Associations of grip strength, muscle mass, and fat-to-muscle ratio with advanced cardiovascular-kidney-metabolic syndrome in chinese community adults

Cardiovascular-kidney-metabolic (CKM) syndrome is a global health challenge. However, few studies have explored the associations between muscle health and CKM syndrome. This study aimed to investigate the associations between appendicular skeletal muscle mass (ASM), grip strength, and fat-to-muscle ratio (FMR) and advanced CKM syndrome in a Chinese community-based population. We conducted an observational study involving 7,330 Chinese adults. CKM syndrome is categorized into five stages, with stages 3–4 defined as advanced CKM syndrome. An electronic dynamometer and bioelectrical impedance analysis were used to measure grip strength, ASM, and FMR. The FMR was calculated as fat mass divided by muscle mass, and ASM/BMI as ASM divided by body mass index (BMI). Associations of grip strength, ASM/BMI, and FMR with advanced CKM syndrome were assessed using multivariable logistic regression, with subgroup analyses by age and sex. Subgroup analyses were further conducted to explore potential interactions. Advanced CKM syndrome was identified in 8.57% of participants. Higher ASM/BMI (Q4 vs. Q1: OR = 0.26, 95% CI: 0.15–0.45) and grip strength (Q4 vs. Q1: OR = 0.42, 95% CI: 0.30–0.59) were inversely linked to the likelihood of having advanced CKM syndrome ( P-trend < 0.001). Conversely, a higher FMR was associated with higher odds of advanced CKM syndrome (Q4 vs. Q1: OR = 2.22, 95% CI: 1.26–3.89; P-trend < 0.05). Furthermore, subgroup analyses showed that the inverse association between grip strength and advanced CKM syndrome was stronger among females ( P for interaction = 0.007). A nonlinear, L-shaped association was observed between grip strength and advanced CKM syndrome, with an inflection point at 26.2 kg in females. Lower ASM/BMI and grip strength, and a higher FMR are associated with an increased likelihood of advanced CKM syndrome. Additionally, a plausible grip-strength threshold (~ 26.2 kg) was identified among females. These findings support evaluating muscle health for risk stratification in CKM syndrome. Registry http//www.chictr.org.cn/, TRN ChiCTR2100054130, Registration date 9 December, 2021.