Objective To explore the relationship between pyrethroid exposure and sarcopenia.

Methods Using a cross-sectional study design, the data were sourced from the U.S. National Health and Nutrition Examination Survey conducted from 2011 to 2016. Adults aged 18-59 years were selected as research subjects. Sarcopenia was assessed by calculating the ratio of skeletal muscle mass to body mass index (BMI) using dual-energy X-ray absorptiometry scanning technology. Pyrethroid exposure levels were evaluated based on urinary 3-phenoxybenzoic acid (3-PBA) concentrations. The association between these factors and the risk of sarcopenia, as well as their dose-response relationships, were analyzed using weighted Logistic regression and restricted cubic spline (RCS) models. Subgroup analyses and interaction tests were employed to examine the stability of the findings and the moderating effect of BMI.

Results A total of 2,867 participants were included, with a prevalence of sarcopenia at 7.57%. Weighted Logistic regression analysis showed that, after adjusting for covariates, for every one-unit increase in log-transformed 3-PBA exposure level, the risk of sarcopenia increased by 21% [OR=1.21, 95%CI (1.02, 1.44), P=0.032]; Group by quartile of ln(3-PBA), compared with the Q1 group, the Q4 group exhibited a 112% increased risk of sarcopenia [OR=2.12, 95%CI (1.22, 3.69), P=0.009]. RCS analysis revealed a linear positive correlation between 3-PBA and the risk of sarcopenia (P_overall < 0.001, P_nonlinearity=0.595), with the risk increase becoming more pronounced when urinary 3-PBA levels exceeded 0.57 μg/L. Subgroup and interaction analyses indicated that this association was stronger in obese individuals with a BMI ≥30 kg/m² [OR=1.43, 95%CI (1.19, 1.71), P_trend < 0.001], and there was an interaction between BMI and 3-PBA on the risk of sarcopenia [OR=1.59, 95%CI (1.18, 2.14), P_interaction=0.003].

Conclusion There is a positive association between pyrethroid exposure and the risk of sarcopenia, which is particularly evident in obese populations. It is recommended to take multi-level prevention and control measures and further research is needed to improve prevention strategies.

1. SayerAA, CooperR, AraiH, et al. Sarcopenia[J]. Nat Rev Dis Primers, 2024, 10(1): 68. doi：10.1038/s41572-024-00550-w

2. SantilliV, BernettiA, MangoneM, et al. Clinical definition of sarcopenia[J]. Clin Cases Miner Bone Metab, 2014, 11(3): 177-180. doi：10.11138/ccmbm/2016.13.2.157

3. SayerAA, Cruz-JentoftA. Sarcopenia definition, diagnosis and treatment: consensus is growing[J]. Age Ageing, 2022, 51(10): afac220. doi：10.1093/ageing/afac220

4. Nunes-PintoM, de MelloRGB, PintoMN, et al. Sarcopenia and the biological determinants of aging: a narrative review from a geroscience perspective[J]. Ageing Res Rev, 2025, 103: 102587. doi：10.1016/j.arr.2024.102587

5. JinH, YooHJ, KimYA, et al. Unveiling genetic variants for age-related sarcopenia by conducting a genome-wide association study on Korean cohorts[J]. Sci Rep, 2022, 12(1): 3501. doi：10.1038/s41598-022-07567-9

6. ChenS, HanH, JinJ, et al. Osteoarthritis and sarcopenia-related traits: the cross-sectional study from NHANES 2011-2014 and Mendelian randomization study[J]. J Orthop Surg Res, 2023, 18(1): 502. doi：10.1186/s13018-023-03960-w

7. LiC, YuK, Shyh‐ChangN, et al. Pathogenesis of sarcopenia and the relationship with fat mass: descriptive review[J]. J Cachexia Sarcopenia Muscle, 2022, 13(2): 781-794. doi：10.1002/jcsm.12901

8. BradberrySM, CageSA, ProudfootAT, et al. Poisoning due to pyrethroids[J]. Toxicol Rev, 2005, 24(2): 93-106. doi：10.2165/00139709-200524020-00003

9. BarrDB, OlssonAO, WongLY, et al. Urinary concentrations of metabolites of pyrethroid insecticides in the general US population: National Health and Nutrition Examination Survey 1999-2002[J]. Environ Health Perspect, 2010, 118(6): 742-748. doi：10.1289/ehp.0901275

10. SaillenfaitAM, NdiayeD, SabatéJP. Pyrethroids: exposure and health effects-an update[J]. Int J Hyg Environ Health, 2015, 218(3): 281-292. doi：10.1016/j.ijheh.2015.01.002

11. BurnsCJ, PastoorTP. Pyrethroid epidemiology: a quality-based review[J]. Crit Rev Toxicol, 2018, 48(4): 297-311. doi：10.1080/10408444.2017.1423463

12. LehmlerHJ, SimonsenD, LiuB, et al. Environmental exposure to pyrethroid pesticides in a nationally representative sample of US adults and children: the National Health and Nutrition Examination Survey 2007-2012[J]. Environ Pollut, 2020, 267: 115489. doi：10.1016/j.envpol.2020.115489

13. López-BenítezA, Guevara-LaraA, Domínguez-CrespoMA, et al. Concentrations of organochlorine, organophosphorus, and pyrethroid pesticides in rivers worldwide (2014-2024): a review[J]. Sustainability, 2024, 16(18): 8066. doi：10.3390/su16188066

14. StoutDM, BradhamKD, EgeghyPP, et al. American Healthy Homes Survey: a national study of residential pesticides measured from floor wipes[J]. Environ Sci Technol, 2009, 43(12): 4294-4300. doi：10.1021/es8030243

15. MuellerW, JonesK, FuhrimannS, et al. Factors influencing occupational exposure to pyrethroids and glyphosate: an analysis of urinary biomarkers in Malaysia, Uganda and the United Kingdom[J]. Environ Res, 2024, 242: 117651. doi：10.1016/j.envres.2023.117651

16. KoyrattyN, OlsonJR, KawynM, et al. Dietary predictors of urinary biomarkers of pyrethroids in the general population-a scoping review[J]. J Nutr, 2024, 154(2): 325-340. doi：10.1016/j.tjnut.2023.11.031

17. RomeroA, RamosE, AresI, et al. Oxidative stress and gene expression profiling of cell death pathways in alpha-cypermethrin-treated SH-SY5Y cells[J]. Arch Toxicol, 2017, 91(5): 2151-2164. doi：10.1007/s00204-016-1864-y

18. ŽelježićD, MladinićM, ŽunecS, et al. Cytotoxic, genotoxic and biochemical markers of insecticide toxicity evaluated in human peripheral blood lymphocytes and an HepG2 cell line[J]. Food Chem Toxicol, 2016, 96: 90-106. doi：10.1016/j.fct.2016.07.036

19. MohammadiH, Ghassemi-BarghiN, MalakshahO, et al. Pyrethroid exposure and neurotoxicity: a mechanistic approach[J]. Arh Hig Rada Toksikol, 2019, 70(2): 74-89. doi：10.2478/aiht-2019-70-3263

20. KahnSE, HullRL, UtzschneiderKM. Mechanisms linking obesity to insulin resistance and type 2 diabetes[J]. Nature, 2006, 444(7121): 840-846. doi：10.1038/nature05482

21. SheikhIA, BegMA, MachaMA. Pyrethroids and reproductive function: some endocrine disrupting perspectives from molecular simulations[J]. Ecotoxicology, 2024, 33(9): 1086-1095. doi：10.1007/s10646-024-02801-8

22. Al-OmarMS, NazM, MohammedSAA, et al. Pyrethroid-induced organ toxicity and anti-oxidant-supplemented amelioration of toxicity and organ damage: the protective roles of ascorbic acid and α-tocopherol[J]. Int J Environ Res Public Health, 2020, 17(17): 6177. doi：10.3390/ijerph17176177

23. FangZ, ChenX, LiuM, et al. Associations of pyrethroid exposure with skeletal muscle strength and mass[J]. Environ Sci Pollut Res Int, 2023, 30(38): 89651-89660. doi：10.1007/s11356-023-28784-3

24. KimB, ParkB, KimCH, et al. Association between endocrine-disrupting chemical mixture and metabolic indices among children, adolescents, and adults: a population-based study in Korea[J]. Environ Pollut, 2022, 315: 120399. doi：10.1016/j.envpol.2022.120399

25. GoreAC, ChappellVA, FentonSE, et al. EDC-2: the endocrine society's second scientific statement on endocrine-disrupting chemicals[J]. Endocr Rev, 2015, 36(6): E1-E150. doi：10.1210/er.2015-1010

26. XuH, MaoY, XuB. Association between pyrethroid pesticide exposure and hearing loss in adolescents[J]. Environ Res, 2020, 187: 109640. doi：10.1016/j.envres.2020.109640

27. PengTC, WuLW, ChenWL, et al. Nonalcoholic fatty liver disease and sarcopenia in a Western population (NHANES Ⅲ): the importance of sarcopenia definition[J]. Clin Nutr, 2019, 38(1): 422-428. doi：10.1016/j.clnu.2017.11.021

28. JanssenI, HeymsfieldSB, BaumgartnerRN, et al. Estimation of skeletal muscle mass by bioelectrical impedance analysis[J]. J Appl Physiol(1985), 2000, 89(2): 465-471. doi：10.1152/jappl.2000.89.2.465

29. YangJ, LiuC, ZhaoS, et al. The association between the triglyceride-glucose index and sarcopenia: data from the NHANES 2011-2018[J]. Lipids Health Dis, 2024, 23(1): 219. doi：10.1186/s12944-024-02201-1

30. LiM, JiR, LiuX, et al. Associations of metabolic syndrome and its components with sarcopenia, and the mediating role of insulin resistance: findings from NHANES database[J]. BMC Endocr Disord, 2024, 24(1): 203. doi：10.1186/s12902-024-01736-9

31. BravoR, CaltabianoLM, WeerasekeraG, et al. Measurement of dialkyl phosphate metabolites of organophosphorus pesticides in human urine using lyophilization with gas chromatography-tandem mass spectrometry and isotope dilution quantification[J]. J Expo Anal Environ Epidemiol, 2004, 14(3): 249-259. doi：10.1038/sj.jea.7500322

32. OlssonAO, BakerSE, NguyenJV, et al. A liquid chromatography--tandem mass spectrometry multiresidue method for quantification of specific metabolites of organophosphorus pesticides, synthetic pyrethroids, selected herbicides, and DEET in human urine[J]. Anal Chem, 2004, 76(9): 2453-2461. doi：10.1021/ac0355404

33. ZhouL, LiG, ChenX, et al. Sex difference in the association between pyrethroids exposure and sleep problems among adolescents: NHANES 2007-2014[J]. Environ Sci Eur, 2023, 35(1): 53. doi：10.1186/s12302-023-00753-0

34. El-DemerdashFM. Lipid peroxidation, oxidative stress and acetylcholinesterase in rat brain exposed to organophosphate and pyrethroid insecticides[J]. Food Chem Toxicol, 2011, 49(6): 1346-1352. doi：10.1016/j.fct.2011.03.018

35. LianD, ChenMM, WuH, et al. The role of oxidative stress in skeletal muscle myogenesis and muscle disease[J]. Antioxidants(Basel), 2022, 11(4): 755. doi：10.3390/antiox11040755

36. MorleyJE. Hormones and sarcopenia[J]. Curr Pharm Des, 2017, 23(30): 4484-4492. doi：10.2174/1381612823666161123150032

37. ZaimM, AitioA, NakashimaN. Safety of pyrethroid‐treated mosquito nets[J]. Med Vet Entomol, 2000, 14(1): 1-5. doi：10.1046/j.1365-2915.2000.00211.x

38. GuptaCR. Veterinary Toxicology. 4th Edition[M]. New York: Academic Press, 2018: 515-520.

39. KimJ, ParkY, YoonKS, et al. Permethrin alters adipogenesis in 3T3‐L1 adipocytes and causes insulin resistance in C2C12 myotubes[J]. J Biochem Mol Toxicol, 2014, 28(9): 418-424. doi：10.1002/jbt.21580

40. FernandesJC, ShahSM, GBD 2021 Adult BMI Collaborators. Global, regional, and national prevalence of adult overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021[J]. Lancet, 2025, 405(10481): 813-838.