Objective  Investigating the relationship between the interactive and combined effects of depression and sarcopenic obesity (SO) and the risk of stroke in Chinses middle-aged and older adults.

Methods  Based on the China Health and Retirement Longitudinal Study (CHARLS) data, middle-aged and older people who participated in the three surveys in 2015, 2018 and 2020 were selected. The Kaplan-Meier cumulative incidence curve was used to analyze the cumulative incidence risk among subjects in different groups. Cox proportional hazards regression models were employed to separately examine the associations between depression and SO, and their interaction, and combined effects with the risk of stroke in middle-aged and older individuals. Sensitivity analyses were conducted to validate the robustness of the results.

Results  A total of 10,694 study participants were enrolled in this study, and a total of 698 (6.53%) of them experienced stroke during the 5-year follow-up period.

Results showed that after adjusting for confounding factors including gender, age, education level, and marital status, compared with the control group, the risk of stroke increased by 52% [HR=1.52, 95%CI (1.28, 1.81)] in the depression group and 47% [HR=1.47, 95%CI (1.08, 1.99)] in the SO group respectively. No interaction effect was observed between depression and SO, but a significant combined effect was identified. Compared with the non-depressed-normal group, the depressed-SO group exhibited a 126% [HR=2.26, 95%CI (1.51, 3.38)] increased risk of stroke.

Conclusion  The combined effect of depression and SO significantly increases the risk of stroke in middle-aged and older individuals. Enhanced psychological counseling, nutritional guidance, and exercise training should be provided to this population to reduce their risk of stroke.

1.Zhao Y, Hua X, Ren X, et al. Increasing burden of stroke in China: a systematic review and Meta-analysis of prevalence, incidence, mortality, and case fatality[J]. Int J Stroke, 2023, 18(3): 259-267. DOI: 10.1177/17474930221135983.

2.Potter TBH, Tannous J, Vahidy FS. A contemporary review of epidemiology, risk factors, etiology, and outcomes of premature stroke[J]. Curr Atheroscler Rep, 2022, 24(12): 939-948. DOI: 10.1007/s11883-022-01067-x.

3.Campbell BCV, De Silva DA, Macleod MR, et al. Ischaemic stroke[J]. Nat Rev Dis Primers, 2019, 5(1): 70. DOI: 10.1038/s41572-019-0118-8.

4.Wu S, Wu B, Liu M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management[J]. Lancet Neurol, 2019, 18(4): 394-405. DOI: 10.1016/S1474-4422(18)30500-3.

5.Harshfield EL, Pennells L, Schwartz JE, et al. Association between depressive symptoms and incident cardiovascular diseases[J]. JAMA, 2020, 324(23): 2396-2405. DOI: 10.1001/jama.2020.23068.

6.Yu B, Jia S, Sun T, et al. Sarcopenic obesity is associated with cardiometabolic multimorbidity in Chinese middle-aged and older adults: a cross-sectional and longitudinal study[J]. J Nutr Health Aging, 2024, 28(10): 100353. DOI: 10.1016/j.jnha.2024.100353.

7.Zhao Y, Hu Y, Smith JP, et al. Cohort profile: the China health and retirement longitudinal study (CHARLS)[J]. Int J Epidemiol, 2014, 43(1): 61-68. DOI: 10.1093/ije/dys203.

8.Zhou P, Wang S, Yan Y, et al. Association between chronic diseases and depression in the middle-aged and older adult Chinese population-a seven-year follow-up study based on CHARLS[J]. Front Public Health, 2023, 11: 1176669. DOI: 10.3389/fpubh.2023.1176669.

9.姜珊, 康琳, 刘晓红. 2019亚洲肌少症诊断及治疗共识解读 [J]. 中华老年医学杂志, 2020, 39(4): 373-376. [Jiang S, Kang  L, Liu XH. 2019 Asian consensus interpretation of diagnosis and treatment of sarcopenia[J]. Chinese Journal of Geriatrics, 2020, 39(4): 373-376.] DOI: 10.3760/cma.j.issn.0254-9026.2020. 04.002.

10.Wen X, Wang M, Jiang CM, et al. Anthropometric equation for estimation of appendicular skeletal muscle mass in Chinese adults[J]. Asia Pac J Clin Nutr, 2011, 20(4): 551-556. https://pubmed.ncbi.nlm.nih.gov/22094840/

11.中国肥胖问题工作组. 中国成人超重和肥胖症预防与控制指南(节录)[J]. 营养学报, 2004, (1): 1-4. [China Obesity Working Group. Guidelines for the prevention and control of overweight and obesity in Chinese adults (Abridged)[J]. Journal of Nutrition, 2004, (1): 1-4.] https://d.wanfangdata.com.cn/periodical/ChVQZXJpb2RpY2FsQ0hJMjAyNTA2MjISDlFLMjAwNDAxOTQxMjE5Ggh0eXQ1OWo4cg%3D%3D

12.Cai W, Ma W, Mueller C, et al. Association between late-life depression or depressive symptoms and stroke morbidity in elders: a systematic review and Meta-analysis of cohort studies[J]. Acta Psychiatr Scand, 2023, 148(5): 405-415. DOI: 10.1111/acps.13613.

13.Barros MBA, Medina LPB, Lima MG, et al. Association between health behaviors and depression: findings from the 2019 Brazilian National Health Survey[J]. Rev Bras Epidemiol, 2021, 24(suppl 2): e210010. DOI: 10.1590/1980-549720210010.supl.2.

14.Arnaud AM, Brister TS, Duckworth K, et al. Impact of major depressive disorder on comorbidities: a systematic literature review[J]. J Clin Psychiatry, 2022, 83(6): 21r14328. DOI: 10.4088/JCP.21r14328.

15.胡婉琴, 曹学华, 李艳, 等. 抑郁症患者服药依从率及其影响因素的Meta分析[J]. 数理医药学杂志, 2024, 37(11): 831-846. [Hu WQ, Cao XH, Li Y, et al. Medication adherence rate and its influencing factors in patients with depression:a Meta-analysis[J]. Journal of Mathematical Medicine, 2024, 37(11): 831-846.] DOI: 10.12173/j.issn.1004-4337.202407094.

16.Varghese FP, Brown ES. The hypothalamic-pituitary-adrenal axis in major depressive disorder: a brief primer for primary care physicians[J]. Prim Care Companion J Clin Psychiatry, 2001, 3(4): 151-155. DOI: 10.4088/pcc.v03n0401.

17.Howren MB, Lamkin DM, Suls J. Associations of depression with C-reactive protein, IL-1, and IL-6: a Meta-analysis[J]. Psychosom Med, 2009, 71(2): 171-186. DOI: 10.1097/PSY. 0b013e3181907c1b.

18.Myint PK, Welch AA. Healthier ageing[J]. BMJ, 2012, 344: e1214. DOI: 10.1136/bmj.e1214.

19.Yang J, Wang Y, Shi X, et al. Prevalence of sarcopenic obesity among older adults in communities of China: a multicenter, cross-sectional study[J]. Nutr Clin Pract, 2024, 39(6): 1375-1387. DOI: 10.1002/ncp.11214.

20.Xia MF, Chen LY, Wu L, et al. Sarcopenia, sarcopenic overweight/obesity and risk of cardiovascular disease and cardiac arrhythmia: a cross-sectional study[J]. Clin Nutr, 2021, 40(2): 571-580. DOI: 10.1016/j.clnu.2020.06.003.

21.Bellanti F, Romano AD, Lo Buglio A, et al. Oxidative stress is increased in sarcopenia and associated with cardiovascular disease risk in sarcopenic obesity[J]. Maturitas, 2018, 109: 6-12. DOI: 10.1016/j.maturitas.2017.12.002.

22.Yu Y, Wei SG, Zhang ZH, et al. ERK1/2 MAPK signaling in hypothalamic paraventricular nucleus contributes to sympathetic excitation in rats with heart failure after myocardial infarction[J]. Am J Physiol Heart Circ Physiol, 2016, 310(6): H732-H739. DOI: 10.1152/ajpheart.00703.2015.

23.Li CW, Yu K, Shyh-Chang N, et al. Circulating factors associated with sarcopenia during ageing and after intensive lifestyle intervention[J]. J Cachexia Sarcopenia Muscle, 2019, 10(3): 586-600. DOI: 10.1002/jcsm.12417.