Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Cardiovasc Diabetol. 2022 Mar 15;21(1):40. doi: 10.1186/s12933-022-01468-x.
Distinguishable sex differences exist in fat mass and muscle mass. High fat mass and low muscle mass are independently associated with cardiovascular disease (CVD) risk factors in people living with type 2 diabetes; however, it is unknown if the association between fat mass and CVD risk is modified by muscle mass, or vice versa. This study examined the sex-specific interplay between fat mass and muscle mass on CVD risk factors in adults with type 2 diabetes living with overweight and obesity.
Dual-energy X-ray absorptiometry (DXA) measures were used to compute fat mass index (FMI) and appendicular muscle mass index (ASMI), and participants were separated into high-fat mass vs. low-fat mass and high-muscle mass vs. low-muscle mass. A two-way analysis of covariance (ANCOVA: high-FMI vs. low-FMI by high-ASMI vs. low-ASMI) was performed on CVD risk factors (i.e., hemoglobin A1C [A1C]; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol; triglycerides; systolic and diastolic blood pressure; cardiorespiratory fitness, depression and health related-quality of life [HR-QoL]) at baseline and following a 1-year intensive lifestyle intervention (ILI) for females and males separately, with a primary focus on the fat mass by muscle mass interaction effects.
Data from 1,369 participants (62.7% females) who completed baseline DXA were analyzed. In females, there was a fat mass by muscle mass interaction effect on A1C (p = 0.016) at baseline. Post-hoc analysis showed that, in the low-FMI group, A1C was significantly higher in low-ASMI when compared to high-ASMI (60.3 ± 14.1 vs. 55.5 ± 13.5 mmol/mol, p = 0.023). In the high-FMI group, there was no difference between high-ASMI and low-ASMI (56.4 ± 12.5 vs. 56.5 ± 12.8 mmol/mol, p = 0.610). In males, only high-FMI was associated with higher A1C when compared to low-FMI (57.1 ± 14.4 vs. 54.2 ± 12.0 mmol/mol, p = 0.008) at baseline. Following ILI, there were significant fat mass by muscle mass interaction effects on changes in the mental component of HR-QoL in males.
Considering that A1C predicts future CVD, strategies to lower A1C may be especially important in females with low fat and low muscle mass living with type 2 diabetes. Our results highlight the complicated and sex-specific contribution of fat mass and muscle mass to CVD risk factors.
脂肪量和肌肉量存在明显的性别差异。在患有 2 型糖尿病的人群中，高脂肪量和低肌肉量与心血管疾病（CVD）风险因素独立相关；然而，脂肪量与 CVD 风险之间的关联是否受肌肉量的影响，或者反之，目前尚不清楚。本研究旨在探讨超重和肥胖的 2 型糖尿病成年人群中，脂肪量和肌肉量对 CVD 风险因素的性别特异性相互作用。
采用双能 X 射线吸收法（DXA）测量计算脂肪量指数（FMI）和四肢肌肉量指数（ASMI），并根据 FMI 和 ASMI 将参与者分为高脂肪量组和低脂肪量组以及高肌肉量组和低肌肉量组。对 CVD 风险因素（即血红蛋白 A1C [A1C]；高密度脂蛋白胆固醇；低密度脂蛋白胆固醇；甘油三酯；收缩压和舒张压；心肺适能；抑郁和健康相关生活质量[HR-QoL]）进行了女性和男性的双因素方差分析（ANCOVA：高 FMI 与低 FMI 与高 ASMI 与低 ASMI），重点关注脂肪量与肌肉量的相互作用效应。
对 1369 名完成基线 DXA 检查的参与者（62.7%为女性）的数据进行了分析。在女性中，基线时 A1C 存在脂肪量与肌肉量的交互作用效应（p=0.016）。事后分析显示，在低 FMI 组中，与高 ASMI 相比，低 ASMI 的 A1C 显著升高（60.3±14.1 与 55.5±13.5 mmol/mol，p=0.023）。在高 FMI 组中，高 ASMI 与低 ASMI 之间无差异（56.4±12.5 与 56.5±12.8 mmol/mol，p=0.610）。在男性中，与低 FMI 相比，仅高 FMI 与较高的 A1C 相关（57.1±14.4 与 54.2±12.0 mmol/mol，p=0.008）。经过 ILI 后，男性的 HR-QoL 心理成分的变化存在明显的脂肪量与肌肉量的交互作用效应。
鉴于 A1C 可预测未来的 CVD，因此对于患有 2 型糖尿病的女性来说，降低 A1C 的策略可能尤其重要，这些女性脂肪量和肌肉量都较低。我们的研究结果突出了脂肪量和肌肉量对 CVD 风险因素的复杂且具有性别特异性的影响。
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