Associations of adiponectin, leptin, and the adiponectin-to-leptin ratio with sarcopenia in older adults with cardiovascular-kidney-metabolic syndrome

OBJECTIVE: Adiponectin and leptin are key adipokines associated with adipose tissue and skeletal muscle metabolism. This study aimed to investigate the associations of adiponectin, leptin, and the adiponectin-to-leptin ratio (A/L ratio) with sarcopenia in older adults with cardiovascular-kidney-metabolic (CKM) syndrome. METHODS: This cross-sectional study included 632 older adults (70.60 ± 6.09 years; 56.8% female) with CKM syndrome stages 1-4. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Plasma adiponectin and leptin were measured by ELISA and multiplex bead array, and were ln-transformed. Binary and multinomial logistic regression were used to analyze the associations of adiponectin, leptin, and the A/L ratio with sarcopenia, with adjustments for demographic characteristics, BMI, and health status. Receiver operating characteristic curves were used to evaluate the discriminative ability of adipokines. RESULTS: 256 (40.5%) and 57 (9.0%) participants had possible sarcopenia and sarcopenia, respectively. Binary logistic regression revealed that higher adiponectin was independently associated with higher odds of low physical function (OR = 2.11, 95% CI: 1.52-2.98); higher leptin with higher odds of low muscle mass (OR = 1.96, 95% CI: 1.26-3.08) and lower odds of low physical function (OR = 0.65, 95% CI: 0.49-0.87); and a higher A/L ratio with lower odds of low muscle mass (OR = 0.80, 95% CI: 0.65-0.98) but higher odds of low muscle strength (OR = 1.26, 95% CI: 1.06-1.50) and low physical function (OR = 1.24, 95% CI: 1.09-1.42) (all P < 0.05). In fully adjusted multinomial logistic regression, adipokines were significantly associated with possible sarcopenia but not with sarcopenia. A/L ratio showed significant AUC values for possible sarcopenia (AUC = 0.641, P < 0.001) and sarcopenia (AUC = 0.617, P = 0.004), with slightly higher performance in CKM stages 1-2 than in stages 3-4. CONCLUSIONS: Adiponectin, leptin, and the A/L ratio exhibit component-specific associations with sarcopenia in older adults with CKM syndrome. These adipokines may help identify sarcopenia status, particularly in early CKM stages.