To investigate the association between body composition (specifically body fat and muscle mass) and neuroimaging markers in patients with cerebral small vessel disease (CSVD).

Ninety-five hospitalized patients diagnosed with CSVD at the Seventh Medical Center of the Chinese PLA General Hospital between January 1, 2022, and June 1, 2023, were enrolled. Body composition parameters assessed including body weight, protein content, basal metabolic rate, body fat percentage (BF), and appendicular skeletal muscle mass (ASM). CSVD neuroimaging markers included lacunar infarcts (LI), white matter hyperintensities (WMH), and cerebral microbleeds (CMB). A composite CSVD score was calculated by integrating these markers. Sex-stratified binary or ordinal logistic regression analyses were performed to evaluate relationships between body composition and both individual neuroimaging markers and the composite CSVD score.

Among male patients (n=48), higher composite CSVD scores were significantly associated with increased BF (OR=1.117, 95%CI: 1.021–1.222, P=0.016) and decreased ASM (OR=0.185, 95%CI: 0.057–0.602, P=0.005). In female patients (n=47), only BF showed a significant positive correlation with composite scores (OR=1.059, 95%CI: 1.071-1.343, P=0.002). In addition, when analyzing individual neuroimaging markers, ASM was independently associated with WMH in males (OR=0.099, 95%CI: 0.032-0.311, P<0.001), whereas no significant associations were observed in females.

Body fat and muscle mass in CSVD patients exhibit stronger correlations with composite CSVD scores than with individual neuroimaging markers, suggesting that these body composition metrics may as indicators of global CSVD burden rather than specific pathological features.