Jalving Annis C, Oosterwijk Milou M, Hagedoorn Ilse J M, Navis Gerjan, Bakker Stephan J L, Laverman Gozewijn D
Department of Internal Medicine/Nephrology, ZGT Hospital, 7609 PP Almelo, The Netherlands.
Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands.
J Clin Med. 2021 Nov 10;10(22):5227. doi: 10.3390/jcm10225227.
Low muscle mass in patients with type 2 diabetes is associated with a progressively higher risk of morbidity and mortality. The aim of this study was to identify modifiable targets for intervention of muscle mass in type 2 diabetes. Cross-sectional analyses were performed in 375 patients of the Diabetes and Lifestyle Cohort Twente-1 study. Muscle mass was estimated by 24 h urinary creatinine excretion rate (CER, mmol/24 h). Patients were divided in sex-stratified tertiles of CER. To study determinants of CER, multivariable linear regression analyses were performed. Protein intake was determined by Maroni formula and by a semi-quantitative Food Frequency Questionnaire. The mean CER was 16.1 ± 4.8 mmol/24 h and 10.9 ± 2.9 mmol/24 h in men and women, respectively. Lower CER was significantly associated with older age ( < 0.001) as a non-modifiable risk factor, whereas higher BMI ( = 0.015) and lower dietary protein intake (both methods < 0.001) were identified as modifiable risk factors for lower CER. Overall body mass index (BMI) was high, even in the lowest CER tertile the mean BMI was 30.9 kg/m, mainly driven by someone's body weight ( = 0.004) instead of someone's height ( = 0.58). In the total population, 28% did not achieve adequate protein intake of >0.8 g/kg/day, with the highest percentage in the lowest CER tertile (52%, < 0.001). Among patients with type 2 diabetes treated in secondary care, higher BMI and low dietary protein intake are modifiable risk factors for lower muscle mass. Considering the risk associated with low muscle mass, intervention may be useful. To that purpose, dietary protein intake and BMI are potential targets for intervention.
2型糖尿病患者肌肉量低与发病和死亡风险的逐步升高相关。本研究的目的是确定2型糖尿病患者肌肉量干预的可改变目标。对糖尿病与生活方式特温特队列-1研究中的375例患者进行了横断面分析。通过24小时尿肌酐排泄率（CER，mmol/24小时）估算肌肉量。患者按CER的性别分层三分位数分组。为研究CER的决定因素，进行了多变量线性回归分析。蛋白质摄入量通过马罗尼公式和半定量食物频率问卷确定。男性和女性的平均CER分别为16.1±4.8 mmol/24小时和10.9±2.9 mmol/24小时。较低的CER与作为不可改变风险因素的年龄较大显著相关（<0.001），而较高的体重指数（BMI）（=0.015）和较低的膳食蛋白质摄入量（两种方法均<0.001）被确定为较低CER的可改变风险因素。总体体重指数（BMI）较高，即使在最低CER三分位数中，平均BMI也为30.9 kg/m²，主要由体重决定（=0.004）而非身高（=0.58）。在总人口中，28%的人未达到>0.8 g/kg/天的充足蛋白质摄入量，在最低CER三分位数中比例最高（52%，<0.001）。在二级护理中接受治疗的2型糖尿病患者中，较高的BMI和低膳食蛋白质摄入量是肌肉量较低的可改变风险因素。考虑到与低肌肉量相关的风险，干预可能是有用的。为此，膳食蛋白质摄入量和BMI是潜在的干预目标。
