Association of lean mass index with a risk of incident stroke: a nationwide epidemiological cohort study

Body compositions are closely related to stroke risk. Recently, lean mass index (LMI) has been demonstrated to be a precise indicator of cardiovascular disease (CVD) risk, and the newly proposed formula enabled the simple estimation of LMI without a computed tomography scan. However, little is known about its attribution to a risk of stroke. Using a large-scale epidemiological cohort, we sought to clarify the association of LMI with a subsequent risk of developing stroke.

This retrospective observational cohort study included 1,410,568 participants in Japan without a history of CVD or kidney replacement therapy from the DeSC Database between 2014 and 2022. The median age was 62 years (IQR, 48-67), and 642,343 participants (45.5 %) were men. Using age, sex, height, weight, and waist circumference, LMI was estimated, with a median of 14.9 (13.2-17.0). Participants were categorized into quintiles based on LMI. The primary endpoint was overall stroke, comprising ischemic and hemorrhagic stroke.

During a mean follow-up period of 1372 ± 793 days, 35,210 stroke events were recorded. Cox regression analysis modeling a restricted cubic spline showed monotonously inverse correlation between LMI and stroke occurrence, with hazard ratios of 1.23 and 0.82 at the lowest and highest LMI quintile, respectively, compared to the middle quintile. This inverse association was consistent across ischemic and hemorrhagic strokes and observed in men and women.

The high LMI was associated with a lower risk of developing stroke, suggesting the importance of maintaining adequate muscle mass from the perspective of stroke prevention.