Combined impact of dynapenic abdominal obesity on stroke risk in middle-aged and older adults: evidence from two nationwide prospective cohorts.

Dynapenic abdominal obesity (DAO), characterised by the combination of low muscle strength and abdominal fat accumulation, is an emerging health risk phenotype. Its association with incident stroke remains inadequately explored. This prospective cohort study investigated the relationship between DAO and new-onset stroke in middle-aged and older adults. We analysed data from the China Health and Retirement Longitudinal Study (CHARLS, n 10 153) and used the English Longitudinal Study of Ageing (ELSA, n 5421) for external validation, over a seven-year follow-up. Participants were categorised into four groups: no dynapenia or abdominal obesity (ND/NAO), isolated abdominal obesity, isolated dynapenia and DAO. After adjusting for socio-demographic, lifestyle and comorbidity factors, multivariable logistic regression revealed that DAO was significantly associated with a higher risk of stroke in both CHARLS (OR = 1·96, 95 % CI: 1·37-2·76, P < 0·001) and ELSA (OR = 2·38, 95 % CI: 1·11-5·10, P = 0·025) compared with the ND/NAO group. The risk conferred by DAO exceeded that of either condition in isolation. Stratified analysis suggested a potentially stronger association in urban Chinese men; however, effect modification was not statistically significant. We conclude that DAO is a significant, independent risk factor for stroke in both populations, with combined effects exceeding isolated conditions. This phenotype represents a practical, cross-population marker for clinicians and nutritionists to identify individuals at elevated stroke risk warranting targeted intervention, with potentially important implications for urban Chinese men.