{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T10:40:00Z","timestamp":1783420800885,"version":"3.54.6"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T00:00:00Z","timestamp":1727913600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82274553"],"award-info":[{"award-number":["82274553"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nObjectives<\/jats:title>\nSarcopenia is prevalent in middle to old age. We aimed to investigate the association between muscle strength and the incident knee osteoarthritis (OA).<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\n12,043 participants were collected from the China Health and Retirement Longitudinal Study. The effects of sarcopenic obesity (defined by obesity in combination with possible sarcopenia) on knee OA onset were calculated using Poisson regression models. Mediation analysis was fit to estimate mediating proportion of muscle strength on the association between obesity and incident knee OA.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nThe study all enrolled 12,043 participants with 2,008 progressed to knee OA. Poisson analyses demonstrated causal association of general obesity (RR:1.23, 95% CI: 1.08 to 1.39) and abdominal obesity (RR:1.23, 95% CI: 1.11 to 1.35) with knee OA onset. For the risk of incident knee OA, participants with the highest level of normalized grip strength had a decreased risk of incident knee OA by 0.33 (RR:0.67, 95% CI: 0.60 to 0.75) times compared to the control group, and chair-rising time was associated with increased risk of incident knee OA by 0.65 (RR:1.65, 95% CI: 1.17 to 2.33) times. Sensitivity analysis identified similar results. Participants with sarcopenic obesity were about 2 times risk of incident knee OA than reference group. Normalized grip strength and chair-rising time mediated the association between obesity and incidence of knee OA.<\/jats:p>\n<\/jats:sec>\n\nConclusions<\/jats:title>\nSarcopenic obesity is correlated with an increased risk of knee OA. Muscle strength recovery may alleviate the risk of incident knee OA in middle to old age with obesity.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0311423","type":"journal-article","created":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T17:39:38Z","timestamp":1727977178000},"page":"e0311423","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Roles of low muscle strength and sarcopenic obesity on incident symptomatic knee osteoarthritis: A longitudinal cohort study"],"prefix":"10.1371","volume":"19","author":[{"given":"Laijun","family":"Yan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiya","family":"Ge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengming","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anping","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinguang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ding","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5883-0347","authenticated-orcid":true,"given":"Yuelong","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,10,3]]},"reference":[{"key":"pone.0311423.ref001","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/S0140-6736(21)00798-4","article-title":"Body-mass index and obesity in urban and rural China: findings from consecutive nationally representative surveys during 2004\u201318","volume":"398","author":"L Wang","year":"2021","journal-title":"LANCET"},{"key":"pone.0311423.ref002","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1016\/S0140-6736(17)30548-2","article-title":"Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: a cohort study","volume":"389","author":"Y Zeng","year":"2017","journal-title":"LANCET"},{"key":"pone.0311423.ref003","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/S0140-6736(16)31678-6","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990\u20132015: a systematic analysis for the Global Burden of Disease Study 2015","volume":"388","author":"Collaborators GDAI","year":"2016","journal-title":"LANCET"},{"key":"pone.0311423.ref004","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/S0140-6736(14)60802-3","article-title":"Osteoarthritis","volume":"386","author":"S Glyn-Jones","year":"2015","journal-title":"LANCET"},{"issue":"1","key":"pone.0311423.ref005","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1002\/jcsm.13115","article-title":"Consensus guidelines for sarcopenia prevention, diagnosis and management in Australia and New Zealand","volume":"14","author":"J Zanker","year":"2023","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"pone.0311423.ref006","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.arr.2016.09.008","article-title":"Sarcopenic obesity or obese sarcopenia: A cross talk between age-associated adipose tissue and skeletal muscle inflammation as a main mechanism of the pathogenesis","volume":"35","author":"A Kalinkovich","year":"2017","journal-title":"AGEING RES REV"},{"key":"pone.0311423.ref007","doi-asserted-by":"crossref","first-page":"155639","DOI":"10.1016\/j.metabol.2023.155639","article-title":"Sarcopenic obesity: emerging mechanisms and therapeutic potential","volume":"146","author":"CL Axelrod","year":"2023","journal-title":"METABOLISM"},{"issue":"Suppl 1","key":"pone.0311423.ref008","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1111\/obr.12781","article-title":"Changes in physical activity over the lifespan: impact on body composition and sarcopenic obesity","volume":"19","author":"KR Westerterp","year":"2018","journal-title":"OBES REV"},{"key":"pone.0311423.ref009","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1016\/j.clnu.2016.03.028","article-title":"Sarcopenia, sarcopenic obesity and inflammation: Results from the 1999\u20132004 National Health and Nutrition Examination Survey","volume":"35","author":"JA Batsis","year":"2016","journal-title":"CLIN NUTR"},{"key":"pone.0311423.ref010","doi-asserted-by":"crossref","DOI":"10.3390\/nu14142889","article-title":"Sarcopenia, Obesity, Sarcopenic Obesity and Risk of Poor Nutritional Status in Polish Community-Dwelling Older People Aged 60 Years and Over","volume":"14","author":"M Murawiak","year":"2022","journal-title":"NUTRIENTS"},{"key":"pone.0311423.ref011","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1002\/art.39707","article-title":"Association Between Overweight and Obesity and Risk of Clinically Diagnosed Knee, Hip, and Hand Osteoarthritis: A Population-Based Cohort Study","volume":"68","author":"C Reyes","year":"2016","journal-title":"ARTHRITIS RHEUMATOL"},{"key":"pone.0311423.ref012","doi-asserted-by":"crossref","first-page":"3796","DOI":"10.1038\/s41598-023-30727-4","article-title":"Association of general and central obesity, and their changes with risk of knee osteoarthritis: a nationwide population-based cohort study","volume":"13","author":"D Park","year":"2023","journal-title":"Sci Rep"},{"key":"pone.0311423.ref013","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1136\/bjsports-2021-104861","article-title":"Knee extensor muscle weakness is a risk factor for the development of knee osteoarthritis: an updated systematic review and meta-analysis including 46 819 men and women","volume":"56","author":"BE \u00d8iestad","year":"2022","journal-title":"Br J Sports Med"},{"key":"pone.0311423.ref014","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.rdc.2012.11.003","article-title":"Update on the role of muscle in the genesis and management of knee osteoarthritis","volume":"39","author":"KL Bennell","year":"2013","journal-title":"Rheum Dis Clin North Am"},{"key":"pone.0311423.ref015","article-title":"Relationship between Knee Muscle Strength and Fat\/Muscle Mass in Elderly Women with Knee Osteoarthritis Based on Dual-Energy X-Ray Absorptiometry","volume":"17","author":"X Zhang","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0311423.ref016","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1186\/s13018-023-03960-w","article-title":"Osteoarthritis and sarcopenia-related traits: the cross-sectional study from NHANES 2011\u20132014 and Mendelian randomization study","volume":"18","author":"S Chen","year":"2023","journal-title":"J ORTHOP SURG RES"},{"key":"pone.0311423.ref017","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1002\/art.40692","article-title":"Risk of Knee Osteoarthritis with Obesity, Sarcopenic Obesity, and Sarcopenia","volume":"71","author":"D Misra","year":"2019","journal-title":"ARTHRITIS RHEUMATOL"},{"key":"pone.0311423.ref018","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.clnu.2024.02.002","article-title":"Associations between sarcopenic obesity and risk of cardiovascular disease: A population-based cohort study among middle-aged and older adults using the CHARLS","volume":"43","author":"M Jiang","year":"2024","journal-title":"CLIN NUTR"},{"key":"pone.0311423.ref019","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.clnesp.2024.02.028","article-title":"Assessment of sarcopenic obesity as a predictor of pneumonia in patients with stable schizophrenia-A prospective study","volume":"60","author":"S Huang","year":"2024","journal-title":"Clin Nutr ESPEN"},{"key":"pone.0311423.ref020","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1093\/ije\/dys203","article-title":"Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS)","volume":"43","author":"Y Zhao","year":"2014","journal-title":"INT J EPIDEMIOL"},{"key":"pone.0311423.ref021","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1001\/jamainternmed.2016.3202","article-title":"Effects of Moderate and Vigorous Exercise on Nonalcoholic Fatty Liver Disease: A Randomized Clinical Trial","volume":"176","author":"HJ Zhang","year":"2016","journal-title":"JAMA INTERN MED"},{"issue":"3","key":"pone.0311423.ref022","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment","volume":"21","author":"LK Chen","year":"2020","journal-title":"J Am Med Dir Assoc"},{"key":"pone.0311423.ref023","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1002\/art.39465","article-title":"The Prevalence of Symptomatic Knee Osteoarthritis in China: Results From the China Health and Retirement Longitudinal Study","volume":"68","author":"X Tang","year":"2016","journal-title":"ARTHRITIS RHEUMATOL"},{"key":"pone.0311423.ref024","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s13075-021-02447-5","article-title":"Development of a model for predicting the 4-year risk of symptomatic knee osteoarthritis in China: a longitudinal cohort study","volume":"23","author":"L Wang","year":"2021","journal-title":"ARTHRITIS RES THER"},{"key":"pone.0311423.ref025","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1093\/aje\/kwh090","article-title":"A modified poisson regression approach to prospective studies with binary data","volume":"159","author":"G. Zou","year":"2004","journal-title":"AM J EPIDEMIOL"},{"key":"pone.0311423.ref026","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1186\/s12889-020-09611-7","article-title":"Incidence and risk factors of symptomatic knee osteoarthritis among the Chinese population: analysis from a nationwide longitudinal study","volume":"20","author":"Y Ren","year":"2020","journal-title":"BMC PUBLIC HEALTH"},{"key":"pone.0311423.ref027","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1002\/art.40928","article-title":"Causal Factors for Knee, Hip, and Hand Osteoarthritis: A Mendelian Randomization Study in the UK Biobank","volume":"71","author":"T Funck-Brentano","year":"2019","journal-title":"ARTHRITIS RHEUMATOL"},{"key":"pone.0311423.ref028","doi-asserted-by":"crossref","first-page":"907750","DOI":"10.3389\/fimmu.2022.907750","article-title":"Obesity, Inflammation, and Immune System in Osteoarthritis","volume":"13","author":"U Nedunchezhiyan","year":"2022","journal-title":"FRONT IMMUNOL"},{"key":"pone.0311423.ref029","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1186\/s13018-023-04089-6","article-title":"Evidence on risk factors for knee osteoarthritis in middle-older aged: a systematic review and meta analysis","volume":"18","author":"Y Dong","year":"2023","journal-title":"J ORTHOP SURG RES"},{"issue":"1","key":"pone.0311423.ref030","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1148\/radiol.212771","article-title":"Role of Thigh Muscle Changes in Knee Osteoarthritis Outcomes: Osteoarthritis Initiative Data","volume":"305","author":"B Mohajer","year":"2022","journal-title":"Radiology"},{"key":"pone.0311423.ref031","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s12877-016-0220-7","article-title":"Sarcopenia-related features and factors associated with lower muscle strength and physical performance in older Chinese: a cross sectional study","volume":"16","author":"P Zeng","year":"2016","journal-title":"BMC GERIATR"},{"key":"pone.0311423.ref032","first-page":"74","article-title":"Chair rising exercise is more effective than one-leg standing exercise in improving dynamic body balance: a randomized controlled trial","volume":"12","author":"F Yamashita","year":"2012","journal-title":"J Musculoskelet Neuronal Interact"},{"issue":"1","key":"pone.0311423.ref033","first-page":"2","article-title":"Sarcopenia-related features and factors associated with low muscle mass, weak muscle strength, and reduced function in Chinese rural residents: a cross-sectional study","volume":"14","author":"HQ Xu","year":"2018","journal-title":"Arch Osteoporos"},{"issue":"11","key":"pone.0311423.ref034","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1097\/JS9.0000000000000653","article-title":"Association between physical performance or parameters and sarcopenia","volume":"109","author":"D Chen","year":"2023","journal-title":"Int J Surg"},{"key":"pone.0311423.ref035","article-title":"Thigh muscle composition changes in knee osteoarthritis patients during weight loss: Sex-specific analysis using data from osteoarthritis initiative","author":"K Moradi","year":"2024","journal-title":"Osteoarthr Cartilage"},{"key":"pone.0311423.ref036","doi-asserted-by":"crossref","first-page":"110937","DOI":"10.1016\/j.exger.2020.110937","article-title":"Effectiveness of non-pharmacological interventions on the management of sarcopenic obesity: A systematic review and meta-analysis","volume":"135","author":"YH Yin","year":"2020","journal-title":"Exp Gerontol"},{"issue":"7","key":"pone.0311423.ref037","article-title":"Effects of Protein Supplementation Combined with Resistance Exercise Training on Walking Speed Recovery in Older Adults with Knee Osteoarthritis and Sarcopenia","volume":"15","author":"CD Liao","year":"2023","journal-title":"Nutrients"},{"key":"pone.0311423.ref038","doi-asserted-by":"crossref","first-page":"e2024027","DOI":"10.4178\/epih.e2024027","article-title":"Mediating effect of lower extremity muscle on the relationship between obesity and osteoarthritis in middle-aged and elderly women in Korea: based on the 2009\u20132011 Korea National Health and Nutrition Examination Survey","volume":"46","author":"M Kim","year":"2024","journal-title":"Epidemiol Health"},{"key":"pone.0311423.ref039","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1002\/jcsm.12905","article-title":"Muscle strength and prediabetes progression and regression in middle-aged and older adults: a prospective cohort study","volume":"13","author":"S Qiu","year":"2022","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"pone.0311423.ref040","article-title":"The Correlation between Waist Circumference and the Pro-Inflammatory Adipokines in Diabetic Retinopathy of Type 2 Diabetes Patients","volume":"24","author":"YJ Lee","year":"2023","journal-title":"INT J MOL SCI"},{"key":"pone.0311423.ref041","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.cytogfr.2018.10.002","article-title":"Pro-inflammatory cytokines: The link between obesity and osteoarthritis","volume":"44","author":"T Wang","year":"2018","journal-title":"Cytokine Growth Factor Rev"},{"key":"pone.0311423.ref042","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1016\/S0140-6736(19)31138-9","article-title":"Sarcopenia","volume":"393","author":"AJ Cruz-Jentoft","year":"2019","journal-title":"LANCET"},{"key":"pone.0311423.ref043","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1002\/jcsm.12048","article-title":"SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes","volume":"7","author":"TK Malmstrom","year":"2016","journal-title":"J Cachexia Sarcopenia Muscle"},{"issue":"4","key":"pone.0311423.ref044","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1093\/ageing\/afz046","article-title":"Sarcopenia: revised European consensus on definition and diagnosis","volume":"48","author":"AJ Cruz-Jentoft","year":"2019","journal-title":"Age Ageing"},{"key":"pone.0311423.ref045","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1053\/joca.1997.0098","article-title":"Clinical validation of self-reported osteoarthritis","volume":"6","author":"LM March","year":"1998","journal-title":"Osteoarthritis Cartilage"},{"key":"pone.0311423.ref046","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.jclinepi.2014.09.019","article-title":"Diagnostic accuracy of self-reported arthritis in the general adult population is acceptable","volume":"68","author":"GM Peeters","year":"2015","journal-title":"J CLIN EPIDEMIOL"},{"key":"pone.0311423.ref047","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1002\/art.41231","article-title":"Association Between Race and Radiographic, Symptomatic, and Clinical Hand Osteoarthritis: A Propensity Score-Matched Study Using Osteoarthritis Initiative Data","volume":"74","author":"F Pishgar","year":"2022","journal-title":"ARTHRITIS RHEUMATOL"},{"key":"pone.0311423.ref048","doi-asserted-by":"crossref","first-page":"2196439","DOI":"10.1080\/07853890.2023.2196439","article-title":"Associations between weather conditions and osteoarthritis pain: a systematic review and meta-analysis","volume":"55","author":"L Wang","year":"2023","journal-title":"ANN MED"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0311423","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T17:39:52Z","timestamp":1727977192000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0311423"}},"subtitle":[],"editor":[{"given":"Simone","family":"Agostini","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,10,3]]},"references-count":48,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0311423","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,3]]}}}