Dynapenic obesity associated with incidence and progression trajectory of cardiometabolic diseases: a prospective cohort study

The impact of dynapenic obesity on the progression of cardiometabolic multimorbidity (CMM) remains poorly understood. This study aimed to explore the association between dynapenic obesity and cardiometabolic diseases (CMD) progression, as well as the mediating roles of C-reactive protein (CRP) and the atherogenic index of plasma (AIP).

The study included 446,862 UK Biobank participants. CMM was defined as the coexistence of two or three CMDs, including type 2 diabetes (T2DM), coronary heart disease (CHD) and stroke. Dynapenic obesity was classified into dynapenic general obesity and dynapenic abdominal obesity, assessed by handgrip strength (HGS), body mass index (BMI), and waist circumference (WC). A multi-state model was employed to evaluate the influence of dynapenic obesity on CMD progression. Counterfactual mediation analyses were conducted to investigate the mediating role of CRP and AIP.

Over a median 13.67-years follow-up, 54,555 participants developed CMD, 5842 developed CMM, and 32,930 died. Compared with non-dynapenia and non-general obesity (ND/NGO), the HRs (95% CI) of first CMD (FCMD), CMM, and death for dynapenia and general obesity (D/GO) were 2.75 (2.61,2.90), 4.61 (4.05,5.24), and 1.68 (1.56,1.80), respectively. Similar results were observed for dynapenic abdominal obesity. Compared with ND/NGO, the proportions of CRP and AIP mediated associations of D/GO with FCMD risk were 19.58% (95% CI: 18.66%, 20.18%) and 18.99% (95% CI: 18.12%, 19.62%), respectively, which were lower than the proportions mediated in the associations of dynapenia and abdominal obesity (D/AO) with FCMD (CRP: 30.38% vs. 19.58%; AIP: 31.40% vs. 18.99%). Furthermore, CRP and AIP accounted for a greater proportion of the association between dynapenic obesity and CMM than FCMD.

This study indicated that there are differential effects associated with dynapenic obesity during the longitudinal progression of CMD. CRP and AIP may play a partial role in mediating this association.