Insights Into the Association Between Stroke and Sarcopenia Risk in Adults Aged ≥ 50 Years: Cross-Sectional Evidence From Two Large Population Longitudinal Cohorts.

BACKGROUND AND AIM: Evidence has already shown that sarcopenia is linked to an elevated risk of cardiovascular disease (CVD). However, the association between stroke and sarcopenia risk remains underexplored in stroke and non-stroke populations. This study investigated the stroke-sarcopenia relationship.

METHODS

We conducted a cross-sectional analysis using data from Wave 3 (2015-2016) of the China Health and Retirement Longitudinal Study (CHARLS) and Wave 14 (2018-2019) of the Health and Retirement Study (HRS), focusing on ≥ 50 years adults. Missing data were imputed using the Python miceforest package with a random forest algorithm. All types of stroke were identified via self-reported records where individuals had received a confirmed diagnosis from a physician. Sarcopenia status was evaluated using muscle strength (evaluated with grip strength in CHARLS and HRS), muscle mass (evaluated with appendicular skeletal muscle), and physical performance (evaluated with gait speed, the five-repetition chair test, and the short physical performance battery). Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the primary analysis, with generalized estimating equation (GEE) models employed in sensitivity analyses to ensure result robustness.

RESULTS

The study comprised 16,859 participants from CHARLS (51% female, mean age 62.9 years) and 16,692 from HRS (41% female, mean age 67.6 years). In CHARLS, stroke was associated with significantly increased risks of possible sarcopenia (OR: 2.07, 95% CI: 1.49-2.99), sarcopenia (OR: 1.93, 95% CI: 1.23-3.06), and severe sarcopenia (OR: 3.42, 95% CI: 2.22-5.34). In HRS, stroke was linked to elevated risks of possible sarcopenia (OR: 3.11, 95% CI: 2.75-3.52) and severe sarcopenia (OR: 2.20, 95% CI: 1.24-3.65). Self-care ability, nutritional status, and inflammatory factors were identified as key mediators, with findings remaining consistent across subgroups and sensitivity analyses.

CONCLUSIONS

Stroke was associated with increased risk for sarcopenia and its severe forms in adults aged ≥ 50 years. We recommend sarcopenia risk evaluation in poststroke patients with accessible tools, also emphasizing that functional rehabilitation, nutritional optimization, and inflammation control hold promise to alleviate sarcopenia risk and enhance long-term outcomes.