Guo Jie, Wei Yuxia, Heiland Emerald G, Marseglia Anna
Department of Nutrition and Health, China Agricultural University, Beijing, China.
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.
J Cachexia Sarcopenia Muscle. 2024 Oct;15(5):1930-1941. doi: 10.1002/jcsm.13542. Epub 2024 Jul 12.
The distribution of fat and muscle mass in different regions of the body can reflect different pathways to mortality in individuals with diabetes. Therefore, we investigated the associations between whole-body and regional body fat and muscle mass with cardiovascular disease (CVD) and non-CVD mortality in type 2 diabetes (T2D).
Within the National Health and Nutrition Examination Survey 1999-2006, 1417 adults aged ≥50 years with T2D were selected. Dual-energy X-ray absorptiometry was used to derive whole-body, trunk, arm, and leg fat mass and muscle mass indices (FMI and MMI). Mortality data until 31 December 2019 were retrieved from the National Death Index. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from Cox proportional hazard models.
A total of 1417 participants were included in this study (weighted mean age [standard error]: 63.7 [0.3] years; 50.5% female). Over a median follow-up of 13.6 years, 797 deaths were recorded (371 CVD-related and 426 non-CVD deaths). Higher FMI in the arm was associated with increased risk of non-CVD mortality (fourth quartile [Q4] vs. first quartile [Q1]: HR 1.82 [95% CI 1.13-2.94]), whereas higher FMI in the trunk or leg was not significantly associated with CVD or non-CVD mortality. Conversely, higher arm MMI was associated with a lower risk of both CVD (Q4 vs. Q1: HR 0.51 [95% CI 0.33-0.81]) and non-CVD (Q4 vs. Q1: HR 0.56 [95% CI 0.33-0.94]) mortality. There was a significant interaction between smoking status and arm FMI on non-CVD mortality (P for interaction = 0.007). Higher arm FMI was associated with a higher risk of non-CVD mortality among current or former smokers (Q4 vs. Q1: HR 2.67 [95% CI 1.46-4.88]) but not non-smokers (Q4 vs. Q1: HR 0.85 [95% CI 0.49-1.47]).
Fat mass and muscle mass, especially in the arm, are differently associated with CVD and non-CVD mortality in people with T2D. Our findings underscore the predictive value of body compositions in the arm in forecasting mortality among older adults with T2D.
身体不同部位的脂肪和肌肉量分布可反映糖尿病患者不同的死亡途径。因此，我们研究了全身及局部体脂和肌肉量与2型糖尿病（T2D）患者心血管疾病（CVD）及非CVD死亡率之间的关联。
在1999 - 2006年国家健康与营养检查调查中，选取了1417名年龄≥50岁的T2D成年患者。采用双能X线吸收法得出全身、躯干、手臂和腿部的脂肪量和肌肉量指数（FMI和MMI）。从国家死亡指数中获取截至2019年12月31日的死亡率数据。通过Cox比例风险模型估计风险比（HRs）和95%置信区间（CIs）。
本研究共纳入1417名参与者（加权平均年龄[标准误]：63.7[0.3]岁；50.5%为女性）。在中位随访13.6年期间，记录了797例死亡（371例与CVD相关，426例为非CVD死亡）。手臂FMI较高与非CVD死亡率增加相关（第四四分位数[Q4]与第一四分位数[Q1]相比：HR 1.82[95%CI 1.13 - 2.94]），而躯干或腿部较高的FMI与CVD或非CVD死亡率无显著关联。相反，较高的手臂MMI与CVD（Q4与Q1相比：HR 0.51[95%CI 0.33 - 0.81]）和非CVD（Q4与Q1相比：HR 0.56[95%CI 0.33 - 0.94]）死亡率较低相关。吸烟状态与手臂FMI在非CVD死亡率方面存在显著交互作用（交互作用P = 0.007）。当前或既往吸烟者中，较高的手臂FMI与较高的非CVD死亡率相关（Q4与Q1相比：HR 2.67[95%CI 1.46 - 4.88]），而不吸烟者则不然（Q4与Q1相比：HR 0.85[95%CI 0.49 - 1.47]）。
脂肪量和肌肉量，尤其是手臂部位的，与T2D患者的CVD和非CVD死亡率存在不同关联。我们的研究结果强调了手臂身体成分在预测老年T2D患者死亡率方面的预测价值。
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