{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:56:49Z","timestamp":1782845809821,"version":"3.54.5"},"reference-count":49,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Aging"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>As the global population continues to age, the prevalence of sarcopenia is gradually increasing, and the loss of skeletal muscle mass is one of the manifestations of sarcopenia. Low calf circumference (CC) is often used as a predictor of poor skeletal muscle mass or sarcopenia. Older adults usually have a combination of multiple chronic diseases. There is a lack of evidence to explore the risk factors for low CC with multimorbidity in Chinese, community-dwelling, older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to explore the risk factors and potential categories in older adult patients with low CC and multimorbidity from an individual-centered perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We selected 15,874 participants from the Chinese Longitudinal Healthy Longevity Survey in 2018 and screened for low CC in older adult patients. The individual-centered latent class analysis was used to classify potential multimorbidity groups. Multiple logistic regression was used to explore the risk factors associated with low CC and multimorbidity by applying the elastic net to screen for reliable risk variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 7956 older individuals were eligible for the study, of whom 3960 (49.8%) were aged &gt;90 years and 2166 (27.2%) had multimorbidity with low CC. The prevalence of multimorbidity increases between the ages of 65 and 89 years. However, the majority of older adults remain in reasonably good health beyond the age of 90 years. Five multimorbidity groups were identified by latent class analysis: multisystem morbidity diseases (78\/2166, 3.6%), arthritis-rheumatism or rheumatoid diseases (400\/2166, 18.47%), diabetes-hypertension diseases (330\/2166, 15.23%), respiratory-heart diseases (347\/2166, 16.02%), and cardiovascular diseases (1011\/2166, 46.68%). Through 12 variables screened by the elastic net, multiple logistic regression showed different impacts on multimorbidity groups, including demographic background, behavioral characteristics, and physical and mental health factors. In particular, older patients who self-report poor health and live in urban areas need more attention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results revealed that low CC is a common phenomenon among community-dwelling older adults, and a substantial proportion also present with multimorbidity. In the older adult population with low CC, the proportion of multimorbidity does not simply increase with age. Multimorbidity in low CC has been identified in 5 potential groups. Different groups have distinctive risk factors. Public health authorities should pay attention to low CC in older adult patients with multimorbidity and carry out targeted interventions, thereby enhancing health outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/68760","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T02:40:09Z","timestamp":1757040009000},"page":"e68760-e68760","source":"Crossref","is-referenced-by-count":1,"title":["Exploring Risk Factors Related to Low Calf Circumference in Older Adults With Multimorbidity: Cross-Sectional Latent Class Analysis"],"prefix":"10.2196","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4852-0109","authenticated-orcid":false,"given":"Xilin","family":"Peng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4674-8319","authenticated-orcid":false,"given":"Xudong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2119-0945","authenticated-orcid":false,"given":"Ruihao","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5121-6831","authenticated-orcid":false,"given":"Fanfan","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4557-8872","authenticated-orcid":false,"given":"Tao","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0303-7111","authenticated-orcid":false,"given":"Guo","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,10,2]]},"reference":[{"issue":"1","key":"R1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/MCO.0b013e328333c1c1","article-title":"Understanding sarcopenia as a geriatric syndrome","volume":"13","author":"Cruz-Jentoft","journal-title":"Curr Opin Clin Nutr Metab Care"},{"issue":"5","key":"R2","doi-asserted-by":"publisher","DOI":"10.3390\/nu12051293","article-title":"Sarcopenia: a contemporary health problem among older adult populations","volume":"12","author":"Papadopoulou","journal-title":"Nutrients"},{"issue":"2","key":"R3","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/j.jamda.2017.11.016","article-title":"Calf circumference as a screening instrument for appendicular muscle mass measurement","volume":"19","author":"Hwang","journal-title":"J Am Med Dir Assoc"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.2196\/42435","article-title":"Development and assessment of assisted diagnosis models using machine learning for identifying elderly patients with malnutrition: cohort study","volume":"25","author":"Wang","journal-title":"J Med Internet Res"},{"issue":"20","key":"R5","doi-asserted-by":"publisher","DOI":"10.3390\/nu14204255","article-title":"Calf circumference, a valuable tool to predict sarcopenia in older people hospitalized with hip fracture","volume":"14","author":"Borges","journal-title":"Nutrients"},{"issue":"2","key":"R6","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afab239","article-title":"Calf circumference refines sarcopenia in correlating with mortality risk","volume":"51","author":"Wu","journal-title":"Age Ageing"},{"issue":"3","key":"R7","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1016\/j.eurger.2016.01.004","article-title":"Calf circumference predicts mobility disability: a secondary analysis of the Mexican health and ageing study","volume":"7","author":"P\u00e9rez-Zepeda","journal-title":"Eur Geriatr Med"},{"issue":"2","key":"R8","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1017\/S0007114510003429","article-title":"The effectiveness of BMI, calf circumference and mid-arm circumference in predicting subsequent mortality risk in elderly Taiwanese","volume":"105","author":"Tsai","journal-title":"Br J Nutr"},{"issue":"21","key":"R9","doi-asserted-by":"publisher","first-page":"34057","DOI":"10.18632\/oncotarget.15976","article-title":"Examining the association between anthropometric parameters and telomere length and mortality risk","volume":"8","author":"Wu","journal-title":"Oncotarget"},{"issue":"7692","key":"R10","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1038\/d41586-018-01668-0","article-title":"Find drugs that delay many diseases of old age","volume":"554","author":"Bellantuono","journal-title":"Nature New Biol"},{"issue":"1","key":"R11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2017-000505","article-title":"Multimorbidity and out-of-pocket expenditure on medicines: a systematic review","volume":"3","author":"Sum","journal-title":"BMJ Glob Health"},{"issue":"10","key":"R12","doi-asserted-by":"publisher","first-page":"1974","DOI":"10.1093\/gerona\/glz185","article-title":"Prevalence and patterns of multimorbidity in a nationally representative sample of older Chinese: results from the China health and retirement longitudinal study","volume":"75","author":"Yao","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"7","key":"R13","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1016\/j.mayocp.2018.05.016","article-title":"Understanding the patterns of multimorbidity","volume":"93","author":"Olson","journal-title":"Mayo Clin Proc"},{"issue":"1","key":"R14","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1002\/jcsm.12503","article-title":"Sarcopenia, long-term conditions, and multimorbidity: findings from UK Biobank participants","volume":"11","author":"Dodds","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.2147\/IJGM.S418015","article-title":"Multimorbidity patterns and associations with gait, balance and lower extremity muscle function in the elderly: a cross-sectional study in Northwest China","volume":"16","author":"Yang","journal-title":"Int J Gen Med"},{"issue":"8","key":"R16","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1111\/ggi.12377","article-title":"Calf circumference as a surrogate marker of muscle mass for diagnosing sarcopenia in Japanese men and women","volume":"15","author":"Kawakami","journal-title":"Geriatr Gerontol Int"},{"issue":"3","key":"R17","doi-asserted-by":"publisher","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":"Chen","journal-title":"J Am Med Dir Assoc"},{"issue":"1","key":"R18","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-024-17846-x","article-title":"Association of changes in waist circumference, waist-to-height ratio and weight-adjusted-waist index with multimorbidity among older Chinese adults: results from the Chinese longitudinal healthy longevity survey (CLHLS)","volume":"24","author":"Chen","journal-title":"BMC Public Health"},{"issue":"1","key":"R19","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-024-04712-z","article-title":"Association between residential proximity to major roadways and chronic multimorbidity among Chinese older adults: a nationwide cross-sectional study","volume":"24","author":"Sun","journal-title":"BMC Geriatr"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1038\/s41572-022-00376-4","article-title":"Multimorbidity","volume":"8","author":"Skou","journal-title":"Nat Rev Dis Primers"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2023.155533","article-title":"Epidemiology of sarcopenia: prevalence, risk factors, and consequences","volume":"144","author":"Yuan","journal-title":"Metab Clin Exp"},{"issue":"1","key":"R22","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-01614-7","article-title":"Sarcopenia risk and associated factors among Chinese community-dwelling older adults living alone","volume":"11","author":"Cheng","journal-title":"Sci Rep"},{"issue":"1","key":"R23","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1093\/bioinformatics\/btr597","article-title":"MissForest--non-parametric missing value imputation for mixed-type data","volume":"28","author":"Stekhoven","journal-title":"Bioinformatics"},{"issue":"2","key":"R24","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1111\/j.1467-9868.2005.00503.x","article-title":"Regularization and variable selection via the elastic net","volume":"67","author":"Zou","journal-title":"J R Stat Soc Series B Stat Methodol"},{"issue":"1","key":"R25","doi-asserted-by":"publisher","DOI":"10.1186\/s13148-019-0730-1","article-title":"Statistical predictions with glmnet","volume":"11","author":"Engebretsen","journal-title":"Clin Epigenetics"},{"issue":"1","key":"R26","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1111\/j.1467-985X.2010.00676_9.x","article-title":"ggplot2: elegant graphics for data analysis","volume":"174","author":"Ginestet","journal-title":"J R Stat Soc Ser A Stat Soc"},{"issue":"8","key":"R27","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1038\/nrendo.2012.49","article-title":"Muscles, exercise and obesity: skeletal muscle as a secretory organ","volume":"8","author":"Pedersen","journal-title":"Nat Rev Endocrinol"},{"key":"R28","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2019.10.034","article-title":"Skeletal muscle as potential central link between sarcopenia and immune senescence","volume":"49","author":"Nelke","journal-title":"EBioMedicine"},{"issue":"1","key":"R29","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-28898-1","article-title":"Handgrip strength in older adults from Antioquia-Colombia and comparison of cutoff points for dynapenia","volume":"13","author":"Pati\u00f1o-Villada","journal-title":"Sci Rep"},{"issue":"3","key":"R30","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.clnu.2023.01.002","article-title":"Calf circumference change and all-cause mortality among community-dwelling Chinese older people","volume":"42","author":"Wang","journal-title":"Clin Nutr"},{"issue":"6497","key":"R31","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1126\/science.aax0860","article-title":"T cells with dysfunctional mitochondria induce multimorbidity and premature senescence","volume":"368","author":"Desd\u00edn-Mic\u00f3","journal-title":"Science"},{"issue":"6","key":"R32","doi-asserted-by":"publisher","first-page":"399","DOI":"10.26599\/1671-5411.2023.06.001","article-title":"Report on cardiovascular health and diseases in China 2021: an updated summary","volume":"20","author":"The Writing Committee Of The Report On Cardiovascular Health And Diseases In China","journal-title":"J Geriatr Cardiol"},{"issue":"11","key":"R33","doi-asserted-by":"publisher","first-page":"2958","DOI":"10.1161\/STROKEAHA.108.520106","article-title":"Calf circumference is inversely associated with carotid plaques","volume":"39","author":"Debette","journal-title":"Stroke"},{"issue":"9","key":"R34","doi-asserted-by":"publisher","first-page":"1078","DOI":"10.1053\/meta.2001.25604","article-title":"Insulin-mediated changes in leg blood flow are coupled to capillary density in skeletal muscle in healthy 70-year-old men","volume":"50","author":"Hedman","journal-title":"Metab Clin Exp"},{"issue":"8","key":"R35","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-024268","article-title":"Prevalence and patterns of multimorbidity among the elderly in China: a cross-sectional study using national survey data","volume":"9","author":"Zhang","journal-title":"BMJ Open"},{"issue":"10","key":"R36","doi-asserted-by":"publisher","first-page":"2079","DOI":"10.1007\/s00264-012-1594-6","article-title":"Muscular atrophy of the lower leg in unilateral post traumatic osteoarthritis of the ankle joint","volume":"36","author":"Wiewiorski","journal-title":"Int Orthop"},{"key":"R37","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2023.104959","article-title":"Association between multimorbidity patterns and healthcare costs among middle-aged and older adults in China","volume":"109","author":"Zhao","journal-title":"Arch Gerontol Geriatr"},{"issue":"1","key":"R38","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-022-03154-9","article-title":"Multimorbidity patterns and associated factors in older Chinese: results from the China health and retirement longitudinal study","volume":"22","author":"Zhang","journal-title":"BMC Geriatr"},{"issue":"1","key":"R39","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-017-0538-9","article-title":"Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China","volume":"17","author":"Zhang","journal-title":"BMC Geriatr"},{"issue":"23","key":"R40","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph192315580","article-title":"Urban-rural differences in mental and physical health among primary care patients with multiple chronic conditions: a secondary analysis from a randomized clinical trial","volume":"19","author":"Bonnell","journal-title":"Int J Environ Res Public Health"},{"issue":"6","key":"R41","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1016\/j.amjmed.2024.02.034","article-title":"Smoking and respiratory diseases in patients with coronary microvascular dysfunction","volume":"137","author":"Freund","journal-title":"Am J Med"},{"issue":"6","key":"R42","doi-asserted-by":"publisher","first-page":"471","DOI":"10.2165\/11536530-000000000-00000","article-title":"Management of chronic arthritis pain in the elderly","volume":"27","author":"Fitzcharles","journal-title":"Drugs Aging"},{"issue":"10","key":"R43","doi-asserted-by":"publisher","first-page":"2244","DOI":"10.1016\/j.clnu.2022.07.041","article-title":"Advances in muscle health and nutrition: a toolkit for healthcare professionals","volume":"41","author":"Prado","journal-title":"Clin Nutr"},{"key":"R44","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2017.06.009","article-title":"Multimorbidity and depression: a systematic review and meta-analysis","volume":"221","author":"Read","journal-title":"J Affect Disord"},{"key":"R45","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2023.02.092","article-title":"Cardiovascular risk indicators among depressed persons: a special case?","volume":"329","author":"van Zutphen","journal-title":"J Affect Disord"},{"issue":"4","key":"R46","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/S2213-8587(22)00033-X","article-title":"Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study","volume":"10","author":"Kivim\u00e4ki","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"4","key":"R47","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1038\/s41584-023-00921-9","article-title":"Rheumatoid sarcopenia: loss of skeletal muscle strength and mass in rheumatoid arthritis","volume":"19","author":"Bennett","journal-title":"Nat Rev Rheumatol"},{"issue":"4","key":"R48","doi-asserted-by":"publisher","DOI":"10.1093\/geroni\/igad047","article-title":"Multimorbidity and quality of life: the mediating role of ADL, IADL, loneliness, and depressive symptoms","volume":"7","author":"Sieber","journal-title":"Innov Aging"},{"key":"R49","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2019.103904","article-title":"Association of physical performance and self-rated health with multimorbidity among older adults: results from a nationwide survey in Japan","volume":"84","author":"Ishizaki","journal-title":"Arch Gerontol Geriatr"}],"container-title":["JMIR Aging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aging.jmir.org\/2025\/1\/e68760","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:55:46Z","timestamp":1782842146000},"score":1,"resource":{"primary":{"URL":"https:\/\/aging.jmir.org\/2025\/1\/e68760"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,2]]},"references-count":49,"URL":"https:\/\/doi.org\/10.2196\/68760","relation":{},"ISSN":["2561-7605"],"issn-type":[{"value":"2561-7605","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,2]]},"article-number":"v8i1e68760"}}