Mediating role of possible sarcopenia in the association between diabetes and stroke: finding from the China health and retirement longitudinal study.

Background: Diabetes and sarcopenia were risk factors for the development of stroke. The presence of diabetes increased the likelihood of developing sarcopenia. No prior study has investigated the potential mediating role of sarcopenia in the association between diabetes and stroke risk. In this study, we aimed to explore the mediating effect of possible sarcopenia between diabetes and stroke, utilizing data from China Health and Retirement Longitudinal Study (CHARLS).

Methods: In this retrospective cohort study, we included 3,997 individuals aged ≥ 65 years old from CHARLS database of 2015, followed up until 2018. The study outcome was the stroke incident. Possible sarcopenia was defined based on the Asian Working Group on Sarcopenia 2019 criteria: low muscle strength with or without reduced physical performance. The observation period for the outcome event was in 2018, while other baseline data were collected in 2015. The relationship between diabetes, possible sarcopenia and stroke were examined by univariate and multivariate logistic regression models. Distribution-of-product method was used to test the mediating effect. P < 0.05 was considered statistically significant for this study.

Results: The incidence of stroke in the studied populations was approximately 7.11%. The result of multivariate logistic regression analysis indicated that diabetes was related to an increased stroke risk [total effect: adjusted odds ratio (OR) = 1.37, 95% confidence interval (CI): 1.04-1.82)], and a higher risk of possible sarcopenia (adjusted OR = 1.21, 95% CI: 1.02-1.43). Additionally, possible sarcopenia was identified as being linked to an associated with stroke risk (adjusted OR = 1.31, 95% CI: 1.01-1.70). Using the distribution-of-product test, a potential mediating effect of possible sarcopenia on the relationship between diabetes and stroke was observed (indirect effect: adjusted OR = 1.062, 95%CI: 1.003-1.156), with a 95% CI for distribution-of-product of 0.060 (95% CI: 0.003-0.145). The percentage of the mediating effect of 5.41%.

Conclusion: Possible sarcopenia partially mediates the association between diabetes and stroke. This finding provides evidence underscoring the significance of maintaining and improving stroke by somewhat reducing the risk of possible sarcopenia, particularly in populations with diabetes. Future studies should focus on understanding the mechanisms underlying these associations.