Association Between Adverse Childhood Experiences and Later‐Life Sarcopenia Among Community‐Dwelling Older Adults: Mediating and Moderating Roles of Depressive Symptoms and Cognitive Impairment
Qinqin Liu, Yu Luo, Yibin Zhao, Ji Wang, Wei ZhangABSTRACT
Background
Adverse childhood experiences (ACEs) are associated with sarcopenia, but underlying pathways remain unclear. This study aimed to examine whether depressive symptoms and cognitive impairment mediate or moderate the associations of threat‐related and deprivation‐related ACEs with sarcopenia.
Methods
Three waves (2011–2015) of the China Health and Retirement Longitudinal Study ( n = 5003, aged ≥ 60 years) were used. Logistic regression and Cox proportional hazards regression tested associations of ACE dimensions, depressive symptoms, and cognitive impairment with sarcopenia. Four‐way decomposition and joint multiple mediator analysis quantified mediation and interaction.
Results
Deprivation‐related ACEs were associated with sarcopenia (HR = 1.143, 95% CI = 1.013–1.289), whereas threat‐related ACEs were not (HR = 1.002, 95% CI = 0.896–1.120). In four‐way decomposition, threat‐related ACEs showed no significant total or direct effect. The small pure indirect effect (PIE) via depressive symptoms (HR = 1.025, 95% CI = 1.008–1.044) is hypothesis‐generating. For deprivation‐related ACEs, significant components comprised a direct effect independent of depressive symptoms (HR = 1.222, 95% CI = 1.035–1.436), a small PIE via depressive symptoms (HR = 1.014, 95% CI = 1.004–1.027), and a reference interaction with cognitive impairment (HR = 1.046, 95% CI = 1.006–1.089), reflecting a significant multiplicative interaction ( p = 0.006). Joint mediator analysis corroborated the non‐significant total effect of threat‐related ACEs, although a small joint indirect effect emerged (HR = 1.020, 95% CI = 1.005–1.036). For deprivation‐related ACEs, total effect (HR = 1.140, 95% CI = 1.006–1.284) was predominantly direct, and the joint indirect effect explained 11.4%.
Conclusion
Deprivation‐related ACEs increased sarcopenia risk through direct pathways and amplified vulnerability among individuals with cognitive impairment, with a minor indirect contribution from depressive symptoms. Threat‐related ACEs showed no significant total effect. The weak indirect effect via depressive symptoms requires replication. Dimension‐specific ACE assessment and targeted psychological intervention are warranted.