Impact of household solid fuel use on sarcopenia in China: A nationwide analysis

Background: Household air pollution from solid fuel combustion is a leading cause of age-related diseases worldwide. However, little is known about the association between indoor solid fuel use and sarcopenia, especially in developing countries.Methods: A total of 10,261 and 5129 participants from the China Health and Retirement Longitudinal Study were enrolled in the cross-sectional and follow-up analysis, respectively. The effects of household solid fuel use (for cooking and heating) on sarcopenia were evaluated using generalized linear models in the cross-sectional analysis and Cox proportional hazards regression models in the longitudinal analysis.Results: The prevalence of sarcopenia in the total population, clean cooking fuel users, and solid cooking fuel users were 13.6 % (1396/10,261), 9.1 % (374/4114), and 16.6 % (1022/6147), respectively. A similar pattern was observed for heating fuel users, with a higher prevalence of sarcopenia among solid fuel users (15.5 %) than among clean fuel users (10.7 %). In the cross-sectional analysis, solid fuel use for cooking/heating, separately or simultaneously, was positively associated with an elevated risk of sarcopenia after adjusting for potential confounders. During the four-years follow-up period, 330 participants (6.4 %) with sarcopenia were identified. The multivariate-adjusted hazard ratio (HR) (95 % confidence interval [95 % CI]) for solid cooking fuel users and solid heating fuel users was 1.86(95 % CI:1.43-2.41) and 1.32(95 % CI:1.05-1.66), respectively. Moreover, compared with persistent clean fuel users, participants who switched from clean to solid fuel for heating appeared to have an increased risk of sarcopenia (HR:1.58; 95 % CI:1.08-2.31). Conclusions: Our findings show that household solid fuel use is a risk factor for sarcopenia development among middle-aged and older Chinese adults. The transition from solid to clean fuel use may help reduce the burden of sarcopenia in developing countries.