Association of N-terminal pro-B-type natriuretic peptide levels with muscle quality and physical function in community-dwelling older adults: the Shizuoka study
M Kato, Y Tanaka, T Adachi, K Kito, W Nakano, S Nakano, Y Kurita, K Miyoshi, D Takagi, S Sato, O Kushida, E Ozaki, N Kuriyama, Y TabaraAbstract
Background
N-terminal pro-B-type natriuretic peptide (NT-proBNP) is widely used as a biomarker of heart failure. In community-dwelling older adults, elevated NT-proBNP levels have also been proposed as an indicator of physical function decline, particularly reduced gait speed. Reduced gait speed has been reported to be weakly associated with skeletal muscle mass, suggesting that muscle quality may be more closely related to physical function. However, direct evidence regarding the association between NT-proBNP and muscle quality in community-dwelling older adults remains limited.
Purpose
This study aimed to clarify the association between NT-proBNP levels and muscle quality in community-dwelling older adults, and to examine the interrelationships among NT-proBNP, muscle mass, muscle quality, and gait speed.
Methods
This cross-sectional study used baseline data from the Shizuoka study, a longitudinal cohort study of community-dwelling residents. Study participants were functionally independent adults aged ≥65 years who voluntarily participated between 2021 and 2026. NT-proBNP levels were categorized into three groups (<125, 125–299, and ≥300 pg/mL) according to the European Society of Cardiology criteria. Muscle thickness of the right tibialis anterior was assessed as an index of muscle mass, and muscle echo intensity at the same site was measured as an index of muscle quality using ultrasound imaging. Higher echo intensity indicates lower muscle quality. Physical function was assessed by usual gait speed. Multivariable linear regression models were adjusted for age, sex, body mass index, comorbidities, and lifestyle-related factors.
Results
The study included 3,106 older adults (mean age 74 ± 5 years), of whom 46% were men. Among the participants, 20% had NT-proBNP levels of 125–299 pg/mL and 7% had levels ≥300 pg/mL. In multivariable analyses, higher NT-proBNP levels were significantly associated with higher muscle echo intensity (p < 0.01), whereas no significant association was observed with muscle thickness (Table 1). In multivariable analyses for usual gait speed, lower muscle thickness, higher muscle echo intensity, and NT-proBNP ≥300 pg/mL (vs. <125 pg/mL) were independently associated with slower usual gait speed (all p < 0.05). Participants with both elevated NT-proBNP levels (≥300 pg/mL) and higher muscle echo intensity (fourth quartile) had the slowest usual gait speed compared with those in the other combinations (Figure 1).
Conclusions
Elevated NT-proBNP levels were significantly associated with lower muscle quality. Furthermore, muscle quality may partially mediate the association between subclinical cardiac stress and physical function decline. These findings suggest that muscle quality, rather than muscle mass, may be a potential target for future interventions aimed at preventing physical function decline in community-dwelling older adults with elevated NT-proBNP levels.