和强化干预措施可能有助于恢复过渡。
BACKGROUND: Sarcopenia, the age-related loss of muscle mass and function, brings multiple adverse outcomes including disability and death. Several sarcopenia consensuses have newly introduced the premorbid concept of possible sarcopenia and recommended early lifestyle interventions. Bidirectional transitions of premorbid states have been revealed in several chronic diseases yet not clarified in sarcopenia. This study aims to investigate the underlying transition patterns of sarcopenia states.
METHODS: The study utilized three waves of data from a nationally representative survey, the China Health and Retirement Longitudinal Study (CHARLS), and included community-dwelling individuals aged 60 years and older with at least two sarcopenia states assessments based on the Asian Working Group for Sarcopenia criteria 2019 (AWGS2019) between 2011 and 2015. The estimated transition intensity and probability between non-sarcopenia, possible sarcopenia, sarcopenia, and death were investigated using multi-stage Markov (MSM) models.
RESULTS: The study comprised 4395 individuals (49.2% female, median age 67 years) with a total of 10 778 records of sarcopenia state assessment, and the mean follow-up period was 3.29 years. A total of 24.5% of individuals with a current state of possible sarcopenia returned to non-sarcopenia, 60.3% remained possible sarcopenia, 6.7% progressed to sarcopenia, and 8.5% died by the next follow-up. The transition intensity of recovery to non-sarcopenia (0.252, 95% CI 0.231-0.275) was 2.8 times greater than the deterioration to sarcopenia (0.090, 95% CI 0.080-0.100) for individuals with possible sarcopenia. For individuals with possible sarcopenia, the estimated probabilities of recovering to non-sarcopenia, progressing to sarcopenia, and transitioning to death within a 1-year observation were 0.181, 0.066, and 0.035, respectively. For individuals with sarcopenia, the estimated probabilities of recovering to non-sarcopenia, recovering to possible sarcopenia, and transitioning to death within 1-year observation were 0.016, 0.125, and 0.075, respectively. In covariables analysis, age, sex, body mass index, physical function impairment, smoking, hypertension, and diabetes are important factors influencing bidirectional transitions.
CONCLUSIONS: The findings highlight the bidirectional transitions of sarcopenia states among older adults and reveal a notable proportion of possible sarcopenia show potential for recovery in the natural course. Screening and intensifying interventions based on risk factors may facilitate a recovery transition.