The relationship between sarcopenic obesity and changes in quadriceps muscle thickness and echo intensity in patients with stroke

Figures & data

Figure 1. Ultrasound images of the quadriceps muscle.

Figure 2. Flow diagram of participants.

Table 1. Participant characteristics.

Variables	Normal n = 31	Simple obesity n = 45	Sarcopenia n = 24	Sarcopenic obesity n = 30	p-value
Age, years (SD)	64.5 (13.6)	66.0 (12.8)	72.7 (9.3)	76.8 (10.2)	<0.001^a §, ††
Sex (male), n (%)	22 (71.0)	23 (51.1)	16 (66.7)	19 (63.3)	0.316^b
Height, cm (SD)	163.1 (10.2)	163.2 (8.1)	163.8 (8.0)	157.0 (9.2)	0.010^a §, ††, ‡‡
Weight, kg (SD)	56.4 (9.3)	69.3 (12.4)	50.6 (6.5)	57.5 (8.0)	<0.001^a †, ¶, ††
BMI, kg/m^Citation2 (SD)	21.1 (2.3)	25.9 (3.3)	18.9 (2.1)	23.3 (2.4)	<0.001^a †, ‡, §, ¶, ††, ‡‡
Stroke subtype, n (%)					0.694^c
Cerebral infarction	19 (61.2)	22 (48.9)	13 (54.1)	19 (63.3)
Intracerebral hemorrhage	11 (35.5)	21 (46.7)	9 (37.5)	11 (36.7)
Subarachnoid hemorrhage	1 (3.2)	2 (4.4)	2 (8.3)	0 (0)
Days from the onset, days (IQR)	16 (13, 23)	14 (11, 17)	18 (14, 21)	16 (13, 21)	0.225^d
SIAS-LM (IQR)	12 (9, 15)	12 (9, 15)	12 (0, 15)	12 (9, 15)	0.651^d
Energy intake, kcal/kg/day (IQR)	27.0 (24.5, 30.6)	21.7 (16.7, 24.3)	26.9 (24.1, 31.3)	24.3 (21.2, 26.1)	<0.001^d †, §, ¶, ‡‡
Pre-morbid mRS (IQR)	0 (0, 0)	0 (0, 0)	0 (0, 0)	0 (0, 0.75)	<0.001^d §, ††
SMI, kg/m^Citation2 (SD)	6.3 (1.0)	6.5 (1.0)	5.8 (0.6)	5.6 (0.7)	<0.001^a §, ¶, ††
HGS paretic side, kg (IQR)	18.5 (1.5, 28.8)	19.0 (6.0, 27.0)	10.3 (0.0, 15.0)	11.5 (3.1, 16.4)	0.005^d ¶
HGS non-paretic side, kg (IQR)	29.0 (20.0, 35.0)	25.5 (21.5, 31.5)	17.5 (12.8, 20.8)	18.0 (12.1, 21.5)	<0.001^d ‡, §, ¶, ††
Body fat percentage (SD)	26.3 (4.7)	39.7 (5.6)	23.9 (7.2)	39.4 (5.3)	<0.001^a †, §, ¶, ‡‡

Abbreviations: SD, standard deviation; BMI, body mass index; IQR, interquartile range; SIAS-LM, Stroke Impairment Assessment Set-Leg Motor; mRS, modified Rankin Scale; SMI, skeletal muscle index; HGS, hand grip strength.

^aOne-way analysis of variance; ^bChi-square test; ^cFisher’s exact test; ^dKruskal – Wallis test.

Multiple comparison: ^†normal vs. simple obesity; ^‡normal vs. sarcopenia; ^§normal vs. sarcopenic obesity; ^¶simple obesity vs. sarcopenia; ^††simple obesity vs. sarcopenic obesity; ^‡‡sarcopenia vs. sarcopenic obesity.

Figure 3. One-way analysis of variance for QMT.

Multiple comparison : *p < 0.05 (normal vs. sarcopenia and sarcopenic obesity; simple obesity vs. sarcopenia and sarcopenic obesity).

QMT, quadriceps muscle thickness.

Figure 4. One-way analysis of variance for QEI.

Multiple comparison:*p < 0.05 (normal vs. simple obesity and sarcopenic obesity; sarcopenia vs. simple obesity and sarcopenic obesity).

QEI, quadriceps muscle echo intensity.

Table 2. Multiple regression analysis for QMT.

Variables	Paretic side Adjusted R^2 = 0.563				Non-paretic side Adjusted R^2 = 0.630
	B	95% CI	β	p	B	95% CI	β	p
Age	−0.07	−0.10, −0.03	−0.27	<0.001	−0.09	−0.12, −0.06	−0.34	<0.001
Sex (female)	−1.17	−1.94, −0.40	−0.18	0.003	−0.95	−1.71, −0.19	−0.14	0.015
BMI	0.49	0.33, 0.66	0.59	<0.001	0.47	0.31, 0.63	0.52	<0.001
Energy intake	−0.0005	−0.09, 0.09	−0.001	0.990	−0.04	−0.12, 0.05	−0.07	0.356
Pre-morbid mRS	−0.26	−0.87, 0.35	−0.06	0.396	−0.06	−0.66, 0.54	−0.01	0.842
SIAS-LM	0.13	0.06, 0.20	0.22	<0.001	−0.02	−0.09, 0.06	−0.03	0.650
Normal (reference)	-	-	-	-	-	-	-	-
Simple obesity	−1.00	−2.19, 0.19	−0.15	0.099	−1.35	−2.52, −0.18	−0.19	0.024
Sarcopenia	−0.61	−1.80, 0.59	−0.08	0.319	−1.63	−2.82, −0.45	−0.19	0.007
Sarcopenic obesity	−2.07	−3.28, −0.87	−0.28	<0.001	−2.94	−4.13, −1.75	−0.37	<0.001

Abbreviations: B, partial regression coefficient; β, standardized partial regression coefficient; CI, confidence interval; QMT, quadriceps muscle thickness; BMI, body mass index; mRS, modified Rankin Scale; SIAS-LM, Stroke Impairment Assessment Set-Leg Motor.

Covariates : age, sex, BMI, Energy intake, pre-morbid mRS, SIAS-LM.

Table 3. Multiple regression analysis for QEI.

Variables	Paretic side Adjusted R^2 = 0.415				Non-paretic side Adjusted R^2 = 0.462
	B	95% CI	β	p	B	95% CI	β	p
Age	0.11	−0.04, 0.25	0.12	0.148	0.20	0.06, 0.35	0.22	0.005
Sex (female)	11.35	7.96, 14.73	0.47	<0.001	10.75	7.47, 14.03	0.44	<0.001
BMI	0.41	−0.30, 1.12	0.13	0.258	0.82	0.13, 1.50	0.26	0.021
Energy intake	−0.16	−0.54, 0.22	−0.08	0.397	−0.04	−0.40, 0.33	−0.02	0.837
Pre-morbid mRS	1.97	−0.71, 4.65	0.11	0.149	1.69	−0.90, 4.29	0.09	0.199
SIAS-LM	−0.16	−0.48, 0.16	−0.07	0.318	−0.006	−0.31, 0.30	−0.002	0.971
Normal (reference)	-	-	-	-	-	-	-	-
Simple obesity	4.98	−0.24, 10.19	0.20	0.061	5.01	−0.04, 10.06	0.20	0.052
Sarcopenia	−0.24	−5.50, 5.02	−0.008	0.927	1.38	−3.71, 6.48	0.05	0.592
Sarcopenic obesity	5.74	0.45, 11.04	0.21	0.034	5.72	0.59, 10.85	0.20	0.029

Abbreviations: B, partial regression coefficient; β, standardized partial regression coefficient; CI, confidence interval; QEI, quadriceps echo intensity; BMI, body mass index; mRS, modified Rankin Scale; SIAS-LM, Stroke Impairment Assessment Set-Leg Motor.

Covariates : age, sex, BMI, Energy intake, pre-morbid mRS, SIAS-LM.

Yoshimura Y, Wakabayashi H, Nagano F, et al. Sarcopenic obesity is associated with activities of daily living and home discharge in post-acute rehabilitation. J Am Med Dir Assoc. 2020;21(10):1475–1480. doi:10.1016/j.jamda.2020.03.029.

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Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.