Satakunta Hospital District, Eurajoki, Finland; Department of General Practice, Turku University and Turku University Hospital, Turku, Finland.
Folkhälsan Research Center, Helsinki, Finland; Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.
Diabetes Metab. 2021 Nov;47(6):101219. doi: 10.1016/j.diabet.2020.101219. Epub 2021 Jan 5.
Most studies examining the associations between body composition and type 2 diabetes have been cross-sectional with prevalent diabetes diagnosis or they have analyzed only fat or lean body mass. Hence, the combined effect of fat and lean body mass on the risk of developing type 2 diabetes remains unclear. We investigated whether baseline lean and fat body mass taken simultaneously into account are associated with incidence of type 2 diabetes over a 15-year follow-up in older adults.
We studied 704 men (n = 297) and women (n = 407) from the Helsinki Birth Cohort Study (mean age 61 years at baseline) without diabetes at baseline. Bioelectrical impedance analysis was used to derive baseline fat mass index (FMI, fat mass/height) and lean mass index (LMI, lean mass/height), dichotomized at sex-specific medians. Incident diabetes was defined as the composite of fasting plasma glucose (FPG) ≥ 7.0 mmol/l, haemoglobin A (HbA) ≥ 6.5% (48 mmol/mol) or physician-based diagnosis.
After a median 14.8 (range 12.5-16.8) years of follow-up, 110 incident diabetes cases occurred (15.6%). Participants with high FMI and LMI at baseline had higher composite incidence of type 2 diabetes (P < 0.001), and significantly increased risk of type 2 diabetes after adjustment for potential confounding factors (sex, physical activity, education and body mass index) compared to the other participants.
Contrary to a general belief greater muscle mass is not protective against type 2 diabetes. High LMI accompanied with high FMI seem to predict subsequent development of type 2 diabetes.
大多数研究都是观察体成分与 2 型糖尿病之间的相关性，这些研究大多采用横断面设计，针对的是现患糖尿病的诊断，或者只分析脂肪或瘦体重。因此，脂肪和瘦体重的综合作用对 2 型糖尿病发病风险的影响尚不清楚。我们研究了在 15 年的随访中，基线时同时考虑到瘦体重和脂肪体重，是否与老年人 2 型糖尿病的发病率有关。
我们研究了来自赫尔辛基出生队列研究的 704 名男性（n=297）和女性（n=407），这些人在基线时无糖尿病（基线时平均年龄为 61 岁）。生物电阻抗分析用于得出基线时的脂肪质量指数（FMI，脂肪量/身高）和瘦体重指数（LMI，瘦体重/身高），并按性别特异性中位数进行二分法。新诊断的糖尿病定义为空腹血糖（FPG）≥7.0mmol/l、血红蛋白 A（HbA）≥6.5%（48mmol/mol）或医生诊断。
中位随访 14.8 年后（范围 12.5-16.8 年），共发生 110 例糖尿病事件（15.6%）。基线时 FMI 和 LMI 较高的参与者发生 2 型糖尿病的综合发病率较高（P<0.001），与其他参与者相比，在调整了潜在混杂因素（性别、体力活动、教育程度和体重指数）后，2 型糖尿病的发病风险显著增加。
与普遍的观点相反，更大的肌肉量并不能预防 2 型糖尿病。高 LMI 伴高 FMI 似乎预示着 2 型糖尿病的后续发生。
