Sarcopenic obesity and the risk of atrial fibrillation in non-diabetic older adults: A prospective cohort study.

Summary

In 4,321 non-diabetic older adults followed for 10.9 years, sarcopenic obesity was associated with the highest atrial fibrillation risk (HR 2.669), exceeding sarcopenia or obesity alone. Mediation analyses implicated insulin resistance (estimated glucose disposal rate), high-sensitivity CRP, and galectin-3 as partial mediators.

Key Findings

• Over 10.9 years, 546 AF events occurred (11.98 per 1000 person-years).
• Sarcopenic obesity conferred the highest AF risk (HR 2.669; 95% CI 2.110–3.377), higher than sarcopenia (HR 1.980) or obesity (HR 1.839) alone.
• Synergistic interaction between sarcopenia and obesity increased AF risk (HR 2.029; 95% CI 1.639–2.512).
• Mediation by insulin resistance (eGDR 34.87%), hsCRP (27.56%), and galectin-3 (21.05%).

Clinical Implications

Screening for sarcopenic obesity and targeting muscle mass, adiposity, insulin sensitivity, and inflammation may help reduce AF incidence in older adults.

Limitations

• Observational design precludes causal inference; residual confounding possible.
• Body composition assessment methods are not fully detailed in the abstract; cohort limited to non-diabetic older adults, affecting generalizability.

Future Directions

Interventional trials targeting muscle strengthening, adiposity reduction, and insulin sensitivity are warranted to test AF prevention; biomarker-guided precision prevention strategies should be evaluated.