Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA.
Nutr Metab Cardiovasc Dis. 2023 Jan;33(1):105-111. doi: 10.1016/j.numecd.2022.09.017. Epub 2022 Oct 10.
Although lower lean mass is associated with greater diabetes prevalence in cross-sectional studies, prospective data specifically in middle-aged Black and White adults are lacking. Relative appendicular lean mass (ALM), such as ALM adjusted for body mass index (BMI), is important to consider since muscle mass is associated with overall body size. We investigated whether ALM/BMI is associated with incident type 2 diabetes in the Coronary Artery Risk Development in Young Adults study.
1893 middle-aged adults (55% women) were included. ALM was measured by DXA in 2005-06. Incident type 2 diabetes was defined in 2010-11 or 2015-16 as fasting glucose ≥7 mmol/L (126 mg/dL), 2-h glucose on OGTT ≥11.1 mmol/L (200 mg/dL) (2010-11 only), HbA ≥48 mmol/mol (6.5%) (2010-11 only), or glucose-lowering medications. Cox regression models with sex stratification were performed. In men and women, ALM/BMI was 1.07 ± 0.14 (mean ± SD) and 0.73 ± 0.12, respectively. Seventy men (8.2%) and 71 women (6.8%) developed type 2 diabetes. Per sex-specific SD higher ALM/BMI, unadjusted diabetes risk was lower by 21% in men [HR 0.79 (0.62-0.99), p = 0.04] and 29% in women [HR 0.71 (0.55-0.91), p = 0.008]. After adjusting for age, race, smoking, education, physical activity, and waist circumference, the association was no longer significant. Adjustment for waist circumference accounted for the attenuation in men.
Although more appendicular lean mass relative to BMI is associated with lower incident type 2 diabetes in middle-aged men and women over 10 years, its effect may be through other metabolic risk factors such as waist circumference, which is a correlate of abdominal fat mass.
尽管在横断面研究中，较低的瘦体重与更高的糖尿病患病率相关，但在中年黑人和白人成年人中，缺乏前瞻性数据。相对四肢瘦体重（ALM），如根据体重指数（BMI）调整后的 ALM，是很重要的，因为肌肉量与全身大小有关。我们研究了在年轻人冠状动脉风险发展研究（Coronary Artery Risk Development in Young Adults study）中，ALM/BMI 是否与 2 型糖尿病的发生有关。
纳入了 1893 名中年成年人（55%为女性）。2005-06 年采用 DXA 测量 ALM。2010-11 年或 2015-16 年定义为空腹血糖≥7mmol/L（126mg/dL）、口服葡萄糖耐量试验（OGTT）2 小时血糖≥11.1mmol/L（200mg/dL）（仅 2010-11 年）、HbA≥48mmol/mol（6.5%）（仅 2010-11 年）或降血糖药物。进行了性别分层的 Cox 回归模型。在男性和女性中，ALM/BMI 分别为 1.07±0.14（平均值±标准差）和 0.73±0.12。70 名男性（8.2%）和 71 名女性（6.8%）发生 2 型糖尿病。按性别特异性标准差增加 ALM/BMI，未经调整的男性糖尿病风险降低 21%[风险比（HR）0.79（0.62-0.99），p=0.04]，女性降低 29%[HR 0.71（0.55-0.91），p=0.008]。调整年龄、种族、吸烟、教育、体力活动和腰围后，相关性不再显著。调整腰围后，男性的相关性减弱。
尽管在中年男性和女性中，相对于 BMI 的更多四肢瘦体重与 10 年后 2 型糖尿病的发生风险降低有关，但它的作用可能是通过其他代谢风险因素，如腰围，这是腹型脂肪量的一个相关因素。
