The association between sarcopenia and carotid artery plaque: a mediation analysis of inflammatory biomarkers.

BACKGROUND

Carotid artery plaque (CAP) and sarcopenia are notable complications in patients with type 2 diabetes mellitus (T2DM). This study aims to explore whether the inflammatory biomarkers neutrophil-to-lymphocyte ratio (NLR) and systemic inflammatory response index (SIRI) mediate the association between sarcopenia and CAP in such patients.

METHODS

Sarcopenia was diagnosed using the criteria of the Asian Working Group for Sarcopenia (AWGS 2019), and CAP was assessed by carotid ultrasonography. Inflammatory biomarkers including NLR and SIRI were calculated, with their natural logarithm-transformed values (Ln-NLR, Ln-SIRI) derived. Restricted cubic spline (RCS) analysis, univariate and multivariate logistic regression analyses were used to investigate the associations among these inflammatory biomarkers, sarcopenia and CAP. Additionally, mediation analysis was performed to explore the mediating role of these inflammatory biomarkers.

RESULTS

A total of 749 patients with T2DM were enrolled in this study. The prevalence of CAP and sarcopenia in the study was 58.9% (n=441) and 33.9% (n=254), respectively. Patients with CAP had significantly higher levels of NLR, SIRI, and a higher prevalence of sarcopenia than those without CAP (all p < 0.05). RCS analysis revealed linear correlations of NLR and SIRI with both sarcopenia and CAP (all p for nonlinear > 0.05). Multivariate logistic regression analysis showed that sarcopenia (adjusted odds ratio (aOR) = 1.67, 95% confidence interval (CI): 1.10-2.54, p = 0.016), NLR (aOR = 1.63, 95% CI: 1.01-2.66, p = 0.047), SIRI (aOR = 1.23, 95% CI: 1.01-1.59, p = 0.046), Ln-NLR (aOR = 1.77, 95% CI: 1.10-2.80, p = 0.037), and Ln-SIRI (aOR = 1.38, 95% CI: 1.02-1.74, p = 0.035) were independently and positively associated with CAP. Mediation analysis further indicated that NLR and SIRI partially mediated the association between sarcopenia and CAP, with mediated proportions of 10.39% and 11.40%, respectively. Similarly, Ln-NLR and Ln-SIRI also exerted partial mediating effects, with mediated proportions of 9.73% and 9.29%.

CONCLUSIONS

Sarcopenia is an independently positively associated factor for CAP in patients with T2DM. NLR and SIRI may partially account for the association between sarcopenia and CAP.

CLINICAL TRIAL NUMBER: Not applicable.