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新诊断且未用药的 2 型糖尿病患者中低肌肉量和腹型肥胖患者的比例和特征。

Proportion and Characteristics of the Subjects with Low Muscle Mass and Abdominal Obesity among the Newly Diagnosed and Drug-Naïve Type 2 Diabetes Mellitus Patients.

机构信息

Division of Endocrinology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.

Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.

出版信息

Diabetes Metab J. 2019 Feb;43(1):105-113. doi: 10.4093/dmj.2018.0036. Epub 2018 Sep 28.

Abstract

BACKGROUND

Sarcopenic obesity (SO) is a serious public health concern, few studies have examined the clinical implications of SO in newly-diagnosed type 2 diabetes mellitus (T2DM) patients. We evaluated the prevalence of the newly diagnosed, drug-naïve T2DM patients with low muscle mass with abdominal obesity and its association with insulin resistance and other diabetic complications.

METHODS

We classified 233 drug-naïve T2DM subjects into four groups according to abdominal obesity (waist circumference ≥90 cm in men and ≥85 cm in women) and low muscle mass status (appendicular skeletal muscle <7.0 kg/m² for men and <5.4 kg/m² for women).

RESULTS

The proportion of the subjects with low muscle mass and abdominal obesity among the newly diagnosed, drug-naïve T2DM patients was 8.2%. Homeostasis model assessment of insulin resistance (HOMA-IR) increased linearly according to body composition group from normal to abdominal obesity to both low muscle mass and abdominal obesity. The multiple logistic regression analysis indicated that subjects with low muscle mass and abdominal obesity (odds ratio [OR], 9.39; 95% confidence interval [CI], 2.41 to 36.56) showed a higher risk for insulin resistance, defined as HOMA-IR ≥3, than those with abdominal obesity (OR, 5.36; 95% CI, 2.46 to 11.69), even after adjusting for other covariates. However, there were no differences in lipid profiles, microalbuminuria, or various surrogate markers for atherosclerosis among the four groups.

CONCLUSION

Subjects with both low muscle mass and abdominal obesity had a higher risk of insulin resistance than those with low muscle mass or abdominal obesity only.

摘要

背景

肌少症合并肥胖症(SO)是一个严重的公共健康问题,很少有研究探讨其在新诊断的 2 型糖尿病(T2DM)患者中的临床意义。我们评估了新诊断的、未经药物治疗的 T2DM 患者中存在低肌肉量伴腹型肥胖的比例,及其与胰岛素抵抗和其他糖尿病并发症的关系。

方法

我们根据腹型肥胖(男性腰围≥90cm,女性腰围≥85cm)和低肌肉量状态将 233 例新诊断的、未经药物治疗的 T2DM 患者分为四组。

结果

新诊断的、未经药物治疗的 T2DM 患者中,低肌肉量伴腹型肥胖的比例为 8.2%。根据身体成分组,稳态模型评估的胰岛素抵抗(HOMA-IR)呈线性增加,从正常组到腹型肥胖组再到低肌肉量和腹型肥胖组依次升高。多因素 logistic 回归分析表明,与腹型肥胖组相比,同时存在低肌肉量和腹型肥胖的患者(比值比[OR],9.39;95%置信区间[CI],2.41 至 36.56)发生胰岛素抵抗(HOMA-IR≥3)的风险更高,而腹型肥胖患者(OR,5.36;95%CI,2.46 至 11.69)。然而,在调整了其他协变量后,四组间的血脂谱、微量白蛋白尿或各种动脉粥样硬化替代标志物均无差异。

结论

与仅存在低肌肉量或腹型肥胖的患者相比,同时存在低肌肉量和腹型肥胖的患者发生胰岛素抵抗的风险更高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0592/6387883/1f45dfef70bf/dmj-43-105-g001.jpg

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