# Adverse childhood experiences and sarcopenia: a prospective study embedded in the Canadian Longitudinal Study on Aging

## TL;DR

This study shows that childhood trauma is linked to muscle loss in older adults, with depression acting as a key link between early adversity and later muscle decline.

## Contribution

The study identifies depression as a mediator linking adverse childhood experiences to sarcopenia in older adults.

## Key findings

- ACE count predicted sarcopenia onset in depressed individuals but not in non-depressed individuals.
- Depression mediated ACE-related declines in muscle mass, handgrip strength, chair rise performance, and gait speed.
- High ACE burden was reported by 12.7% of participants, with 2.8% developing sarcopenia during follow-up.

## Abstract

Adverse childhood experiences (ACEs), known to increase lifelong health risks, have recently been linked to frailty. This study examined whether ACEs predict the onset and progression of sarcopenia, a core component of the frailty phenotype.

We analysed 23 476 participants aged 45–85 years in the Canadian Longitudinal Study on Aging with 3-year follow-up (49.5% female; mean age 62.1 ± 9.9). Eight ACEs were assessed using validated retrospective instruments. Associations between ACE count and incident sarcopenia (revised European Working groups on Sarcopenia in Older People criteria) were evaluated using multivariable logistic regression, while changes in continuous sarcopenia components were assessed with lagged linear models adjusted for age, sex and ethnicity. Moderating effects of age, sex, ethnicity, depression (CESD ≥ 10) and socioeconomic position (education, income) were explored.

Overall, 12.7% of participants reported a high ACE burden (≥3). Among 21 910 participants without baseline sarcopenia, 614 (2.8%) developed sarcopenia. Depression, but not sociodemographic factors, moderated the ACE–sarcopenia association. ACE count predicted incident sarcopenia among depressed participants [OR (odds ratio) = 1.10 (95% (confidence interval) CI: 1.02–1.20), P = .016], but not among nondepressed participants [OR = 0.98 (95% CI: 0.93–1.03), P = .399]. Depression also moderated ACE-related declines in lean muscle mass and handgrip strength. Post hoc analyses showed that ACE-related worsening of chair rise performance and gait speed was mediated by depression.

ACEs are associated with modest declines in muscle mass and function, with depression emerging as a key pathway linking early adversity to later-life sarcopenia. These findings highlight the need to integrate psychosocial history and mental health into risk stratification and preventive strategies for functional decline.