SAT-256 Association between Remnant Cholesterol and Poor Muscle Quality Based on Muscle Quality Map and Abdominal Computed Tomography

Abstract Disclosure: J. Moon: None. Y. Cho: None. E. Kim: None. M. Lee: None. W. Lee: None. H. Kim: None. C. Jung: None. Background: Lipid metabolism and skeletal muscles are closely linked. Remnant cholesterol has been recently considered as an important risk factor for cardiovascular and metabolic diseases. Fat infiltration in skeletal muscle, otherwise known as myosteatosis, reflects muscle quality and is one of the hallmarks of sarcopenia. However, there are limited studies on the relationship between remnant cholesterol and sarcopenia. This study aimed to investigate the association between remnant cholesterol level and myosteatosis. Methods: This cross-sectional study analyzed data from 11,570 patients not taking lipid-lowering medications who underwent abdominal CT for health check-ups in Seoul, South Korea, between 2012 and 2013. Total abdominal muscle area (TAMA), measured at the L3 level, was segmented into skeletal muscle area (SMA) and intramuscular adipose tissue. SMA was further divided into normal attenuation muscle area (NAMA: good quality muscle) and low attenuation muscle area (LAMA: poor quality muscle). NAMA divided by TAMA (NAMA/TAMA) index was previously developed as an indicator of muscle quality. We defined myosteatosis as having NAMA/TAMA index T-score below -1. Remnant cholesterol was calculated as total cholesterol minus LDL-C and HDL-C. Subjects were categorized into four groups according to the quartiles of remnant cholesterol levels. We conducted multivariate logistic analysis for each sex to assess the association between remnant cholesterol and myosteatosis defined by NAMA/TAMA index. Additional analyses examined the relationship between remnant cholesterol and sarcopenia, defined as appendicular skeletal muscle mass (ASM) divided by BMI. Results: Among 6,335 men, 950 (14.95%) were defined as having myosteatosis, and among 5,215 women, 800 (15.34%) were defined as having myosteatosis. There was an increasing trend in the percentage of subjects with myosteatosis across higher quartiles of remnant cholesterol. After adjusting for various confounding factors, those in the highest remnant cholesterol quartile group showed significantly increased odds ratio (OR) for myosteatosis compared to the lowest quartile group. (OR 1.38, 95% confidence interval (CI) 1.12-1.70 for men; OR 1.23, 95% CI 0.96-1.56 for women). Multivariate-adjusted OR for ASM/BMI in the highest quartile remnant cholesterol group in men was 2.17 (95% CI 1.45-3.26), while in women, remnant cholesterol level did not show a significant association with ASM/BMI after adjustment. Conclusion: Elevated remnant cholesterol is significantly associated with a higher risk of having myosteatosis measured by abdominal CT. Remnant cholesterol may serve as a marker for the prediction of poor muscle quality. Presentation: Saturday, July 12, 2025