黒瀨 聖司

ABSTRACT Aim To investigate the association between social frailty and sarcopenia and their combined effect on clinical outcomes in outpatients with stage B heart failure (HF). Methods This post hoc analysis of the PAPRIKA‐HF study included 331 patients aged ≥ 65 years with stage B HF. Patients were stratified into three groups based on social frailty and sarcopenia. The primary outcome was a 2‐year composite of all‐cause death, myocardial infarction, and HF hospitalization. Results Of 308 patients, 189 (61%) had social frailty. Sarcopenia prevalence was higher in patients with versus without social frailty (20.6% vs. 11.8%, p  = 0.04). Event rates for the composite outcome differed across groups (absence of social frailty and sarcopenia: 1.9% vs. presence of social frailty or sarcopenia: 3.0% vs. presence of both: 33.3%; log‐rank p  < 0.001). In the multivariable Cox model, no significant difference existed between absence of social frailty and sarcopenia and presence of social frailty or sarcopenia (hazard ratio 2.44; 95% confidence interval 0.51–11.52; p  = 0.26), while presence of both had higher risk compared with absence of both (hazard ratio 12.98; 95% confidence interval 2.46–68.50; p  < 0.01). Conclusion The coexistence of social frailty and sarcopenia is associated with adverse outcomes in outpatients with stage B HF. Early identification and multidisciplinary interventions for social frailty may help improve long‐term prognosis.

Abstract Adults with obesity have increased fat mass and greater absolute skeletal muscle mass, which may confound interpretation of exercise‐induced myokine responses. This study examined sex‐specific differences in myokine dynamics based on exercise habits in adults with obesity matched for body composition. This retrospective, sex‐stratified, matched cross‐sectional study included adults with obesity (body mass index ≥30 kg/m ² ) attending an obesity clinic. Eighty participants (20 males and 20 females in each exercise habit group) were matched for age, body weight, body mass index, body fat mass and lean body mass. Regular exercise habits were defined as ≥30 min at least twice weekly. Serum concentrations of myostatin (MST), follistatin, irisin, brain‐derived neurotrophic factor, follistatin‐like protein 1 (FSTL1), and secreted proteins acidic and rich in cysteine were measured. A significant interaction between sex and exercise habits was observed for serum FSTL1 levels ( p  = 0.023), whereas MST showed significant main effects of both sex and exercise habits. Multiple regression analysis revealed that daily physical activity in females was an independent determinant of MST (β = −0.400, p  = 0.011) and FSTL1 (β = −0.417, p  = 0.007). These findings suggest that daily physical activity is an independent determinant of circulating MST and FSTL1 levels in females with obesity, highlighting sex‐specific differences in myokine regulation.