School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, QLD, 4558, Australia.
Eur Geriatr Med. 2020 Jun;11(3):451-458. doi: 10.1007/s41999-020-00309-y. Epub 2020 Mar 19.
Several biological mechanisms describing the pathway to mobility disability and functional decline in older adults with type 2 diabetes mellitus (T2DM) have been postulated, including skeletal muscle atrophy and the concurrent accumulation of fat mass. Therefore, we explored the association between adiposity, muscle strength and physical performance in community-dwelling older adults with T2DM.
Adiposity was measured by waist circumference (WC) or body fat percentage (BF %) derived from dual-energy X-ray absorptiometry (DXA). The Short Physical Performance Battery (SPPB) and gait speed were used to evaluate lower extremity physical function. Muscle strength was assessed using hand-grip strength (HGS) or chair stands. Multiple regression analysis was used to examine the association between measures of adiposity, SPPB score, gait speed, HGS and chair stands adjusted for age, gender and total appendicular skeletal muscle (ASM).
A total of n = 87 participants (71.2 ± 8.2 years; BMI 29.5 ± 5.8 kg/m; BF % 37.8 ± 7.3%) were included in this cross-sectional analysis. Pearson's correlation coefficients revealed that BF% was negatively associated with hand-grip strength (r = - 0.430; P < 0.001) and total ASM (r = - 0.223; P = 0.03), but positively associated with increased time to compete chair stands (r = 0.366; P < 0.001). After adjusting for age, gender and total ASM, WC and BF% were inversely associated with HGS (WC: β = -0.385; P = 0.001; BF% β = - 0.487; P < 0.001). Similarly, in the adjusted model, both WC and BF% were positively associated with increased time to complete chair stands (WC: β = 0.479; P < 0.001; BF% β = 0.415; P = 0.002).
Adiposity, independent of the criteria used, was inversely associated with muscle strength, suggesting that adiposity negatively influences muscle quality in older adults with T2DM. Screening for poor muscle strength and quality has the potential to facilitate early exercise and dietary interventions aimed at preserving muscle function in older adults with T2DM.
已经提出了几种描述 2 型糖尿病（T2DM）老年患者向运动障碍和功能下降发展的生物学机制，包括骨骼肌萎缩和同时积累的脂肪量。因此，我们探讨了社区居住的 T2DM 老年患者中体脂、肌肉力量与身体表现之间的关联。
通过双能 X 射线吸收法（DXA）测定腰围（WC）或体脂百分比（BF%）来测量体脂。使用短体适能表现测试（SPPB）和步速来评估下肢身体功能。使用握力（HGS）或椅子站立来评估肌肉力量。使用多元回归分析，根据年龄、性别和四肢总去脂体重（ASM）来调整体脂、SPPB 评分、步速、HGS 和椅子站立的相关性。
共纳入 n=87 名参与者（71.2±8.2 岁；BMI 29.5±5.8kg/m；BF% 37.8±7.3%）进行这项横断面分析。Pearson 相关系数显示，BF%与握力（r=-0.430；P<0.001）和四肢总去脂体重（r=-0.223；P=0.03）呈负相关，与椅子站立完成时间（r=0.366；P<0.001）呈正相关。在调整年龄、性别和四肢总去脂体重后，WC 和 BF%与 HGS 呈负相关（WC：β=-0.385；P=0.001；BF%：β=-0.487；P<0.001）。同样，在调整模型中，WC 和 BF%与椅子站立完成时间增加呈正相关（WC：β=0.479；P<0.001；BF%：β=0.415；P=0.002）。
不论采用何种标准，体脂与肌肉力量呈负相关，提示肥胖对 T2DM 老年患者的肌肉质量有负面影响。筛查肌肉力量和质量较差的情况可能有助于促进针对 T2DM 老年患者的早期运动和饮食干预，以维持肌肉功能。
