Dietary intake based leg muscle building and fat loss: reducing the cardiovascular-cause mortality

Abstract Background Recent studies have demonstrated that novel pharmacological agents, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, exhibit significant clinical efficacy in weight loss, conferring substantial cardiovascular benefits. However, the concomitant loss of muscle mass during weight loss has raised widespread concern. The impact of total or regional muscle mass on the risk of cardiovascular-cause mortality remains incompletely understood. Meanwhile, optimizing daily dietary and nutritional strategies to gain muscle mass while achieving weight loss could be a promising and safe strategy for potential intervention. Purpose To elucidate the impact of total and regional muscle mass on the cardiovascular-cause mortality and to identify dietary protective factors that can enhance muscle mass while promoting weight loss. Methods Participants aged 40 and above whounderwent dual-energy X-ray absorptiometry from National Health and Nutrition Examination Survey (NHANES) database (n=5355) were included, with a median follow-up of 5.17 years. Total or regional muscle mass/ body weight ratio (MWR) was calculated based on the results of dual-energy X-ray absorptiometry and body measure. Dietary intake components were obtained from a 24-hour dietary recall interview. Results Median age was 50 years, 50.8% were female, and 34.8% were nonwhite. More than two-thirds participants were overweight (74.5%, BMI≥25 kg/m2) and nearly half of participants were obese (53.3%, BMI≥28 kg/m2). Median whole body MWR at baseline was 63.7%, median arm MWR 7.2%, median leg MWR 19.8% and median trunk MWR 32.5%. Cox proportional hazard analysis revealed that higher leg MWR reduced cardiovascular-cause mortality risk (aHR=0.971, 95CI% 0.946-0.996, p=0.022) after adjusted for age, gender, ethnicity, BMI, hypertension, hypercholesterolemia, alcoholic drinking, creatinine and history of cardiovascular diseases including coronary heart diseases, heart attack and heart failure. And higher dietary intake of magnesium (r=0.291, -0.232 and -0.047, respectively), potassium (r=0.278, -0.254 and -0.031, respectively), Vitamin B6 (r=0.253, -0.226 and -0.016, respectively), Vitamin B1 (r=0.233, -0.235 and -0.013, respectively), Vitamin B2 (r=0.231, -0.211 and -0.009, respectively) and total folate (r=0.220, -0.206 and -0.051, respectively) were highly correlated with both higher leg MWR, decreased leg fat/body weigh ratio (FWR) and lower BMI (all p0.001). Conclusion Greater legMWR reduces risk of cardiovascular mortality, independent of BMI. Six dietary-derived elements are associated with increased legMWRas well as reduced fat mass and BMI. Individuals at high cardiovascular risk, especially those with overweight or obesity, are highly likely to benefit fromlower limb exercise and increased intake of these specific dietary elements in their daily diet and mitigate future mortality risk via muscle building and fat loss.Cox proportional hazard analysis Correlation with dietary intake elements