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Epidemiology and Population Health

Dynapenic obesity associated with incidence and progression trajectory of cardiometabolic diseases: a prospective cohort study

International Journal of Obesity volume 49, pages 1820–1828 (2025)Cite this article

Subjects

Abstract

Background

The impact of dynapenic obesity on the progression of cardiometabolic multimorbidity (CMM) remains poorly understood. This study aimed to explore the association between dynapenic obesity and cardiometabolic diseases (CMD) progression, as well as the mediating roles of C-reactive protein (CRP) and the atherogenic index of plasma (AIP).

Methods

The study included 446,862 UK Biobank participants. CMM was defined as the coexistence of two or three CMDs, including type 2 diabetes (T2DM), coronary heart disease (CHD) and stroke. Dynapenic obesity was classified into dynapenic general obesity and dynapenic abdominal obesity, assessed by handgrip strength (HGS), body mass index (BMI), and waist circumference (WC). A multi-state model was employed to evaluate the influence of dynapenic obesity on CMD progression. Counterfactual mediation analyses were conducted to investigate the mediating role of CRP and AIP.

Results

Over a median 13.67-years follow-up, 54,555 participants developed CMD, 5842 developed CMM, and 32,930 died. Compared with non-dynapenia and non-general obesity (ND/NGO), the HRs (95% CI) of first CMD (FCMD), CMM, and death for dynapenia and general obesity (D/GO) were 2.75 (2.61,2.90), 4.61 (4.05,5.24), and 1.68 (1.56,1.80), respectively. Similar results were observed for dynapenic abdominal obesity. Compared with ND/NGO, the proportions of CRP and AIP mediated associations of D/GO with FCMD risk were 19.58% (95% CI: 18.66%, 20.18%) and 18.99% (95% CI: 18.12%, 19.62%), respectively, which were lower than the proportions mediated in the associations of dynapenia and abdominal obesity (D/AO) with FCMD (CRP: 30.38% vs. 19.58%; AIP: 31.40% vs. 18.99%). Furthermore, CRP and AIP accounted for a greater proportion of the association between dynapenic obesity and CMM than FCMD.

Conclusion

This study indicated that there are differential effects associated with dynapenic obesity during the longitudinal progression of CMD. CRP and AIP may play a partial role in mediating this association.

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Fig. 1: Numbers (percentages) of participants in transition pattern A and B.
Fig. 2: Hazard ratios (95% confidence interval) for transition pattern A by dynapenic obesity in multistate models.
Fig. 3: Mediation proportion (95% confidence interval) of mediating factors on dynapenic obesity and outcomes.

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Data availability

The data that support this study are available from the UK Biobank, which were used under license for the current study, and so are not publicly available. More details can be found at https://www.ukbiobank.ac.uk/.

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Acknowledgements

We thank the faculties from the UK Biobank Access Management Team for helping us in the data preparation (Application Number 170605).

Funding

This work was supported by the National Natural Science Foundation of China (Nos. 82304251 and 82371597).

Author information

Author notes

  1. These authors contributed equally: Yongli Yang, Xuezhong Shi.

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China

    Nana Wang, Xiaocan Jia, Chaojun Yang, Yuping Wang, Jingwen Fan, Chenyu Zhao, Yali Niu, Yongli Yang & Xuezhong Shi

  2. School of Public Health, Jilin University, Changchun, Jilin, China

    Tianrun Wang

  3. Department of Cardiology, The First College of Clinical Medical Science, China Three Gorges University and Yichang Central People’s Hospital, Yichang, Hubei, China

    Zhixing Fan

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Contributions

NNW, TRW, and XCJ contributed to the design of study, conducted study, and drafted the initial manuscript. YPW, JWF, YLN, and CYZ revised the manuscript. CJY and ZXF assisted in analyzing the data. XZS and YLY were involved in study supervision. All authors read and approved the final version of the manuscript.

Corresponding authors

Correspondence to Yongli Yang or Xuezhong Shi.

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Competing interests

The authors declare no competing interests.

Ethical approval

All participants in UK biobank received written informed consent and ethical approval from the North West Multi-Centre Research Ethics Committee. The resource application number for this study is 170605. The study was conducted in accordance with the Declaration of Helsinki, and all methods were performed in accordance with the UK Biobank Ethics and Governance Framework.

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Wang, N., Wang, T., Jia, X. et al. Dynapenic obesity associated with incidence and progression trajectory of cardiometabolic diseases: a prospective cohort study. Int J Obes 49, 1820–1828 (2025). https://doi.org/10.1038/s41366-025-01831-4

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