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Mediating effect of lower extremity muscle on the relationship between obesity and osteoarthritis in middle-aged and elderly women in Korea: based on the 2009-2011 Korea National Health and Nutrition Examination Survey
Minjun Kim, Joonwoong Kim, Inhwan Lee
Epidemiol Health. 2024;46:e2024027.   Published online February 2, 2024
DOI: https://doi.org/10.4178/epih.e2024027
  • 4,935 View
  • 111 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated whether the lower extremity muscle mass index (LMI) mediates the relationship between general obesity, central obesity, and knee osteoarthritis in middle-aged and elderly women in Korea.
METHODS
Data of 2,843 women aged ≥50 years were collected from the Korean National Health and Nutrition Examination Survey conducted between 2009 and 2011. General obesity and central obesity were evaluated based on body mass index (BMI) and waist circumference (WC), calculated through anthropometric measurements and body composition assessments. LMI was calculated by dividing the muscle mass in both legs—measured using the dual-energy X-ray absorptiometry—by body weight. Knee osteoarthritis was defined as a Kellgren-Lawrence scale (KL) grade of ≥2 as assessed through radiographic images.
RESULTS
Knee osteoarthritis prevalence, indicated by KL grades, was significantly higher in the general obesity and central obesity groups compared to the normal group, and conversely, lower with varying LMI levels. Using mediation analysis with bootstrapping and adjusting for covariates, we found that LMI mediated the relationship between BMI and KL (β, 0.005; 95% confidence interval [CI], 0.000 to 0.010) and WC and KL grade (β, 0.002; 95% CI, 0.001 to 0.003), explaining 4.8% and 6.7% of the total effects of BMI and WC on KL grade, respectively.
CONCLUSIONS
The study suggested that LMI partially mediates the link between general obesity and/or central obesity and knee osteoarthritis, proposing that a higher proportion of lower limb muscle mass relative to body weight can alleviate the increased risk of knee osteoarthritis caused by obesity.
Summary
Korean summary
본 연구는 한국의 50세 이상 여성들을 대상으로 비만 및 복부비만과 무릎골관절염의 관계에 대한 다리근육비율의 매개 효과를 분석한 결과, 다리근육비율은 비만의 진단하는 사용되는 체질량지수, 복부비만의 진단에 사용되는 허리둘레와 무릎 골관절염의 진단에 사용되는 KL등급의 관계를 부분적으로 매개하는 것으로 나타났다. 이러한 결과는 다리근육의 강화가 비만 및 복부비만으로 인한 무릎골관절염의 위험을 완화할 수 있음을 시사하며, 건강한 생활습관과 규칙적인 근력운동의 병행을 통해 다리 근육을 강화하는 것이 무릎 골관절염의 예방을 위한 전략으로 권장되어야 함을 시사한다.
Key Message
Research examining the mediating effect of lower extremity muscle mass on the relationships of knee osteoarthritis to general and central obesity is scarce. Herein, we demonstrate the mediating effect of lean mass index on the relationships of knee osteoarthritis with body mass index and waist circumference in Korean women aged 50 years or older. We propose that strengthening leg muscles may mitigate, to some extent, the risk of knee osteoarthritis associated with general and central obesity. We recommend a regimen for strengthening leg muscles through healthy lifestyle habits and regular strength training, in conjunction with weight and abdominal fat management.

Citations

Citations to this article as recorded by  
  • Roles of low muscle strength and sarcopenic obesity on incident symptomatic knee osteoarthritis: A longitudinal cohort study
    Laijun Yan, Haiya Ge, Zhengming Wang, Anping Shen, Qinguang Xu, Ding Jiang, Yuelong Cao, Simone Agostini
    PLOS ONE.2024; 19(10): e0311423.     CrossRef
Association of appendicular skeletal muscle mass with carotid intima-media thickness according to body mass index in Korean adults
Ji Eun Heo, Hyeon Chang Kim, Jee-Seon Shim, Bo Mi Song, Hye Yoon Bae, Ho Jae Lee, Il Suh
Epidemiol Health. 2018;40:e2018049.   Published online October 7, 2018
DOI: https://doi.org/10.4178/epih.e2018049
  • 15,511 View
  • 203 Download
  • 17 Web of Science
  • 15 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The combined effects of obesity and appendicular skeletal muscle (ASM) on atherosclerosis, especially in middleaged populations, remain poorly understood. This cross-sectional study investigated the effects of ASM on carotid intima-media thickness (IMT) according to body mass index (BMI) in middle-aged Korean adults.
METHODS
Herein, 595 men and 1,274 women aged 30-64 years completed questionnaires and underwent health examinations as part of the Cardiovascular and Metabolic Disease Etiology Research Center cohort. ASM was measured via bioelectrical impedance analysis and adjusted for weight (ASM/Wt). IMT was assessed using B-mode ultrasonography; highest quartile of IMT was defined as gender-specific top quartile of the IMT values. Higher BMIs was defined as a BMI over 25.0 kg/m2 .
RESULTS
Compared to the highest ASM/Wt quartile, the lowest ASM/Wt quartile was significantly associated with highest quartile of IMT in men with lower BMIs (adjusted odds ratio [aOR], 2.78; 95% confidence interval [CI], 1.09 to 7.13), but not in those with higher BMIs (aOR, 0.59; 95% CI, 0.24 to 1.91). In women, there was no significant association of low skeletal muscle mass with highest quartile of IMT, regardless of BMI.
CONCLUSIONS
Low appendicular skeletal muscle mass is associated with carotid arterial wall thickening in men with lower BMIs, but not in men with higher BMIs. Our findings suggest that the risk of atherosclerosis may be low in middle-aged Korean men with appropriate body weight and skeletal muscle mass maintenance.
Summary
Korean summary
한국 중년 성인을 대상으로 사지근육양과 죽상경화증(경동맥 내중막 두께≥75 percentile)의 관련성을 체질량지수(≥25, <25 kg/m2)로 층화하여 평가하였다. 체질량지수 25 kg/m2 미만인 남자에서는, 사지근육양이 낮으면 죽상경화증의 위험이 유의하게 높았으나, 체질량지수 25 kg/m2 이상인 남자에서는 관련성이 없었다. 반면 여자에서는 체질량지수에 상관없이 사지근육양과 죽상경화증의 독립적인 관련성이 관찰되지 않았다.

Citations

Citations to this article as recorded by  
  • A multifaceted and inclusive methodology for the detection of sarcopenia in patients undergoing bariatric surgery: an in-depth analysis of current evidence
    Eunhye Seo, Yeongkeun Kwon, Ahmad ALRomi, Mohannad Eledreesi, Sungsoo Park
    Reviews in Endocrine and Metabolic Disorders.2024; 25(4): 677.     CrossRef
  • No association between vascular aging and sarcopenia in healthy participants
    Daniel Bunout, Gladys Barrera, Joselyn Arce, Raquel Burrows, Paulina Correa-Burrows, Sandra Hirsch
    Clinical Nutrition ESPEN.2024; 63: 384.     CrossRef
  • Contribution of low skeletal muscle mass in predicting cardiovascular events: A prospective cohort study
    Yiting Xu, Tingting Hu, Yun Shen, Yufei Wang, Yuqian Bao, Xiaojing Ma
    European Journal of Internal Medicine.2023; 114: 113.     CrossRef
  • Low appendicular skeletal muscle index increases the risk of carotid artery plaque in postmenopausal women with and without hypertension/hyperglycemia: a retrospective study
    Yayun Lu, Jianguang Tian, Liangyu Wu, Qing Xia, Qinzhong Zhu
    BMC Geriatrics.2023;[Epub]     CrossRef
  • Relationship between neck vessel abnormalities and sarcopenia: results of a study examining trends in health and aging in western China
    Huaying Ding, Xiaoyan Chen, Sha Huang, Birong Dong
    European Geriatric Medicine.2023; 15(1): 253.     CrossRef
  • A new paradigm in sarcopenia: Cognitive impairment caused by imbalanced myokine secretion and vascular dysfunction
    Danbi Jo, Gwangho Yoon, Oh Yoen Kim, Juhyun Song
    Biomedicine & Pharmacotherapy.2022; 147: 112636.     CrossRef
  • Low serum creatinine to cystatin C ratio is independently associated with sarcopenia and high carotid plaque score in patients with type 2 diabetes
    Jang Yel Shin
    Nutrition, Metabolism and Cardiovascular Diseases.2022; 32(6): 1454.     CrossRef
  • Association of High Muscle Mass with Carotid Atherosclerosis: A Community-Based Population Cohort Study
    Y. Xu, T. Hu, Y. Shen, Y. Wang, Xiaojing Ma, Yuqian Bao
    The Journal of nutrition, health and aging.2022; 26(12): 1087.     CrossRef
  • Sarcopenia, sarcopenic overweight/obesity and risk of cardiovascular disease and cardiac arrhythmia: A cross-sectional study
    Ming-Feng Xia, Ling-Yan Chen, Li Wu, Hui Ma, Xiao-Ming Li, Qian Li, Qiqige Aleteng, Yu Hu, Wan-Yuan He, Jian Gao, Huan-Dong Lin, Xin Gao
    Clinical Nutrition.2021; 40(2): 571.     CrossRef
  • Muscle mass and grip strength in relation to carotid intima-media thickness and plaque score in patients with type 2 diabetes
    Jang Yel Shin, Jung Soo Lim
    Nutrition, Metabolism and Cardiovascular Diseases.2021; 31(10): 2935.     CrossRef
  • Low muscle mass is associated with carotid atherosclerosis in patients with type 2 diabetes
    Da Hea Seo, Yong-ho Lee, Young Ju Suh, Seong Hee Ahn, Seongbin Hong, Young Ju Choi, Byoung Wook Huh, Seok Won Park, Eunjig Lee, So Hun Kim
    Atherosclerosis.2020; 305: 19.     CrossRef
  • Associations of skeletal muscle mass with atherosclerosis and inflammatory markers in Korean adults
    Soon-Kyu Yoon, Ha-Na Kim, Sang-Wook Song
    Archives of Gerontology and Geriatrics.2020; 90: 104163.     CrossRef
  • Impact of sarcopenia on glycemic control and atherosclerosis in Japanese patients with type 2 diabetes: Cross‐sectional study using outpatient clinical data
    Shuhei Nakanishi, Masahiro Iwamoto, Hisanori Shinohara, Hideyuki Iwamoto, Hideaki Kaneto
    Geriatrics & Gerontology International.2020; 20(12): 1196.     CrossRef
  • Quantification of Plasma Kynurenine Metabolites Following One Bout of Sprint Interval Exercise
    Ada Trepci, Sophie Imbeault, Victoria L Wyckelsma, Håkan Westerblad, Sigurd Hermansson, Daniel C Andersson, Fredrik Piehl, Tomas Venckunas, Marius Brazaitis, Sigitas Kamandulis, Lena Brundin, Sophie Erhardt, Lilly Schwieler
    International Journal of Tryptophan Research.2020; 13: 117864692097824.     CrossRef
  • Cohort Profile: The Cardiovascular and Metabolic Diseases Etiology Research Center Cohort in Korea
    Jee-Seon Shim, Bo Mi Song, Jung Hyun Lee, Seung Won Lee, Ji Hye Park, Dong Phil Choi, Myung Ha Lee, Kyoung Hwa Ha, Dae Jung Kim, Sungha Park, Won-Woo Lee, Yoosik Youm, Eui-Cheol Shin, Hyeon Chang Kim
    Yonsei Medical Journal.2019; 60(8): 804.     CrossRef

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